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Health Context Analysis in Global Health Engagements Health Context Analysis in Global Health Engagements

Health Context Analysis in Global Health Engagements - PowerPoint Presentation

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Health Context Analysis in Global Health Engagements - PPT Presentation

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

context health communication cultural health context cultural communication patient party interpreter ghe provider personnel analysis considerations population concerns verbal

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Slide1

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

27

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

30

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

36Slide37

37Slide38

38Questions/Comments?Health Context Analysis