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

We believe the time has come to revise common views

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We believe the time has come to revise common views of culture as overtly shared and largely unscientific ideas and practices. Culture can as much concern what we take for granted and do not critique—what we assume is universal—as what we understand at the level of social diversity. We therefore recommend the following definition of culture: The shared, overt and covert understandings that constitute conventions and practices, and the ideas, symbols, and concrete artifacts that sustain conventions and practices, and make them meaningful. Why culture matters In 1952, the French anthropologist Claude Lévi-Strauss led a study 13 commissioned by UNESCO to address the issue of racism and the threat that it posed to world peace and stability. In the period after World War 2, when colonial values were still common, the project provided a direct attack on ethnocentrism and its assumptions about the superiority of one society over another. Lévi-Strauss “warns against genetic determinism, reveals the fallacies of ethnocentrism and facile cultural evolutionism, defends the rights of small societies to cultural survival, and revels in the intricacies of the symbolic systems of societies to most of his readers”. 13,14 Embedding these concerns into a key UNESCO document by a leading anthropologist assured that the idea of culture would inform contemporary views of multiculturalism, cultural competence, and the value of social diversity. UNESCO’s perspective on cultural rights became the foundation of how health rights are now defined multiculturally. But to defend local cultures, and especially to appreciate how culture affects local ideas about health and related health outcomes, is not always easy. Since Lévi-Strauss’ report, UNESCO has struggled to mediate between the need for universal human equality and the right to harbour diverse worldviews, and it has been criticised for its perceived ambivalence. Indeed, its policies (embodied in its 1995 report) 15 reignited the right-to-culture debate by promoting “a relativistic view of development and a universalist view of ethics”. 14–16 In short, the diffi culty with respecting local differences while promoting health universalism is that under such conditions, culture can be used “to legitimise not just exclusiveness, but exc- lusion as well”. 14 Apartheid, for instance, is an intolerable form of multiculturalism—separate but unjust, rather than separate and just. 17 Although Lévi-Strauss’ document 13 provided a basis for decision making about culture, no-one knew at that time how globalisation would affect the dissolution of cultural diversity. The 1950s was the era of salvage anthropology, in which anthropologists were charged to record dying cultures and their local social practices. At that time, people needed to recognise the benefits of indigenous knowledge—of how surgical practices, for instance, might be advanced through understanding the Amazonian use of curare to paralyse muscle tissue.
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  • Summer '18
  • Jeanne Hughes
  • Lancet

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