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

Social affect it could be argued is what created

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social affect, it could be argued, is what created modern biomedicine as we know it. However, for Rivers, culture mattered greatly. He was unequivocal about why culture is important to medicine, stating that health and beliefs are: “so closely inter-related that the disentanglement of each from the rest is diffi cult or impossible; while there are yet other peoples among whom the social processes to which we give the name medicine can hardly be said to exist, so closely is man’s attitude towards disease identical with that which he adopts towards other classes of natural phenomena.” 30 Although Rivers might be credited with laying the foundation for the ethnographic study of culture and health, medical anthropology as a taught discipline is much more recent, dating mainly to the advent of consciously multicultural societies, the decline of overt colonialism, and failures resulting from the unilateral export of untenable models of development across the world. Likewise, the idea of medical humanities can be traced to the 1940s and the work of pioneering medical historians such as Henry Siegerist. Although a thorough understanding of medical humanities can enrich one’s awareness of how health is defined across cultures and over time, medical anthropology in particular shows how systems of medical knowledge are a result of both the natural environments within which cultures develop (eg, the use of particular medicinal herbs) and local under- standings of people, the cosmos, and what constitutes acceptable (ethically and morally) forms of behaviour. 31,32 Although medical anthropologists do still focus on exotic beliefs and practices, now they just as often ask how sets of beliefs (both familiar and unfamiliar) affect their illness behaviours in their own societies. We cannot consider in this Commission the complex explanation of such processes, but the reader should bear in mind how a basic idea—eg, the notion of divine judgment—can have an important effect on how an individual might deal with, for example, chronic disability. 33–36 Similarly, ways of thinking that at first seem foreign and exotic might seem less so once one understands how complex beliefs and practices overlap to produce coherent and consistent forms of meaning. 37 In many societies—especially those in which malnutrition is ubiquitous—obesity is often mistaken for health, 38 whereas in other cultures (Brazil, for instance) the right to be beautiful (as it is culturally defined) might extend to plastic surgery for poor people. 39 Beliefs about the body that might baffl e physicians— for example, the idea that diseases are the consequences of ancestral actions—might parallel new and emerging ideas in science about epigenetics, symbiosis, disease vectors, or evolutionary principles.
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