European Shiatsu Federation

Call for action

The CAM Associations of patients, practitioners and doctors organising the October 2012 conference on Complementary and Alternative Medicine, Cam, in the European Parliament have made the attached conclusions and Call for Action.

Here is a link to the EU CAM Policy - current status and potential in European Healthcare.


The European Shiatsu Federation was formed in 1993 with the object of establishing and advancing Shiatsu as a healing therapy throughout Europe and to promote high standards of professional practice. The current national members are:

Czech Republic

CAM Practitioners in Europe and ESF Political Work Strategy and Action. 

At the European Forum for Complementary and Alternative Medicine (EFCAM) (The European Shiatsu Federation is a founder member).
We are very pleased to let you know that all our lobbying efforts have been rewarded and reference to Complementary and Alternative Medicine (CAM) was included in the 2013 Work Program for the EU's current FP7 Research program.  The provision made is for very general research project into CAM rather than for projects in any one specific modality. Nonetheless this is an important step forward. It will be discussed at next weeks meeting of the Administrative Board of the European Information Centre for CAM (EICCAM).

Meanwhile, another small development has been a survey carried out in Switzerland that shows 80% of citizens want CAM included in their health insurance program provision. Some of you may remember that the Swiss Government controversially withdraw CAM from the national health insurance programme some years ago using falsely based pretences for doing so, one item of which was the Shang et al research paper on homeopathy printed in the Lancet.

The Aims of the ESF

The principal aim of the ESF is the achievement of the legal right to practise Shiatsu throughout Europe and everything else it does is to support the attainment of this. This support process includes:

  • To promote the development of professional education and standards of practice;
  • To promote the research into the effectiveness and benefits of Shiatsu;
  • To promote research, educational, practical and social exchange between Shiatsu professionals in Europe;
  • To represent the interests of the Federation and its members to the European
  • Union and all its relevant institutions;
  • To promote the establishment of National Professional Shiatsu Associations where these do not exist;
  • To support the activities of the National Professional Associations in furthering these objectives;
  • To establish good working relationships with other organisations that share these or other compatible objectives.


The BSF (Belgian Shiatsu Federation) is now in the process of changing from a non-profit organisation into a trade organisation to seek recognition from the Ministry of Trade. Once the organisation is recognised the profession itself can begin the process of being recognised because at present it is technically illegal to practise. This is the first step on a long path to be taken over the next few years.


Here there is the opportunity to become completely recognised and legal and be able to work in their equivalent of NHS trusts. Again they cited EU initiatives and specifically mentioned the presentation by Professor Long and Seamus Connolly of the first stage of the ESF research project into Shiatsu. The idea will be to officially recognise courses and practitioners through Irish educational awards bodies and look at them in the same way as any other form of higher education study or profession. The Irish Shiatsu Society can write the criteria itself, however, the awards body will be looking for standards in the region of lower degree or possibly honours degree. The draw back is that initially the cost will be in the region of 7,000 euro to get the level quality assured and then there will be further costs to get the provider/school checked. In one way it is unfortunate that it is not compulsory, as the schools do not have to do it if they do not want to. This could mean that even though there is no specific time limit the opportunity might be missed. However, once the process has been achieved there would be no going back and no likelihood of major changes such as threats of imposing masses of Western Medicine hours. Once accepted it would be accepted! The Irish initiatives are encountering dragging feet and possibly getting lost in mazes of lack of interest. It's all slow going and requires masses of energy.


Laws to regulate and legalise CAM are now in operation. One of the reasons for putting the laws together was because of an EU initiative mentioning CAM regulation in the 6th Framework Program dating back to 1994-96. Because Brussels had been directly lobbied by CAM groups, including the ESF, action eventually has filtered through and politicians are being stimulated to look at the Complimentary Health field. Unfortunately, in Cataluna the doctors and physiotherapists want to take the local government to court to nullify the law, because it would mean instant legal recognition of those who could prove in various ways they had been practicing for 5 years or more. Those with less than 5 years experience would need extra evidence and an assessment examination is being prepared by the local Shiatsu ‘negotiator/representative’. However providers/schools will have to have their courses, premises etc checked and passed by Local Government officials, probably accompanied by the traditional mountains of red tape. This then means that some practitioners are in favour and others will find it very difficult to get a small school through the maze. The Madrid initiatives are encountering dragging feet and possibly getting lost in mazes of lack of interest. It's all slow going and requires masses of energy.


One of the main sticking points in Sweden where a full member needs to only do 400 hours plus treatments is that the largest school, which has an international reputation for Swedish massage treats its Shiatsu course as more of an add on than a full 3-year course. What makes it more difficult is that the school is much bigger than the Swedish Association, which has been trying to convince it to expand its courses. Perhaps if the school sees that there is a European Baseline Curriculum and they fall below it, they may not appreciate being below the required amount. Perhaps a diplomatic external push might help them rethink.

The news from different countries suggested we are going to have to consider the possibility of 2 levels of Shiatsu with 2 levels of study. A non-therapeutic level where quality Shiatsu massage is given but no attempt is made at client evaluation, the other a therapeutic level equivalent to a practitioner where client evaluation is normal. This concept was echoed in various countries particularly Belgium, Spain and Greece. However the ESF felt it important to continue to promote the higher level and higher standards, as it regards Shiatsu as very much a part of CAM. This does not mean that in the future it will fail to acknowledge the lower non-therapeutic practitioner/therapist as flexibility of approach is important.

The law in Cataluna, Spain, legalising bodywork etc has been suspended for a minimum of two years and there is not enough money to challenge the challenge by doctors, physiotherapists etc and local practitioners expect it will just gather dust.

There was considerable discussion around the affiliation of groups in Italy and the apparent divisions between the large organisations there. However ESF decided to allow affiliation to two groups for 2006 with possible renewal and the ESF intends to send two representatives to an Italian Shiatsu conference in the autumn in order to promote both the research project and the support for harmony and alliance within the Italian Shiatsu community, which is actually very large. The ultimate aim of the ESF is to help bring about the creation of an Italian National Association. Contact was also made with a large French institute, which has done considerable research into how Shiatsu is used and received throughout Europe. They gave a very professional presentation and their aims appeared very much along the lines of those of ESF. However, it will not be so easy to establish such a forward-thinking National Association in France as the largest group does not appear to have an expansive view of the future of Shiatsu.

In Brussels there are soon to be fresh opportunities for amendments to a European Health program initiative. The ESF representatives will be going to a preliminary European Forum for Complementary and Alternative Medicine (EFCAM) meeting in 2 weeks time to establish which MEP’s to target and then will compose a draft of a letter for all of us to send to them. However, they stressed the letters would have to be individually written and not a blanket-campaign letter (since these are invariably binned). The World Bank had come up with two helpful statements, in paraphrase – Western Medicine was not cost effective and was not a financial benefit to society, i.e. it costs more than it saves. And two – the economics of wellness is being ignored (and money talks). Perhaps there will be a drive to keep people well if only for financial gain, and CAM can play a very large part in that.

There has been no response to previous invitations by the ESF to members of the International Shiatsu Network (ISN) to come to a meeting and so over time it was felt there was no point. However, the ESF on request of its Austrian representative, will try again to set up a commuication link with the ISN after the rep reported that there was now a more open and positive wish for such a bridge within the ISN.

An election for a new president for the ESF will be held at its AGM in February 2008 and there will also be updates to the statutes at that time (because like our Rules and Regulations it is the only time they can be officially changed).

Plans for the future include:

How to use the very positive results from the research project at a political level to influence the EU more. EG, not a spin-off research project into effectiveness on pain but perhaps more one on cost-effectiveness and the impact on life-style change, which is more suitable to the political agenda of the EU Health Action Plan. The dissemination of the first research project will also be a sales pitch for the second Research Project.

Lobbying in Brussels, targeting the inclusion of CAM in the Research Framework, Influencing the Health Action Plan, developing an ‘Intergroup for CAM’ (An intergroup is a group of MEP’s who are interested in supporting a particular piece of agenda etc).

Strengthen EFCAM and support its political activities. Finally there is a desire to investigate, along with various practitioner profiles, the area of professionalism and training with regard to such things as business skills, how to get funding for small businesses etc, where the knowledge usually needs to come from outside the shiatsu community and be bought in. However, without this many practitioners never really get off the ground. This came from a premise along the lines of, ‘If we do something that is so good, so effective, so beneficial why isn’t everybody working their thumbs to the knuckles?’

A European Baseline Curriculum/Syllabus

All the members have agreed a core baseline curriculum/syllabus and most individual associations have signed up to recognise the standards asked for by the ESF curriculum/syllabus and that they will regard them as a minimum. In addition, each individual association has the right to ask for additional study criteria in order to meet their own regulatory standards. Each association is asked to accept the 45 hours studied under through the ESF curriculum/syllabus as equal to 450 hours of their own association’s study period.

The association is also asked to acknowledge that the principal purposes of the curriculum/syllabus are:

To create a unified recognised minimum standard of Shiatsu study throughout Europe
To facilitate the free movement of practitioners around the member countries
To encourage and support associations to work towards he same minimum standard (to this aim the ESF will make the curriculum/syllabus readily available to countries, particularly those beginning to organise national associations)
There is a lot of common ground across Europe, however, there are also many differences, the national borders of Shiatsu need to become more permeable without loss of integrity and standards. An acknowledgement of a European standard can go a long way to helping this. It was agreed there would almost always be the need for a type of interview, akin to the MRSS as practitioners moved around from country to country. Previous experience and membership of an ESF association that met the European Curriculum/Syllabus should mean that for a practitioner an interview supported by documentation would be sufficient.


The Effects and Experience of Shiatsu: A Cross-European Study December 2007

The Shiatsu Society are a member of the ESF (European Shiatsu Federation) and have contributed towards this european research project which has been carried out by Professor Andrew F Long, School of Healthcare of the University of Leeds.

The development of the study design took particular account of the fact that Shiatsu practice occurs within the energetic relationship between the practitioner and the client, that it is intuitive in nature, and that it is broad in its guiding philosophy and scope of application. The findings summarised below speak volumes about this ancient art. They validate an intuitive but practical system with contemporary and rational tools, bridging longstanding cultural gaps. These findings are now offered in service to the public, the profession, researchers, policy makers and health care providers.

Economic Implications; A reduction in physician/hospital visits over time alongside a reduction in use of conventional medication was evident.

Sympton Changes; A statistically significant reduction in sympton severity was found for all of the symptom groups.

The ESF hope to organise two presentations in the UK, one in London in February and one in Edinburgh in March/April in addition to presentations later in the year around Europe.

If anybody feels they can help with the dissemination open to all, for the benefit of all, then please let us know.

A report on phase 2 of the project can be downloaded here.

At the EU level, unfortunately no consideration of funding for research into CAM will now be considered before 2012 when a new (8th) framework plan will be unveilied, however the ESF, through EFCAM, are also targeting the EU Health Action Plan which is expected to emphasize prevention and self health promotion and the results from the research project are very positive towards these areas of health consideration, so this line of lobbying will be pursued more intensively. In addition, there is a 'CAM Visibility Project' being funded by Chinese Herbal producers and suppliers (i.e. with money) which will focus on translating research data into a form understandable by lay people with little knowledge of CAM (i.e. most MEP's). It is important to understand that any new EU initiative must include the new accession states in the plan so it is essential to build bridges at all levels with the new EU members.

ESF At Work

Call for Action: Information on why the Government should recognise Shiatsu

The approach of direct representation is at last beginning to have an effect as Government's across Europe look to regulate CAM stimulated by European Directive 2005/36/CE, committing countries to the regulation of professions in 2007.

Unified Promotion of Shiatsu through the European Shiatsu Week
Promotion is a big part of the on-going development of education, standards of practice and research into the effectiveness and benefits of Shiatsu. To this end the ESF has encouraged all member Societies to participate in a European Shiatsu Week and to turn it into an annual event with extra activity and promotion in September with the wake up idea of “Shiatsu is happening all over Europe”..

CAM EU Health Program - Trakatellis Report
On 9th May 2007 The Committee on the Environment, Public Health and Food Safety (ENVI) voted in Brussels on the Second Reading of the EU-Health Programme 2007 - 2013, the so-called Trakatellis Report. An amendment was tabled by the Green MEPs Caroline Lucas (UK) and Hiltrud Breyer (DE) (see page 4 of the Trakatellis Report. It proposes a clear reference to CAM in recital 23 a of the EU-Health Programme. The amendment has been voted for by the ENVI Committee with a very large majority. The Trakatellis report as a whole was then adopted by the ENVI Committee, 42 votes in favour, none against and one abstention. It will now be presented as such for final voting in the second reading (including the amendment on CAM) at the plenary session of the European Parliament in Strasbourg on July 11th.

At this point we will need to mobilise a support campaign to get all MEPs to support it. Click here for a sample support letter.

Report on EPHA conference Bratislava April 2007
“Health in the Enlarged EU“

The conference was organised by the European Public Health Alliance (EPHA) and attended by 149 delegates from 20 countries (3 non-EU). The discussion topics included: EU Public Health strategy, alcoholism, chemical contamination of water supplies, tobacco, barriers to mental health services and complementary therapies ( CAM). I would say that it was a success in itself to get CAM onto this agenda. There was also a networking reception attended by the Head of Health Strategy in DGSANCO Mr Bernard Merkel. The focus of this report is on the discussion and outcomes relating to CAM. 46 of the participants attended the CAM workshop. Papers were given by CAM representatives on: Awareness of CAM in the EU; Regulation and legislation on the practice of CAM by doctors; Regulation and legislation on practice by non-doctors; the patients view; the status in the new accession States; the CAM product producers perspective. See for the papers.

Four workshop groups dealt with the following questions:

The benefits of integration of CAM and conventional medicine especially in the new accession States
The obstacles to this
How they could be overcome.
The following is a summary of the Reports to the Plenary Session from the workshops.1. The benefits of integration envisaged were:

increased promotion of health and prevention of illness
increased access to CAM
increased referral for CAM
fewer side-effects of treatment
earlier cross referral
increase in taking responsibility for health with an anticipated decrease in use of cash starved State healthcare systems
lower cost provision of health services
access to research funding for CAM
a healthier workforce
( it was noted that there only benefits were envisaged!)
2. The Obstacles noted were:

the block by conventional medical establishment
the fragmented legal rights to practice
the fragmented availability and access to information about CAM
the lack of research
the lack of interest in the new accession States
the lack of access to the political system
4. Overcoming the Obstaclesan Integrated organised local, National and European lobby

  • Research funding and publication of studies in the Lancet
  • Establishment of Europe-wide guidelines on standards of therapies
  • Unified patient organisations
  • Demonstration of the economic benefits
  • A Brussels information centre for CAM
  • A postcard campaign to DGSANCO
  • A submission to the Petitions Committee
  • All of these were presented in the Plenary session to Mr Merkel Head of DGSANCO health strategy.Conclusions. Attendance at the conference has strengthened the CAM agenda within EPHA

It has strengthened our contacts within EPHA and revealed how we can be a resource for EPHA as well
It identified potential new members for EFCAM. Stephen Gordon and I will follow this up and report further
It clearly articulated the role of CAM in EU health strategy to the Head of strategy himself. I spoke with him personally as did Stephen Gordon. Personal identification with the issues always helps so long as it is friendly.
We got a better insight into the realpolitik of lobbying for CAM in the EU.
Apparently the Health Directorate, DGSANCO, is disorganised, the Commissioner is seen as weak both within the Directorate and within the Commission, there is a lack of leadership so the Health agenda in general is suffering.

The health strategy for the next few years is not yet fixed so we could, if we push hard immediately, get some recognised role for CAM
CAM could be included as one of the Key Actions in the strategy
Action at DGSANCO only is not the best strategy. All Community policies that have or should have a health input should be targeted by us.
6. We made contacts for developing a CAM research project that might have the possibility of EU funding. I will be able to follow this up at the Munich research conference where there is a networking meeting on the Friday. We were also able to show Mr Merkel, though it is not his direct area, that there is a political agenda preventing research funds for CAM. We will be able to follow this up through EFCAM.7. Finally we had a good collaboration with the CAM doctors and I think they see more and more that we have to work together even if we do not formalise that into an organisation at this time.

Seamus Connolly, ESF