Planned and unplanned migrations, diverse social practices, and emerging disease vectors transform how health and wellbeing are understood and negotiated. Simultaneously, familiar illnesses—both communicable and non-communicable—continue to affect individual health and household, community, and state economies. Together, these forces shape medical knowledge and how it is understood, how it comes to be valued, and when and how it is adopted and applied. Future plans for the NHSThe principal challenge for high-income countries that have achieved universal health coverage is sustainability. To address the health needs of growing and ageing populations with multiple comorbidities is increasingly expensive. For instance, if funding for the UK's National Health Service (NHS), the world's largest single provider of health care, remains tied to economic growth over the next 5 years, there will likely be a £30 billion deficit by 2020. Given this stark reality, NHS England published its Five Year Forward View on Oct 23. Full-Text PDF David Napier: cultivating the role of culture in healthEach autumn, in Adirondack Park, Upstate New York, David Napier invites a few kindred spirits to what he describes, tongue firmly in cheek, as a philosophers' camp in the grounds of his cabin in the woods. There, the fireside discussions will take in everything from the relations between epidemics and xenophobia to homelessness, and that's just to mention a couple of Napier's many interests. Talking to him before his guests arrive, it becomes clear that trying to pin down Napier's free-ranging career is no easy task. Full-Text PDF Culture and healthWe read the Culture and Health Commission by David Napier and colleagues,1 and agree that, to ensure high-quality health care for culturally diverse populations, physicians need to acquire specific knowledge, attitudes, and skills. Although the report addresses these issues explicitly and comprehensively, one important question is still unanswered: how will medical students acquire these competencies? It is of paramount importance that medical teachers are adequately prepared to teach their students about culture and health. Full-Text PDF Culture and healthThe Lancet–University College London Culture and Health Commission by David Napier and colleagues (Nov 1, p 1607)1 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”;2 governments, intergovernmental organisations, and thinktanks are highlighting the need to look beyond gross domestic product towards more equitable and more sustainable targets (eg, wellbeing),3 and funders (such as the Wellcome Trust)4 have ramped up support for a more multidisciplinary, integrated approach for health research (for instance, via the medical humanities). Full-Text PDF Culture and healthThe Culture and Health Commission by David Napier and colleagues1 is a comprehensive and important report. However, we would argue that a core competency for any health professional is to recognise that culture affects the way in which health and illnesses are viewed. This responsibility cannot be delegated to others, and is an integral part of health care; without it, health-care professionals' understanding of the patient as a person rather than as a disease or case is incomplete. The report2 recognises the importance of development and research of cultural training in medical education—some steps to start this have already taken place. Full-Text PDF Culture and health–Author's replyWe thank Nisha Dogra, Jeanine Louise Suurmond, and Nils Fietje, Claudia Stein and colleagues for their interest in our Commission.1 Dogra and Suurmond exemplify ongoing efforts to introduce cultural competency training within medical education. Both attempts represent important developments in the drive to make competency a central part of clinical training, but the fact that these isolated programmes are exemplary shows the extent to which cultural competency training is still peripheral to clinical education. Full-Text PDF Quotations on the cover page of the journalAs a longtime enthusiast of The Lancet, I have been irritated many times by the often-meaningless quotes on the front cover of the journal. I consider these a waste of precious space. Full-Text PDF
