Over the past few years, intercultural health has become an emerging issue in health policy. Intercultural health is an approach in health that aims at reducing the gap between indigenous and western health systems, on the basis of mutual respect and equal recognition of these knowledge systems. This article questions the applicability of such a concept in the context of Chile. Here, conflicting interests between the Mapuche and the Chilean state are related to (...) aspects of economic development, modernity processes, integration, intercultural relations, and indigenous rights and are deeply reflected also in projects for an intercultural health system. By analysing the experience of the intercultural practice of Makewe Hospital, this article argues that effective and equitable intercultural health practices will not take place unless there will be an integral valorisation of the Mapuche culture from a broader perspective. (shrink)

Este artículo tiene como objetivo sistematizar los avances del enfoque narrativo en bioética con el fin de proponer una fundamentación de las prácticas de salud intercultural que facilite su complementariedad con el conjunto del sistema sanitario. Para ello revisará críticamente los fundamentos de la bioética narrativa y su vinculación con las corrientes hermenéuticas en las éticas aplicadas y con el movimiento de la medicina narrativa. A la vez relacionará el enfoque narrativo con el paradigma intercultural en salud, en (...) orden a evaluar sus capacidades de complementación y articulación con la sabiduría ancestral mapuche, desde su raigambre y especificidad. Finalmente informará sobre las posibilidades de desarrollo de una bioética narrativa en clave intercultural, adecuada a las prácticas en el ámbito sanitario que se basan en el acervo de la sabiduría ancestral mapuche. This article aims to systematize the progress of the narrative approach in bioethics in order to propose a groundwork for intercultural health practices. Seeks propose a basis for intercultural health practices that facilitate the complementarity of the health system through the recovery of ancestral Mapuche Worldview, their roots and specificity. It will critically review the basics of narrative bioethics and its relationship with the hermeneutical currents in applied ethics and the movement of Narrative Medicine. At the same time relates the narrative approach to the intercultural paradigm in health, in order to assess its capabilities complementation and articulation. And finally it will report on the possibilities of developing an intercultural key Narrative Bioethics appropriate to the intercultural practices in health care based on the acquis of the Mapuche Ancestral Wisdom. (shrink)

Concerns about intercultural communication practices in child and family health were raised during a South Australian ethnographic study. The family partnership model was observed as a universal pedagogic tool introduced into the host organisation in 2003. It has a role in shaping and reshaping cultural production within child health practice. In this study, we draw on insights from postcolonial feminist scholarship together with three‐body analysis to critique the theoretical canons of care that inform intercultural communication (...) in the child and family health setting.We contend that although the family partnership model may be very useful, its intended universal application is problematic in the context of multiculture. Issues of race, gender and class were seemingly unattended when using a communication approach based in historical scientific rationalism. Liberal interpretations of discourses of equity and empathy arising out of contemporary models of communication were often adopted by child and family health nurses and protected them from seeing the inherent binaries that constrain practice. Insights from postcolonial feminist thinking enabled us to recognise the problems of applying theory to practice in a linear fashion. We demonstrate the use of three‐body analysis as a deconstruction strategy to refigure how theory might be understood and worked with in the multiculture that is Australia. (shrink)

This study presents a first assessment of the challenges faced by Dutch health care providers dealing with the increasing cultural diversity in Dutch society. Qualitative interviews with 24 Dutch caregivers and policy-makers point to a number of important difficulties encountered when confronted with the growing diversity of patient populations. The study focuses explicitly on the challenges health care providers perceive in their direct interactions with patients. On the basis of the observations of the 24 respondents five strategies were (...) formulated to improve the delivery of care in a multicultural environment. Their findings were further evaluated by confronting the empirical data with care-ethical notions (attentiveness, responsibility, competence, and responsiveness) and intercultural communication-theory. (shrink)

Existing ethical guidelines that aim to guide the development of mental health apps tend to overemphasize the role of Western conceptual frameworks. While such frameworks have proved to be a useful first step in introducing ethics to a previously unregulated industry, the rapid global uptake of mental health apps requires thinking more deeply about the diverse populations these apps seek to serve. One way to do this is to introduce more intercultural ethical perspectives into app design and (...) the guidelines that aim to encourage best practices. In addition to this, existing ethical guidelines can also benefit from the ethical scholarship from the feminist and disability traditions, both of which highlight specific ethical considerations for vulnerable users. Rethinking the ethical responsibilities of mental health app designers through the prisms of feminism, disability studies, and intercultural philosophy leads us to a more global and inclusive set of ethical considerations in app design. This white paper explores what existing guidelines for the regulation of mental health apps are missing. It also explores how these guidelines could be improved for users who inhabit an increasingly diverse and globalized world. (shrink)

This study presents a first assessment of the challenges faced by Dutch health care providers dealing with the increasing cultural diversity in Dutch society. Qualitative interviews with 24 Dutch caregivers and policy-makers point to a number of important difficulties encountered when confronted with the growing diversity of patient populations. The study focuses explicitly on the challenges health care providers perceive in their direct interactions with patients. On the basis of the observations of the 24 respondents five strategies were (...) formulated to improve the delivery of care in a multicultural environment. Their findings were further evaluated by confronting the empirical data with care-ethical notions (attentiveness, responsibility, competence, and responsiveness) and intercultural communication-theory. (shrink)

– This paper aims to examine the present status of the research field intercultural information ethics including the foundational debate as well as specific issues., – A critical overview of the recent literature of the field is given., – The present IIE debate focuses on a narrow view of the field leaving aside comparative studies with non‐digital media as well as with other epochs and cultures. There is an emphasis on the question of privacy but other issues such as (...) online communities, governmentality, gender issues, mobile phones, health care and the digital divide are on the agenda., – The paper addresses basic issues of IIE that may open new vistas for research and practice in this field. (shrink)

English translation by Glenn H. Shepard Jr. Revision by Matthew MeyerThis article reports on the recent “International Congress of Traditional Medicine, Interculturality, and Mental Health” held by the Takiwasi Center in Tarapoto in the Peruvian Amazon. The event united 218 researchers and indigenous and religious representatives from 22 countries to present results of scientific discussions and engage in political and ethical debates surrounding the increasingly globalized, transnational, and biomedicalized reach of indigenous medical practices, especially ayahuasca-based therapy and religious (...) practice. The author interviewed several key researchers and representatives present at the event, and presents several important controversies in the field of ayahuasca and traditional medicine. She also reports on the colorful and eclectic nonacademic sessions at the event which included Inca chiropractics, ayahuasca sessions, and various forms of indigenous medicine. The text also reflects on the tragic events that unfolded in nearby Bagua, Peru, on the evening of the meeting, bringing a special urgency to the event's focus on indigenous cultural heritage. (shrink)

Over the last two decades or so, the need to decolonise bioethics and make it inclusive, equitable and accommodative of voices from the traditionally marginalised global South has received increasing attention in academic scholarship. The recent publication by Pratt and de Vries offers a very comprehensive critical analysis and thoughtful overview of the issue, using global health ethics as its starting point.1 I fundamentally agree with their characterisation of the issue as an ‘epistemic justice’ problem. I further find their (...) recommended conceptual and practical ideas for measuring epistemic injustice and ethical responsibilities to promote epistemic justice very thoughtful and insightful. However, I find their responses to possible objections to their arguments a bit hasty and unclear, especially the idea that ‘greater epistemic justice calls for global health ethics to advance a transcultural framework of ethical values and principles’ (p. 7). They look ambiguous on their position on the fundamental global bioethical question regarding the possibility of an intercultural ethical framework. I think the question of whether there are global ethical values and principles that are commonly shared among human beings in the global world is a fair and legitimate issue that deserves deep attention and a persuasive answer by those who call for more inclusive and equitable global bioethics. I attempt to flesh out this issue in a bit more detail to further enrich the discussion. Pratt …. (shrink)

Based on an empirical study regarding ethical challenges within intercultural health care, the focus of this article is upon autonomy and disclosure, discussed in light of philosophy and anthropology. What are the consequences for patients if the patients’ right to be autonomous and to participate in treatment and care decisions by health care workers is interpreted as an obligation to participate? To force a person to make independent choices who is socio-culturally unprepared to do so, may violate (...) his/her integrity. This may in turn jeopardise the respect, integrity and human worth the principle of autonomy was meant to ensure, and if so, may damage any relationship of trust that may exist between patient and health care worker. There is necessarily a link between autonomy and disclosure. Western disclosure practices may make the relationship between patients and health care workers difficult -- even distrustful. To confront a patient with a very serious diagnosis may be seen not only as a tactless action, but also an unforgivable one. Hence, among many ethnic groups it is a family member’s duty to shield patients from bad or disquieting news, e.g., a cancer diagnosis. If a family member is used to interpret in such situations, will the information given equal the information communicated by that interpreter? Even though respect for a person’s autonomy is part of the respect for a person, one’s respect for the person in question should not depend on his/her ability or aptitude to act autonomously. (shrink)

The metaphor of host and guest has value for exploring the practice and role identity of nurses on inpatient mental health units. Two complementary texts, one from the ancient Zen record of Lin‐chi, and the other from the contemporary hermeneutic philosopher Richard Kearney, are used to elaborate meanings of host and guest that can be applied to the situation of mental health nurses. In a doctoral study with a hermeneutic design, I addressed the topic of nurse–patient relationship using (...) an interpretive framework that included sources from Buddhist thought. The positions of host and guest emerged from interviews with nurses as one interpretive theme to open up new understanding of the topic. The two texts, originally distant in era and culture, both employ the host and guest metaphor. They are applied to extracts from interviews to open up discussions of hierarchy, status, patients' perspectives, otherness and resistances as features of nurses' complex experience. These provide insights into understanding practice and suggest implications for how institutional environments shape practice. An intercultural reading of texts can provide a source of new understanding of nurse–patient relationships. (shrink)

The exportation of Western biomedicine throughout the world has not resulted in a systematic homogenization of scientific ideology but rather in the proliferation of many forms and practices of biomedicine. Similarly, in the last decade, bioethics has become increasingly an international enterprise. Although there may be consensus regarding the inherent value of ethical discourse as it relates to health and medical care, there are disagreements about the nature and parameters of medical morality. This lack of consensus exists because (...) our beliefs about morality are culturally constituted, embedded in social, religious, and political ideologies that influence particular individuals and communities at specific historical moments. (shrink)

Workplace politeness concerns the structural, interactional and individual level. Using the example of mobbing, it is illustrated how small acts of impoliteness can lead to the destruction a person psychologically and physically. Particularly, so-called downward mobbing is an increasing problem worldwide; most of the cases are orchestrated by superiors, the people subordinates depend on the most. Data clearly illustrate the social toxin created by up to 45 seemingly small actions in five areas of work life. These actions result in (...) class='Hi'>health hazards and ultimately loss of jobs. By example of workplace harassment, it is illustrated how systematic acts of impoliteness are used to manipulate a person's emotion and identity, to ensure anxiety-born solidarity in others while abusing power, with high costs for the target, the organisation, and society. The discussion gives way to considerations about intercultural cooperation at the workplace, showing similarities between subtle devaluations in intercultural communication called microaggression and what has been discussed as mobbing. Overall, impoliteness is deconstructed as a sign of degrading social bonds, security and health, thereby raising awareness of the importance of intercultural interaction without microaggression. The practical value of linguistic impoliteness research and its connection to work psychology becomes apparent. (shrink)

Many people in the developing world access essential health services either partially or primarily through programs run by international non-governmental organizations (INGOs). Given that such programs are typically designed and run by Westerners, and funded by Western countries and their citizens, it is not surprising that such programs are regarded by many as vehicles for Western cultural imperialism. In this chapter, I consider this phenomenon as it emerges in the context of development and humanitarian aid programs, particularly those delivering (...) medical treatment, nutrition and access to clean water. I argue that in order to avoid contributing to cultural imperialism, INGOs have a duty to ensure that they do not offer services in a way that requires their beneficiaries to choose between accessing essential health services and violating or otherwise undermining traditional norms and practices which have significance for their beneficiaries. Following Onora O'Neill, I argue that offers requiring such a choice are effectively “unrefuseable” and so coercive. INGOs therefore, must avoid making such offers, and can accomplish this by means of an iterated process of reciprocal negotiation under conditions of equality, in which both the INGOs’ and the beneficiaries’ deep values and concerns play a role. In essence, I claim that employing such a process is a requirement of procedural justice, given the non-ideal conditions in which INGOs must operate. (shrink)

Abstract:Representations of the space of the village, the wilderness, and the overlapping edge of the forest between them often play a critical role in intercultural collisions between the “developing” world's spaces and pressures from the ‘developed’ world's activities within them. These collisions include land grabs and resource extraction, conversion of forest or wilderness to mechanized agriculture, uneven legal disputes over what constitutes ownership and use, and conservation efforts to reduce climate change or restore genetic biodiversity in forests. This study (...) illuminates how the physical and perceptual spaces of village, wilderness, and forest change, resist change, and are forced to change in three key domains: health (traditional medicine), food security (hunting, farming, and resource extraction in general), and use-ownership (as indigenous knowledge, occupancy, and access to land-use generally). Findings from the study disclose a need to include time (as the pace of change) whenever changed perceptions of space are proposed or occur. Recommendations include applying the criterion to strive always for the least disruptive (short-term) procedures for addressing a problem such that those outcomes achieve the most sustainable impacts over the long-term. (shrink)

The fourteen authors in this collection used phenomenology and hermeneutics to conduct deep inquiry into perplexing and wondrous events in their work and personal lives. These seasoned scholar-practitioners gained remarkable insight into areas such as health care and illness, organ donation, intercultural communications, high-performance teams, artistic production, jazz improvisation, and the integration of Tai Chi into education. All authors were transformed by phenomenology's expanded ways of seeing and being.

Increasing privacy concerns are arising from expanding use of aggregated personal information in health practices. Conversely, in light of the promising benefits of data driven healthcare, privacy...

This article, corresponding to a part of the restitution of a financed international research project between France, Brazil, Canada, Italy and Belgium, aims to offer a modelisation and qualitative evaluation of mediation care settings based on an original methodological tool that involves identifying the typical games at the foundations of creativity, following a multidisciplinary perspective. Therapeutic mediations are settings or devices organised around a “pliable medium”, often artistic, like painting, modeling, writing, ​and theatre, which are very widespread in institutional (...) class='Hi'>practices, both in France and abroad. The scientific objectives of this research consist in a multi-disciplinary exploration (anthropology, criminology, neuroscience, clinical psychology) of the process of creative symbolisation understood as a process of transformation involving play. According to this orientation, play can be defined as a psychic process whereby a subjective experience can be explored with pleasure, and consequently symbolised and appropriated. Our fundamental and original hypothesis is that play is at the source of the creative process, conceived as a work of metabolisation by the psyche of playful experiences during the different stages of life. The review of the understanding of play in psychoanalysis, anthropology, criminology and neuroscience emphasises the richness of this model and the importance of reflecting on the typical games in the field of psychic care. A clinical example of treatment in a pictorial therapeutic mediation setting of a child with psychotic disorders makes it possible to identify a number of typical games as well as the modalities of interpretation of the therapists through play. These multidisciplinary studies lead to the presentation of a general table of typical games, and these first results highlight the richness of identifying typical games in clinical settings. Ultimately, the multidisciplinary approach shows the interest of the model of play in the evaluation of therapeutic mediation settings, with a convergence of the different disciplines emphasising the pertinence of this model. The scientific impact of this research overlaps with its societal impact, through the development of innovative tools for evaluating therapeutic mediations, in order to take account of the evolution of the different forms of social expression of psychic suffering. (shrink)

We are in the midst of a crisis of climate change and environmental degradation that will only get worse, unless significant changes are rapidly made. Globally, the healthcare sector causes a large share of our total environmental footprint: 4.4% of greenhouse gases. Sustainable healthcare has emerged as a way for healthcare sectors in high‐income countries to help mitigate climate change by reducing their emissions. Whether global health should be sustainable and what ethical grounds might exist to support such a (...) claim are not questions that have been investigated. The paper argues that global health practice—the delivery of health services to underserved populations in resource‐poor areas of the world—should be sustainable as a matter of climate justice and solidarity. Reducing climate change‐related risks and harms for the vulnerable is integral to the mission of global health and thus it is necessary to consider the climate impact of its practice. The field has a duty to provide sustainable health services that are responsive to climate change‐related changes in the local burden of disease and to build sustainable health system infrastructure. Specific responsibilities for global health funders, managers, and implementers to uphold the duty are proposed. To conclude, the paper considers what limits might be placed on the duty to deliver sustainable global healthcare. (shrink)

The concrete insertion of nurses into the context of an inquiry contributes to empirical evaluation research of health promotion programs. As interveners and concrete actors in social movements, nurses are in a privileged position to give realism to a local understanding of the political and cultural context of evaluative research. Drawing on the practice of empirical evaluation research, this paper seeks to generate new methodological approaches in a way that broadens nursing inquiries in community health nursing. It explores (...) new ways of thinking about epistemology and knowledge production in nursing practice. For 5 months an evaluative research project adopting a participatory‐action research approach was conducted with local community actors in an AIDS prevention project in Amazonas (Brazil) in a prostitution setting. An auto‐ethnographic journal was used as a reflective approach for the critical analysis of nursing research activities. This paper calls for a closer relationship between scientific research settings and the sociopolitical and the sociocultural aspects of nursing practice. It increases an incorporation of popular, social and professional experiential learning and skill acquisition in embedded knowledge production. (shrink)

This study investigates the effects of issue framing on public support for programs encouraging farmer adoption of soil health practices. While extensive research exists on farmer adoption of best soil management practices, this study uniquely examines public willingness to support such initiatives. Using data from a survey of Oklahoma residents, we assess the public’s attitudes concerning hypothetical programs supporting farmer adoption of soil health practices to control soil erosion, sequester carbon, and retain moisture. Three implementation (...) methods were considered and framed as voluntary adoption, subsidies, and mandatory. The results indicate a strong public preference for voluntary adoption over subsidized or mandated practices. Additionally, support varies with demographic factors; older individuals, those who perceive political consensus on climate change, and those with pro-environmental values are more likely to support soil health adoption by producers. These findings provide insights into aligning conservation policies with public preferences concerning producer uptake of soil health practices and promoting sustainable agricultural outcomes. (shrink)

Should mental health insurance cover only disorders found in DSM‐IV, or should it be extended to treatment for ordinary shyness, unhappiness, and other responses to life's hard knocks?

What are the Differences between Public Health Practice and Research? This perplexing question constantly arises in the planning and performance of public health activities involving the acquisition and use of identifiable health information. Public health agencies collect and analyze significant identifiable health data from health care providers, insurers, other agencies, or individuals to perform an array of public health activities. These activities include surveillance, epidemiological investigations, and evaluation and monitoring. Few debate that these (...) essential public health activities, often specifically authorized by law, are classifiable as public health practice.Other public health activities in which identifiable health data are acquired or used, however, can resemble, include, or constitute human subjects research. “Human subjects research” is legally defined as “a systematic investigation, including research development, testing, and evaluation, designed to develop or contribute to generalizable knowledge” that involves living human subjects. (shrink)

In recent years, scholars have begun to lay the groundwork to justify a distinct application of ethics to the field of public health. They have highlighted important features that differentiate public health ethics from bioethics, especially public health’s emphasis on population health rather than issues of individual health. Articulations of public health ethics also tend to emphasize the role of social justice compared to the predominance of autonomy in the bioethical literature. Now that the (...) field of public health ethics is developing a unique focus and a language of its own, including a code of ethics disseminated by the American Public Health Association, the future of public health ethics may well be global health ethics, focusing on issues of global justice. As public health ethics evolves from its nascent stage of reflection to a place of action and application in the national and global arenas, two interrelated developments will need to occur: public health professionals, including practitioners, policymakers, and scholars, will need a richer understanding of the ethical challenges practitioners face on a daily basis and scholars will need to develop useful tools that practitioners may employ for identifying and tackling these ethical challenges. (shrink)

Standards for professional training and practice are defined by accrediting organisations or statutory bodies. These describe the arena in which the practitioner may speak with authority. The sphere of authorised practice is further delineated by the external resources available. Within this explicit framework, unconscious mental processes can affect the professional response in potentially adverse ways. This is particularly important in mental health practice. Professionals must be prepared to examine their own responses on this basis in order to enhance their (...) knowledge of the patient and minimise the possibilities of the patient becoming the victim of the professional's own psychopathology. The maintenance of such a position in an institution or organisation requires a similar process within its structure in order to provide the necessary setting and define the limits of good practice. In this paper, the field of adolescent mental health is specifically examined. (shrink)

Two areas of ethical conflict in intercultural nursing — who needs single rooms more, and how far should nurses go to comply with ethnic minority patients’ wishes? — are discussed from a utilitarian and common-sense morality point of view. These theories may mirror nurses’ way of thinking better than principled ethics, and both philosophies play a significant role in shaping nurses’ decision making. Questions concerning room allocation, noisy behaviour, and demands that nurses are unprepared or unequipped for may be (...) hard to cope with owing to physical restrictions and other patients’ needs. Unsolvable problems may cause stress and a bad conscience as no solution is ‘right’ for all the patients concerned. Nurses experience a moral state of disequilibrium, which occurs when they feel responsible for the outcomes of their actions in situations that have no clear-cut solution. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Pains And Gains Of Rural Health Practice:Lessons Books Never TaughtSridevi Seetharam, Bindu Balasubramaniam, G. S. Kumar, and M. R. SeetharamHow The Journey BeganIn the early 1980s, as fresh graduates from Mysore Medical College in southern India, we were brimming with a zeal to "cure the sick" and "change the world." We had an ideal of evidence-based, rational, ethical and equitable health care and set out to serve (...) rural and under-served communities which included displaced forest-based tribes. In the initial years, with the naivety of the inexperienced, we believed that by correcting the dehydration of the doe-eyed six-year-old Mare and giving her a free course of antibiotics, we had made health care accessible to her. Much to our dismay, within a month, Mare was back in the outpatient clinic, with diarrhea all over again and looking thinner than ever. We realized that it was a losing battle to keep her healthy as long as she continued to drink water from the same contaminated stream, live in unhygienic surroundings, and eat only the paltry meals that her family could barely afford. We gradually began to connect these living examples to what our preventive medicine text books had stressed all along—there are many social determinants of health which, if left unaddressed, do not permit realization of the vision of health for all.Such instances continually pulled us out of the hospital building and into the villages and tribal hamlets. We discovered that our textbook of Preventive and Social Medicine (Park, 1986) (P&SM as we used to call it), was our most valuable possession. [End Page 106] We devoured the descriptions of national health programs, sanitation procedures, water treatment protocols, and maintenance of cold chain for vaccines with a completely new perspective. We discovered the Manual of Basic Techniques for a Health Laboratory, (World Health Organization, 1980) detailing how to set up a laboratory with low cost, reliable and simple methods. We learned to drive a jeep to haul supplies and patients. To step up the level of clinical care, some of us pursued post-graduate programs and equipped ourselves to provide more specialized care too. It has been over two decades since we embarked on this journey. We have encountered a variety of perplexing dilemmas with no clear solutions. We have sometimes been compelled to adopt health practices that were not really evidence-based, seemingly irrational, inequitable and even downright unethical. This narration describes only a few of our thousands of cases, and hopefully conveys our periods of self-doubt, despair and hope, as well as, the challenges we face to reconcile with the difficult choices we are forced to make every day.Unforeseen Challenges in Saving Mothers and ChildrenHigh maternal and child mortality rates have been one of the most disturbing aspects of the health care scenario in rural India. To ensure immunization of all children, health workers with vaccine carriers go from village to village and hamlet to hamlet to reach those infants that would have missed visits to the immunization clinics. Our grass-root workers facilitate these visits by identifying households with such children. Occasionally, they encounter families who spirit away the infant into the adjoining woods as soon as the health worker is seen approaching, and blandly proclaim that the child is not at home. Despite reassurance and counseling about the safety and necessity of the vaccine, their apprehensions and misconceptions are insurmountable. What is the extent of the responsibility of the health worker? Is it ethical to hunt down the child and force the administration of the vaccine in view of the public health gains, besides the child's welfare?A few months ago, a pre-term neonate was admitted to our hospital, but worsened and needed referral to a higher centre in the city. The family refused to go despite repeated persuasion and detailed explanation about the technical limitations of care at our centre. From the family's perspective, the variety of social, cultural, and monetary challenges they would face in the city were themselves limitations for care. We were compelled to retain the baby and continue giving the best care we could.Two... (shrink)

Stigma can influence the prevention and identification of fetal alcohol spectrum disorder, a leading cause of developmental delay in North America. Understanding the effects of public health practices and policies on stigma is imperative. We reviewed social science and biomedical literatures to understand the nature of stigma in FASD and its relevance from an ethics standpoint in matters of health practices and policies. We propose a descriptive model of stigma in FASD and note current knowledge gaps; (...) discuss the ethical implications of stigma based on two distinct criteria ; and describe two cases and the concerns associated with inadvertent stigmatization by public health initiatives for FASD. We recommend further empirical and ethical analyses to examine whether public health policies and practices inadvertently stigmatize and impact the success of public health initiatives and programs for FASD. (shrink)

Las naciones y pueblos indígenas presentan preocupantes índices respecto a la salud, así como otras carencias como la pérdida de sus tierras, la alimentación, la educación y, en general, el ejercicio de sus derechos, consagrados por organizaciones internacionales como la ONU y la OMS-OPS. En Ecuador, de acuerdo con el orden jurídico constitucional, se han instrumentado políticas de salud que incluyen el lineamiento general de un enfoque intercultural de la atenciónprimaria que incorpora los saberes y prácticas ancestrales. Mediante una (...) revisión documental se examina la situación actual de la salud y la atención primaria entre las etnias indígenas del Ecuador. De este análisis se desprenden consideraciones para las políticas públicas de salud, la formación intercultural de los profesionales de los equipos de salud y, en especial, la articulación de las creencias, saberes y prácticas de la cultura de las etnias para la atención primaria de salud. Palabras Clave: Etnia, nacionalidad indígena, pueblo indígena, derecho a la salud, atención primaria. Referencias [1]Asamblea General de la Organización de las Naciones Unidas, «Resolución 48/134 de la Asamblea General de las Naciones Unidas sobre los Derechos de los pueblos y naciones indígenas,» de Asamblea General Resolución 48/134, New York, 2009. [2]Organización Panamericana de la Salud, «Derechos Humanos y Salud de los pueblos indígenas,» Organización Panamericana de la Salud, New York, 2008. [3]Alto Comisionado para los Derechos Humanos de la Organización de las Naciones Unidas, Declaración de las Naciones Unidas sobre los derechos de los pueblos indígenas. Manual para las instituciones nacionales de Derechos Humanos, Nueva York: Alto Comisionado de los Derechos Humanos de la Organización de las Naciones Unidas, 2013. [4]C. Torres Parodi y M. Bolis, «Evolución del concepto etnia/raza y su impacto en la formulación de políticas públicas para la equidad,» Revista Panamericana de Salud Pública, vol. 22, nº 3, pp. 405-414, 2007. [5]IIDH-OPS, «Salud indígena y derechos humanos,» OPS, Quito, 2006. [6]Organización Panamericana de la Salud, «Iniciativa de la Salud para los Pueblos Indígenas. Lineamientos estratégicos. Plan de acción 2003-2007,» Organización Mundial de la Salud, Quito, 2003. [7]Consejo Mundial de las Iglesias, «Segunda Asamblea Mundial de la Salud de los Pueblos,» Consejo Mundial de las Iglesias, Quito, 2005. [8]Grupo Internacional de Trabajo sobre asuntos indígenas, Instituto de Promoción de Estudios Sociales, Fundación Diversidad, «El Derecho a la Salud de los pueblos indígenas en aislamiento y en contacto inicial,» Grupo Internacional de Trabajo sobre Asuntos Indígenas, Quito, 2007. [9]Organización Panamericana de la Salud, «Salud de los pueblos indígenas de las Américas,» OPS, Quito, 1998. [10]Organización Inernacional del Trabajo, «Convenio número 169 de la OIT. sobre pueblos indígenas y tribales: hacia un futuro inclusivo, sostenible y justo.,» OIT, New York, 2019. [11]L. Almeida Vera, «Fundamentación del modelo de gestión intercultural ecuatoriana en la atención primaria desalud,» Medisam, vol. 8, nº 18, pp. 46-61, 2014. [12]Organización Internacional del Trabajo, «Implementación del Convenio núm 169 de la OIT sobre los pueblos indígenas y tribales: Hacia un futuro inclusivo, sostenible y justo,» OIT, New York, 2019. [13]C. Eysaguirre, Proceso de incorporación de la medicina tradicional, alternativa y complementaria en las prácticas oficiales de la salud. Tesis Magister Antropología, Lima: Universidad Nacional Mayor de San Marcos, 2016. [14]Organización de las Naciones Unidas para la Agricultura y la Alimentación, «Sobre la salud y la seguridad de los pueblos indígenas en riesgo debido al coronavirus,» FAO, New York, 2020. [15]Enlace Continental de Mujeres Indígenas de las Américas, Alianza de Mujeres Indígenas de Centroamérica y México, Red de Mujeres Indígenas Asiáticas, Organización de Mujeres Indígenas Africanas, «Llamado colectivo de las mujeres indógenas ante el COVID 19. Foro Internacional de Mujeres Indígenas,» ONU, New York, 2020. [16]Laboratorio de interculturalidad FLACSO Ecuador, Etnohistoria de los pueblos y nacionalidades originarias del Ecuador, Quito: FLACSO Ecuador, 2015. [17]UNICEF, Nacionalidades y pueblos indígenas. Políticas interculturales en Ecuador, Quito: UNICEF, 2009. [18]República del Ecuador, «Constitución de la República del Ecuador,» de 2008, Quito, 2008. [19]S. Ramírez Hita, «Políticas de salud basadas en el concepto de multiculturalidad: los centros de salud intercultural en el altiplano boliviano,» Avá Revista de Antropología, vol. 14, nº 2, pp. 1-28, 2009. [20]E. Arteaga, M. San Sebastián y A. Amores, «Construcción participativa de indicadores de la implementación del modelo de salud intercultural en el cantón Loreto, Ecuador,» Saúde em Debate, vol. 36, nº 94, pp. 402-413, 2012. [21]L. Véliz Rojas, A. Bianchetti Saavedra y M. Silva Fernández, «Competencias interculturales en la atención primaria de salud: un desafío para la educación superior frente a contextos de diversidad cultural,» Cuadernos de Saúde Pública, vol. 35, nº 1, pp. 62-71, 2019. [22]C. Walsh, Interculturalidad: Estado, sociedad: luchas decoloniales de nuestra época, Quito: Abya Yala UASB, 2015. [23]E. Ortiz Prado y G. Ceballos Serra, «Marco estratégico para la protección de los pueblos indígenas en aislamiento voluntario y contacto inicial. Consultoría sobre situación de salud de los pueblos indígenas en aislamiento y contacto inicial en el Ecuador,» Organización del Tratado de Cooperación Amazónica, Quito, 2014. [24]J. Betancurt, A. Green, J. Carrillo y Anane-Firempong, «Defining Cultural competence: a practical framework for adressing racial/ethnic disparities in health and health care,» Public Health, vol. 118, nº 2, pp. 293-302, 2016. [25]R. Ceballos, A. Amores y R. Rojas, Prestación de servicios de salud en zonas con pueblos indígenas, Quito: Programa Regional de Salud de los Pueblos Indígenas, 2009. [26]L. Pereira de Melo, «A contemporaneidade da teoría do cuidado cultural de Madeleine Leininger: una perspectiva geohistórica,» Ensaios e Ciencia: ciencias biológicas, agrarias e da Saúde, vol. 14, nº 2, pp. 21-32, 2010. [27]C. Rohrbach-Viadas, «Introducción a la teoría de los cuidados culturales enfermeros de la diversidad y la universalidad de Madeleine Leininger,» Revista Cultura del cuidado, vol. 2, nº 3, pp. 32-46, 1998. [28]O. Aguilar Guzmán, I. Carrasco González, M. García Piña, A. Saldívar y R. Ostiguín Meléndez, «Madeleine Leininger: análisis de sus fundamentos teóricos,» Revista de Enfermería Universitaria, vol. 4, nº 2, pp. 26-32, 2007. (shrink)

Whereas theories on health generally argue in favor of one specific concept, we argue that, given the variety of health practices, we need different concepts of health. We thus approach health concepts as a Wittgensteinian family of thick concepts. By discussing five concepts of health offered by theory, we argue that all capture something that seems relevant when we talk and think about health. Classifying these concepts reveals their family resemblances: each of these (...) concepts differs from the others in at least one respect and resembles the others in several respects. Moreover, our classification shows that “health” always both describes a condition and evaluates that condition at the same time. Having both descriptive and evaluative dimensions, we can see health concepts as “thick concepts.” It is because of this evaluative dimension that it is important to reflect on the question of what understanding of health guides specific practices. We show that the distinctions revealed by our classification can serve as a conceptual toolbox for reflection on the assumptions and purposes of particular health practices. Finally, we illustrate how such reflection could work out by briefly exploring three specific health practices. (shrink)

This book concerns clinical psychology, but it is most concerned with the world outside the clinic. That world—where culture, history, and economy are found—radically impacts the public’s mental health. However these worldly considerations often do not feature centrally in the science and practice of clinical psychology, a subfield of psychology seemingly dedicated to mental health. Desai offers a corrective by travelling out of the clinic and into the world, exploring ideas, movements, and thinkers that help broaden our approach (...) to well-being, by situating it within its cultural, historical, and sociopolitical contexts. The book aims to be an intercultural journey itself—encountering Buddhism, phenomenology, Edmund Husserl, Mahatma Gandhi, and Rev. Dr. Martin Luther King, Jr. along the way. Featuring a Foreword by Jeffrey Sachs, the book positions pressing matters such as social justice, racial justice, and environmental justice as integral components of good mental health work. The book will be of interest to readers interested in cultural and community approaches to psychological science and practice. (shrink)

In applied health care research, an essentialised notion of culture is often used when studying ethnic disparities in health and health care access between the majority populations of Western countries and migrants, with ethnic backgrounds that differ from majority population. This notion of culture, however, is considered highly problematic in anthropology and ethnic studies. Therefore, in our research on Dutch illness certification practices, we employed a dynamic conceptualisation of culture. Our research shows that, in practice, when (...) clients fail to meet the implicit norms of this practice, doctors ascribe this nonconformity differently when the client is a migrant than when he or she is a Dutch client. More specifically, when migrants fail to meet the norms, doctors are inclined to automatically ascribe this nonconformity to the assumed cultural background of the client. Consequently, these doctors feel less able to use the tools they normally use to coach their clients. This, in turn, results in more problematic and longer reintegration trajectories for migrants in comparison to Dutch clients in similar circumstances. In other words, framing the problems of migrants in terms of culture results in greater sick leave rates for migrants than for Dutch people. Clearly, culturalistic perspectives on ethnic differences have negative consequences. We therefore implore the application of a dynamic notion of culture in applied research. (shrink)

This book opens up philosophical spaces for comparative discussions of education across ‘East and West’. It develops an intercultural dialogue by exploring the Anglo-American traditions of educational trans-/formation and European constructions of Bildung, alongside East Asian traditions of trans-/formation and development. Comparatively little research has been done in this area, and many questions concerning the commensurability of North American, European and East Asian pedagogies remain. Despite this dearth of theoretical research, there is ample evidence of continued interest in (self-)formation (...) through various East Asian practices, from martial arts to health and spiritual practices (e.g. Aikido, Tai Chi, Yoga, mindfulness etc.), suggesting that these ‘traditional’ practices and pedagogical relations have something important to offer, despite their marginal standing in educational discourse. This book will appeal to all researchers and students of comparative education studies with an interest in issues of interpretation and translation between different traditions and cultures. (shrink)

The Flint water crisis demonstrates the importance of adequate legal preparedness in dealing with complicated legal arrangements and multiple statutory responsibilities. It also demonstrates the need for alternative accountability measures when public officials fail to protect the public's health and explores mechanisms for restoring community trust in governmental public health.

This book draws on both the historical context & contemporary research evidence to present the roles of mental health social work, AMHP & BIA, within an ethical framework. Codes of practice & statutory legal requirements, such as the Mental Health Act, Mental Capacity Act & the Human Rights Act, are all considered.

In the UK, higher education and health care providers share responsibility for educating the workforce. The challenges facing health practice also face health education and as educators we are implicated, by the way we design curricula and through students’ experiences and their stories.

From the perspective of values-based practice, there is much of interest in Lorenzo Gilardi and Giovanni Stanghellini's "I am a Schizophrenic." Their dialogue exhibits many of the key elements of VBP, it exemplifies the particular challenges presented by VBP in mental health, it illustrates the power of phenomenology in meeting these challenges, and it points by extension to an insight into contemporary psychiatry's professional identity as a medical profession.VBP is a resource for working with values—with what matters or is (...) important to those concerned—in healthcare. Avoiding preset answers, it offers instead a process that supports those concerned in a given situation... (shrink)

Intercultural mediation essentially deals with perceptions. Perceived reality is frequently very different and far removed from actual reality. From our human and cultural position we must endeavor to understand the «other», starting from the principle that our lives are guided by certain norms and principles that are impregnated with cultural values and traditions. Any attempt to find logical reasons for this perception, in other words, the causes and consequences of the behavior and attitudes of those who do not share (...) our culture, will be in vain and take us nowhere. Only by changing our approach can we achieve the fluency of understanding and comprehension that we all strive for. In sum, we must face up to the difficulties of communication by questioning why reality is perceived in this way. This approach activates our perceptive capacity, facilitates attitudes of comprehension, and stimulates the dialogue and communication on which interculturality is grounded.La mediación intercultural esencialmente es una cuestión de percepciones. Desde una posición humana y cultural debemos comprender al «otro» partiendo del principio que nuestras vidas están orientadas por normas y principios que están impregnados de valores y tradiciones culturales. Aplicar «nuestra lógica» buscando las causas y las consecuencias del comportamiento y de las actitudes de aquellos que no comparten nuestra cultura es un intento vano que no nos lleva a ningún lado. Sólo cambiando nuestro enfoque podemos lograr el entendimiento fluido y la comprensión que deseamos. En suma, debemos enfrentarnos a las dificultades de comunicación cuestionándonos por qué la realidad es percibida de esta manera. Esta aproximación aumenta nuestra capacidad de percepción, facilita actitudes de comprensión estimulando el diálogo y la comunicación. (shrink)

The public expects members of the medical profession to conduct themselves according to the terms of the Hippocratic oath, yet few physicians and virtually no laypersons know what is in that oath. For the oath to reach beyond its symbolic importance, ethical conduct must be learned and practised. There are many texts on the practice of medicine, surgery and all of the related disciplines, yet one is hard pressed to find anything on ethical practice in any of them. Scholarly texts (...) on ethics tend to deal with the landmark issues and dilemmas that have occurred within particular jurisdictions or religions. This book is intended as a student-friendly text that seeks not to turn students into ethics scholars but to provide them with a practical guide to ethical conduct in everyday medical practice. and discussion are provided for each of the following areas: Ethical Practices in Health Care Law and Ethics Rights of Patients and Responsibilities of Health-Care Providers The Rights of Health-Care Professionals The Duty of Care Confidentiality Consent to Treatment Life and Death Research Ethics Ethics in Public Health Practice Ethical Practice in Everyday Health Care is useful, practical and student friendly. The exercises and discussions will stimulate thought about ethical conduct and help students to develop and translate ethical principles into their daily practice as health-care workers. Dr Walrond offers a ready and concise source of information for medical students on ethical issues. The text is simple, comprehensive and factual, addressing issues encountered in everyday medical practices. Case studies provide practical illustrations of complex ethical issues. (shrink)

Privacy must be protected for social reasons. That is what was argued in “Privacy and Health Practices in the Digital Age” (Pyrrho, Cambraia, and de Vasconcelos 2022). Versalovic, Goering, and Klei...

The discursive production of the ‘self in the context of mental health care has potential implications for how the subjects of intervention come to understand and experience themselves. Eating disorders provide an illustrative example of the ways in which conceptualizations of the self that structure mental health practices can be gendered, because they are mainly diagnosed in women and dominant explanations of their origins are feminized. This discourse analytic study examines the gendered nature of mental health (...) workers’ constructions of the eating-disordered self through the psychological construct of ‘identity’, examining the dominant discourses implicated in the feminization of deficient identity, and addressing the implications of this construction for mental health practice. (shrink)

Dissociative Identity Disorder is an uncommon disorder that has long been associated with exposure to traumatic stressors exceeding manageable levels commonly encompassing physical, psychological and sexual abuse in childhood that is prolonged and severe in nature. In DID, dissociation continues after the traumatic experience and produces a disruption in identity where distinct personality states develop. These personalities are accompanied by variations in behaviour, emotions, memory, perception and cognition. The use of literature in psychiatry can enrich comprehension over the subjective experience (...) of a disorder, and the utilisation of 'illness narratives' in nursing research have been considered a way of improving knowledge about nursing care and theory development. This research explores experiences of DID through close textual reading and thematic analysis of five biographical and autobiographical texts, discussing the lived experience of the disorder. This narrative approach aims to inform empathetic understanding and support the facilitation of therapeutic alliances in mental healthcare for those experiencing the potentially debilitating and distressing symptoms of DID. Although controversies surrounding the biomedical diagnosis of DID are important to consider, the lived experiences of those who mental health nurses encounter should be priority. (shrink)

: This paper argues that three salient corrupt practices that mark contemporary Chinese health care, namely the over-prescription of indicated drugs, the prescription of more expensive forms of medication and more expensive diagnostic work-ups than needed, and illegal cash payments to physicians—i.e., red packages—result not from the introduction of the market to China, but from two clusters of circumstances. First, there has been a loss of the Confucian appreciation of the proper role of financial reward for good (...) class='Hi'>health care. Second, misguided governmental policies have distorted the behavior of physicians and hospitals. The distorting policies include (1) setting very low salaries for physicians, (2) providing bonuses to physicians and profits to hospitals from the excessive prescription of drugs and the use of more expensive drugs and unnecessary expensive diagnostic procedures, and (3) prohibiting payments by patients to physicians for higher quality care. The latter problem is complicated by policies that do not allow the use of governmental insurance and funds from medical savings accounts in private hospitals as well as other policies that fail to create a level playing field for both private and government hospitals. The corrupt practices currently characterizing Chinese health care will require not only abolishing the distorting governmental policies but also drawing on Confucian moral resources to establish a rightly directed appreciation of the proper place of financial reward in the practice of medicine. (shrink)