And the import ance of understanding the practices

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and the import ance of understanding the practices and limitations of the professional culture of health-care delivery in which caregivers participate. Caregivers cannot know the importance and pervasiveness of their patients’ cultures if they do not recognise their own cultural assumptions and biases. If medical students cannot learn to care, then new professions in cultural mediation and local community health advocacy should be developed and prioritised. Competence should be reconsidered across all cultures and systems of care Culture is crucial to the sustainability of local health- care systems, and the strengths and weaknesses of care practices. Competence in health-care delivery can be improved through studying the wellbeing practices of other cultures. Some stable and progressive health systems (eg, New Zealand) have introduced guidelines and stringent cultural competence requirements for health-care professionals. 243 The eff ects of such guidelines should be studied. The destabilising consequences of health-care brain drains and worldwide shifts in professional opportunities should also be monitored to establish the eff ects of health migration on local cultures and their systems and care. Competence awareness, therefore, means not only the introduction of more exploratory thinking into care training to increase awareness of the importance of culture in caring, but also an understanding of how worldwide priorities and health migrations can undermine value-based local caring by eroding fragile resources. Exported and imported practices and services should be aligned with local cultural meaning Culture is the most important factor in the promotion of global health. Policy makers in high-income countries should be aware of the effects of exporting treatment, pharmacological remedies, and untenable delivery models to poorer countries. Capacity building in public health should augment heroic relief strategies. Where relief is urgently needed, the strategies of capacity building should be mediated both by honest assessments of indigenous capacities to respond to global health interventions and by an open acknowledgment of waste by elitist cultures in high-income countries that export practices that are neither locally relevant nor sustainable. Worldwide salvation dramas should be replaced by honest analyses of local capacities to respond to international recommendations and interventions. Export of untenable ideologies has harmed people in need and increasingly damaged the willingness of fair- minded people worldwide to participate with the best of intentions in health interventions that they now see as heavy handed and arbitrary. Such a change of perspective will require that WHO review its skills, as recommended in a Chatham House Report.
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  • Summer '18
  • Jeanne Hughes
  • Lancet

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