The International Growth of Chiropractic

What’s ahead for chiropractic? In the following interview with The American Chiropractor (TAC), David Chapman-Smith and Sira Borges, D.C., discuss the rapid growth of chiropractic in Latin America and worldwide.

TAC: What are the roles of the WFC and FLAQ?
Chapman-Smith:  Details of the WFC, whose voting members are national associations of chiropractors in eighty-six countries, including both the American Chiropractic Association and International Chiropractors Association in the United States, are at A key role of the WFC is to promote the international growth and success of the chiropractic profession, based on consistent educational standards, market identity, and legal scope of practice.

Borges: The role of FLAQ, which works closely with the WFC, is to advance chiropractic in Latin America.  This is particularly important today.  This is partly because in many countries—such as Argentina, Brazil, Chile, Costa Rica and Guatemala—there is no law regulating chiropractic education and practice and many unqualified people are claiming to be chiropractors as chiropractic services become better known and more popular.  There are now three university-based chiropractic schools in, Latin America—in Brazil (2) and Mexico (1)—and many more DC’s practicing in the region.

TAC: Can you tell us about the schools in Mexico and Brazil?
Borges: The Mexican school, at the Universidad Estatal del Valle de Ecatepec (UNEVE), is in a state university with student fees almost fully paid by the government.  The four- year fulltime program is at the same level as US chiropractic colleges, and is delivered with faculty support from Parker College in Dallas, Texas.  On graduation, students complete a one-year hospital rotation during which they are paid by the government.  After that, they go on to private practice.  This has worked so well that it is expected that there will soon be another two or three Mexican schools in state universities.

In Brazil, there are two four-year university-based schools similar to the one at UNEVE, and with a total of approximately seven hundred students.  One is at Feevale Central University in Novo Hamburgo in the south of Brazil and has been developed in partnership with Palmer College.  The other is at the University Anhembi Morumbi (UAM) in Sao Paulo and has been developed in partnership with Western States Chiropractic College.

TAC: Are other schools planned in Latin America?
Borges:  Several are in the planning stage.  Next schools are, most likely, in Argentina and Chile, both of which now have an established chiropractic profession, and Costa Rica, which is in the final stage of passing laws to recognize and regulate chiropractic practice.

TAC: Will the WFC and FLAQ be able to guarantee similar educational standards for chiropractors internationally—and how important is that?
Chapman-Smith: It is of fundamental importance—just ask osteopaths, who have lost their international identity and are not growing nearly as successfully as chiropractic because of different educational standards in different countries.  We all know the world gets smaller every day.  It is crucial that DC’s everywhere have a distinct philosophy, practice and identity, based on common education and values.

And, yes, the WFC and its partners, such as the Council on  Continuing Education (CCE) International and the Association of Chiropractic Colleges (ACC) are succeeding in keeping one international standard of education.  A huge step in that direction came last year when the World Health Organization (WHO) published its Guidelines on Basic Training and Safety in Chiropractic.  The WFC worked with WHO for six years on that project.

WHO, which has huge influence in most countries, recommends to governments in its guidelines that chiropractic should be an important part of each national health care system, but that the practice of chiropractic should be regulated by law and limited to individuals with proper education.  The WHO Guidelines have already been translated into several languages (e.g., Finnish, French, German, Japanese, Korean, Portuguese, Spanish) and are proving a great help to the chiropractic profession worldwide.

TAC: How is the profession developing in Asia?
Chapman-Smith: Rapidly—which is important since fifty percent of the world’s population lives there.  Chiropractic is only recognized by law in Hong Kong (with sixty-five DC’s) and Thailand (twenty DC’s) but is legal in most countries.  The largest number of chiropractors is in Japan, with approximately ten thousand, though not all with a high standard of education.  There are chiropractic schools in Japan and Korea, and draft chiropractic legislation is presently before legislators in Korea and Taiwan.

TAC: How about other parts of the world?
Chiropractic is growing faster in Latin America and Europe than anywhere else. In Europe, there are chiropractic schools open or soon to be opened in Denmark, France, Italy, the Netherlands, Norway, Spain, Switzerland and the UK (with three schools already).  But North American DC’s may be surprised to learn, for example, that Middle Eastern countries, like Cyprus, Iran and the United Arab Emirates, have chiropractic legislation and thriving chiropractic professions.  One hospital in Saudi Arabia has six DC’s on staff.  Chiropractic is well-established in Israel, where the government pays for chiropractic services through HMO’s.

TAC: Explain the WFC’s recent work on a market identity for chiropractic and why that’s important.
Chapman-Smith:  Is chiropractic mainstream or alternative? Will chiropractic practice grow to include use of prescription drugs? What is the key identity and role of chiropractic services?

Chiropractic has been at the crossroads on all of this, with many predicting significant loss of market share unless the profession had a much clearer identity.  As a result, WFC member associations asked the WFC to lead a major consultation on identity in 2003.

This finished in June 2005, with the WFC members unanimously accepting the recommendations of the forty-person task force that chiropractors should be seen as “the spinal health care experts” within mainstream health care.  That is the leading concept. There are several important supporting statements, and the full identity and Task Force Report can be found at  Significantly, the agreed WFC identity was recently supported by the international chiropractic educational community at the WFC/ACC Conference in Cancun, October 25-28, 2006.

Borges:  FLAQ and chiropractors in Latin America fully support this market identity, which is much wider than back pain but more focused than general wellness care.  Under the WFC identity, chiropractic remains a drug-free profession. FLAQ will be encouraging individual DC’s in Latin America to be consistent with the WFC identity in their marketing efforts.

TAC: What are the major plans of FLAQ and the WFC for the year ahead?
Borges:  FLAQ has an important meeting in the Republic of Panama on February 22-23, at TAC’s Chiropractic’07, to pass an amended constitution, elect new officers and plan for the year ahead.  One area we are emphasizing is sports chiropractic.  Next year brings the Pan American Games in Rio de Janeiro and FLAQ is working with others to see strong representation of sports chiropractic at this important event.

Chapman-Smith:  The WFC’s biggest meeting—which I encourage all DC’s to consider attending—is the WFC Congress in Portugal, May 17-19, 2007.  There is a great venue, a superb social and academic program, and we expect approximately eight-hundred DC’s.  All details are at www.wfc.or/congress2007.

Work with WHO is ongoing, including a new WHO publication on the proven benefits of chiropractic care.  However, perhaps the WFC’s priority will be international adoption of Straighten Up America, the impressive program headed up by Dr. Ron Kirk from Life University, which has just been adopted worldwide as the theme for spinal health by the Bone and Joint Decade.  There are already versions, for example, such as Straighten Up Australia and Straighten Up South Africa.  The WFC is promoting Straighten Up events in all its member countries for World Spine Day on October 16, 2007.  Straighten Up is a superb public health program in itself, but also fully consistent with the profession’s identity and an excellent vehicle for promotion of the profession.

The World Federation of Chiropractic is a co-sponsor of the 2nd annual International Chiropractic Symposium in the Republic of Panama Feb. 22-24.  The Federation of Latin American Chiropractors (FLAQ) will also be using this event as an opportunity to nominate leaders and establish a constitution for the association. For more information call 1-888-668-8728.

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