Worldwide, the chiropractic profession has made progress in the early part of the 21st century, varying from region to region based on the socioeconomic and political climate. The total number of chiropractors in established practices has gone from 72,000 to 79,000 in nine years and there are six additional chiropractic schools, bringing the current total to 42, with another six in the preparation stages.In 1999, chiropractors were practicing in 99 countries; as of 2009, we have DCs in 115 countries, albeit in very small numbers where there is new growth.
The lack of local organizational support will continue to result in slow growth in many if not most countries. The Chiropractic Diplomatic Corps has been monitoring these growth trends since 1997 and produced a "white paper" in 2002 on chiropractic's international growth titled "Chiropractic GPS - Global Professional Strategy." (The full 39-page text can be downloaded at www.chiropracticdiplomatic.com/strategies/global_strategy.pdf.) This article revisits the chapter on Country Rating with a particular focus on Asia, a region of great interest to many. The chart/table helps to bring the reader current on the status of each Asian country; its chiropractors, association capacity, DC schools and condition of laws recognizing or regulating chiropractors.
Asia represents about 40 percent of the world's population and will be the next region of the world to experience the most chiropractic development. As India and China strengthen their economies and current chiropractic growth efforts in other countries begin to gain greater momentum, Asia will become the bright spot in the chiropractic profession's international presence. A region rich in history of traditional healing, there will be amazing contributions that can take chiropractic to new and unexpected advancements.
Asia has the potential to lead the chiropractic profession from a global presence of approximately 80,000 today to 200,000 by the end of this century. Naturally, this will not come easy and many good people will need to step forward and do their part to open doors and pocketbooks, to conduct themselves ethically, and to hold all DCs accountable to their individual responsibilities to their profession as well as to their patients and families.
The most improved countries are Thailand, Japan, Indonesia and China. This also is the first time we have seen lasting growth of chiropractic within India, Vietnam and mainland China. Lagging behind are India and the Philippines because of difficulties attracting DCs, and Laos, Tibet, Cambodia, Myanmar, Bangladesh and Papa New Guinea because of the poor economics, corrupt politics and/or the oppressive nature of their governments.
Progress, Current Status
What are some of the characteristics that have contributed to the development in each country? Characteristics range from the local economy and government stability to the local DC leadership. In 1999, there were 16 Asian countries in the "Pioneer Stage" of development. This stage is characterized by a ratio of one DC for greater than 1 million people; DC students numbering less than 10; and no formal chiropractic law. As of 2009, there are still 14 with a Pioneer rating; two have advanced in status.
The "Advancing Stage" is characterized by a ratio of one DC for greater than 100,000 but less than 1 million people; DC students numbering greater than 10 but less than 100; and some degree of formal recognition or progress. As of 2009, we see only Hong Kong and South Korea with an Advanced rating, with Japan and Thailand improving as well.
Australia and New Zealand are the only countries rated as 10 on a scale of 1-10 and have also reported growth, with Australia adding a third school in Perth and breaking the 3,000-plus DC number, giving them a ratio of one DC for every 6,000 people. New Zealand has experienced a large increase as well, with 330 DCs or a ratio of one DC for every 12,000 people.
Only Thailand has made significant progress in terms of government recognition, while Hong Kong's initial developments in the previous decade finally saw the establishment of a registration board in this recent decade.
The growth of 1,000 additional DCs in Asia may have taken 10 years, but the next decade will see much more rapid growth. One potentially significant development is the formation of the Asian Pacific Chiropractic Doctors Federation (www.apcdf.wordpress.com), registered in Australia, which has the potential to perform a similar role as the European Chiropractors' Union, which has made historic contributions to Europe's pro-growth environment. Key to the success of the APCDF is the presence of an increasingly functional chiropractic national association (CNA) in each country. The focus of the CNA will require change and adaptability as the profession grows.
Schools First, Licensing Later
In the Pioneer Stage, the principal role of the CNA is to increase the number of DCs at all cost. This is done by promoting repatriation of indigenous DCs practicing abroad; attracting DCs with family ties and via short-term missions; by sending students abroad for chiropractic education and getting them to return to practice; and by preventing attrition whenever possible by creating a community spirit among the current practicing DCs.
In the Advancing Stage, the focus shifts to the establishment of a chiropractic school, although this can happen earlier; to pressing the government for legal recognition, even if only partial; to building on the brand name of chiropractic within the country; to improving DC member services and further strengthening the CNA.
The "Established Stage" is when it becomes possible for the CNA to focus on adding schools if population size justifies it; doing more research; strengthening institutions; getting included in health insurance schemes; and acquiring professional equity with other primary care health professions.
1999 - 2009
1999 - 2009
|10||Australia||2,500||3,000||Complex||2||3||Chiropractic Act with full protection|
|0.5||Brunei||1||1||None||-||-||No recognition and no regulations|
|1.0||China||0||12||Pioneer||0||0*||No recognition and no regulations|
|5.5||Guam||8||10||Basic||-||-||Tolerated under general US laws but no local law|
|6.0||Hong Kong||55||110||Intermediate||0||0||Chiropractic Act 1993, registration since 2001|
|1.0||India||1||3||Pioneer||0||0*||No recognition and no regulations|
|3.5||Indonesia||1||30||Pioneer||0||0||Formal recognition but no regulations|
|4.0||Japan||30||195||Intermediate||1||3||No recognition and no regulations|
|0.5||Macao||0||3||Under HK||-||-||No recognition and no regulations|
|4.0||Malaysia||6||25||Basic||0||0*||Formal recognition under CAM but no regulations|
|10||New Zealand||200||330||Complex||1||1||Chiropractic Act with full protection|
|3.5||P. New Guinea||1||2||Pioneer||-||-||No recognition and no regulations|
|1.5||Philippines||6||18||Pioneer||0*||0||Formal recognition under CAM but no regulations|
|3.5||Singapore||8||30||Basic||0||-||No recognition but under self-regulation|
|4.0||South Korea||30||120||Intermediate||1||1||Practice of Chiropractic is illegal|
|1.5||Taiwan||10||12||Pioneer||0||0||Practice of Chiropractic is illegal|
|3.5||Thailand||2||30||Basic||0||0||Chiropractic Act 2006, probationary|
|0.5||Vietnam||0||2||None||0||0||No recognition and no regulations|
|Total 18 countries||2919||3932||3 new countries||5||8||Added 2 regulated countries and 3 DC schools|
What Can You Do?
Chiropractors who have Asian ancestry or family ties, who have good teaching skills, and who are willing and able to relocate and help build new schools are in great demand. Be warned: Asia is not a place where unprofessional conduct will be tolerated. It will require hard work by people of great courage, like the South Koreans, for example, who face persecution by Oriental medicine doctors and competition by lay manipulators who openly call themselves chiropractors.
History is in the making and pioneering opportunities exist for the right people all over the world. Visit www.chiropracticdiplomatic.com and browse the 300+ pages of information designed to inform and encourage global chiropractic development.
Dr. Michel Tetrault, a 1979 graduate of Life Chiropractic College, is founder and executive director of the Chiropractic Diplomatic Corps. He has been active in various pro-chiropractic initiatives related to global public health, including serving as a member of the World Federation of Chiropractic and delegate to the World Health Organization.