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

Although whos new health 2020 agenda 240 has

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Although WHO’s new Health 2020 agenda 240 has identified wellbeing as one of its six domains to monitor, its acknowledgment of the complexity of doing so demands that it rethinks the role of the medical humanities in improving our understanding of the drivers of human wellbeing. 241 Health is not just the absence of illness or disease. Health should be promoted more broadly, encompassing positive wellbeing, its origins in cultural value systems, and its maintenance through social processes that affect biological wellness. As WHO claimed more than 60 years ago, “health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity”. 242 Narrow definitions of health based solely on biomedical status do not address adherence and limitations to adherence. To prevent disease, behaviour change is needed from those who can change, and those who lack social capability should not be left unassisted. To meet these needs, care structures should be reframed at the level of local cultural values. Such reframing will not only need broad policies that recognise the importance of culture to resolve the huge waste created by non-adherence, but also the creation of models of care that take seriously the importance of community health mediators, however they might be defined. Culture should be better defined Culture is not merely defi ned by national, ethnic, or racial affi liation. Culture consists of conventional understandings manifest in actions, institutions, and things. Culture is key to the practices and behaviours of organisational structures and professions, including the health professions; the health priorities of individuals, groups, and systems of health delivery; and the practices of professionals that bring together or alienate givers and receivers of care. In this context, culture also includes the collective practices of the ill and disabled, and the advocacy groups they participate in and that represent them. Systems of health-care delivery and the practices that they promote should be studied as cultures, with the goal of reassessing what matters in health and perceived wellbeing. Studies of culture in medicine should not be overlooked in favour of a sole focus on the ethnic group of patients and how local practices affect adherence. Short-term management priorities should be aug- mented by long-term investments in wellbeing promotion, and worldwide organisations established to promote health should embrace culture less as a mistaken influence on biological health than as a key determinant of health and wellbeing. WHO’s Health 2020 agenda and so-called health-in-all-policies approaches are important steps in this direction. How- ever, organisations that drive these initiatives should address their own biomedical biases and limitations. To say that culture matters while continuing to favour wholly biomedical research and policy does little to alter the longstanding and deep neglect of the cultural determinants of health and their importance to health outcomes and equity.
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  • Summer '18
  • Jeanne Hughes
  • Lancet

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