Improving Global Health by De-Othering Global Citizens

IMPROVING GLOBAL HEALTH BY DE-OTHERING
Improving Global Health by De-Othering Global Citizens

By: Jennifer Herget
Global Citizen, LLC

Durham, NC
Signed by:
Student:
Jennifer Herget
Signature: __________________ Date: _________
Agency Preceptor:
Katherine Turner
Signature: __________________ Date: _________
Internship Coordinator:
Jeffrey Milroy
Signature: __________________ Date: _________

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Part 1: Problem Definition and Description

Health in a Global Setting
Global health is a broad term that simply means the health of populations in a global
context. The goal of global health is to improve health outcomes and achieve equity in health for
all people worldwide (Koplan et al., 2009). This is an incredibly broad goal, due to the many
types of health problems that impact global populations.
Peoples conceptualization of global health often centers upon headline grabbing health
crises. Swine flu, typhoon response, and most recently, Ebola, have grabbed the US publics
attention. However, global health problems exist beyond the headlines. One report that
examined the World Health Organization (WHO)s 2012 Global Burden of Disease data found
that in the first seven months of 2014s Ebola outbreak, a projected 70 times as many people
were likely to have died from the malaria virus (Nelson, 2014). And there are many viruses that
threaten global health beyond Ebola and malaria, including HIV (which is responsible for about
1.5 million deaths a year), influenza (estimated to kill between 250,000 and 500,000 people each
year), and tuberculosis (responsible for about 1.4 million deaths a year) (Centers for Disease
Control and Prevention [CDC], 2014; WHO, 2003; WHO, 2013).
Of course viruses are not the only threats to global health. Geopolitical conflicts have
far-reaching impacts on health, causing death, combat injuries, Post-Traumatic Stress Disorder
(PTSD), hunger, and increased rates of sexual assault among soldier and civilian populations, as
well as among refugees fleeing the violence (Pike, Straight, Oesterle, Hilton, & Lanyasunya,
2010). Current estimates of the number of ongoing global conflicts vary, with most estimates
ranging between 50 and 166 (The World at War, n.d.; List of Ongoing Conflicts, n.d.). The
number of conflicts at any given time is difficult to determine because many of the conflicts are

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not between two nation states, but are rather between a country and an armed uprising,
militarized drug traffickers, or other guerrilla groups. No matter which estimate is used, it is
plain to see that the number of ongoing conflicts is high enough to cause a huge impact on global
health.
There are many other threats to global health, too. These include high rates of unplanned
pregnancies, which tend to increase infant mortality rates and have severe health consequences
for women and their families, and other sexual health issues such as high rates of sexually
transmitted infections and violence against women and LGBTQ populations (Worldwide action
needed to address hidden crisis of violence against women and girls, 2014). Additionally,
natural disasters can have large impacts on global health, particularly in areas that lack the proper
infrastructure to respond quickly and appropriately (Powles & Comimo, 2014). Hunger is
another wide-ranging global health problem-- it is estimated that 1 out of every 9 people in the
world does not have enough to eat (The Hunger Project, n.d.). Substantial increases in chronic
health conditions like diabetes and heart disease are also affecting global populations in
developing as well as developed nations (Bures, Mabry, Orleans, & Esposito, 2014).
The immense number of global health problems brings increased urgency to the goal of
global health to improve health outcomes and achieve equity in health for all people worldwide.
This goal is important because diseases do not respect borders, and because global health
impacts economic and social development and global security for all global populations. The
world is more connected now than ever before. Ideas and information can be shared in seconds;
economic globalization uses chains of production that span continents; and world leaders
increasingly work together to resolve regional conflicts. Health issues also exist on this global
scale, transcending national borders and leading to one countrys systemic failures to adequately

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address health crises to create health consequences worldwide. This point was made all too clear
earlier this yearin March, Guinea experienced an outbreak of the previously easily controlled
Ebola virus; by November the outbreak had spiraled into a pandemic that claimed over 4,000
lives throughout West Africa (WHO, 2014). According to the Centers for Disease Control and
Prevention (CDC), the globalization of foods and medicines, as well as the rise in antimicrobial
resistance and the ease with which pathogens can be manipulated have raised our vulnerability
and interdependence (Schuchat, Tappero, & Blandford, 2014). Additionally, global health crises
can lead to more global conflicts because they increase the political and social destabilization
that cause it (Brown, 2011).
The Non-Health Problem: Addressing the Root Cause of Global Health Problems
Improving global health is a complex process. Traditionally, individual-focused health
experts reasoned that there are just as many causes of global health problems as there are health
problems themselves. For every disease there is a vector, for every case of hunger a lack of food,
and so on. However this type of reasoning barely scratches the surface of the root causes of the
health problems. The deeper questions that health educators must ask are ones like Why is this
vector so successful in spreading this virus? or Why isnt there enough food? To answer
these questions health educators must use a systems science approach, which frames health
issues by modeling interrelated phenomena and the social, environmental, and organizational
systems in which they occur (Bures et al., 2014). Some of the many systems that cause and
reinforce global health problems are geopolitical, economic, environmental, healthcare, and aid
delivery systems (Mabry & Kaplan, 2013). To create systemic change, health educators must
address the factors that enable and perpetuate these systems.

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The current political environment is favorable to using a systems science approach to

improving global health because of three recent stimuli. The first is that the recent Ebola
outbreak provided a palpable example that demonstrates the vulnerability and potentially dire
health consequences of leaving the current systems unchanged. The second stimuli is that the
mission of academic public health is undergoing a change in framing that is moving focus from
individual-based interventions to interventions that are based on the Social Ecological Model and
systems science. The third is the recent turmoil in US healthcare delivery and financing that has
brought public attention to the need for health reform (Greenberg, Raymond, & Leeder, 2011).
The intersection of these stimuli create a moment in public health when educators and the
communities they work with are more likely than ever before to implement interventions targeted
toward creating systems change.
Global Citizen, LLC

Global Citizen, a global health curriculum development and consultation company in
Durham, NC, is uniquely poised to address some of the contributing factors to the systems that
cause and perpetuate global health problems because their clients are the people and
organizations whose missions are to improve global health equity. Global Citizen defines their
own mission as seeking to strengthen professionals' and companies' ethical practices and global
competence and to prepare students for successful global health careers by advising, training and
speaking on strategic global partnerships, capacity building and creating effective, sustainable
programs.
The company is primarily driven by its sole employee, founder and president Katherine
Turner. Turners leadership of Global Citizen can be seen as both an organizational strength and

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a weakness. A strength is that she brings a deep understanding of global health issues and
international relationships, and provides a clear vision for the organizations work. Turner also
has a strong network of connections in the local and global health communities. She is an
adjunct professor at The Gillings School of Public Health at the University of North Carolina,
which gives her access to a steady stream of volunteers and interactions with many students who
will be future health leaders, as well as other faculty who are involved in global health initiatives.
Turner is also employed at Ipas, a global non-governmental organization dedicated to ending
preventable deaths and disabilities from unsafe abortion. Through this position she has access to
coworkers and clients who have global perspectives on health, and who are allies for creating
compassionate global citizens dedicated to raising the level of health worldwide. However, the
weakness of Global Health being run by only one part-time person is that their scope of work is
inherently limited. Turner is unable to deliver her curriculum as often or to as many audiences as
she would like. She has also been unable up to this point to do extensive evaluation to test the
long term outcomes of her curricula.
The primary opportunity now for Global Citizen to create systemic change to benefit
global health is that the political climate is currently very supportive of it. The U.S. is also
experiencing an increase in dialogue about racism and inequalities, brought into focus by two
recent cases in which white law enforcement officers killed unarmed black men. This may be
another opportunity for Global Citizen to promote its mission and vision, as American social
justice advocates have a renewed commitment to addressing racism and its consequences.
With this opportunity comes the threat that many people and organizations are now also
understanding how complex and slow-moving creating systems change can be. Even though
building awareness of global health needs and improving companies understanding of ethical

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issues will bring the systemic causes of health problems into focus, the increased focus does not
always bring about systemic change. A failure to bring about change after increasing global
awareness of a problem was seen with the Kony 2012 campaign that sought to remove Liberian
warlord Joseph Kony from power. The campaign was centered on a short YouTube video that
gained over 12 million views within its first five days of being uploaded. Joseph Kony became a
household name worldwide, and many people were newly outraged at the atrocities he
committed. But despite the increase in awareness, two years later Kony remains at large
(Sanders, 2014).
Another threat to Global Citizens success is the ethical dilemma that arises when a health
educator puts their limited resources forward to address systemic causes of a problem instead of
ameliorating the immediate health crises in front of them. However, although medical treatment
and other direct care is essential and often in short supply, the field of public health recognizes
the upstream determinants of health (Dorfman & Krasnow, 2014). Even though the outcomes of
systemic change are often not tangible for years to come, there is increasing recognition that the
solutions to the most burdensome public health problems will be guided by theory from behavior
and social sciences (Mabry, Olster, Morgan, & Abrams, 2008).
Part 2: Problem Analysis

Global health problems are widespread and varied. They are caused and perpetuated by
the interaction of systems like the economic system, the geopolitical system, and the aid
distribution system. It is impossible for a small organization like Global Citizen to singlehandedly bring change to an entire system. However, they can bring change to some of the
factors that create and reinforce these systems.

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A changeability matrix can help organizations decide where they are able to make the
most impact. Because Global
Citizen has the broad goal of
affecting positive change within
the systems that cause and
reinforce global health problems,
the points that are plotted on the
changeability matrix are the
contributing factors to these
Figure 2.1: Changeability matrix of factors that contribute to systemic

causes of global health problems
systems. These include people and organizations seeking political power or financial gain,
history, social norms, and apathy. The points are plotted along an x-matrix that represents the
ease of change, and a y-matrix that represents the importance of change. The farther into the
quadrant that represents easier and more important to change, the more impact the organization
can have addressing this issue. In the Changeability Matrix of Contributing Factors to Systems
(see Figure 2.1), the only contributing factor that falls within the easier and more important to
change quadrant is apathy.
The concept map below (Figure 2.2) illustrates the root causes of apathy, and illustrates
how it, along with other contributing factors, can create and/or reinforce the systems that cause
or exacerbate global health problems. By depicting the other systemic contributing factors, the
concept map shows that apathy does not impact global health problems alone. The concept map
also traces the root causes of apathy from the othering of global populations. Othering, a
term borrowed from sociology and feminist theory, describes the process of identifying people
who are thought to be different from the mainstream. Othering can reinforce positions of

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domination or subordination, or even be used to frame certain people as less than human
(Johnson et al., 2004). Othering leads to apathy toward advocating, donating, and acting to
improve global health (Gutsell & Inzlicht, 2010). The concept map shows some of the reasons
that people in the US may engage in othering global populations, including ethnic, cultural, or
religious biases, geographic distance from people, xenophobia, and the scale of many of the
health problems that global populations face (Lee, 2006).
Figure 2.2: Concept map: The impact of apathy on the systems that impact global health
Literature on Other Approaches to the Problem

To decrease apathy, Global Citizen must decrease the othering of global populations by
US health professionals and aid organizations, and among the people and governments that
support them through their advocacy and donations. Previous interventions have encouraged

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resistance to othering by using autoethnographies and literary theory, engaging in travel, and
teaching intercultural skills.
Autoethnographies are texts in which people undertake describing themselves in ways
that engage with representations that others have made of them (Tsalach, 2013).
Autoethnographies have been powerful tools for post-colonial writers because they break down
the borders between those who have traditionally been silent or othered, and those who have
done the silencing or othering. They also provide a site for critical investigation by embodying
readers with a sense of lived experience of otherness, which has the potential of bridging the
divide between social positions of individuals who would otherwise never meet (Tsalach, 2013).
Literary theory has been used along with autobiographical narratives from othered or
marginalized people in order to elicit empathy from the narratives audience and to move the
narrator from a place of marginalization into the center of their own story (Zyngier & Fialho,
2010). Post-modern thinkers argue that audiences of autobiographies have a natural tendency to
relate the narrative to their own histories in order to understand them better. This tendency
works in tandem with the chronotyping, or placement of a story within time and space, that
occurs whenever narrative or memory is fixed in language. By eliciting empathy and demarginalizing the narrator, autobiography and applied literary theory de-other the narrator in the
mind of the storys audience (Harden, 2000). The impact of narrative on empathy has also been
proven in literary fiction. A 2013 study found that literary fiction improves the readers capacity
to identify and understand others subjective states, which increases successful navigation of
complex social relationships by supporting the empathic responses that maintain them (Kidd &
Castano, 2013).

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Engaging in travel has also been used to improve cultural competency and demarginalized others. Pat Sikes, a professor from the United Kingdom, wrote that her experience
meeting sex workers in Thailand challenged and altered the perception of them that she had
developed through her research. When reflecting on her experience, Sikes quoted Edward Said,
writing findings from research should be based on concrete human history or experience, not on
donnish abstractions or on obscure laws or arbitrary systems, (Sikes, 2006). A literature review
on the benefits of college study abroad experiences also found that students often cited travel as
the reason that their perceptions and beliefs about other culture changed, and that it helped them
to develop new frameworks for understanding other cultures (Stone & Petrick, 2013).
College courses aimed at increasing intercultural competency focused around increasing
(a) open-mindedness, (b) cultural empathy, (c) emotional stability, (d) flexibility, and (e) social
initiative. Many of the professors instructing these courses found that the most effective method
available to them was creating a safe space by acting as a moderator while encouraging crosscultural dialogues among students in the room (King, Perez, & Shim, 2013). However, this
intervention was done at a culturally diverse institution, and would not be nearly as successful in
a more mono-cultural environment. Even so, it proves the value of creating safe space for
dialogue and the development of new cultural ideas.
Global Citizens Approach to Systems Change

The objective of Global Citizen is to decrease apathy among people and organizations in
the US and other developed nations toward people in developing nations. Apathy to advocating,
donating, and acting to improve global health contributes to the systems that cause and
perpetuate global health problems. Using strategies developed in the intervention methods

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above, Global Citizen will present narratives by people from other countries and from nondominant cultures in order to de-marginalize and de-other them.
Part 3: Internship Activities Plan/ Methods

To increase empathy and decrease apathy about global health among people and
organizations from the US and other developed nations, Global Health has hired an intern to
develop a video which will de-other people from other cultures and countries. The interns
activities are depicted in the logic model below (Figure 3.1). She will have access to camera
equipment and video editing software, and will recruit up to twenty participants for the video
through Katherine Turners contacts at Ipas. The intern will also recruit participants for a focus
group to test up to three drafts of the video in order to increase the effectiveness of the videos
message. After the video is created, the intern will modify Global Citizens website so that the
video is prominently displayed. This will allow all website visitors, as well as the groups that
Global Citizen consults with, to access and view the video. The short-term goals of this activity
will be over 50 views of the video within its first month live on the site. This will be followed by
a long-term goal of video viewers experiencing increased empathy and decreased apathy, leading
to the viewers increasing their advocacy, donations, and actions to improve global health.
Ultimately, this will contribute to improving the systems that cause global health problems, and
will improve health and create better health equity for worldwide populations.

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Figure 3.1 Global Citizen video creation logic model
Steps of Internship
The internship will focus around the creation and message targeting of the video, which
will be done using the Social Marketing and Response Tool. This will create three datacollection phases of the internshipthe first will be collecting interviews from the video
participants, the second will be conducting two focus groups, and the third will be gathering web
analytics on video views to evaluate the short-term outcome of the video.

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Materials
Materials will be developed during the internship process. They will include:
Photo releases for video participants
Video interview questions
Recruitment materials for focus groups
Focus group questions
Timeline of Internship
The GANTT charts on the following pages show the timeline for this internship.
Included in addition to the video tasks are a supporting task of improving Global Citizen
marketing materials, and a potential additional task of creating an evaluation tool for the Global
Citizen consultation materials.

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Video Tasks
December
January
February
Create storyboard for video (2 messaging options)
Review literature on
using story to
change social
x
norms/ increase
empathy/ de-other
Review examples
x
Storyboard drafts 1
x
Storyboard drafts 2
x
Final storyboards
x
Interview
x
participants
Create videos (2 messaging options)
Draft 1
x
Draft 2
Final
Focus group
Review literature on
x
using SMART
March
April
x
x

16
Recruit participants
Consent to
participate (and
record?)
Conduct 1st focus
group
Conduct 2nd focus
group
Disseminate
information on
message creation
process
x
x
x
x

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Marketing Tasks
December
Website
Create mock-ups of
2- 4 different site
platforms, with cost
and hosting
information included
Select platform
Transfer old web
materials to new site
Identify site features
from other site
examples that would
add value to site
Implement/ create
plan for
implementing
additional features
Brand Guide
Create 3- 4 color
palette examples;
select one for
marketing material
consistency
Select font family
using process above
Identify elements or
emotions for logo
Create plan for logo
design
Brochure
Find 5 examples of
marketing brochures
to draw from
Select elements
from website
materials to include
in brochure
Create brochure
Evaluation Tasks
January
February
March
April
x
x
x
x
x
December
January
February
March
April

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Review Curriculum Materials

Access course
materials (this will
help me to develop a
x
better feel for the
marketing materials
and video, as well)
Review course
learning objectives
Review current endof-course evaluation
materials
Observe 1 or more
classes
Create Evaluation
Plan
Begin to Draft
Evaluation
Instrument
x
x
x
x
x

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References
Brown, G. K. (2011). The influence of education on violent conflict and peace: Inequality,
opportunity and the management of diversity. Prospects, 41, 2, 191-204.
Bures, R. M., Mabry, P. L., Orleans, C. T., & Esposito, L. (2014). Systems science: A tool for
understanding obesity. American Journal of Public Health, 104(7), 1156.
Centers for Disease Control and Prevention. (2014). HIV/AIDS. Retrieved from
http://www.cdc.gov/hiv/statistics/basics/
Global Citizen, LLC. (n.d.). Retrieved from http://www.globalcitizenllc.com/
Dorfman, L., & Krasnow, I. D. (2014). Public health and media advocacy. Annual Review of
Public Health, 35, 293-306.
Greenberg, H., Raymond, S. U., & Leeder, S. R. (2011). The prevention of global chronic
disease: Academic public health's new frontier. American Journal of Public Health,
101(8), 1386-1391.
Gutsell, J. N., & Inzlicht, M. (2010). Empathy constrained: Prejudice predicts reduced mental
simulation of actions during observation of outgroups. Journal of Experimental Social
Psychology, 46, 5, 841-845.
Harden, J. (2000). Language, discourse and the chronotope: Applying literary theory to the
narratives in health care. Journal of Advanced Nursing, 31(3), 506-512.
Health as a Human Right. (2003). Anthropology News, 44, 5, 30.
The Hunger Project. (n.d.). Know your world: Facts about world hunger and poverty. Retrieved
from http://thp.org/knowledge-center/know-your-world-facts-about-hunger-poverty/

20
Johnson, J., Bottorff, J., Browne, A., Grewal, S., Hilton, B., & Clarke, H. (2004). Othering and
being othered in the context of health care services. Health Communication, 16(2), 253271.
Kidd, D. C., & Castano, E. (2013). Reading literary fiction improves theory of mind. Science,
342, 6156, 377-380.
King, P. M., Perez, R. J., & Shim, W. (2013). How college students experience intercultural
learning: Key features and approaches. Journal of Diversity in Higher Education, 6(2),
69-83.
Koplan, J. P., Bond, T. C., Merson, M. H., Reddy, K. S., Rodriguez, M. H., Sewankambo, N. K.,
Wasserheit, J. N., Consortium of Universities for Global Health Executive Board. (2009).
Towards a common definition of global health. Lancet, 373, 9679, 1993-5.
Lee, M. M. (2006). "Going Global": Conceptualization of the "Other" and Interpretation of
Cross-Cultural Experience in an All-White, Rural Learning Environment. Ethnography
and Education, 1, 2, 197-213.
List of Ongoing Conflicts. (2014). Retrieved from http://www.warsintheworld.com/?
page=static1258254223
Mabry, P. L., & Kaplan, R. M. (2013). Systems science: A good investment for the public's
health. Health Education & Behavior, 40, 1.
Mabry, P. L., Olster, D. H., Morgan, G. D., & Abrams, D. B. (2008). Interdisciplinarity and
systems science to improve population health. American Journal of Preventive Medicine,
35, 2, 2.

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Nelson, F. (2014). Ebola may be gruesome but its not the biggest threat to Africa. Retrieved
from http://www.telegraph.co.uk/news/worldnews/ebola/11167158/Ebola-may-begruesome-but-its-not-the-biggest-threat-to-Africa.html
Pike, I. L., Straight, B., Oesterle, M., Hilton, C., & Lanyasunya, A. (2010). Documenting the
health consequences of endemic warfare in three pastoralist communities of northern
Kenya: A conceptual framework. Social Science & Medicine,, 70, 1, 45-52.
Powles, J., & Comim, F. (2014). Public health infrastructure and knowledge. Retrieved from
http://www.who.int/trade/distance_learning/gpgh/gpgh6/en/
Sanders, S. (2014). The 'Kony 2012' effect: Recovering from a viral sensation. Retrieved from
http://www.npr.org/2014/06/14/321853244/the-kony-2012-effect-recovering-from-aviral-sensation
Schuchat, A., Tappero, J., & Blandford, J. (2014). Global health and the US Centers for Disease
Control and Prevention. Lancet, 384(9937), 98-101.
Sikes, P. (2006). Travel broadens the mind or making the strange familiar the story of a visiting
academic. Qualitative Inquiry, 12(3), 523-540.
Stone, M. J., & Petrick, J. F. (2013). The educational benefits of travel experiences: A literature
review. Journal of Travel Research, 52(6), 731-744.
Tsalach, C. (2013). Between silence and speech: Autoethnography as an otherness-resisting
practice. Qualitative Inquiry, 19(2), 71-80.
World Health Organization. (2014). Ebola virus disease. Retrieved from
http://www.who.int/mediacentre/factsheets/fs103/en/
World Health Organization. (2013). How many TB cases and deaths are there? Retrieved from
http://www.who.int/gho/tb/epidemic/cases_deaths/en/

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World Health Organization. (2003, January 1). WHO | Influenza. Retrieved from
http://www.who.int/mediacentre/factsheets/2003/fs211/en/
The World at War. (n.d.). Retrieved November 24, 2014, from
http://www.globalsecurity.org/military/world/war/
Worldwide action needed to address hidden crisis of violence against women and girls. (2014).
Retrieved from http://www.who.int/mediacentre/news/releases/2014/violence-womengirls/en/
Zyngier, S., & Fialho, O. (January 01, 2010). Pedagogical stylistics, literary awareness and
empowerment: a critical perspective. Language and Literature, 19, 1, 13-33.

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