Issue 4 - February 2002 P.1
A monthly electronic newsletter of the Chiropractic Diplomatic Corps
In this Issue:
Until the last twenty years, the majority of countries where chiropractic grew and eventually became established
were formerly colonies that did well economically in the industrial and post-colonial eras. The two criteria that
stand heads-above-shoulders are: the size of the country's middle class and access to affordable education.
This rings true in 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.
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 well 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.
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.
Economics and Education
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. 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.
COUNTRY TOPICS: - Commonwealth Countries P.2
There are a total of 54 Commonwealth countries including: Antigua & Barbuda, Australia, The Bahamas,
Bangladesh, Barbados, Belize, Botswana, Brunei Darussalam, Cameroon, Canada, Cyprus, Dominica, The
Gambia, Ghana, Grenada, Guyana, India, Jamaica, Kenya, Kiribati, Lesotho, Malawi, Malaysia, Maldives,
Malta, Mauritius, Mozambique, Namibia, Nauru, New Zealand, Nigeria, Papua New Guinea, St Christopher
& Nevis, St Lucia, St Vincent & The Grenadines, Samoa, Seychelles, Sierra Leone, Singapore, Solomon
Islands, South Africa, Sri Lanka, Swaziland, Tanzania, Tonga, Trinidad & Tobago, Tuvalu, Uganda, United
Kingdom, Vanuatu, Zambia and Zimbabwe. (The ones in bold have been reported to have chiropractors.)
In comparing countries that were previously colonized by Spain, France or Holland with the list above we find
15% of the world's chiropractors are found within the Commonwealth. Statistics indicate that 97% of all DCs
graduated from English-speaking countries therefore we can attribute the English language as a factor for easier
expansion within these countries. As indicated in the article above on Economics there are also better financial
opportunities for chiropractic graduates in Commonwealth countries. Still, there are both exotic places to see
and invigorating cultures to enjoy for those who have difficulty learning a language other than English, keeping
in mind that the local economy of the smaller or developing countries may only sustain a small number of DCs.
The British Virgin Islands are a good example of this fact where 2 DCs represent 100% of the DCs needed to
serve that country's small population. (World Listing by Country)
To work as a DC in Commonwealth countries one has to first follow the visa regulations that authorize any
person to work, then to follow the business laws required by that local government. Information about
authenticating your Chiropractic Diploma can be found in the TOPIC section of our website along with other
practical information. The next stop would be the embassy or consulate offices nearest you for that country.
Don't forget to look up embassy information on the Internet and travel books at local bookstores.
There are over 5,500 DCs representing 80% of the DC/Pop. ratio seen in the USA. This is the only country other
than Australia and the USA where the profession can be regarded as fully established. (Canada Information Page)
There are about 2,500 DCs representing about 60% of the ratio seen in the USA. (Australia Information Page)
There are some 200 DCs representing about 40% of the ratio seen in the USA. (New Zealand Information Page)
In 2002 there are an estimated 1600 DCs in the UK representing about 15% of the ratio seen in the USA.
850 are members of the British Chiropractic Association, the McTimoney Chiropractic Association has about 550
members and the Scottish Chiropractic Association has 100 members. A 1994 law authorizes the General
Chiropractic Council as the regulatory board for England and Scotland. (UK Information Page) In Ireland there is
nothing in the law prohibiting the practice of chiropractic that is considered an independent primary health care
profession; chiropractors practice as spinal specialists. Currently there are about 65 DCs representing less than
10% of the ratio seen in the USA. (Ireland Information Page)
Hong Kong is the next advancing country in this group with 61 DCs representing less than 5% of the ratio seen
in the USA; while Singapore with 11 DCs has less than 2% of potential DCs needed there. Cantonese is the
language of preference in both these countries but English is extensively used in commerce. Any other country
in the Commonwealth group has zero or less than 1% of the needed DCs with much yet to be done.
Experienced DCs with a capacity to adapt to foreign cultures are the best candidates to pioneer the profession in
this last group. When you are practically the only DC there - YOU ARE CHIROPRACTIC and carry an awesome
responsibility both clinically and professionally. If you have never been to a country it is advised that you take a
vacation there ASAP to create an adequate level of familiarity before you can expect to make a serious decision.
Naturally, the best scenario would come from someone with family and/or cultural ties to the country.
This newsletter is intended to inform and encourage the International growth of Chiropractic. If you know someone who may be interested in
receiving this newsletter, please have them go to www.ChiropracticDiplomatic.com/register and complete the Foreign Service Registry form, their
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