User:Npac/sandbox

=Cultural contexts of health=

Cultural contexts of health and well-being  (CCH) is a project run by the World Health Organization (WHO) that is concerned with enhancing public health and policy-making through a nuanced understanding of how cultural contexts, including value systems, traditions and beliefs, affect health, well-being and health care. The project was established in January 2015, building upon the finding of the 2014 The Lancet Commission ‘Culture and Health’, which argued that the neglect of culture in health and health care is one of the biggest barriers to better health outcomes worldwide. In view of the immense role culture plays in influencing health outcomes and defining the social worlds of patient, doctor, and biomedicine more generally, the CCH project aims to demonstrate to policy makers the value of being attentive to the cultural contexts in which health and illness exists.

The project is run from the WHO Regional Office for Europe, Copenhagen, Denmark, within the Division of Information, Evidence, Research and Innovation. The CCH project is guided by an expert group of academics and from different disciplinary backgrounds. The CCH expert group helps extend WHO's focus beyond the biomedical emphasis on disease and disease prevention to individuals' and communities' complex, lived experience of health and well-being.

The project addresses three key areas:
 * Advocacy: Clarifying the concepts behind the cultural contexts of health and making a case for their importance;
 * Research: Commissioning policy-relevant research on the influence of cultural contexts in specific public health initiatives, such as measuring well-being; and
 * Reporting: Policymaking approaches to wellbeing

Most technical guidance and research produced by the CCH project is divided into one of four themes:
 * Nutrition
 * Well-being and mental health
 * Migration
 * The Environment

The CCH project is funded by the Robert Wood Johnson Foundation and the Wellcome Trust, and works in collaboration with international organizations and governing bodies including the Organisation for Economic Co-operation and Development, UNESCO and others.

Background
The Lancet Commission of 2014 argues that the perceived divide between science and culture is a social fact, and that distinctions between ‘culture’ and ‘science’ are themselves cultural artefacts. To overcome barriers to equitable global healthcare, the Commission argues that healthcare practitioners should consider the ways in which their understanding of their patients is constructed by cultural contexts. Twinned with this is the requirement that healthcare practitioners recognize that they themselves are constructed by particular cultures. This refers not just to the practitioner themselves, but also to biomedical claims, which are shaped by political, economic, and cultural forces. Viewing culture as a veil that must be removed in order to reveal the physiological cause of morbidity is the incorrect approach, it is argued. To achieve equitable healthcare, the view that doctors have ‘knowledge’ and patients have ‘beliefs’ must be challenged.

The commission argues that attention to culture, in the medical curriculum, examination room, and discussions of etiology, is essential for achieving equality in healthcare. This is because culture is not synonymous only with ethnicity, language and nationality, but is found within organizations, and is manifest in a multitude of ways in individuals’ lives. In addition to being essential in order to achieve equity in healthcare, culture is also presented as a useful tool that can be used to aid well-being. For example, a study of 50,000 individuals in Norway found that participation in cultural activities is associated with good health, increased life satisfaction, and decreased levels of anxiety and depression.

Expert Group
An expert group assists the Regional Office in determining how to approach issues relating to understanding how cultural contexts affect health and health care. The group comprises 21 experts from a variety of disciplines, including epidemiology, statistics, anthropology, public health, history, cultural studies, philosophy and geography. The group met for the first time in January 2015, and meet annually to discuss the work and strategy of the CCH project.

WHO Collaborating Centers
WHO Collaborating Centres form part of an institutional collaborative network set up by WHO to support its technical work. They provide services to WHO at the country, regional and global levels, and are involved in technical cooperation for national health development. There are two WHO Collaborating Centres affiliated with the CCH project, dedicated to the area of culture and health.

University of Exeter
Academics from the Centre for Medical History at the University of Exeter are working with the CCH project team, producing research activities across a range of medical humanities and social sciences topics and providing interdisciplinary research support and technical guidance on the Cultural Contexts of Health. The research, which explores how experiences of health, illness and medical knowledge are shaped by cultural practices and beliefs, aligns with the four key research themes focused upon by the CCH project team (nutrition, well-being and mental health, migration, and the environment).

The Collaborating Centre is Co-directed by Professor Mark Jackson and Dr Felicity Thomas. 

University of York
The Centre for Global Health Histories (CGHH) is part of the Department of History and a member of the Humanities Research Centre at the University of York (UK). It produces interdisciplinary work on themes of medical, scientific, environmental, and public health importance. The centre works in partnership with academics, policy-makers and multilateral and non-government organizations.

The Collaborating Centre is directed by Professor Sanjoy Bhattacharya. 

Global Health Histories Seminar series
In collaboration with the Centre for Global Health Histories at the University of York (UK), the CCH project co-hosts a seminar series on ‘Global Health Histories’. This seminar series aims to demonstrate that understanding the history of health can inform practice within the field of global public health today. The seminar series brings together historians, policy makers, and WHO experts to examine global health topics such as:
 * ‘Vaccine hesitancy – why do some people not vaccinate?’
 * ‘Cultural contexts of health and wellbeing: can art save lives?’ and
 * ‘Polio, immunization and universal health coverage’.

Previous speakers have included:
 * David L. Heymann (London School of Hygiene and Tropical Medicine, and Head of the Centre on Global Health Security at Chatham House & formerly WHO Assistant Director General),
 * Heidi Larson (Professor of Anthropology, Risk and Decision Science, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine) and
 * Daisy Fancourt (Wellcome Research Fellow, Institute of Epidemiology & Health Care, University College London and winner of the ‘Best Doctoral or Early Career Research’ at the Health Humanities Medal awards.)

The GHH seminar series has a global reach, and seminars have been held in Sri Lanka, Hong Kong, and Switzerland, as well as at the University of York and at the WHO Regional Office for Europe, UN City, Copenhagen.

Publications
The CCH project has produced a number of publications with the aim of enhancing public health and policy-making by focusing on how specific aspects of cultural contexts affect health outcomes and healthcare:


 * Culture and reform of mental health care in central and eastern Europe (2018)
 * Culture Matters: Using a cultural contexts of health approach to enhance policy making (2017)
 * Focus on culture: Developing a systematic approach to the cultural contexts of health in the WHO European Region (2016)
 * Cultural Contexts of Health: The Use of Narrative Research in the Health Sector (2016)
 * Beyond Bias: Exploring the cultural contexts of health and well-being measurement (2015)

Beyond Bias: Exploring cultural contexts of health and well-being measurement
The first meeting of the expert group in the cultural contexts of health and well-being was convened by the WHO Regional Office for Europe in 15-16 January 2015. The meeting aimed to generate advice on how to consider the impact of culture on health and well-being, and how to communicate findings from well-being data across Europe, a very culturally diverse region. During their first meeting the expert group focused upon:


 * Agreeing on a working definition of culture
 * Rethinking data and evidence needs for well-being
 * suggesting ways to report more effectively on well-being
 * identifying research gaps in relation to culture and well-being

It was also agreed that the CCH project should adopt the United Nations Educational, Scientific and Cultural Organization (UNESCO)'s 2001 definition of culture:


 * (Culture is) the set of distinctive spiritual, material, intellectual and emotional features of a society or a social group, and that it encompasses, in addition to art and literature, lifestyles, ways of living together, value systems, traditions and beliefs.

Focus on culture: Developing a systematic approach to the cultural context of health in the WHO European Region
The expert group convened on the 4-5 April 2016 in UN City, Copenhagen. The expert group discussed the necessity of demonstrating the usefulness of articulating a CCH approach, and demonstrating its usefulness to health policy-makers, particularly in relation to migration and health. The objectives of the meeting were to:


 * Create a strategic framework for the Regional Office’s CCH project;
 * Strengthen CCH advocacy and expand the CCH network;
 * Provide technical feedback on draft outputs, particularly the draft
 * policy brief; and
 * Recommend CCH approaches in the context of four focus areas:

the environment, nutrition, mental health and migration.

The meeting also strengthened the partnership between CCH and the UNESCO Section for Intangible Cultural Heritage, which focuses on traditions or living expressions inherited from our ancestors and passed on to our descendants, such as social practices, rituals, skills to produce traditional crafts, and culture-specific food production techniques.

Embedding a CCH approach across the WHO European Region
On 26-27 April 2018, the CCH expert group met to discuss ways through which the current progress of the CCH project could be tracked, and to consider how the CCH approach might be developed further and translated into practical action on the ground within specific countries. The meeting provided the expert group with the opportunity to:


 * Review the progress and status of the CCH project
 * Provide technical feedback on current CCH work, including a policy brief on antibacterial resistance, a pilot chapter on well-being in Italy, and two concept notes for Health Evidence Network (HEN) reports on cultural mediators and waste management
 * Provide suggestions relating to proposed future areas of CCH work
 * Reflect more broadly on the next strategic steps for the CCH project with a particular focus on knowledge translation, impact and outcomes.

HEN Reports
The CCH project also produces Health Evidence Network (HEN) reports. HEN reports synthesize the best available evidence related to key policy questions, and provide synopses of key findings and policy options derived from this evidence in an easily accessible form for policymakers. HEN reports published in collaboration with the CCH project include reports examining the way values- based concepts associated with Health 2020 have been implemented by policymakers:


 * Community Resilience
 * Community Empowerment
 * Narrative Research
 * Cultural Mediators in migrant and refugee healthcare.

The report entitled 'Cultural contexts of health: the use of narrative research in the health sector' received the 2017 BMA Medical Book Awards 'Highly commended' recognition in the public health category. It was authored by Trisha Greenhalgh of the Department of Primary Care Health Sciences at the University of Oxford (UK). The report examines the importance of narratives to public health research, focusing on storytelling to convey individual experiences of illness and well-being.

Case Stories
The CCH project also publishes case stories, in collaboration with University of Exeter Collaborating Centre. The case stories provide specific examples that illustrate the value of social science and humanities based approaches to understanding health and well-being, particularly the use of qualitative research sources and methods. Previous case stories include:


 * Breathe Magic: overcoming loss of motor skills among children and young people with hemiplegia
 * Hearing voices: reducing stigma
 * Socio-cultural dynamics of antibacterial resistance: expanding policy horizons, opening up new fields of intervention
 * Gender differences in drinking practices in middle aged and older Russians
 * Antenatal support - tackling cultural exclusion
 * Rickets, 'race' and public health strategies in the twentieth century

Photo Story
In addition to published texts, the CCH project has released a photo story, entitled 'How do you see (perceive) well-being?'. The photo story includes images that explore themes such as representations of well-being in western contexts, the 'Eudaimonic' model of well-being, and conceptions of life satisfaction.