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

Called culture an empty vesselie a concept defi ned

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called culture an empty vessel—ie, a concept defi ned at its peripheries. 7 The vessel’s walls are tangible—they separate inside and out, and give shape to contents that might be less easily defi ned. Most importantly, culture is a dynamic concept— sometimes overtly expressed, sometimes not openly defined. For example, citizens might rally around national identity in times of conflict, but happily return flags to their cupboards in times of peace. Likewise, they might fundamentally believe in human equality, but participate actively in prestige hierarchies in their places of work. Because it is often taken for granted, culture as a category of inquiry is crucial to the experience of health and wellbeing, and the provision of health care. Culture, then, can be thought of as a set of practices and behaviours defined by customs, habits, language, and geography that groups of individuals share. As the UN Educational, Scientific, and Cultural Organization (UNESCO) affi rms 8 in its adoption of anthropologist Edward Burnett Tylor’s 1870 definition of culture, 9 we need to find ways to develop a complex understanding of how customs, moral values, and belief systems manifest themselves in particular settings over time. Here, part- icularly, a medical humanities approach could be used to reshape medicine and health care. Prestige hierarchies are hierarchies created by real or perceived differences in status and authority, and acted out in a defined environment, such as a clinic or hospital
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The Lancet Commissions 1610 Vol 384 November 1, 2014 However, the diffi culty of acknowledging the impor- tance of culture does not alone enable us to recognise our own cultural assumptions. Indeed, the hardest thing to know in a relative and comparative sense might be one’s own culture: what anthropologists call the anthropological paradox. On the one hand, we believe that it takes one to know one; whereas, on the other, we acknowledge that the hardest thing to know is one’s own culture—ie, to critique objectively the subjective nature of our own practices. 10,11 This diffi culty accounts for why culture remains, for many, a vague concept. By definition, being immersed within a culture can be hard to recognise. This dimension of culture is seen in the initial NHS example, and is crucial to our major claim: the systematic neglect of culture in health and health care is the single biggest barrier to the advancement of the highest standard of health worldwide. Although we accept, along with the Francis Commission, 12 the accountability of culture for clinical malpractice, we also suggest that examination of culture holds the key to good practice. Not only are the things we find most diffi cult to examine the things we take for granted.When a society’s own objectivity is compromised by local practices and covert understandings, we begin to understand why culture matters in ways that affect us all.
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