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More Than Words – The Case for Cultural Sensitivity in Translation

This blog was written by Sandra Alboum, founder and CEO of Alboum Translation Services as part of Global Health Council’s Member Spotlight Series. Alboum Translation Services is a translation agency that serves nonprofits worldwide. Their clients include the World Health Organization, Elizabeth Glaser Pediatric AIDS Foundation, American Cancer Society, Johns Hopkins Bloomberg School of Public Health, Pathfinder International, and Planned Parenthood, as well as other organizations working in public health, education, the environment, human services, and arts and culture. For more information, visit www.alboum.com or contact Sandra at sandra@alboum.com. Alboum Translation Services is a Global Health Council 2018 member.

Tibetan nomadic women attend a maternal and child health education session © 2005 Aleksandr Dye, Courtesy of Photoshare

“Your auntie’s aunt.” Roughly translated from Mandarin to English, that’s how Chinese women refer to getting their period each month. Your auntie’s aunt arrives and then when she longer comes because of menopause, she goes on holiday. More than slang, this is how physicians also refer to women’s monthly cycles in conversations with patients.

Understanding this cultural nuance was critical to the success of one nonprofit’s recent global patient education campaign. The organization had embarked on an effort to educate women worldwide about early signs of ovarian cancer. US-based program managers felt strongly that all materials should use accurate medical terminology rather than colloquialisms, as the program sought to provide women with appropriate language to use when speaking with their doctors. Brochures and fact sheets were translated from English into six languages. When, as part of the quality control process, translations were back-translated into English, the less formal language of “your auntie’s aunt” and “holiday” were found. Program managers insisted these be changed – calling into question the overall quality of the translation. Translators and editors pushed back, however, citing the program’s goals as the reason for the non-medical terminology.

In the end, the translation team’s recommendations prevailed and the educational materials were published utilizing language that was truly understood by the intended audience. While not the terminology we’d use in the United States in English, it was the terminology that made the campaign the most effective and impactful in China.

Had translators used medical terminology in the ovarian cancer prevention campaign described, the materials would have been rendered useless before they were placed in a single patient’s hand. Terms like menstruation, menstrual cycle, and menopause would have not been understood as relevant to them – they would have been glossed over as something they’d never heard of and therefore never experienced. With this story in mind, and as you consider your own organization’s global campaigns, here are a few ways to ensure effective communications and materials.

1) Skip Google Translate (and other automated tools). You get what you pay for with a free tool. Professional translators bring the human element of communication – the understanding of context and cultural nuance that is essential to a quality translation. While fluency in both the original and target language is essential, translators who are familiar with the subject matter of the material being translated bring additional value to delivering an accurate, effective translation.

2) Know Your Audience. Spanish isn’t Spanish worldwide and even in the United States. Start by defining your audience – where will the material be used or where is your audience from? If you’re targeting European Spanish speakers, their dialect will be notably different from those hailing from Mexico or Ecuador. Also consider the reading level of your audience. If you’re talking to a population with lower (or no) education, their ability to understand complex material may be limited.

3) Consider Cultural Nuances. How one culture refers to a health condition is often notably different from another. Be flexible with both words and graphics to most effectively convey your message in another language or geography. In addition, review images to ensure they reflect the audience as well. There’s little value in a photograph of a white woman in shorts and a short-sleeved t-shirt on a tree-lined street in a communication being used in the Middle East where women traditionally cover their bodies and communities look markedly different that those in suburban America.

As with any marketing, advocacy, fundraising, or communications program, global campaigns and domestic programs targeting non-English speaking populations must consider the program goals, audience, materials, and budget for them to have maximum effectiveness.

Four Ways Global Health Organizations Can Correct the Gender Imbalance in Their Own Leadership—and Beyond

This blog post was originally posted on the IntraHealth International website. The post is written by Constance Newman, senior team leader on gender equality and health at IntraHealth International; P.K. Chama of the Catholic Medical Mission Board in Lusaka, Zambia; M. Mugisha of QD Consult Ltd. in Kampala, Uganda; C.W. Matsiko of MATSLINE Consult Ltd. in Kampala, Uganda; and Vincent Oketcho, Uganda country director at IntraHealth.

Image credit: IntraHealth International

Women make up the vast majority of the workforce in healthcare worldwide and in the field of global health, but relatively few fill senior leadership roles in these sectors. A new article published in Global Health, Epidemiology, and Genomics offers guidance on how global health organizations can help change this.

Gender stereotyping, discrimination and cultural roles often prevent women from reaching positions of highest authority, according to the authors of “Reasons behind Current Gender Imbalances in Senior Global Health Roles and the Practice and Policy Changes that Can Catalyze Organizational Change”.

For instance, women make up 75% of the health workforce in many countries, but only 25% of leadership roles. Only 31% of the world’s ministers of health are women. And at the 2015 World Health Assembly, only 23% of chief delegates of member state delegations were led by women.

Global health organizations face the same imbalances. While women make up the vast majority of global health students (up to 84%), they hold only 24% of global health faculty positions among the top 50 US universities and a quarter of directorships in global health centers.

But global health organizations can become beacons of analysis and change. They can also play a key role in helping us reach Sustainable Development Goal 5: to achieve gender equality and empower all women and girls.

The authors offer several key steps organizations can take to correct these imbalances, including:

Conduct participatory organizational gender analyses: These can help pinpoint the processes, mechanisms, and structures—such as glass ceilings and gender stereotypes related to reproductive roles—that keep women from rising to leadership roles. Governance leaders, human resources (HR) managers, and employees should all be involved and should share their findings widely.

Identify the harms of gender stereotyping and implement strategies to eradicate them. One example comes from a focus group response the authors received during a gender analysis in Zambia: “Men have a biological make-up that makes them vulnerable to appearance…” the male respondent said. “I think there are some cases where women are really suggestively dressed, and it is difficult because it creates an environment which is very hard…because men mostly, we go for what we see.”

Societal stereotypes like these make their way into the workplace and keep women from reaching leadership roles. Of course, changing such conceptions in society is a task beyond any one organization, the authors say, but the first step to organizational change is to challenge them. Organizations can raise awareness of the harmful effects of stereotypes at work and help build their employees’ capacity to challenge such stereotypes.

Use substantive equality principles in organizational governance and HR management. Setting targets, establishing quotas, taking steps toward affirmative mobilization and fairness can all mitigate the impact of discrimination and help correct gender imbalances.

Put special measures and enabling conditions in place. Consider the issue of paid family leave. Taking paternity leave, the authors write, “can put male employees who might opt for it at as much risk of being stigmatized as the female employees who, in leaving work early to work the ‘second shift’ at home, may be stigmatized as less productive and reliable. There are therefore built-in (organizational) cultural disincentives for both women and men to use these arrangements which must be addressed in communications and incentives for their use.”

Organizations should not design family leave on an individual basis, the authors say. Instead, they should create family-friendly policies for the long-term—and with a firm understanding of the gender dynamics at play.

Read the full article to learn more.

Youth Spoke Up to Step Up the Pace on NCDs

This blog was written by Victoria Watson, member of NCD Child’s Governing Council as part of Global Health Council’s Member Spotlight series. Victoria has been contributing to their youth engagement work since 2015. Outside of this work, she works as a policy coordinator at Cancer Care Ontario supporting screening program design. NCD Child is a global multi-stakeholder coalition championing the rights and needs of children, adolescents, and young people living with or are at risk of developing non-communicable diseases (NCDs). NCD Child is a 2018 Global Health Council member.

For the global health community, the start of the new year signals a time of escalated efforts around the NCD target in the Sustainable Development Goals (SDGs). In 2017 we saw unprecedented collaboration among governments, multilateral organizations, and civil society to prepare for the 3rd High-level Meeting (HLM) of the UNGA on NCDs. These synergies culminated at the end of 2017 during the Second Global Alliance Forum in Sharjah, UAE.  Among the 300+ delegates included more than 20 young advocates — a step in the right direction for putting youth needs at the forefront of NCD control priority-setting for years to come.

Turning the tides for NCD prevention and control in 2018

It is recognized that youth – children, adolescents, and young people – require unique healthcare services. This creates the imperative to carve out a space for their specific needs to be addressed within NCD target related commitments, policies, and dialogue to positively impact their health outcomes. To create such a space for youth, a committee led by NCD Child, alongside representatives from NCDFREE, IFMSA, the United Nations Major Group for Children and Youth, and others recruited 20 talented, diverse participants to join the conversation in Sharjah.  The Youth Planning Committee had a clear charge: identify practical strategies to engage young people before, during, and after the Forum.  We began with a pre-forum workshop which sought to identify shared priorities and approaches for ensuring youth have a seat at the table among civil society organizations and governments.  It was a great space to hear directly from our colleagues on why young people need to be included in both the making of policy and within policy.

Following energetic discussions, negotiation, and compromise, a set of 3 priorities were put forward in the Call to Action: Youth, NCDs, & 2018.

1) Ensure universal and equitable access to high-quality, affordable, age-appropriate health care
2) Scale up financing and resources for prevention, management, and treatment of NCDs across the life-course
3) Raise awareness of children, adolescents, and young people, and sensitize government officials about the risk factors, prevalence, and impact of NCDs

The call to action and the collaboration that informed it signifies a milestone in moving youth from the periphery to the center of global dialogue. But can a milestone be transformed into sustained action? 

Sustaining Engagement

As we planned for our workshop, a question loomed over us: how can we leverage the renewed sense of enthusiasm generated by the forum to ensure our priorities and activities have sustained impact in 2018, for the UN HLM and beyond?

We did not want our call to action to be lost in a vacuum of an ongoing dialogue. We wanted to ensure our champions were given the resources and support to continue their engagement in advocating for, and creating change around NCD prevention and control. Most of all, we wanted to continue the heightened level of collaboration and action established among participants during the workshop.

The planning committee spent a lot of time thinking about sustainability, next steps, and going beyond ‘just talking.’  A simple outline helped guide our post-forum efforts – both for the participants and the many youth champions who were not in Sharjah.  Before the event, NCD Child developed Youth Voices Connect, an online community for youth advocates to share ideas on a real-time basis. Using insights gained from the online community and our own experiences, the committee identified four core principles to help us ensure the shared priorities and activities (developed in Sharjah) become a reality in 2018.

Photo credit: NCD Child

What’s Next: Taking Action

Along with shared priorities, the Call to Action outlines four key action items, linked to the shared priorities, for youth and relevant stakeholders.  The action items align with our core principles for sustained, meaningful impact.  To continue the conversation and ensure the youth component is not buried in the follow-up, we’ve encouraged our delegates to write blogs from their experience.  We want to take our communications further and help develop aligned messages for youth leaders to disseminate locally.  A policy working group is in the making – resources will be developed and reviewed by youth.  We need more young leaders to speak up about NCD financing; to help facilitate, a simple-language toolkit will be created ahead of the April financing meeting.  Finally, we need to be speaking to our government leaders more often and with more concise, effective talking points.

The committee is moving forward with four small working groups to take these ambitious activities from paper to reality. Being successful requires engaging youth stakeholders from all corners of the globe, not only those who attended the forum, and supporting such youth as we pursue meaningful, sustained action in 2018.

Photo credit: NCD Child

What can you do to support the inclusion of youth?

This commitment to engaging youth in the transformation of NCD prevention and control requires action from all sectors. Having youth voices formally recognized by NCD stakeholders and brought in to dialogue is a critical step in ensuring our needs can be represented appropriately in policy.

Here are a few ways individuals and organizations can contribute:

1) Invite young people to author blogs for your website; share the piece broadly with your network
2) Put youth on the program of every high-level side event, conference, or panel you’re hosting – engage early and ensure they are on the agenda
3) Emphasize the importance of youth inclusion in discussions with the Ministry of Health, civil society, and private sector
4) Connect with NCD Child for additional support and resources.

Is World Health Organization (WHO) walking the talk on gender equality?

The Reflections on WHO’s Global Program of Work (GPW13) was written by  Dr. Roopa Dhatt, Dr. Kelly Thompson and Ann Keeling of Women in Global Health and was originally posted on their site. Graphics were designed by Caity Jackson, Women in Global Health. Established in 2015, Women in Global Health was founded with the values of being a movement. WGH works with other global health organizations to encourage stakeholders from governments, civil society, foundations, academia and professional associations and the private sector to achieve gender equality in global health leadership in their space of influence. 

Graphics: Caity Jackson, Women in Global Health

Women in Global Health proposed a series of strategies to achieve gender parity in global health leaders within WHO and to strengthen gender equality in WHO’s work. Below is an assessment of the GPW13 from a gender lens based on Women in Global Health’s recommendations. They submitted 30+ recommendations – this GPW has integrated 23 out of 30 recommendations, 76% of all recommendations on gender equality have been integrated. Women in Global Health acknowledge that most of the points that have not been addressed are mainly operational in nature (5 points), therefore 96% of recommendations for strategic planning have been integrated.
While this is an ambitious agenda with many priorities, it is one we can afford to fail at—leaving no one behind, includes achieving gender equality. Their Call to Action to WHO and its Members States, is in the hands of Members States. Women in Global Health supports the most recent draft of GPW13, with the clear expectations that steps will be taken to ensure sufficient funding streams are aligned for the achievement of gender equality and gender mainstream strategies outlined in the GPW13.

Reflections on WHO’s Global Programme of Work (GPW13) Advanced Draft

Women in Global Health’s Overall Following of the GPW13

142nd WHO Executive Board Session Updates

 

Some highlights:

1) GPW marks a step change for WHO on gender equality
2) WGH is delighted that WHO has listened to civil society on GE, (24 out of 30 recommendations, 76% of all their recommendations have been integrated, 96% of recommendations for strategic planning have been integrated).
3) Delivery will need serious funding.
4) WHO has stepped up. Now there is a need to see similar level of commitment from the Member States, multi-laterals working in health and key donors and civil society if global targets – SDGs and UHC – are to be met.
5) WGH will support positive change because Gender Equality = smart global health.

WGH reiterates to WHO DG Dr. Tedros, the GPW13 team, Member States and to the global health community that women are agents of change, drivers of health at all levels–we must shift our mindsets to ensure our strategies realize this and we approach our solutions differently, with greater investment in gender parity and diversity in our leadership for a smarter, more sustainable global health.
142nd WHO Executive Board (EB) Session Updates

Global Health Council (GHC) is hosting a delegation to the 142nd Session of the World Health Organization (WHO)’s Executive Board (EB) Session. The WHO EB Session is currently in progress in Geneva, Switzerland and will conclude on January 27The following updates were provided by Danielle Heiberg, Senior Advocacy Manager, Global Health Council.

142nd WHO EB Meeting in session. Photo credit: Danielle Heiberg

MORE INFORMATION ON THE WHO EB SESSION

VIEW JOINT EB STATEMENTS FROM GHC & MEMBERS

Reflections on WHO’s Thirteenth Global Programme of Work (GPW13) – Women in Global Health

Make sure to follow @GlobalHealthOrg on Twitter to stay informed of live updates from our delegates and partners attending the Session.

Day 3: Midway Through

The EB covered several topics today: Public Health Preparedness and Response (NSA statements); Polio Transition; Health, environment and climate change; and Addressing the global shortage and access to medicines and vaccines.

Matt Robinson with GHTC provided a short write up on the last issue:

The afternoon session on access to medicines produced far less controversy than expected. Though the topic remains contentious overall, the late introduction of a resolution asking WHO to spend the next year developing a “roadmap” for its work on access to medicines appeared to defuse any simmering tension by providing the opportunity for more dialogue behind closed doors. The session reached such consensus that New Zealand actually proposed closing debate without hearing statements from non-EB members, unless there were any objections. As a result of the resolution, expect this debate to continue over the coming year.

GHC members presented statements on preparedness and responsepolio transition and access to medicines.

The GHC delegation met with members of the U.S. delegation at the WHO EB Session.

In addition, GHC’s delegation met with Garrett Grigsby and Jenifer Healy from the Office of Global Affairs at the U.S. Department of Health and Human Services.

Tomorrow, (Thursday, January 25), the debate will begin with the Global strategy and action plan on public health, innovation, and intellectual property, followed by the agenda items on the high-level meetings on NCDs and TB. The EB will be in session during the day, as well as the evening in order to get through a number of agenda items.

 

 



Day 2: Public Health Preparedness and Response

Today the Executive wrapped up agenda item 3.1 on the draft Global Programme of Work. GHC read a statement that included a few areas of concern specifically on health workforce, WASH and polio transition.

The EB also considered WHO reform, as well as agenda item 3.3. on Public Health Preparedness and Response. The session ended later so that all Member States could provide their interventions. Tomorrow morning (Wednesday, January 24) the session will open with statements from NSAs. PATH will read a statement on behalf of GHC, AAP, PATH, GHTC, and IDSA.

Philippe Guinot, PATH, reads the EB statement on Agenda 3.3 Public Health Preparedness and Response on behalf of GHC, AAP, PATH, GHTC, and IDSA.

The U.S. government, led by Garrett Grigsby from the Office of Global Affairs at the Department of Health and Human Services, delivered a statement on preparedness and response that touched on several ideas (special thanks to Annie Toro for the summary):

1) Highlighted the importance for the Joint External Evaluations (JEEs) to drive preparedness and HSS
2) Enforced standard operating procedures to ensure consistency across regions
3) For health emergencies, a dashboard should be shared with member states
4) R&D – work with all partners in emergency contexts
5) Full IHR implementation is key and an obligation of WHO
6) Consider the important role of sectors outside of health for security purposes
7) Consider issues regarding biosafety as well as national and financial issues for biosecurity

To find out what is next on the agenda, follow the daily journals (published every morning, Geneva time) here: http://apps.who.int/gb/e/e_eb142.html.

 



Day 1: Tedros’ Dialogue with Member States

The WHO Executive Board (EB) session kicked off with a dialogue between Director-General Dr. Tedros Adhanom Ghebreyesus and Member States. Dr. Tedros’ speech focused on three key elements: Universal Health Coverage (UHC), Global Health Security (GHS), and what the WHO of the future looks like.

A few highlights:

1) Dr. Tedros will send letters to the heads of all Member States challenging them to commitment to three concrete steps to achieve universal health coverage. He will ask Member States to make their commitments at the upcoming World Health Assembly (WHA) in May.
2) Since the start of his tenure, Dr. Tedros has been working to strengthen foundations of organization; developing a plan to transform that includes a “rethink” of resource mobilization for the agency; and building strong leadership including achieving gender parity in top ranks and geographical diversity.
3) Dr. Tedros put out a call to Member States to commit in-kind supply donations and personnel to a “Global Health Reserve Army” that could be ready to respond to an outbreak within 72 hours.
4) In regards to funding for WHO, Dr. Tedros spoke several times about the need for “unearmarked” funds to allow the agency greater flexibility in addressing priorities.

Dr. Tedros’ comments should be available here.

Before adjourning for the day, the EB began member statements on agenda item 3.1 the Global Program of Work. On the second day, the remaining 15 Member States will give their statements followed by non-state actors.

We expect several statements to be read by our delegation today on the Global Program of Work, Public Health Preparedness and Response, and possibly, Polio Transition Planning.