244 those who influence global health and wellbeing

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244 Those who influence global health and wellbeing should temper their idealism with options that are real and feasible. They should, moreover, be prepared to invest in vulnerability assessments and informed allocation of scarce resources, with local expression of worldwide standards of basic wellbeing as their main focus. Although an evidence base synthesises and prioritises what is already known, these evidence bases should be augmented by a value base that encourages examination of other and new ways of thinking. Building trust in health care should be prioritised as a cultural value New worldwide economic alliances and cultures of offshore health-care provision can weaken the capacities of nations to chart their own health-care destinies. When weakened nations and political institutions become incapacitated, they not only become dysfunctional, but also disillusion citizens from participating in health-improving initiatives. As personal mobility becomes increasingly released from local meaning, disjunction between what people value morally in their daily lives and perceive to be the values of society at large can diverge sharply. This disjunction in values places people at odds with their daily practices and encourages selfishness and personal gain rather than care for others. WHO and the large health charities should rethink their views of public–private partnerships, advocating such partnerships only when and where altruism can be safeguarded from hostile profiteering. Long-term damage resulting from what seem to be short-term gains should be examined carefully and their effects on trust accounted for. Policy makers should step
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The Lancet Commissions Vol 384 November 1, 2014 1633 back from short-term cost-controlled objectives and ask how trust emerges over time. Instead of governments presenting a publicly structured system of welfare behind which lie for-profit private providers about whom patients know nothing and in which they express no trust, new models of care should be sought, carefully assessed, and either modified or replicated. New models of wellbeing and care should be identified and nourished across cultures In this Commission, we present a new opportunity to remodel medical practices by stressing the importance of culture and its effect on wellbeing. Medical practice needs to account for how cultural values and related heritage can be better understood and nourished in the interests of health. Engagement with the idea of culture can enable a change in health-care planning and delivery, from a focus on medical technocracy to humanity; from biomedical cures to the uses and misuses of such potential cures; and from often unrealistic magic bullet research to improved wellbeing. To live up to a health-in-all-policies approach will not mean merely to claim the relevance of wellbeing in WHO’s Health for All ideology in its yearly health reporting, 245 but to augment its focus on economic inequality (eg, as defined by the 2011 Rio Political Declaration on the Social Determinants of Health ) 246
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  • Summer '18
  • Jeanne Hughes
  • Lancet

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