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

It is important then to understand how wellbeing is

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It is important, then, to understand how wellbeing is socioculturally generated and understood, and how cultural systems of value relate or not to notions of health and to systems of care delivery. Because wellbeing is increasingly recognised as both biological and social, health-care providers can only improve outcomes if they accept the need to understand the sociocultural conditions that enable people to be healthy and make themselves healthier—ie, to feel well. To achieve such an understanding means asking what is lost to health care by ignoring the cultural systems of value of not only patients, but also caregivers, health administrators, charities, and researchers. Thus, in this Commission, we assess how a closer attention to local and worldwide meanings can improve health in a world of burgeoning health-related costs and diminishing resources. We critically examine what is known about how caring for one another succeeds or fails across cultural divides, how cultures of care function or collapse in response to changing values, how health cultures alternately ameliorate or exaggerate inequality and inequity, and how health itself is affected by the presence or absence of general wellbeing in any given sociocultural group. In this Commission, we assess the nature of cultural competence (how people communicate across cultural divides), the adverse eff ects of health inequality (how culture can unequally limit opportunities to become healthier), the structure and function of communities of care (how collective activities around health either succeed or fail), and the social conditions that under- mine or improve human wellbeing (how personal health relates to the presence or absence of social trust). This Commission is less an inventory of culture-specifi c defi nitions of illness and healing (ie, of traditional medical anthropology) than an assessment of why cultural awareness matters in health.
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The Lancet Commissions 1612 www.thelancet.com Vol 384 November 1, 2014 Cultural competence Background Although an interest in other societies has taken many forms throughout history, examination of how different cultural concepts affect health-related behaviours began only at the start of the 20th century, with the advent of long-term anthropological fieldwork that exposed the diversity, complexity, and continuity of local health-related practices across cultures. 29 One of the earliest clinicians to take up the comparative method for examining the influence of culture on health was William Rivers, the pioneer doctor and social anthropologist who is equally remembered for his work as an experimental psychologist. Rivers both founded the British Journal of Psychology in 1904 and became the first person to use double-blind trials in scientific experiments. Ironically, this development of double-blind trials eventually led to the use of placebos to eliminate social meaning from clinical trials, thereby making possible a wholly biomedical field of inquiry. The complete elimination of
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