Public Health & Human Rights

Improving health and protecting rights through culturally intelligent living

I was talking recently with a public health colleague who works with First Nations communities in Canada, and the conversation turned to the importance of cultural sensitivity and understanding when working with people of other cultures. As she stated, we need to make sure that our "programs fit the people" rather than making the people fit the program.

Having spent a lot of time outside the borders of the U.S., culture and the impact it has on our lives and the way we see the world is a topic that greatly interests me. From the footpaths of Kalimantan to the dusty village roads of Gujarat to the mountain trails of Yoro to the subways in Singapore, the culture in which we live profoundly affects the way we see the world. And, in this increasingly interconnected world, our ability to effectively talk to each other has a direct impact on the work we do to improve health and protect rights.

Respect for culture and for people of different nations is fundamental to public health and human rights work, but this respect goes far beyond a simple affirmation of differences or the teachings one can receive in a half-day training. More than knowledge, we need to think differently. The relatively new field of cultural intelligence (CQ) provides a helpful framework for understanding the complexity of effective cultural interaction.  It is troubling that many excellent organizations send people to other cultures with little to no training, yet the evidence is clear that cultural intelligence is vital for anyone working, or planning to work, in a cross-cultural setting (and, of course, you don’t even need to leave your country to encounter cross-cultural differences). 

A person who is culturally intelligence, is able, as an outsider, to interpret unfamiliar gestures and actions as if they were from that culture. The study of cultural intelligence focuses on four key factors:

Knowledge CQ: this is a person’s understanding of the differences between cultures. Knowledge about economics, laws, politics, religious beliefs, values, customs, social norms, and worldview all come under this CQ factor. One example of a question to ask is how well you know the rules for expressing non-verbal behaviors.

Interpretive CQ: this is how a person makes sense of cultural experiences and includes judgments they make about their thoughts and the thoughts of others. A person strong in this area will mentally check their assumptions as they are engaging others and they will adjust if their experience differs from what they expected. One example of a question to ask is how well you check the accuracy of your cultural knowledge when you are with people from other cultures.

Motivational CQ: this is a person’s interest in experiencing other cultures and interacting with people from those cultures. A person strong in this area will put a lot of energy toward learning about another culture and learning how to live in that culture. They also will be able to empathize with others and will want to have a strong desire to connect, even though the differences are great. It has been said that this is the most difficult factor of cultural intelligence, yet the one that can lead to the biggest cultural gains. One example of a question to ask is whether you enjoy interacting with people from other cultures.

Behavioral CQ: this is a person’s ability to adapt their behavior in ways that are culturally appropriate, and this includes both verbal and non-verbal behavior. One example of a question to ask is whether you change your verbal behavior (tone, speed, use of silence and pauses) when talking to people from another culture.

The cultural intelligence framework adds richness to the concept of culture and allows us to be more relationally effective. It brings a sense of humility to our interactions with others as it forces us to realize that we may not be the experts we think we are, and it forces us to ask uncomfortable questions about our beliefs and assumptions. In the end, cultural sensitivity is not simply about being successful in our work. It is about living intentionally and missionally with a focus on others.

Barack Obama's closest policy advisors (see previous post for McCain's advisors)

As I mentioned here before, politics, human rights, and public health are closely interwoven. And, knowing those who are most closely advising the candidates and who may well continue their roles with the next president helps me to better understand who I’m voting for and potential implications.

The information here is all public and published information and was compiled by a non-partisan health policy group. I’m going to focus here solely on the key health and foreign policy advisors of these candidates since both issues say much about how the future president may impact health and rights globally.

These are Barack Obama's closest health policy advisors:

David Cutler

• Economics professor and dean of social sciences at Harvard
• Member of the Institute of Medicine
• Has been a primary developer of Obama’s health plan
• Thinks that the primary goal of health care should be to improve quality, and feels that most healthcare spending is good.
• Author of "Your Money or Your Life: Strong Medicine for America’s Healthcare System"

Stuart Altman

• Healthcare economist and Dean of Brandeis University Social Policy and Management School.
• Worked on health care proposal for John Kerry and played a central role in the writing of Obama’s plan.
• Author of "A Cure for Spiraling Healthcare Costs"

Gregg Bloche

• Professor of law at Georgetown and adjunct professor at John Hopkins School of Public Health.
• Visiting fellow at the Harvard Program on Ethics and Health
• Consultant on South Africa’s Truth and Reconciliation Commission on human rights in the healthcare sector.
• Author of several books including "Consumer Directed Healthcare and the Disadvantaged"

Tom Daschle

• Former Senate majority leader.
• Consultant for a law firm advising on healthcare and other issue.
• A senior fellow at the Center for American Progress
• Co-Chair of ONE Vote ’08, which aims to address health and poverty in developing countries.
• Author of "Critical"

David Blumenthal

• Professor of Medicine and Healthcare Policy at Harvard
• Has worked on past presidential candidates’ healthcare proposals including Obama’s plan.
• A strong advocate of health information technology.
• Author of "Health Information Technology: What is the Federal Government’s Role?"

These are Barack Obama's closest foreign policy advisors:

Denis McDonough

• Senior fellow at the Center for American Progress
• A former foreign policy advisor to Tom Daschle, including work on HIV/AIDS, war on terror, and other topics.
• Author of "Balancing our Climate Debt: The Group of Eight have an Obligation"

Greg Craig

• Partner at a law firm who has represented several high profile clients including former U.N. secretary Kofi Anan.
• Advised Senator Edward Kennedy on defense and foreign policy in the 1980s and a former director of policy during the Clinton administration.

Susan Rice

• Was recently a senior fellow at the Brookings Institution
• A senior advisor on the Kerry campaign
• Author of "The Threat of Global Poverty"

Tony Lake

• Professor of diplomacy at Georgetown.
• National security advisor to President Clinton

Richard Danzig

• Bioweapons consultant to the Pentagon
• Former Secretary of the Navy from 1998 – 2001.
• Believes the overall US strategy should be to reduce the amount of armed conflict in the world.
• Author of "The Big Three: Our Greatest Security Risks and How to Address Them"

Dan Shapiro (Middle East policy advisor)

• Vice president of a lobbying and consulting firm
• Former legislative advisor

Dan Restrepo (Latin American policy advisor)

• Director of the Americas Project at the Center for American Progress
• Author of "The United States and Latin America: After ‘The Washington Consensus’"

Scott Gration (national security advisor)

• CEO of Millennium Villages, a project to assist African nations out of poverty based on the U.N.’s Millennium Development Goals.
• Retired 2-star general in the Air Force.

John McCain's closest policy advisors (see next post for Obama's advisors)

As I mentioned here before, politics, human rights, and public health are closely interwoven. And, knowing those who are most closely advising the candidates and who may well continue their roles with the next president helps me to better understand who I’m voting for and potential implications.

The information here is all public and published information and was compiled by a non-partisan health policy group. I’m going to focus here solely on the key health and foreign policy advisors of these candidates since both issues say much about how the future president may impact health and rights globally.

These are John McCain’s closest health policy advisors:

Douglas Holtz-Eakin

• President of DHE Consulting
• Former director of the Congressional Budget Office
• Chief economist for President Bush’s Council of Economic Advisors
• Argues that health reform is needed and advocates relying on market forces.
• Author of "Healthcare Reform in the U.S: How, When and Why"

Stephen Parente

• Professor of finance at the University of Minnesota and a professor at the Bloomberg School of Public Health.
• Helped craft McCain's health care plan.

Raissa Downs

• A partner at a lobbying firm that specializes in healthcare. Client include AARP, Amgen, Sanofi-Aventis, and Blue Cross Blue Shield.
• Former Deputy Assistant Secretary for Health at the U.S. Department of Health and Human Services.

Tom Miller

• A resident fellow at the American Enterprise Institute for Public Policy Research
• A former senior health economist for the joint Economic Committee of the U.S. Congress
• His research focuses on transparency for health services, regulation, and consumer-driven health care.
• Author of "Measuring Disparities, Improving Health: Closing the Gap"

Regina Herzlinger

• Professor at Harvard Business school known as a strong supporter of consumer-driven healthcare. She has published books and articles about health care and the need for a consumer-driven system.
• Author of "Who Killed Healthcare?"

Dan Crippen

• Member of the 2007 Google Health Advisory Council and a healthcare consultant. 
• Helped found the lobbying group, the Duberstein Group.
• Former director of the Congressional Budget Office and was a domestic policy advisor to President Reagan.

These are McCain's closest foreign policy advisors:

Randy Scheunemann

• Founder of Orion Strategies, a lobbying firm.
• Co-founder of the Committee for the Liberation of Iraq, a NGO seeking support for the democratization of Iraq.

Richard Williamson

• Serving as the U.S special envoy to Sudan.
• Served as the ambassador to the U.N. for special political affairs and as the ambassador to the U.N.’s Commission on Human Rights.
• A senior foreign policy advisor for Presidents Reagan, Bush, and Bush.
• Author of "Seeking Firm Footing: America in the World in the New Century"

John Lehman (national security advisor)

• Member of the 9/11 Commission
• Former Navy Secretary in the Reagan administration.

James Woolsey (national security advisor)

• Director of CIA from 1993-1995
• Main focuses are energy policies and their role in national security.  An advocate of clean energy, electric transport, and biofuels.

When the free market isn't always the best answer

When the actions of the free market lead to a near-global economic collapse, it's time to begin seriously considering whether the free market is the answer for health care.

The free market is not the answer to lowering health care costs (which is greatly needed) nor the answer to better health care for everyone.  In fact, the closest example of market-based health insurance, Health Savings Accounts (HSAs), cannot fairly be called health insurance at all.  Nonetheless, market-based solutions to health care are the politically popular ones and the only options that continue to receive serious consideration.

Greed, lack of transparency, and complex sets of rules are what people are agreeing has brought the economic market to its critical point today in need of rescue, and there is no reason to think that a free-market solution to health care will have better results. 

Looking for some professional or personal learning or some packaged presentations?

The Global Health Education Consortium (GHEC) is an excellent source for personal learning about global health issues or for finding quality presentations ready for you to teach or present.  Two places in particular at their site that I recommend are their teaching/learning modules here and their resources page.

Presentations include everything from "gender and health" to "globalization and its impact on health" to "water and sanitation" to understanding the term, "third world."  And many other presentations will soon be added, including ones that deal directly with health and human rights.

The mission of the GHEC is "to improve the health and human rights of underserved populations worldwide and the ability of the global workforce to meet their needs through improved education and training."

It's a site I appreciate, and I think you will too.

The politics of health and the politics of faith

Politics and health are closely intertwined, and, while I’d rather not belabor the upcoming vote for the U.S. president here, there is no getting away from the fact that any U.S. president can have a lasting impact on health and rights both in America and across the globe.

The connections between politics and faith are not new and go back for millennia, but Francis Schaeffer played a prominent role in very recent history as a significant figure in the political activism of the Christian pro-life movement.  He was widely recognized during his lifetime, and still today, as one of the most important influences in the modern activism of Christians against abortion. 

 

In his important book, “How Should We Then Live,” (1976) Schaeffer made his first call for Christian activism against abortion, although not the main topic of the text.  Two later books, and arguably more important in their influence, were, "A Christian Manifesto," (1981) and, "Whatever Happened to the Human Race?" (1983).  His later two books made specific and explicit calls for Christians to act non-violently to bring an end to abortion.

 

Each of these three books is worth reading, and there are many valuable points made in each.  Yet, as I read them, I am struck by two issues.  First, that Schaeffer consistently was focused on the Biblical basis for human dignity.  He clearly and passionately believed that all humans were, because of their creation, inherently valuable.  But second, his focus on abortion seemed to be in reaction to the 1973 Roe v. Wade decision, and it seemed, (stated explicitly at times) to also be tied to a desire to return to the "Judeo-Christian roots of historical America".  My point is simply that in none of these foundational texts (for the Christian pro-life political movement) is there a clear Biblical argument made for a focus on abortion.  The focus on abortion seems to be more of a reaction and passionate desire to return to a "Christian America."

 

I find this relevant because I continue to look for and not find (either in the Bible or in those who are "single-issue" voters) the reason that we should think of abortion as the only or most important issue regarding human dignity and human worth.  There is no denying that the Bible speaks forcefully to the value of life, but there are many ways to deny a person their dignity.  In a day filled with issues like war, poverty, health care, discrimination, etc, we can't afford to be single-issue voters who care only where a person stands on the issue of abortion.  How they think about abortion is important, but no less important are many other issues. 

 

Whether you vote for Obama or McCain, let it not be solely because of how they stand on the one issue of abortion.  The health and rights of millions of people around the world will be affected by the next U.S. president, regardless of who is chosen, and they deserve more than a single-issue voter. 

 

Images of Public Health: Celebrating Alma Ata and Jamkhed, India

 (image source: Comprehensive Rural Health Project)

This post is categorized both under "images of public health" and as part of the "change-makers" series.  While I did not plan to post another in the "change-maker" series so soon, it seemed inappropriate to let this important day pass without this post.

The women in the above image are volunteer village health workers trained through the Jamkhed Model at the Comprehensive Rural Health Project in India.  This project was one of only a handful of community health projects specifically highlighted at Alma Ata 30 years ago today (September 12, 1978).  The lessons learned from this project, and several others, guided the writers of the final Alma Ata Declaration, a declaration that is still hailed today and is being celebrated and re-energized worldwide and with a special issue of the Lancet. 

Mabelle and Raj Arole were physicians who graduated from the Vellore Christian Medical College in 1959 and who then went to work at a rural missions hospital.  Disappointed by the lack of impact they were making in peoples' health through their hospital work, they decided, in 1970, to start a public health program.  Looking for an area to build, they were invited to Jamkhed in the state of Maharashtra, India where they settled and began building their center. 

From a modest center drilling water wells for nearby villages, they later began village health surveys and health education.  Later, they expanded into many other areas of development such as promoting reforestation and improving environmental conditions.  Over a period of 25 years, 250,000 men and women who previously had been marginalized had been empowered to change and improve their lives and the health of their villages.  Infant mortality dropped from 175 per 1000 births to 18 per 1000 births during that time period.

Mabelle and Raj Arole deserve much more text than I am providing here and I urge you to visit the site of the Comprehensive Rural Health Project to learn more about the model and what they have done.

As I mentioned earlier, their work and the lessons learned guided the development of the Alma Ata Declaration.  Later, in the early 1980's, officials from WHO and UNICEF visited Jamkhed to learn how to adapt the model to other parts of the world.  In 1989, Drs Mabelle and Raj were invited as visiting professors to the Johns Hopkins School of Public Health.  And, in 1995, Dr. Mabelle became a senior advisor for UNICEF.  Dr. Mabelle passed away in 1999.

In 2005, Dr. Raj Arole received the Mother Teresa Award for Social Justice, and his work and the exemplary work of the Comprehensive Rural Health Project continues today.  As stated in their vision, "We envision communities where families are healthy and enjoy fulfilling lives....We are called to facilitate and empower the poor and marginalized and enable them to achieve their full potential through a value-based approach with equity and justice."

See here for much more: http://www.jamkhed.org/index.htm

Change-makers: Yen Yangchu (Jimmy Yen)

Go to the people.

Live with the people.

Learn from the people.

Plan with the people.

Work with the people.

Start with what they know.

Build on what they have.

Teach by showing, learn by doing.

Not a showcase, but a pattern.

Not piecemeal, but integrated.

Not odds and ends, but a system.

Not to conform, but to transform.

Not relief, but release.

Poem by Jimmy Yen

Jimmy Yen is credited with being the first to scientifically understand and document the key components of community-based development and change. The lessons and principles he learned during the 1930s in Ding Xian, China have helped transform the lives of people in communities all over the world.

Jimmy Yen grew up in Szechuan Province attending a China Inland Mission school and later graduated from Yale University in 1918. Immediately after graduating, he volunteered with the Young Men’s Christian Association (YMCA) to work among a group of 5,000 Chinese laborers in northern France. He vowed that he would devote his life to the "release of the pent-up, God-given powers in the people…. When we have a new heart, we become new people, and then we have a new society, then there is a new nation."

His experiences in France shaped the rest of his life, for it was there, moved by a desire to improve the lives of his fellow countrymen who could not read, that he began teaching those Chinese laborers how to read and write. He wrote the first Chinese books for simple literacy and decided to dedicate the rest of his life to the education of development of his fellow Chinese.

He returned to China after World War I, and, in 1923, began the first literacy campaign in Hunan Province, supported by the YMCA. Yen, and his colleagues pioneered the use of a simplified Chinese script so that illiterate rural peasants would have less difficulty learning to read and write.

In 1926 Yen and some colleagues started the Ding Xian Experiment for Rural Reconstruction, which provided people living in rural areas practical tools for improving their lives. This rural reconstruction movement evolved and matured rapidly into four topic areas taught by local "farmer scholars." Literacy, community organization, livelihood (to improve agriculture and income), and health and family planning were the four components of the program. The farmer scholar was a person chosen by the local community who was then trained by a small team of professionals in each topic area. This person’s role then was to test the methods and ideas he had learned from the experts, to adapt them as needed, and to work with local villages to implement and modify the ideas based on what would work in each village.

The Ding Xian experiment and the resulting four-fold program is considered the first example of evidence-based community development. They were simple, low-cost, and local methods yet they revolutionized education and health throughout rural China. In 1951, Yen established the International Mass Education Movement for application to other developing countries. The principles and lessons learned in those early days still apply today and can be seen in community-based projects around the world.

In 1943, Jimmy Yen, along with Albert Einstein, Orville Wright, Henry Ford, and six others, was honored at Carnegie Hall in New York City with the Copernican Citation as one of the ten outstanding "Modern Revolutionaries" of the world. He also, in 1983, received the Eisenhower Medallion of the People-to-People Foundation for his "exceptional" contribution to world peace and understanding.

Jimmy Yen died on January 17, 1990 in New York City. The principles and lessons learned by Yen, and still relevant today, are summarized in a poem he wrote, which is where this post began.

Sources:

"Just and Lasting Change" by Daniel Taylor-Ide and Carl E. Taylor

The International Institute of Rural Reconstruction

Christianity Today magazine

The Ramon Magsaysay Award Foundation

Change-makers: An introduction

I enjoy studying history, especially the various histories of which I am a part. Two history topics of particular interest to me are those of health and faith. And yet, until recently, I had mostly read about and understood those histories separately.

There is a mindset, by some, that people of faith are not interested in the health/rights of others and, similarly, that those working in health and rights are not peoples of faith. But, I have become increasingly aware of the fact that people of faith have been instrumental in working for the health and rights of others around the world for a long time.

I’d like to begin a new occasional series here about people of faith who have made a profound difference in the health and well-being of people across the globe. These are not necessarily people you have heard of before, but, by any objective measure, they have profoundly changed the world and improved the lives of many.