Addressing Health Disparities in Integrative Medicine

Health disparities in America and throughout the world are significant. Health and health care disparities refer to “differences in health and health care between groups that stem from broader social and economic inequities,” according to Ndugga and colleagues. ¹ Disparities in affordability, accessibility, insurance coverage, and quality of care worldwide lead to significant differences in health outcomes. The field of integrative medicine is affected by these inequities as well. For example, integrative care and therapies may or may not be provided in conventional settings or covered by insurance and are often siloed in their availability, leading to the potential for increased costs and decreased accessibility. This column addresses the deficits and progress being made in this regard.

Facts about Heath and Health Care Disparities

Studies suggest that health and health care disparities only worsen if not specifically and actively addressed and can be prevented if action is taken at the individual, community, national, and international levels. One analysis by Bendavid and colleagues exploring within-country inequalities found that, “Globally, health inequality decreased from 1960 to 2021, consistent with improvements in infant mortality and life expectancy. However, inequality trends diverged by country income group, improving more rapidly in high-income than in low-income countries. In the US, health inequality decreased but less than in other high-income nations: it ranked 19th in 1960 but 77th in 2021 among 181 countries and territories, and 55th among 59 high-income countries.” ²

A new global report published by the World Health Organization (WHO) highlights that the underlying causes of ill health are often caused by factors beyond the health sector, such as lack of quality housing, education, and job opportunities. The report stated that the social determinants of health equity show that “such determinants can be responsible for a dramatic reduction of healthy life expectancy—sometimes by decades—in high- and low-income countries alike. For example, people in the country with the lowest life expectancy will, on average, live 33 years shorter than those born in the country with the highest life expectancy. The social determinants of health equity can influence people’s health outcomes more than genetic influences or access to health care.” ³

Disparities in Integrative Medicine

In terms of disparities in integrative medicine, it becomes more complex to analyze, as there is less research in this area. However, what holds true for the world also holds true for any field of medicine. Specifically, studies have shown that common disparities in integrative medicine include similar categories, including affordability, accessibility, and insurance coverage. Demographics, environment, location, job status, and more also contribute to a person’s ability to engage effectively in and access integrative medicine.

In an editorial by Dr. Robert Saper on integrative medicine and health disparities, he defined a health disparity as “a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.” ⁴

Dr. Saper shared facts regarding integrative medicine disparities that occur as a result of a number of sociodemographic variables, including:

“Use among Hispanics (22%) and non-Hispanic blacks (19.3%) were both less than use among non-Hispanic whites (37.9%).

Despite the increasing use of integrative medicine today, Dr. Ana Maria Lopez commented in an article that significant disparities exist in integrative health care and referred to these disparities in oncology specifically. She stated that contributing factors include access to care and affordability and that despite limited coverage, integrative health care is sought by many.” She added, “Of note, nearly 50% of cancer survivors in the United States seek integrative health approaches. Currently most National Cancer Institute (NCI)—designated comprehensive cancer centers offer information about integrative therapies, with about 75% offering at least one integrative care modality.” ⁵ Of significant interest, she said that the NHIS (National Health Interview Survey) reported that the annual nonallopathic health expenditure in the United States exceeded $30 billion as out-of-pocket costs.

Disparities also affect research in the area of integrative medicine. Raja and colleagues stated, “The widespread global use of TCIM (Traditional, Complementary and Integrative Medicine) therapies and the growing body of research surrounding its diverse therapeutic modalities highlights the field’s increasing popularity. However, financial constraints, a deficiency in research training and educational support, and a lack of standardization and methodological barriers, pose hurdles for prospective TCIM researchers.” ⁶ The authors added, “These challenges not only impede the progression of TCIM research but also reinforce negative biases. Language biases in TCIM research, evident in the disparities between the findings reported in English-language and non-English-language journals reinforce negative attitudes towards TCIM making the translation of research findings into clinical practice difficult.” ⁶ Of course, this affects the knowledge of clinical practitioners and quality of care that people receive.

In a 2025 NEJM (New England Journal of Medicine) Catalyst Insights report titled, “Integrative Care Grows in Popularity, Despite Payment and Workforce Challenges”, Jonas and Mehta stated that, “If integrative medicine is a bellwether of whole-person care, the survey points to its continuing struggle. While the international leaders that NEJM Catalyst surveyed continue to see multiple benefits of integrative care for practice, they also report inadequate training, capacity, and payment to deliver it, which have remained unchanged in the last 2 years. Without re-envisioning how we care for people, the world will not have the workforce, the tools, or the capacity to improve the long-term health of people, nor reduce the growing rates of chronic disease or costs.” ⁷

Taking Action to Reduce Disparities

Dr. Saper suggested a multitude of actions to reduce disparities in integrative medicine, including:

Increasing awareness of effective integrative approaches through the media, school-based health education, and community-based events and public and health sector awareness, which will lead to a “greater demand for making integrative services more available in historically low-income, minority communities.” ⁴

Integrative Medicine for the Underserved (IM4US) is a cutting-edge organization that has a commitment to equity, diversity, and inclusion, focusing on advancing integrative health care that is available, affordable, and accessible to the underserved. Through outreach, education, and collaboration, IM4US provides an “equity-focused annual conference, fellowship advancement initiatives, and a comprehensive practitioner toolkit—all designed to revolutionize integrative medicine in underserved communities.” ⁸ Providing support to a diverse community of health care practitioners, IM4US works with their members to ensure that clinical practice and research initiatives are not only person-centered but also that health equity remains central to the future of whole-person healing science, according to their website. There are opportunities for membership and volunteering and a number of tools for people in the medical profession on the website to help assist in delivering integrative care for the underserved.

The Academic Consortium for Integrative Medicine & Health is geared for medical professionals and students at academic health centers and systems and is “the world’s most comprehensive community for advancing the practice of whole health, with leading expertise in research, clinical care, and education. By consolidating the top institutions in the integrative medicine space, all working in unison with a common goal, the Academic Consortium is the premier organizational home for champions of whole health,” according to the website. ⁹ The website adds, “Together with over 80 highly esteemed member institutions from the United States, Australia, Brazil, Canada, and Mexico, our collective vision is to transform the health care system by promoting integrative medicine and health for all.” ⁹ The consortium launched the Whole Health in the States (WHITS) Initiative in 2019, which is a project that “uses a multi-stakeholder approach to solve a range of problems that state and local regions face in providing whole person care to medically underserved patients,” ⁹ according to the website. The website adds, “The inaugural program area of WHITS is to support the efforts of Early Adopters of comprehensive, whole person pain care for patients, which overcomes implementation, utilization, and reimbursement barriers to support adequate measurement and evaluation of care delivery models. WHITS works with academic health centers, federally qualified health centers, the Veterans Health Administration, other health systems, and public and private payers to achieve these goals.” ⁹ Visit the website https://imconsortium.org/ for more information about their work and how to get involved.

In addition to those mentioned, many smaller and large efforts across the globe are working to advance the cause of the underserved in the field of integrative medicine and to address obstacles to care that affect people for all of the reasons mentioned.

Conclusion

It is clear that without ongoing and continuous action, nothing will change to any significant degree, and lest any of us think someone else will take these challenges on, we must first turn to ourselves and consider the many ways we can help. What about a massage therapist or any integrative medicine practitioner offering free services once a month? What about clinicians holding free seminars and samplings of the integrative approach and therapies once a month? Many clinicians and practitioners do this, but certainly not all and perhaps not frequently enough in order to engage participants.

Raja and colleagues commented, “In navigating these [disparity] challenges, a comprehensive approach is essential, encompassing increased funding, enhanced research literacy, strategic efforts to increase open science practices, and integrate TCIM content in professional health care programs to reduce negative biases and attitudes. Addressing these barriers collectively opens up a more inclusive, informed, and integrative health care domain that recognizes and incorporates the benefits of evidence-based TCIM therapies.” ⁶

Bendavid and colleagues concluded, “Inequalities and disparities in health and health care are a defining concern of public health and health policy, made more acute during the COVID-19 pandemic. A substantial amount of health policy and epidemiology research aims to identify health inequalities and the levers that can be used to reduce them. This is particularly true in the US, where the number of publications and National Institutes of Health research grants focused on health disparities has increased exponentially between 2004 and 2024.” ²

Finally, Dr. Tedros Adhanom Ghebreyesus, Director-General of WHO, stated, “Our world is an unequal one. Where we are born, grow, live, work and age significantly influences our health and well-being,” and added, “But change for the better is possible. The WHO world report illustrates the importance of addressing the interlinked social determinants and provides evidence-based strategies and policy recommendations to help countries improve health outcomes for all.” ³

Perhaps we as clinicians and practitioners can today begin to understand and learn more about the problems of health disparities in integrative medicine and consider how we might get involved in reducing health inequities.▪