Contextualising the need for a different approach to cultural
humility:
Since the 1980s, social scientists have tracked the increasing
democratization and technologising of medical knowledges, and the
consequent ethical-political transformations that have been brought to
research and medical practices15,16. As these authors
differently suggest, current socio-cultural practices of health care
systems have been reconstituted in several interconnected ways. Medical
guidelines for assessment and intervention, together with the authority
of practitioners have become organized epistemologically (and
increasingly, legally) in line with mathematically driven evidence about
population health and pharmacological treatment
efficacy10. As previously mentioned, computer stations
housed in the different spaces of clinical engagement (eg., examination
room) feed a constant flow of health information to health care
providers. The screen together with its informational flows demand
material-discursive attention, and yet, the care provider is compelled
to simultaneously stay near to the patient as an embodied physical
presence and as a differently attuned source of
knowledge17,18.
This felt tension between often incommensurate epistemologies -
evidenciary truths revealed by computational, big-data analytics, and
everyday patient and professional situated knowledges derived from the
contingencies inhering in clinical based
interactions10 - is reflective of the entwining of
what19 and Rose and Novas20 have
differently labeled bio-citizenship and the technologising of medical
knowledges. The rise of grass-roots medical activism over the past four
decades by those most affected by different diseases has been a central
catalyst in a shift towards a consideration of the epistemologies of the
patient in medical decision making and formation of health policy
(including the rise of more culturally attuned models of
care)21,22. Concomitantly, advances in technologies
assisted storage and dissemination of information have allowed for the
democratisation of access to a host of health knowledges, including
those generated by corporate sponsors or patient-based social movements
outside or alongside the knowledge producing apparatus of
biomedicine15. From self-help strategies, to
vaccination scepticism, to evidence generated via random control trials
or social media reporting, distributed forms of knowledge are widely
transmitted via the internet to a host of health consumer
publics20, and are significant actants in the clinical
exchange11.
Regulatory mechanisms of medical care systems have also been
transformed. Governance structures have steered away from a “government
by command” model that imbued physicians with decision making
authority, towards an “uncoupled system of
self-steering”10. This is a system of diffused
management and “distributed accountability”10 where
not only health care providers but patients - at least those represented
by powerful lobby groups in advanced democracies - have become equally
implicated in effecting positive health outcomes23,24.
In this shifting, governmental, technologically mediated calculous, the
very conceptualisation and (embodied) practices of patienthood have been
rearticulated20. Patienthood is no longer being
conceptualised as a site of localised pathogen, but as a site of agentic
decision making, health/wellness/illness management and (moralized)
accountability16,22.
In the wake of these transformations, the social-health experiencing
body has become a site of technologised hybridization entangling the
somatic body, social identity and technologies. Pharmacological
prophylaxis, the growth of communications and new “smart” technologies
are facilitating the intensification of physician guided and patient
administered health surveillance and diagnostic capabilities. Boundaries
between the previously conceptualized “natural” body, and the
technologies understood to be integral to its existence and correct
functioning have become confounded. So much so, in fact, that today’s
“techno-scientific” bodies are comprehended as bodies in a continuous
process of becoming ‘healthier’ – always in a state of ‘recovery’ from
but also in avoidance of biological vulnerabilities9.