214 they also show in their dogmatic approach to

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214 They also show (in their dogmatic approach to public–private partnerships) just how culturally driven mainstream ideas are about global health needs, global health provision, and the concept of global health itself. Recognition that different societies and disciplines have vastly divergent ways of understanding and measuring health and illness should be included in medical education and care provision worldwide. 215,216 Likewise, work should not be devalued if carried out in locations that are perceived to be less rigorously controlled. 217 Researchers and policy makers often fail to prevent assimilation of practices and findings from other countries precisely because their own prejudices and practices are largely cultural in nature. 107,218–220 Ideas about suffering and healing need an examination of how knowledge is culturally negotiated in clinical practice. 64,221,222 Understanding, for example, how non-adherence to pharmaceutical therapies is less a function of un- willingness to adhere than of an absence of informed choice provides just one example of a mistaken assumption about clinical behaviour. Until a full analysis of caring communities is provided and clinical encounters are better understood, using exclusively financial models to scale up service delivery will continue to fail at providing genuine care. 223 Migration and communities of care Although migration can substantially improve quality of life, when instability forces a transition from one culture to another, destabilisation produces both opportunities and vulnerabilities. On the one hand, health outcomes of migrants explain the urge to migrate. Bangladeshi women, for instance, can increase their life expectancy by a decade or more by migrating to Europe. 224 Cypriot migrants can expect to live as long and as healthily as those who stay in times of peace provided they migrate into families and stable communities. Otherwise, their health outcomes are worse. 225 These conditions are mediated, moreover, by so- called hyperdiverse worldwide environ ments in which communities are continually reshaped. 226 On the other hand, vulnerability increases exponentially when family networks and the heritage that they embody cannot also migrate. This effect needs to be accounted for, particularly in hyperdiverse environments where new alliances need to be made rapidly, and where individual opportunities emerge at the cost of secure, extended sociocultural networks. Recruitment of allies in unstable moments is crucial to survival for migrators, especially when the behaviours, rituals, and artifacts of culture disappear. This fact is made clear by the high rates of mortality and morbidity attached to those who migrate into new environments lacking family and ethnic ties. Heritage is more than a polite celebration of a sense of belonging. As a stabilising device, it provides public self-definition and acknowledgment.
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  • Summer '18
  • Jeanne Hughes
  • Lancet

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