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

Health promotion or a curiosity about the great

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health promotion, or a curiosity about the great unknown that other viewpoints represent? 109 Cultural awareness and competence should not be a secondary concern for health-care trainees, but an essential element of training and research into training—something fully and centrally supported as an educational and research priority. Medical training institutions need to change if they are to promote clinical competence. Not only should administrators and training staff become more aware of their own cultural practices, but they should take culture more seriously than whatever subspecialties are presently drawing the most attention of those in training. Moreover, they should show clear evidence that such initiatives are substantive and genuinely supported by training staff. Training institutions should stand up for the rights of future caregivers to learn and implement new ways to provide care through training that is extended and exploratory. If professional schools object on the grounds that students already have far too much basic science knowledge to absorb, then new care-mediating professions should emerge on an equal footing in terms of academic status and financial remuneration.
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The Lancet Commissions 1618 www.thelancet.com Vol 384 November 1, 2014 Culture, inequality, and health-care delivery Dynamic inequalities Societies and groups (cultural, political, or professional) are built on consensus and conventional, often taken for granted, practices. These groups can become vulnerable in periods of great change and when exposed to external and internal stressors. Especially in unstable times, groups tend to focus on social and cultural diff erences rather than similarities. 110–112 Although the views of individuals within societies, and the practices of those individuals that are based on diverse views, can vary widely, generalisations about perceptions of wellbeing can be measured collectively and become salient within broad populations as a result of cultural values. Broad cultural attitudes can vary over time and place, just as social determinants of health can vary from culture to culture. The ancient practice of understanding oneself by differencing ourselves from others is, in part, what makes people social and enables local alliances to emerge. 113 When societies are stable or moving towards stability, they are naturally less concerned about what they perceive to be outside influences. 114–116 However, assimilation of those perceived to be outsiders (however one might define them) becomes diffi cult in moments of political instability, social insecurity, and crisis. 117–122 Americans who once invited in the tired and poor might attempt to ring-fence themselves after 9/11, and in the UK, Prime Minister David Cameron might even proclaim that “multiculturalism has failed”, asking in turn that physicians become gatekeepers for the identification of irregular migrants 1 .
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