I'm not expert on this topic, but I'm interested in health care for minorities. In Spain we have done some research in sub-Saharan immigrant groups and prevention of harmful traditional practices. The issue is really complex because you have to find the balance in the complex interplay between rights and cultural values. Between respect for tradition, law and the loyalty conflict that is generated. On the other hand in our country there is little tradition of health care that respects cultural differences. For example, we did some research for the prevention of female genital mutilation and found that this is a health problem, wich is perhaps not very prevalent at present, but wich surpases the purely healthcare framework and confers:

• The violation of the most basic human rights: the right to physical integrity, to health and equality.

• The need for a transcultural approach to these questions which is closely linked to the identity of the

migrant persons.

• The moral commitment of the healthcare professionals to avoid these traditional practices which imply a discriminatory, violent, degrading and painful treatment towards women.

Knowledge of these practices and preventive approaches from a transcultural perspective may represent

a positive intervention model in relation to integrative care to migrant populations, which is respectful of

their values and culture while being effective in the elimination of the physical and psychological consequences.

We need to develop a true patient-centered culturally sensitive health care.

What a fantastic answer and thank you so much for taking the time to discuss it with me. I could not agree with you more fully. In the US, most indigenous practices are not harmful (in fact, I don't know of those that are, but then, I'm not an expert, just a provider). We continually try to force Indians into our various models of healthcare by throwing three years of funding at them, telling them how to run a project and then walking off when the three years are over -- and we wonder why nothing seems to gain stability and why do Native Americans have such shorter life expectancy than those of us in the dominant society. You are so right in your comments re: transcultural perspective and I'd even go further to say that as much as I preach "evidence-base" to my students, I am now going to be searching for ways to include native approaches into the evidence-base. So much to do... I'm so appreciative of your thoughtful response, many thanks! You're doing interesting work and I'm going to follow you on RG -- emjay

There's an important publication about this critical topic. It's "The Nicomachean Ethics" of Aristotle (384-322 BC). "We feel that the good is something individual and inalienable" (I, 4.26). "Welfare is not a common quality, which is expressed under a single idea" (I, 6.26), but varies depending on the population: "As regards the actions and what is worthwhile in life has nothing stable, as well as regarding health "(II, 2.a3-5). Unfortunately scientists as "aim at some good, and while seeking what is missing to get to them, they neglect their knowledge" (I, 6.a5-7).

May be that the cultural colonization is the first colonization. So the "global" W.H.O.'s definition of health will become the first step of the colonization of health and healthcare. If this hypothesis is correct and you look for de-colonize, it's necessary looking by the eyes of others, using others' words and their ideas inside words.

Great suggestion, thank you so much -- I love the interaction on this site from folks I never would have had the opportunity to meet. This is a great suggestion, thank you! emjay

At the level of care (I am family doctor ) a part of the solution lies in the focus on the patient centered care under the classical principles:

Patient-centered concepts incorporate 6 interactive components. The first component is the physician’s exploration of both the patients’ disease and 4 dimensions of the illness experience including: their feelings about being ill, their ideas about what is wrong with them, the impact of the problem on their daily functioning, and their expectations of what should be done. The second component is the physician’s understanding of the whole person. The third component is the patient and physician finding common ground regarding management. In the fourth component the physician incorporates prevention and health promotion into the visit. The fifth component is the enhancement of the patient-physician relationship. Finally, the sixth component requires that patient-centered practice be realistic.