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

209 social security cannot be generated in the

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itself measurable. 209 Social security cannot be generated in the absence of social trust when security is defined only as the economic advantage over others. Application of business models to health cultures of care is therefore diffi cult and potentially dangerous (panel 9). However, because health businesses often do employ well-intentioned people, private enterprise can sometimes provide useful innovations that are in the public interest, as long as they can maintain a strong financial base. Conflict-free altruism does become possible for businesses, but mainly when their market shares are immune to hostile pressures for profit, as when charitable trusts own a controlling interest in a company. The diffi culty with strategies that rely on private investment for public wellbeing is that businesses more often fall vulnerable to profiteering. Indeed, they may even at times be sued by their shareholders if they do not put legitimately accrued profit-making ahead of altruism, no matter how seriously they take corporate social responsibility. Although profit can incite productivity, it cannot induce altruism unless the charitable efforts of business are protected from financially motivated decision making; competitive gain is never a gain without another’s loss, 201 otherwise gain is not competitive. The danger with making health a business is that the financial gains are potentially infinite, while the losses to wellbeing might prove irreversible. Illness needs (what patients need to get better) do not, in this sense, lend themselves to simple cost–benefit considerations, which is why courts remain so busy dealing with health neglect. If public–private partnerships are to serve communities, new ways to establish trust need to be developed that are not mediated by financial demands of shareholders or the prestige cultures subscribed to by policy makers and global health leaders. We believe that the trend towards favouring public– private partnerships in care needs to be rethought so that the responsibility for health-care needs can be reconsidered at the level of social trust. Corporate health culture (in which private companies provide health care for profit) should, then, be required to embrace systems of ownership that do not merely reward aggressive financial practices at the cost of altruism. When needs are defined as marketable provisions, businesses that serve the needy act in predatory ways, which is why the public health goals of some health-care providers can be legitimately questioned, despite support for care commissions and other overseeing bodies. Providers need to be careful about how they harness social capital as a method for further reductions in support of failing health-delivery cultures.
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