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

The modern world the sentiment could not be more

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the modern world, the sentiment could not be more troubling: “meaningless”. Classical social theory offers a term to describe this sense of futility. That term is anomie—an absence or decrease of ethical standards, a kind of “psychological as well as physiological weariness, disillusionment, disappointment, psychic pain, and a tendency to grope at random, which in turn brings on still other crises, until life itself seems ‘intolerable’”. 133 It is a state not only common amongst many groups and societies worldwide, but also pervasive in mid-career health-care providers. 134,135 Social scientists recognised long ago the dangers of combining social disillusionment with social expressions of ego and self-interest, a danger that can escalate when social conditions seem threatened by what is thought to be the all-consuming needs of minorities and immigrants. At such moments, a group—a community, a culture, or a society—cannot feel confident about its own resilience because it finds itself caught between its own anxiousness and the need to overstate its exclusive identity. At such a time a group is in danger of becoming actively exclusive. Although we should abhor inequality, the problem of exclusivity might have less to do with levelling inequalities than with recognising inequality in the first place; for equality is always relative. People will often perceive grades of inequality more intensely when they feel insecure. However, since security and insecurity are defined and changed by cultural systems of value, a concern about culture should supersede a concern about social inequality. When societies become wholly undone, people with high social status—eg, academics, doctors, or health activists—can find themselves held in suspicion precisely because they are perceived as having unequal advantage. Here, calls for equality by the advantaged becomes culturally intolerable. Doctors were horrifically persecuted by Pol Pot’s regime in Cambodia during 1975–79, 136 as are Red Cross volunteers in war-torn regions. In many poor countries, caregivers are perceived locally as having unfair prestige and advantage, possessing access to what others desperately need. In a so-called sick society, people can fail to trust the very caregivers whose efforts they fundamentally rely on. Advocates of equal opportunities applaud the focus on and attention to the social determinants of health and the incapacitating of individuals to affect their own futures that results from poverty. How can we expect poor people to be motivated when they lack social capability and opportunity? With respect to inequality, culture is often perceived negatively—ie, as an excuse to not acknowledge straightforward oppression. “Aren’t traditional cultures so happy to live with so little?”, the tourist sometimes asks. Indeed, even UNESCO guidelines ask for restricted development in world heritage sites.
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