It therefore promotes dialogue with the goal of reaching a harmonious coexistence. However, if this approach is taken without the full participation of indigenous peoples, there is a risk of merely advancing integration without more equitable decision-making or clearer power relations. Harmonious living approaches, for example, may encourage ethnographic studies that are conducted only with the objective of learning about other cultures so that the dominant group can feel that those who are different are indeed "normal" and, based on this, can create health programmes for them. First, states continue to assert monoculturalism as a way of promoting national unity. Second, health care sector reform is leading to increased privatization, making it more difficult to hold health providers accountable even to international human rights standards, much less to any of the collective rights of indigenous peoples. In addition, as traditional medicine is explored by non-indigenous actors, there is an increased risk of piracy of the intellectual property of indigenous peoples, as well as a risk that indigenous practices will be popularized and performed in ways that do not adhere to the histories, values and visions of indigenous peoples.