From: hound23x@gmail.com   
      
   Neglect of culture in medicine is 'single biggest barrier' to achieving better   
   health   
      
   Date:   
   October 28, 2014   
   Source:   
   The Lancet   
   Summary:   
   "Health is as much about caring as it is about curing," experts argue in a new   
   article. Culture is often blamed for clinical malpractice, such as in the case   
   of the Francis Inquiry in the UK, where serious malpractice at the Mid   
   Staffordshire NHS    
   Foundation Trust was ultimately attributed to the organisation's culture. But   
   the authors point out that if culture can be responsible for such a serious   
   lapse in standards of care, examining culture more deeply might also hold the   
   key to better practice.   
      
      
   The systematic neglect of culture is the single biggest barrier to advancing   
   the highest attainable standard of health worldwide, say the authors of a   
   major new report on culture and health, led by Professor David Napier, a   
   leading medical anthropologist    
   from University College London (UCL), UK, and published in The Lancet.   
   Related Articles   
   The arts   
   Western culture   
   Paranoia   
   Urbanization   
   Adolescence   
   Fly agaric toadstool   
   Bringing together experts from many different fields, including    
   nthropologists, social scientists, and medics, the Commission is the first   
   ever detailed appraisal of the role of culture in health. The authors argue   
   that cultures of all kinds -- not only    
   people's religious or ethnic identity, but also professional and political   
   cultures -- have been sidelined and misunderstood by both medical   
   professionals and society as a whole.   
   Until now, culture has largely been conceived of as an impediment to health,   
   rather than a central determining feature of it. However, the Commission makes   
   a powerful case to the contrary, showing that culture not only determines   
   health -- for example,    
   through its influence on behaviours such as smoking and unhealthy eating --   
   but also defines it through different cultural groups' understandings of what   
   it means to be well.   
   Culture is often blamed for clinical malpractice, such as in the case of the   
   Francis Inquiry in the UK, where serious malpractice at the Mid Staffordshire   
   NHS Foundation Trust was ultimately attributed to the organisation's culture.   
   But the authors point    
   out that if culture can be responsible for such a serious lapse in standards   
   of care, examining culture more deeply might also hold the key to better   
   practice.   
   According to Professor Napier, "Biomedical approaches to health and wellbeing   
   have contributed to important reductions in mortality and morbidity worldwide,   
   but they have yet to adjust to the strong effects of culture on health. After   
   all, had cultures    
   of trust been key components of ebola care in West Africa, the world would   
   almost certainly not now be facing a potential ebola pandemic. Few patients   
   care about disease indicators such as viral load, blood pressure, or lung   
   capacity in the abstract; it    
   is only when they are connected in a recognisable way to themselves and their   
   life goals that these measurements become significant."   
   The systematic neglect and misunderstanding of culture in medicine has led to   
   the development of medical systems where personal contact between patients and   
   caregivers is neglected, say the authors, which together with a proliferation   
   of expensive    
   medical procedures and management cultures has led to unsustainable financial   
   pressures on many countries' health systems.   
   Condemning the widespread and increasing role of profit making enterprises in   
   health (so-called "public-private partnerships" used by many public health   
   providers, including the UK's NHS), the Commission questions whether such   
   enterprises can ever be    
   compatible with a health system that truly has individual and community health   
   and wellbeing at its heart. Governments, WHO, and the large health   
   mega-charities need to reconsider their views of the effectiveness of such   
   partnerships, say the authors,    
   advocating them only when and where altruism can be safeguarded from hostile   
   profiteering.   
   "Only if health professionals, researchers, and health managers begin to   
   appreciate the central role of culture in how we perceive and understand   
   health will we begin to be able to move towards a system in which health is as   
   much about caring as it is    
   about curing," says Professor Napier. "Continuing to ignore the effects of   
   culture on health is not an option: not only will we fail to address the   
   biggest health problems faced by the world today, but the resulting waste of   
   public and private resources    
   will continue to cripple health care delivery worldwide."    
   The Commission calls for better recognition among those who care for the sick   
   of their own cultural assumptions and biases, pointing out that medical   
   professionals cannot understand the importance and pervasiveness of their   
   patients' cultures, if they do    
   not appreciate their own. Such awareness includes acknowledging and, if   
   necessary, challenging the hierarchies and structures inherent in medicine.   
   "Clinical students and staff need to spend less time reporting to superiors   
   and more time engaging with the ill and understanding their needs," says   
   Professor Napier. "While cultural competency training is offered to doctors in   
   the UK and elsewhere,    
   presenting cultural understanding as an optional 'add on' to regular training   
   could actually undermine the central role that culture plays in improving and   
   maintaining health. Rethinking the role of culture in health is absolutely   
   essential if we are to    
   advance our ability to care for one another, and this will not be achieved by   
   simply sending doctors and nurses on short-term training courses."    
   Moreover, by neglecting the role of culture in health, there is a risk that   
   positive contributions which could result from a better understanding of other   
   cultures may be lost. While some medical research projects are exploring the   
   potential of    
   traditional remedies in western biomedical models, or how traditional models   
   of caring might be translated to other circumstances, the rapid decline in   
   diversity of cultures across the world means that further contributions of   
   this sort are in danger of    
   being lost forever.   
      
   [continued in next message]   
      
   --- SoupGate-Win32 v1.05   
    * Origin: you cannot sedate... all the things you hate (1:229/2)