Background: Achieving better health for the entire population will require high quality primary care which incorporates “integrated, whole person health” that is accessible and equitable health care (NASEM, 2021) through creating structures, processes and resource allocation to support whole health for the whole nation (NASEM, 2023). Evidence-based, culturally inclusive Integrative, Complementary, and Traditional Health Practices (ICTHP) and lifestyle approaches are critical components of whole person care. These help mediate the downstream effects of stress, a significant contributing factor to illness. Today, accessing these is a privilege of the few who can pay additional costs to see practitioners outside of their health plan coverage. Those who need it the most because of the toxic stress of SDOH are left out, thus worsening disparities. Further, focusing on individual lifestyle change when circumstances make this impossible (due to lack of resources or structural constraints), blames the individual rather than addressing the systems which have been built in ways that perpetuate inequities. It causes harm by increasing their allostatic load.

Methods: We discuss how ICTHP fits within a health equity framework. One approach is to make whole person care, inclusive of ICTHP, accessible to everyone, by spreading and scaling to all primary care settings and ensuring SDOH interventions are available. The VA’s Whole Health provides a framework for this approach and tools (PHI/HOPE toolkit and CME) have been developed and tested to help practices beyond the VA implement whole person care (Rosenbaum et al, 2023).

Results: The HOPE toolkit was implemented across 16 sites, with 942 Hope tools completed (Rosenbaum et al, 2023). Participants reported impact on knowledge, skills and attitudes(Rosenbaum et al, 2023).

Discussion: It is possible to systematically change how ICTHP is offered. Implementing the Hope Toolkit in primary care is one approach. From a public health perspective, it is necessary to address SDOH alongside ICTHP and lifestyle interventions. Implementing traditional healing practices in a respectful way and acknowledging the origins of healing practices that are offered are essential (IM4US). Policy and payment reform that is inclusive of ICTHP is critical to advancing health equity.

References:

Geronimus, A. Weathering: The Extraordinary Stress of Ordinary Life in an Unjust Society. 2023.

Hofrichter, R and R. Bhatia. Tackling health inequities through public health practice: theory to action. 2010.

IM4US. Cultural Misappropriation in Integrative Health. im4us.org. 2023

Krishnaswami J, et al. Community-Engaged Lifestyle Medicine as a Framework for Health Equity: Principles for Lifestyle Medicine in Low-Resource Settings. Am J Lifestyle Med. April 2019.

Krist, A, et al., eds. Achieving Whole Health: A New Approach for Veterans and the Nation. National Academies Press; 2023.

McCauley, L, et al., eds. Implementing high-quality primary care. National Academies Press; 2021.

Rosenbaum, E, et al., Implementing Whole Person Care: Results of a Year-long Learning Collaborative. Journal of the American Board of Family Medicine. July 2023.

Saper R. Integrative Medicine and Health Disparities. Global Advances in Health and Medicine. January 2016.

Short, SE and S. Mollborn. Social Determinants and Health Behaviors: Conceptual Frames and Empirical Advances. Curr Opin Psychol. Oct 2015.

Introduction

Health equity and justice are cornerstones of public health. Incorporating processes that assess and promote equity in all aspects of health care have become more refined in the past twenty years, affecting many disciplines including integrative health and medicine. The purpose of our scoping review was to determine if and how integrative health researchers were describing efforts to promote health equity.

Methods

Following principles for conducting a scoping review, we searched for articles that specifically addressed the issue of equity in integrative health and medicine using the following electronic databases: PubMed, Embase, Web of Science, PsychInfo, CINAHL, Google Scholar. Three inclusion criteria were established: (1) article published in English in peer-reviewed journal from year 2000 onward; (2) article specifically addressed at least one form of integrative health approach and (3) article specifically addressed equity concerns faced by vulnerable populations. Both authors independently reviewed each article. After selecting an initial set of articles that met our inclusion criteria, we examined the reference section of each article to determine the next set of potentially relevant articles. We continued this iterative process until the numbers of newly identified articles fell below a certain threshold and that the number of duplicate articles exceeded a predetermined limit.

Results

Four hundred forty-three papers were potentially eligible for our scoping review. Of these, 79 met our inclusion criteria. Numbers of papers published between the year 2000 and 2023 steadily increased over this time period and most (81%) were from the U.S. Types of articles included: questionnaires (21); commentaries (13); randomized clinical trials (8); review articles (5); focus groups (3); secondary analyses from U.S. national health surveys (3); cross-sectional analyses (3); retrospective cohort studies (2); medical record reviews (2); global report summaries (2); phone survey (1); prospective cohort study (1); observational cohort study (1); meta-analysis (1); prospective pragmatic trial (1); secondary analysis of randomized clinical trial (1); implementation study (1); scoping review (1); case study (1); mixed methods (1); program development(1).

Types of integrative approaches included mindfulness-based interventions (21); integrative medicine group visits (12); Traditional/Indigenous approaches(7); acupuncture and related studies (5); 34 studies used multiple forms of approaches including nutrition and gardening; Ayurvedic approaches; yoga; naturopathic medicine; and chiropractic manipulation.

Conclusion

Papers on health equity and integrative health approaches spanned a number of topics and approaches. A variety of metrics were utilized to promote health equity in Integrative health and medicine. This reflects the complex inter-relationships of population characteristics related to social determinants of health and indicates the significance of measurement and determining appropriate metrics to promote equity and justice in integrative health.

Safety-net clinics such as Federally Qualified Health Centers are some of the most accessible healthcare facilities in the United States, providing primary care and some specialty services to people of all income levels. Although integrative health modalities are now recommended in clinical guidelines for some of the most common conditions seen in primary care, little is known about the availability of integrative healthcare within safety-net clinics in the United States.

In the current study, we conducted a national survey of safety-net clinics in the United States and U.S. territories to assess the prevalence and availability of integrative healthcare in the U.S. The survey was delivered online and disseminated through professional organizations related to primary care, public health, and integrative healthcare. All employees of safety-net health clinics were eligible to participate. Data collection is ongoing.

As of March 2024, we have received 108 responses from twenty two states, the District of Columbia, and Puerto Rico. The most represented states were California (N=27) and Florida (N=12). The integrative practitioners most commonly employed by safety-net clinics included acupuncturists (n=45); chiropractors (n=30), yoga therapists or teachers (n=20), Health coaches (n=29), Mindfulness or Meditation teachers (n=16) and Naturopathic doctors (N=15). The most widely available integrative health services included acupuncture, mindfulness, nutrition education, osteopathic manual treatment and herbal medicine. Forty-one respondents reported providing integrative pediatric care, and forty-four reported providing group medical visits. Group medical visits included care for diabetes; group acupuncture, and chronic pain and were offered in Chinese, Vietnamese, Spanish, French and English.

This is the first national survey to investigate how widely integrative healthcare is provided in safety-net clinics in the United States. Despite limitations, these findings can inform future research and clinical implementation initiatives aimed at improving access to integrative healthcare across the economic spectrum.

**Understanding Insufficient Sleep and Integrative Medicine in Black Communities**

**Introduction**

The significance of sleep in maintaining health cannot be overstated, with adults typically recommended to get 7-8 hours of sleep per night. However, insufficient sleep (IS), defined as less than 7 hours per night, has been linked to an increased risk of chronic diseases like cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM). Integrative medicine, which combines modern and traditional approaches to health, has emerged as a promising tool in addressing sleep-related issues. Despite its potential, there remains a gap in understanding how integrative medicine impacts black individuals, who often bear a disproportionate burden of IS and chronic disease. This qualitative study aimed to bridge this gap by exploring integrative health practices within black communities to address IS and overall health.

**Methods**

Utilizing photovoice methodology, a community-engaged qualitative approach, participants in Miami, Florida, were instructed to capture images over one week that represented their integrative practices for improving sleep and overall health. Subsequently, they engaged in individual interviews to elaborate on these images and participated in follow-up focus groups for further discussion and data triangulation. Interviews were conducted over Zoom and transcribed for formal content analysis using Nvivo software.

**Results**

The study sample comprised 25 diverse black individuals from the United States, with a mean age of 37 years. A significant proportion were unemployed, and the majority were women. Analysis revealed five prominent themes: natural wellness, self-care, leisure, mental stimulation, and spiritual wellness. These themes underscored the heterogeneity of beliefs and behaviors regarding sleep and health among black individuals.

**Conclusion**

Addressing IS in black communities requires a multifaceted approach that integrates cultural sensitivity, family and community dynamics, education, mental health support, and informed policymaking. Furthermore, future interventions should consider the nuances of sleep health literacy, stress appraisal, and coping strategies specific to race and ethnicity to ensure tailored and effective approaches.

In summary, this study sheds light on the importance of understanding integrative health practices in black communities to combat IS and promote overall health equity. By recognizing and addressing the unique sociocultural factors at play, we can develop more inclusive and effective interventions to improve sleep outcomes and mitigate the burden of chronic disease among black individuals.