Culture and health

Abstract

The Lancet–University College London Culture and Health Commission by David Napier and colleagues (Nov 1, p 1607) is welcome and timely, but does not come as a surprise. In the past decade, a growing number of initiatives related to medicine and public health have prepared the ground for a re-examination of this very topic. The Lancet itself published a planetary health manifesto, calling for “collective public health action at all levels of society”; governments, intergovernmental organisations, and thinktanks are highlighting the need to look beyond gross domestic product towards more equitable and more sustainable targets (eg, wellbeing), and funders (such as the Wellcome Trust) have ramped up support for a more multidisciplinary, integrated approach for health research (for instance, via the medical humanities). Together, these initiatives might be characterised as examples of what Phil Hanlon has described as a “fi fth wave” in public health—a phase that seeks to engage public health with the full complexity of the subjective, lived experience. At the WHO Regional Office for Europe, this shift is embodied in the publication of the European health policy framework, Health 2020, which aims to “significantly improve the health and wellbeing of populations”. As the Commission makes abundantly clear, wellbeing is a notion that is culturally constructed. The term itself often presents a linguistic challenge since translations such as “Wohlbefi nden” in German, or “bien-etre” in French are either artificial creations or different in resonance from the English word. Having embarked on a journey to measure and improve the wellbeing of populations throughout the entire European region, the WHO Regional Office for Europe therefore fi nds itself in challenging territory; having to embrace nuance and subjectivity, while still being informed about evidence and preserving WHO’s normative function as a global organisation for public health. To help it think through some of the inevitable challenges, particularly with respect to measurement of wellbeing, the WHO Regional Office for Europe has launched a project on the cultural determinants of health. Guided by a multidisciplinary expert group, which met for the first time on Jan 15–16, 2015, this project will engage more seriously with much of the important work on culture and health that is being done in medical anthropology and the wider health-related social sciences. And, as the Commission Report recommends, the project is also looking to the medical humanities to help ask the right kind of questions, as we begin to reshape “our understanding of how we conceptualise health and what makes us healthy”.