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

As evidenced by the history of the nhs if communities

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As evidenced by the history of the NHS, if communities of care are to re-emerge, patients need advocates—non-conflicted ones—as much as they need drugs. Patients are much more willing to burden their suffering when that suffering has shared meaning. For this reason, health cannot be separated from culture. Indeed, health-care provision can only be advanced by a reassessment of, and renewed interest in, the role of culture in health. The importance of culture for the future of health care lies not only in policy formation, but also in policy implementation. 210,211 The activities of those providing services have a large eff ect on delivery. 212 Health-care workers have much control over the allocation of rewards and sanctions; without this discretion, the health-care system would collapse under the weight of its own rigidity. This discretion, however, often benefi ts or harms particular groups or individuals, and so increases both horizontal Panel 9: Cultures of care In apartheid South Africa, what has come to be known as the Pholela experiment 206 helped establish a model for culturally sensitive primary care and the idea of cultural competency. Under the direction of its founders, Sidney and Emily Kark, the Pholela Health Center provided integrated community care to the poorest Zulu people in the eastern province of Natal (South Africa). Offering culturally sensitive clinical care and attending to food, housing, and sanitation, the centre helped generate new interest in social epidemiology and, to an extent, what is now called medical anthropology. 207 Pholela also provided a model for community health centres around the world. Although the study of alternative ways of caring can provide new models of how to meet diverse needs, such research can also alert us to new forms of clinical meaning that might have been lost on modern biomedicine. As health care and the role of health-care workers is reassessed, potential contributions of other cultures should not be underestimated.
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The Lancet Commissions www.thelancet.com Vol 384 November 1, 2014 1629 inequality (when neighbours and even family members compete for the same few services) and vertical inequality (when inequalities are created by advantages of income or social class). Overworked, underpaid, and undertrained providers can render empty universal political declarations on the future of health, as shown when so many worldwide health goals are unfulfi lled, such as WHO’s Alma Alta decree— Health for All by the Year 2000 . 213 Where are such issues being acknowledged? Developments in culturally informed biomedical app- roaches, such as the Movement for Global Mental Health and the 10/90 gap of the Global Forum of Health Research (10% of research expenditure on the poorest 90% of need), show the danger of capitalist societies and market economies imposing fi scally driven biomedical templates on the understanding and treatment of illness.
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