Sayed Shinwari MD MPH Health Context Analysis Course Learni Define the concept of Health Context Describe key elements of Health Context Understand the importanc e of sociocultural and crosscultural communication factors in health ID: 740019
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Health Context Analysis in Global Health EngagementsSayed Shinwari, MD, MPHSlide2
Health Context AnalysisCourse LearniDefine the concept of Health ContextDescribe key elements of Health ContextUnderstand the importance of socio-cultural and cross-cultural communication factors in health context
Explain the
implications
of understanding Health Context for Global Health Engagements (GHE)
2
Learning ObjectivesSlide3
Health Context Analysis“A standardized tool for obtaining, organizing, analyzing, and presenting information about a specific country or region to inform global health engagements” 3
The Health Context Analysis FrameworkSlide4
Health Context AnalysisMilitary Health System personnel are increasingly involved in Global Health Engagements (GHE):Medical Security CooperationMil-Mil Capacity-buildingDisaster ResponseHealth Support to COIN/Stabilization OperationsHealth Sector ReconstructionAll of these activities require an understanding of the relevant Health Context.4BackgroundSlide5
Health Context AnalysisDo No Harm!Damage can be caused by applying contextually inappropriate and/or harmful interventions or programs.The Stakes are high:Health-related Contextually inappropriate interventions can lead to unintended consequences and undesirable outcomes (e.g., failed or unsustainable health programs) and jeopardize mission success.5BackgroundSlide6
Health Context AnalysisHealth Needs AssessmentStep 1: Getting StartedStep 2: Identifying Health PrioritiesStep 3: Assessing a Priority for ActionStep 4: Action PlanningStep 5: Moving on/review 6BackgroundSlide7
Health Context Analysis7Country Context
Health Communication
Socio-Cultural Considerations
Health Systems
Determinants of Health
Country Application
The Health Context
ModulesSlide8
Health Context Analysis8MODULE ITHE COUNTRY CONTEXT Slide9
Health Context AnalysisHistory
Geopolitics
Politics
Security
Economy
Infrastructure
environment
9
The Country Context
Early history
Colonization
Independence
Conflicts
Competing for territory/resources
Influential actors for power
What drives change
What causes conflict
Citizen’s voice and accountability
Stability and absence of violence
Government effectiveness
Regulatory quality
Rule of Law
Control of corruption
Livelihood
State Security
Human Security
Gross Domestic Product (GDP) per capita
Primary sources of income
External debt
Foreign investment
Currency and exchange rate
Employment
Inequality score
Government spending of
social services
Electric power
Distribution
Transportation systems (road, rail, waterways, air)
Communication technologies (internet and cellular)
Climate
Topography
Natural resources
Environmental concerns
Water, food, shelter securitySlide10
Health Context AnalysisMODULE IIDeterminants of Health and Application to GHE Slide11
Health Context Analysis11Determinants of HealthSlide12
Health Context AnalysisPopulation Health ProfileSlide13
Health Context AnalysisPopulation Health - MortalitySlide14
Health Context AnalysisPopulation Health - MortalitySlide15
Health Context AnalysisSocial Determinants of HealthSlide16
Health Context Analysis Proportion of population with access to safe water Proportion of population with access to sanitation Food availability and access Proportion of the undernourished Prevalence of
underweight
in children under five
Public Health ConcernsSlide17
Health Context AnalysisPublic Health Concerns – Food AvailabilitySlide18
Health Context AnalysisPublic Health Concerns – Food AffordabilitySlide19
Health Context AnalysisPublic Health Concerns – Public Health GHE PossibilitiesSlide20
Health Context AnalysisPublic Health Concerns – Public Health GHE PossibilitiesSlide21
Health Context AnalysisMODULE IIIHealth Systems as a Component of Health ContextSlide22
Health Context AnalysisOverlapping Health SystemsSlide23
Health Context AnalysisWHO Conceptual FrameworkSERVICE DELIVERYHEALTH WORKFORCEINFORMATIONMEDICAL PRODUCTS, VACCINES & TECHNOLOGIES
FINANCING
LEADERSHIP/GOVERNANCE
SYSTEM BUILDING BLOCKSSlide24
Health Context AnalysisMODULE IVSocio-Cultural Considerations in GHESlide25
Health Context AnalysisSlide26
Health Context Analysis In USA, CLAS Standards recommends the delivery of culturally and linguistically appropriate services.Cultural competence training requirements.Similar standards and competencies are needed for global health engagements.BackgroundSlide27
Health Context AnalysisPopulation
Social Structure
Culture
Health Culture
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Socio-Cultural
Considerations in GHE
Major drivers of population size/stability
Fertility
Mortality
Immigration
Indicators for population/demographic
Population size and growth rate
Age structure, % under age 15 and % over age 60
Fertility rate
Birth rate (M/F) and sex ratio
Percent urban population
Net migration rate (internal/international)
Class
Gender
Race/Ethnicity
Social structural inequalities
Indicators to understand the country’s social structure
Cultural Identity
Nationality
Ethnicity/Race
Religion
Age
Socioeconomic Status
Education
Urban versus Rural Residence
Cultural Traits
Individualism versus collectivism
Power distance
Uncertainty avoidance
Masculinity versus femininity
Long/short-term orientation
Culture Competence
Explanatory Models of Health and Illness
Western (Modern) Biomedical Model
Indigenous (Local) Medical Model
Health Seeking Behavior
Recognition of Symptoms
Health-Related Stigma
Treatment Approaches
Traditional Medicine
Medicine, Culture, and Ethics
Health – Related Stigma
Culture and Treatment ApproachesSlide28
Health Context AnalysisMODULE VCross-Cultural Health Communication in GHESlide29
Health Context AnalysisUK & USA= O.K.RUSSIA = ZEROJAPAN = MONEYBRAZIL = INSULTSlide30
Health Context AnalysisVerbal and Non-verbal Communication
Barriers to Cross-cultural Health Communication
Overcoming Barriers to Cross-cultural Health Communication
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Cross-Cultural
Health Communication
Languages
Dialects
Styles of Communication
Low-context
High-context
Forms of non-verbal communication
Paralinguistic features (vocal effects that accompany speech).
Facial expressions
Body language and gestures
Personal space
Eye contact
Touching
Practical Implications
Language Differences.
Misinterpretation of non-verbal communication.
Differing perceptions of Health and Illness.
Differing Expectations from Health Care Encounters.
Patients’ level of Health Literacy.
Language skills acquisition.
The use of interpreters.
Knowledge of cultural interpretation of different forms of non-verbal communication.Slide31
Health Context AnalysisWorking with InterpreterThe Professional Healthcare Interpreter……is proficient in all working languages…abides by interpreter ethics and standards…has interpreting skills (protocols and modes)…is culturally aware/competent
…has familiarity with
medical practices and terminologySlide32
Health Context AnalysisWorking with InterpreterWhen selecting an interpreter, consider 3 KEY FACTORS that dictate their skills, cultural knowledge, and professionalism:Do they have PROFESSIONAL INTERPRETING training?Are they members of the MILITARY OR CIVILIANS?
Are they from the
UNITED STATES OR THE LOCAL COUNTRY
where the mission is taking place?Slide33
Health Context AnalysisBest Practice – Positioning Considerations
Triangle Positioning:
NOT RECOMMENDED
Frequently used position in healthcare settings and for meetings.
Interpreter is the center of attention.
Parties miss important non-verbal queues.
Parties fail to develop primary relationship with each other and instead focus on the interpreter.
Provider /
Personnel
Patient /
Party
InterpreterSlide34
Health Context AnalysisBest Practice – Positioning Considerations
RECOMMENDED
Provider/ personnel can look and speak directly to the patient / other party, observing non-verbal communication.
Patient/other party may look at provider or interpreter when speaking.
Possibility of patient/other party feeling isolated.
Effective for patient education.
Patient /
Party
Provider /
Personnel
InterpreterSlide35
Health Context AnalysisBest Practice – Positioning Considerations
RECOMMENDED
Provider/personnel and patient/party look directly at each other.
Patient/party supported during the visit.
Patient/party more likely to develop primary relationship with provider/personnel and communicate more freely.
Patient /
Party
Interpreter
Provider /
PersonnelSlide36
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38Questions/Comments?Health Context Analysis