the-lancet---culture-and-health.pdf

Succeed they might be thought of as doing so at the

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succeed, they might be thought of as doing so at the expense of those they purport to represent, participating as much in a society’s inequalities of achievement as changing them. Sick societies In the Problems of the World , 132 the UN summed up the worldwide price of modernity. Asked to provide single words that corresponded to the diffi culties characteristic of various societal domains, respondents painted a sorry picture. For “culture”, the response was “rootless”; for “politics”, “powerless”; for “economics”, both “jobless” and “ruthless”; and for the “environment”, “futureless”. Panel 4: Masking biomedicine The fact that between 85% and 90% of citizens self-medicate even in countries claiming widespread primary care provision 130 means that what appears to constitute a system of organised biomedical care could well mask both an absence of regulation and a workforce of caregivers who remain almost wholly untrained. For example, findings from a study 131 in rural Madhya Pradesh, India, show that 67% of health-care providers have no medical qualification whatsoever and, perhaps worse, adherence to checklists and related best practices differs little between trained and untrained doctors. The nature and scope of the issue suggest that merely arguing for more medical providers is inappropriate. Although 70% of rural primary care visits are carried out by providers that have no formal training (15-times as many providers have no qualifications as those who do), training is not even correlated with higher-quality care. Findings from the study, in fact, showed no meaningful variation between the ability of trained and untrained health-care workers to provide an accurate diagnosis or correct treatment. The assumption that quality of care in rural India is, therefore, higher for trained doctors should be openly questioned so that, at the very least, the culture of primary care in India focuses more on the training and practice of caring than on the availability of expensive drugs and equipment. 131 Findings from this study call for a much broader debate 125 and beg a fundamental moral question: should systems of care be promoted that cannot be implemented or sustained? Furthermore, is self-reporting on the presence or absence of primary care an adequate means of assessing levels of care provision? Is it morally acceptable to expect countries with limited health infrastructure to adopt systems that are not only unworkable, but that also hide the depths of destitution into which so much of the world has fallen? Should WHO reassess standards of health so as to take account of the worldwide absence of clinical competency? How can we work openly to achieve the eight Millennium Development Goals if some of the data for care provision used to assess benchmarks do not take into account an assessment of levels of competency?
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The Lancet Commissions 1620 Vol 384 November 1, 2014 When asked what one word summed up the condition of
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