Principle 1: Embrace cultural humility and community engagement.

Principle 1
  • With a foundation of cultural humility and commitment to community engagement, public health professionals can develop and implement meaningful and ethical projects and partnerships to better address health equity, health disparities, and health inequities.
  • Everyone who works cross-culturally and cross-linguistically will make mistakes. In a world with diverse cultures and languages, it is crucial to be flexible, to take responsibility for mistakes, and to be open to learning/adapting as cultures and languages evolve. Doing so helps build the trust, relationships, and communication that are key to effective global public health efforts.
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  • Public health professionals, programs, and related global communications should demonstrate that as evidence-based public health and scientific agencies, we have the humility to learn from mistakes, and continually adapt our approaches to achieve better outcomes based on rigorous evaluation and feedback from involved communities.
  • Cultural humility is active engagement in an ongoing process of self-reflection, in which individuals seek to:
    • Examine their personal history/background and social position related to gender, ethnicity, socio-economic status, profession, education, assumptions, values, beliefs, biases, and culture, and how these factors impact interpersonal interactions.
    • Reflect on how interpersonal interactions and relationships are impacted by the history, biases, norms, perception, and relative position of power of one’s professional organization.
    • Gain deeper realization, understanding, and respect of cultural differences through active inquiry, reflection, reflexivity, openness to establishing power-balanced relationships, and appreciation of another person’s/community’s/population’s expertise on the social and cultural context of their own lives (lived experience) and contributions to public health and wellbeing.
    • Recognize areas in which they do not have all the relevant experience and expertise and demonstrate a nonjudgmental willingness to learn from a person/community/population about their experiences and practices.
  • Avoid the posture, framing, and language of hierarchy, patriarchy, supremacy, saviorism, and colonialism. The primary role of a global public health professional should always be as an invited partner. Global public health professionals should:
    • Emphasize collaborative, mutually beneficial, and peer-to-peer approaches for solving shared challenges together.
    • Make findings and final products accessible to the communities/collaborators involved, including forms of communication in local languages and beyond written text (e.g., verbal presentations, group meetings, individual discussions, infographics).
    • Actively identify and remove markers of hierarchy and supremacy that are often seen in the global public health sector. The markers noted below are intersectional in that they can occur across different forms of hierarchy and supremacy rooted in nationality, ethnicity, gender, income, education, ability, age, sexual orientation, etc. Cross-cutting examples include:
      • An assumption that assistance is needed from people/groups who are not part of the population of focus and/or a lack of acknowledgement or discussion of how support is wanted or unwanted. If support is not wanted, respect the partner’s/community’s wishes and only engage in a mutually agreeable manner.
      • An assumption by visiting individuals and organizations that they know more about a country, community, or health issue than the people who are from that country or community. This can lead to a patronizing tendency of non-community members explaining to community members the very things they experience every day (i.e., lived experience).
      • Greater value placed on the opinions/voice/expertise of select experts from high-income countries (HICs) or experts who were educated in HICs or urban centers, that devalues the knowledge and expertise of those with lived experience or non-traditional education paths (e.g., birth attendants, doulas).
      • A disregard for local knowledge and ability and/or an inflated sense of personal knowledge and ability.
      • An assumption of power or domineering posture when speaking with representatives from local organizations/populations.
      • Lack of willingness to share authority, credit for success, or responsibility for challenges/failures.
      • A reluctance/refusal to discuss with, listen to, learn from, or partner with members of the population of focus in a manner that is culturally appropriate and that treats them as equals.
      • A lack of flexibility/understanding that inhibits respect or patience for diverse local traditions, religions, beliefs, ideas, and expertise.
  • Global public health professionals should prioritize community engagement. Doing so builds foundational trust and relationships, strengthens collaboration, and helps ensure that everyone involved has an equal opportunity to share their voice/opinions/ideas for the public health research, projects, and communications that will impact their lives and livelihood. Community engagement leads to more effective, sustainable, locally appropriate, and community-owned communication, programs, partnerships, and research. Ultimately, effective engagement results in global work that represents the lived experiences of groups who have experienced historical and contemporary injustices.
      • Is the community/intended audience the people who reside within specific geographic boundaries? Or is the community/intended audience a group of people with common ethnicity, income, age, gender, language, country of origin, migrant or refugee status, belief or faith, etc.?
      • Is the community/intended audience based on institutions, such as faith communities, schools, or healthcare facilities? Or a group of people with similar interests or hobbies?
      • Is the community/intended audience a combination of the above?
      • How can the community be involved to ensure fair representation from populations experiencing disadvantage due to poverty and income status, living in rural areas or peripheral urban settlements, discrimination, migrant or refugee status, country of origin, language, culture, faith, age, gender, or other factors?
A health professional engages with community members in rural Thailand

A health professional engages with community members in rural Thailand during an epidemiological investigation of hand, foot, and mouth disease. Photo by Tawatchai Apidechkul/TEPHINET

  • Leverage preexisting relationships with local partners and community members to proactively identify, listen to, consider, and incorporate a wide array of individuals, lived experiences and perspectives, and accumulated knowledge throughout planning, development, implementation, and evaluation phases. If a preexisting relationship with the community is not yet present, work with and follow the lead of trusted intermediaries who do have a preexisting relationship. Note that it can take weeks, months, or even years for trusting relationships to be established between community members and non-local public health professionals. See CDC’s Global Health Equity Strategy for additional considerations on partnership.
  • Ensure platforms and safe spaces are available and accessible for voices from all affected parties to be included in a project, from beginning to end. Set aside enough time for each affected party to have equal speaking time. At each stage of a project, consider who is/is not speaking and who has been included/excluded in the process.
    • Communicating in the local language facilitates inclusive engagement. Global public health professionals who are not familiar with the local language should work closely with partners/intermediaries/translators who are fluent.
    • Consider whether any social or security constraints on participation are in place and how engagement, planning, and implementation can be adapted. For example, perhaps the affected party includes women with limited mobility or farmers who are busy during the day or seasonal workers who are unavailable at certain times of the year.
    • Assess the appropriateness of descriptive video, close caption, teletypewriter (TTY), and other accommodations for individuals with diverse abilities. When these options are not available, consider recording meetings/events and allowing members extra time to review material.
  • Ensure that communities are encouraged and have the opportunity to actively participate in designing, implementing, leading, evaluating, and improving public health research, projects, and communications. Identify potential gaps in participation and implement the most inclusive process possible before moving to the next stage. Ideally, community members should determine priorities and lead subsequent action/initiatives.
    • If some participants are present but not active in a discussion, consider whether any power dynamics exist within in the group that may impact participants’ willingness to speak. For example, in some communities/cultures, people perceived to be at a lower social caste may be unwilling or hesitant to speak in front of people perceived to be at a higher social caste. Consider whether it is necessary to convene some participants separately (e.g., a women’s group and a men’s group; or a group of adults and a group of adolescents).
    • Note: It is possible that some key community members may be unable to participate due to crises, trauma, abundance of other duties, or other life circumstances. Participation should be encouraged and welcomed, but never forced.
  • Especially for communication activities that involve storytelling, engage all parties to tell their own story, ensuring the overall narrative is from the people and not merely about the people.
    • Especially in storytelling, the person with lived experience is the expert on their own story. Ideally, the power to write/dictate the story should rest with the person/community with lived experience. In such an arrangement, a professional communicator should be in a support role, offering input and advice as appropriate.
    • When a professional communicator is the one developing the story, use quotes, expand on the surrounding context, and focus the narrative and action on the featured person’s/community’s own ideas about what is needed for them to live healthy and secure lives.
    • When storytelling across languages, ensure that translations are of high quality so that key nuance is not lost.
    • Ensure a that stories that incorporate a range of experiences to represent the diversity of the population.
  • Especially for research publications, invite local partners to contribute as authors. Any authors from local institutions who contribute and meet authorship criteria must be included as authors in the final, published version.
    • While abiding by institutional and journals’ authorship criteria, engage in open discussion to clarify contributions, negotiate authorship, and publish with an accurate/adequate order of authorship.
    • Encourage and promote local authors as first and senior authors. Local authors are often underrepresented in key authorship positions in literature about their own countries.
Page last reviewed: August 8, 2022
Content source: Global Health