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– The economic conditions that support the development of chiropractic, simply explained.

Occasionally someone in the world experiences a brief moment of creative genius that propels an idea into a life-changing event. That moment happened on September 19th in 1895 when D.D. Palmer made the connection between spinal misalignments and a compromised nervous system. This revelation rapidly developed into the Philosophy, Art and Science of Chiropractic and a new profession was born.

The first fifty years saw this new profession remain almost exclusively in America. Eventually there were foreign graduates and the profession began to spread throughout the world. Interestingly enough, the rate and distribution pattern of this growth occurred primarily in Western Europe like Switzerland, France, Italy, Norway, Denmark or the UK and elsewhere in English speaking countries such as Canada, Australia, New Zealand, South Africa, Hong Kong, Singapore and the Caribbean Islands. What these countries do have in common is a large economic middle class.

There are other characteristics that can be used to explain the profession’s peculiar distribution pattern of growth. The majority of these countries were formerly colonies that did well in the post-colonial industrialization era. Still others also have a geographical advantage that favors strong International trade such as major seaports or highly skilled laborers. Further studies into modern day social profiles of countries will reveal still other identifying factors that have favored the growth of chiropractic in their country but, for the purposes of this article, we will stick to the most basic element, economics. In conducting this type of analysis we find economic profiling as the common element. The string that ties it all together is the size of a country’s middle class.

I was reading an article by a young female chiropractor that opened an office with another woman chiropractor in Costa Rica. One comment in particular stuck in my mind. She said: “At first, we were surprised by the type of patients we saw. Knowing that Costa Rica is a third-world country, we assumed we would be catering mainly to the poor people. But, while poverty exists in Costa Rica as it does in any nation, mainly we’ve attracted the middle-to-upper class population (1).” The doctor does go on to say that they frequently donate their services to the poor whenever they visit outlying villages.

This story actually narrates what is and has been occurring in all developing countries where there are primarily two dominant socio-economic classes and an ever slowly increasing small middle class. In these countries, chiropractic is an imported specialty that is only financially accessible to the middle and upper classes that can afford to pay beyond basic medical care.

There is another report about a chiropractor in the Philippines that admittedly understands this two-class reality. First he has located his clinic in the city’s most exclusive mall to attract the portion of the population that can afford his regular fee. Then, on every other Sunday at his church, he donates his afternoons to hold a free clinic for the poor. Until governments can afford to provide for a larger safety net it seems to be up to the individual doctors to step in where possible. High profile foreign missions are also a part of solving this equation when designed to include the local chiropractors.

In order to truly appreciate the effect of economics on providing a fertile ground for the growth of chiropractic it follows that a review of the economic factors in the United States could well explain much of what has occurred through out the world. Yes, the USA stands heads up above the rest of the world with the highest Gross Domestic Product per Capita (GDP/c) of around $34,000. This compares to the lower GDP/c in Canada ($23,000) and Australia ($22,000) or to the much lower GDP/c in China ($3,800) and India ($1,800). Unique countries like Switzerland ($27,000) and Singapore ($28,000) are in the upper GDP/c ranges because of their small size, highly skilled laborers and globalized societies.

Looking at the United States and referring to a study by Harvard University that outlines four economic sub-groups: the very wealthy (3%), the well off (10%), the average working person (60%) and the underemployed, unemployed or unsuitable for employment (27% – which includes the children), the benefits of a country that has over 70% of the people contributing to the tax base means that there is enough money for everyone to afford healthcare. The taxes support a broad variety of welfare and unique social programs that provide an extensive “safety net” for the entire population.

Our lesson of basic-economics-in-action is like this: the very wealthy invest their money into businesses that are managed by highly qualified and well paid, now well off people. These businesses provide jobs for the average working person in the community who can now afford the services of professionals who are able to charge a high fee and join the well off group. Everyone gets to pay a fair portion in taxes which takes care of the community needs for a high quality of life and leaves enough money left over to provide for the 27% dependant and otherwise less fortunate people.

If you live in America and need or want chiropractic care, you can get it through public and private insurance, workers’ compensation and other plans. For that matter, the same can be said about Canada, England, Australia, Sweden, etc.

However, the same cannot be said about India and China where there are two chiropractors for over one billion people. There is one chiropractor for every one million people in Egypt, Kenya, Argentina, Ecuador, Guatemala, Hungary, Romania, Russia, Turkey, Brazil, etc. If one considers the proportionate economic middle class population of these countries it becomes obvious why it has been difficult to see a rapid demand for chiropractic.

Now, there is another important factor to consider… language. As we enter this new century, only 3% of all the chiropractic students in the world are being taught in the 17% of the schools (#6) that are teaching in a language other than English. This is the one single factor, other than the size of the middle class, which has severely hindered the establishment of chiropractic in most other parts of the world. The truth is that until chiropractic is taught in or near that country the profession can almost never become truly established, or enough to reach even the poor in their midst.

Here again, the issue is economics! In third-world countries only the middle class families can afford to put their children through college. The very wealthy families however can afford to send their children abroad for college and that is how chiropractic finds its way into many developing countries today; in addition to the hundreds of scholarships provided through chiropractic colleges in the modern countries. The current challenge is to create the right dynamics that will favor the establishment of new schools in all regions and all major languages like Spanish, Arabic, Russian, Cantonese, Africans, Punjabi, Hindu, etc.

In reviewing the two primary factors that are necessary for chiropractic to have a healthy growth, namely a large middle class and access to affordable chiropractic education, we can better strategize for future growth efforts. Looking at the flip side of this equation we can also see where not to waste our energy and resources and try not to allocate the majority of our focus on the establishment of the profession in countries where the conditions continue to be unfavorable for chiropractic; to do this it may be necessary to create a sliding graph that represents the conditions of each country along this scale; to be able to say in 10 or 30 years that the overall benefit to the people of the world has been good. It’s a matter of priorities.

As the chiropractic leadership begins to absorb these concepts there will be better progress because it will result from clearer intention rather than the more random-type results that are observed. It has been said: “When things don’t change… things don’t change.” It’s not that any change is a good change; but simply, that good people can promote the right kinds of change when they are given access to good information and are courageous enough to act.

(1) A Costa Rican Chiropractic Adventure by Lara Long, DC – The Chiropractic Journal, March 2000.