190 self monitoring is necessary for health

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190 Self-monitoring is necessary for health maintenance, but chronic stigma can lead to a sense that one is never actually well. Rethinking cultures of care Culture and knowledge Health outcomes can be improved and money saved if caregivers are allowed time to engage with patients and help patients integrate into care communities. Why have more resources not been invested worldwide to support development of integrated communities of care that bridge the gap between biomedical settings and the diverse needs of multicultural groups? One reason is that increased medicalisation of clinical care throughout the 20th century has limited the role of empathy in health care. An implicit assumption within biomedicine, there fore, needs challenging—namely, that doctors have knowledge, and patients have beliefs. Patients are, of course, implicitly and sometimes explicitly held responsible for corrupting medical knowledge (as when they are blamed for not following instructions). When societies reframe, translate, or merely do not or cannot participate in medical science, patients may also be unduly blamed. Those vulnerable to being blamed make up most of the world’s citizenry for whom biomedical care is either unaff ordable or unavailable—people who depend on human care for health, instead of on health care per se. At stake are not only biomedical needs, but also the status of rational knowledge systems compared with beliefs held by patients. 191,192 This potential for blame itself constitutes a true source of symbolic violence. Yet, social scientists have established a framework and body of knowledge through which biomedical claims are also shown to be shaped by a range of political, economic, and cultural forces. 46,126,193,194 Evidence-based medicine and practice are not wholly neutral, objective bodies of knowledge. They are products of specific contexts, and anchored within specific historical frameworks, just as
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The Lancet Commissions Vol 384 November 1, 2014 1627 beliefs and practices are embedded within traditional worldviews. 77,85,195 Vested interests—including those of the pharmaceutical industry and scientifi c laboratories, and the biomedical status and cultural identities of researchers and their institutions—establish research questions, study design, sampling techniques, research instruments, data analyses, and interpretation. 196,197 Above all, they not only shape illness categories, 198,199 but also constitute cultural systems of value in themselves. They have their own ethics, confl icts of interests, dynamics of power, and methods of knowledge production that can diff er substantially from those of other cultures, sets of values, and the community needs that they should serve. How community health gets regenerated in a world of widespread fi scal and ideological retrenchment presents, therefore, one of the biggest hurdles to contemporary health care. The constant reminder of what cannot be aff orded is perhaps the greatest obstacle to thinking about what is possible.
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  • Summer '18
  • Jeanne Hughes
  • Lancet

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