2014|Facilitator’s Guide
CULTURE, BELIEFS,
VALUES AND ETHICS
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]
This publication was made possible in part through the support provided by the United States
Agency for International Development (USAID). The opinions expressed herein are those of
the author(s) and do not necessarily reflect the views of USA ID or the US Government.
USAID reserves a royalty-free nonexclusive and irrevocable right to reproduce, publish, or
otherwise use, and to authorize others to use the work for Government purposes
.
Preface
“One Health” is an important global activity based on the concept that
human, animal and environmental/ecosystem health are interdependent, and
professionals working in these areas best serve the population by collaborating
to better understand all the factors involved in disease transmission,
ecosystem health, the emergence of novel pathogens and emerging zoonotic
agents, as well as environmental contaminants and toxins that are capable of
causing substantial morbidity and mortality, and impacting on socioeconomic
growth, including in less developed countries.
This CULTURE, BELIEFS, VALUES AND ETHICS Module is part of a
complete series of One Health educational and training documents designed
to be used in whole or in part, and to be modified as needed to serve as a
context- and culturally-relevant source of information for teaching
undergraduate students and university graduate students, and for training
workshops focused on One Health professionals responsible for human,
domesticated animal, wildlife and ecosystem/environmental health. The goals
are to:

increase exposure to and improve cross-sectoral and inter-professional
collaboration on key disease surveillance and disease outbreaks;

provide practical strategies useful for field investigations of disease
outbreaks, and a realistic exposure for students and faculty interested
in emerging infectious diseases, including emerging zoonotic
infectious agents, newly identified infectious agents capable of causing
pandemic threats, disease management and public awareness
campaigns, environmental and ecosystem health; and

improve cooperation among national, regional and district-level
government health officials interested in the One Health principle,
along with multilateral health agencies (such as the World Health
Organization [WHO], the Food and Agriculture Organization of the
United Nations [FAO], and the World Organisation for Animal
Health [OIE]), as well as non-governmental organizations (NGOs)
and private industry.
For more information
about this course, contact:
Stanley Fenwick
Regional Technical
Director RESPOND
Stanley_Fenwick@dai.com
Felicia B. Nutter, DVM,
PhD, RESPOND Project
Senior Technical Officer
Tufts University
+1 508 887 4921
Felicia.Nutter@tufts.edu
Roberta Talmage
TRG, Inc.
Organizational
Development & Training
Specialist
Arlington, VA 22203
+1 703-875-8909
rtalmage@trg-inc.com
This complete set of One Health modules can be used individually by
professors and trainers, but all users are encouraged to begin the activity by
consulting the this module, the introductory module, to provide an
appropriate context and background.
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All of the training material represents contributions by the faculty and leadership of the Southeast Asia
One Health University Network (SEAOHUN), and the input of technical and managerial support from
the partners of the USAID’s RESPOND Project, part of the larger Emerging Pandemic Threats (EPT)
program, including Tufts University, University of Minnesota, Training Resources Group (TRG),
Ecology and Environment, Inc. (E & E), and). Development of these training materials would not have
been possible without the contributions of the following individuals and groups:
Southeast Asia One Health University Network (SEAOHUN)
 Dr. Abu Tholib Aman, Universities Gadjah Mada, Indonesia
 Mr. Irwin Fernandez Chavez, Mahidol University, Thailand
 Dr. Ede Surya Darmawan, Universitas Indonesia, Indonesia
 Dr. Latiffah Hassan, Universiti Putra Malaysia, Malaysia
 Dr. Nongyao Kasatpibal, Chiang Mai University, Thailand
 Dr. Sumalee Lirtmunlikaporn, Chiang Mai University, Thailand
 Dr. Sarmin MP, Universities Gadjah Mada, Indonesia
 Dr. Mohd Rizal Abdul Manaf, Universiti Kenbangsaan Malaysia, Malaysia
 Dr. Roslaini Bin Abd. Majid, Universiti Putra Malaysia, Malaysia
 Dr. Walasinee Moonarmart, Mahidol University, Thailand
 Dr. Pham Hong Ngan, Hanoi University of Agriculture, Thailand
 Dr. Mohd Sham Bin Othman, Universiti Kenbangsaan Malaysia, Malaysia
 Dr. Surachai Pikulkaew, Chiang Mai University, Thailand
 Dr. Trioso Purnawarman, Bogor Agricultural University, Indonesia
 Dr. Agik Suprayog, Bogor Agricultural University, Indonesia
 Dr. Metawee Thongdee, Mahidol University, Thailand
 Dr. Kriangkrai Thongkorn, Chiang Mai University, Thailand
 Mr. Luu Quoc Toan, Hanoi School of Public Health, Thailand
 Dr. Ronald Enrique Morales Vargas, Mahidol University, Thailand
 Ms. Le Thi Thanh Xuan, Hanoi Medical University/Institute for Preventive Medicine and Public Health,
Thailand
RESPOND Project, USAID Emerging Pandemic Threats (EPT) Program
Development Alternatives International (DAI): Dr. Douglas Hatch, Ms. Pornthip Rujisatian,
Environment and Ecology, Inc. (E&E): Ms. Louise Flynn
University of Minnesota: Dr. Jeein Chung, Dr. Karin Hamilton
Tufts University: Dr. Stanley Fenwick, Dr. Felicia Nutter, Dr. Raymond Hyatt, Dr. Jennifer Steele
Training Resources, Inc. (TRG): Ms. Kimberly Kennedy, Ms. Roberta Talmage
The following attribution should be used by anyone copying materials or content from the One Health
modules series:
One Health Educational Module, Southeast Asia One Health Network (SEAOHUN), 2014
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SEAOHUN One Health Course - Facilitator’s Guide
Module: Culture, Beliefs, Values and Ethics
Module Description This module provides learners with an understanding of culture, beliefs, values
and Learning
and ethics at the individual and societal levels, which is critical when working
Outcomes
across disciplines and contexts to achieve One Health goals. Key outcomes of
this module are to:
 Understand, analyze, appreciate and respect social, religious and
historical diversity among individuals, within societies, and across
cultures.
 Know how to work professionally with One Health stakeholders
across sociocultural differences to develop and implement One Health
interventions.
Target Learner
Undergraduate and Graduate University Students; or
One Health Partners, Practitioners and Professionals
Learning Map
Framework for
Understanding How
Culture Shapes Illness,
Health Care and Wellness
Beliefs
Adapt One Health
Interventions to be
Effective in Local
Cultures
Define Personal Values
and Professionalism
Impact of Cultural Beliefs
about Gender and
Implications for One
Health Initiatives
Self-Assess
Cultural Beliefs
Create Trust Across
Cultures
Impact of Cultural Beliefs
about Animals and
Implications for One
Health Initiatives
Impact of Cultural Beliefs
about Environment and
Implications for One
Health Initiatives
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Module: Culture, Values, Beliefs and Ethics
Module Competencies
Competency #1
Identify and interpret local
norms, wisdom and culture
about human, animal and
environmental health.
Learning Objectives to Develop Competency
Understand and distinguish different cultures and beliefs about
human and animal health and health care, and the environment and
the impact that these beliefs have on One Health initiatives by:
 Analyzing local cultures and their beliefs about illness,
medical care and health.
 Understanding the roles of health care providers, healers
and leaders in health care decision-making within the
context of specific cultures.
 Identifying common and specific (local/regional) cultural
norms and sensitivity issues around health/health care,
animals and the environment.
Competency #2
Learning Objectives to Develop Competency
Generate trust among the
community within One
Health interventions.
Understand personal beliefs about health and health care and how,
as a One Health practitioner, you can adapt One Health
interventions to be effective in local cultures and belief systems by:

Being aware of one’s own culture and beliefs.

Demonstrating familiarity with local languages and/or
working with a translator, local leaders and/or cultural
guides.

Understanding and practicing gender diversity.

Adapting disease management to cultures, beliefs and
practices in order to effectively involve various ethnic
groups in outbreak areas.

Demonstrating an understanding of cultural norms.

Showing respect for existing cultural values during field
work.
Competency #3
Learning Objectives to Develop Competency
Demonstrate values, ethics
and professionalism in
planning and implementing
One Health interventions.
Define personal values, code of conduct and response to ethical
situations in order to model One Health professionalism by:
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
Articulating personal values.

Reviewing professional code of conduct for respective
discipline.

Identifying ethical issues that occur in One Health
interventions and determining and practicing the
appropriate professional responses.

Understanding ethical issues in relation to: human subjects’
protection, voluntary participation in studies/surveys,
confidentiality, privacy, institutional review boards, etc.
SEAOHUN One Health Course - Facilitator’s Guide
Module Overview
Time
Topic
Materials
Module PowerPoint
Computer, LCD projector,
screen/blank wall
 Handouts
 Student Guide
 Module PowerPoint
 Computer, LCD projector,
screen/blank wall
 Student Guide
 Module PowerPoint
 Computer, LCD projector,
screen/blank wall
 Student Guide
 Module PowerPoint
 Computer, LCD projector,
screen/blank wall
 Flipchart or whiteboard and
markers
 Article
 Student Guide
 Module PowerPoint
 Computer, LCD projector,
screen/blank wall
 Flipcharts with quotes
 Student Guide
 Module PowerPoint
 Computer, LCD projector,
screen/blank wall
 Internet access
 Student Guide
 Module PowerPoint
 Computer, LCD projector,
screen/blank wall
 Student Guide
 Computer, LCD projector,
screen/blank wall
 Module PowerPoint
 Student Guide
 Handout
 Student Guide


75 Minutes
Introduction to Culture and Health Beliefs
90 Minutes
Cultural Dimensions and Models
135 Minutes
Culture and Gender
90 Minutes
Culture and Animals
60 Minutes
Culture and the Environment
600 Minutes
Creating Trust Across Cultures - Field
Observation
270 Minutes
Personal Values and Professionalism
60 Minutes
Protection of Human Subjects, Confidentiality
and Voluntary Participation
60 Minutes
Learning Reflections and Evaluation
 Note: Times include in-class assignments. To reduce classroom time, assignments may be given as
homework.
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Module: Culture, Values, Beliefs and Ethics
Facilitator Background Resources
Additional Resources
Altman, I. and Chemers, M. M. (1984). Culture and Environment (Environment and Behavior). United
States: CUP Archive.
Dolins, F. L. (1999). Attitudes to Animals: View on Animal Welfare. Ann Arbor: University of Michigan.
Hall, E. (1976). Beyond Culture. United States: Anchor Books.
Hofstede, G. (2010). Cultures and Organizations: Software of the Mind. United States: McGraw-Hill.
Trompenaars, F. and Hampden-Turned, C. (2011). Riding the Wave of Culture: Understanding Diversity in
Global Business. United States: McGraw-Hill.
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SEAOHUN One Health Course - Facilitator’s Guide
INTRODUCTION TO CULTURE AND HEALTH BELIEFS
Learning Objective:
Type of Learning:
Timing:
Equipment and
Materials:
Understand and distinguish the differences in cultures and beliefs about
health care, animals and the environment and the impact that these beliefs
have on One Health initiatives by:
 Analyzing local cultures and their beliefs about illness, medical
care and health;
 Understanding the roles of health care providers, healers and
leaders in health care decision-making with the context of specific
cultures.
 Identifying common and specific (local/regional) cultural norms
and sensitivity issues around health/health care, animals and the
environment
Large Group; Role Play Activity; Individual Reflection
75 Minutes
 Computer, LCD Projector, Screen/Blank Wall
 Flipchart or whiteboard and markers
 Module Presentation
 Handout – Minankabau and One Health Practitioner Role Cards
 Student Guide
Detailed Facilitator Notes
15 Minutes Give a quick overview of the competencies and activities in the module.
Lecture
Culture, Beliefs, Values and Ethics Module Core Competencies
 Identify and interpret local norms, wisdom and culture about human,
animal and environmental health.
 Generate trust among the community within OH interventions.
 Demonstrate values, ethics and professionalism in planning and
implementing One Health interventions.
75 Minutes
90 Minutes
135 Minutes
Topics and Activities
Introduction to Culture and Health Beliefs
Cultural Dimensions and Models
Culture and Gender
90 Minutes
Culture and Animals
60 Minutes
Culture and the Environment
600 Minutes
Creating Trust Across Cultures - Field Observation
270 Minutes
Personal Values and Professionalism
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Module: Culture, Values, Beliefs and Ethics
60 Minutes
60 Minutes
Topics & Activities Continued
Protection of Human Subjects, Confidentiality and
Voluntary Participation
Learning Reflections and Evaluation
30 minutes Culture and Health Care Beliefs Simulation
Begin the session with a simulation. Ask students to turn to the “Orangutan
and Minangkabau” simulation background information in their Student
Large Group
Guides; give them a few minutes to read it.
Activity
Simulation Background Information:
Orangutans and the Minangkabau
The future of the orangutan (Pongo spp.) in Sumatra is far from secure
despite the species’ high profile and media attention. The traditional threat
to the orangutan has been widespread logging, but the continuing
conversion of their remaining habitat for oil palm (Elaeis guineensis) is
hastening the orangutan’s extinction in the wild. This situation is driven
by a robust global market for palm oil as a vegetable oil and biofuel. In
tackling this conservation problem, therefore, economic factors cannot be
overlooked. Of significance are the high opportunity costs of orangutan
conservation and market failures associated with the public-goods nature
of the orangutans’ forest habitat. Conservationists should consider these
constraints when formulating remedial action.
There have been reports that the local human community in Kalimantan
living near oil palm plantations are suffering from higher than expected
rates of infection due to Mycobacterium tuberculosis. Some individuals believe
this problem may be due to tuberculosis (TB) being transmitted to
humans from orangutans being kept as pets (after being orphaned as a
result of the forest clearing for plantations), so additional scientific studies
are needed to determine whether the actual origin of this outbreak was TB
infection among humans. The Indonesia Government is concerned
whether a Minangkabau community in Saluang village in Sumatera is also
vulnerable to such zoonoses because they, too, keep orphaned orangutans
as pets. The government has assigned a group of One Health practitioners
to assess the situation in Saluang village.
Show a short video clip of orangutans:
 Getting Up Close with Orang Utan, Semenggoh, Sarawak, Malaysia
http://www.youtube.com/watch?v=l9iRQqu5_-E
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SEAOHUN One Health Course - Facilitator’s Guide
Assign two-thirds of the class the role of the Minangkabau people of the
Saluang village and assign the remaining one-third of the class the role of One
Health practitioners. Designate one area of the classroom as the Saluang village
and send the Minangkabaus to the village, handing them the Minangkabau
handout cards as they enter the village. Make sure that the Minangkabau do not
share the information on their cards with the One Health Team.
Then designate an area (preferably in a different room) for the One Health
Team Command Center and send the One Health practitioners to that area.
Hand out the One Health Team cards to the One Health practitioners and
have the students select specific One Health Team roles (e.g., veterinarian, field
health worker, epidemiologist, environmental health specialist, ecologist,
anthropologist or economist). They should prepare a team that will best meet
the challenges based on the somewhat limited information that they have been
provided.
Tell the groups that they each have 10 minutes to study their roles and prepare
for the One Health visit to the village. After 10 minutes has passed, bring the
One Health Team into the village and allow the groups to interact for 20
minutes.
 Note: While the students, particularly the One Health practitioners, might
ask to have more information about the scenario or what they need to do
as a One Health Team, it is important not to share additional details.
During the interaction, write notes of your observations of the interaction
and make sure the items you observed are mentioned during the
discussion.
25 Minutes Reconvene the group and ask the One Health practitioners to reflect on and
answer the following questions:
 Were you successful in getting permission to interview each family and
Large Group
do a TB screening? (Note: Good point to discuss whether teams
Discussion
discussed clearly, in local language, the purpose of the activity to headof-household, that participation was voluntary [interview and TB
screening], and that family had right to refuse to participate).
 If yes, how did you approach community members and what made you
successful?
 If not, what do you think were the stumbling blocks?
 What did you learn about the Saluang village culture? Who makes the
decisions and what is the protocol for approaching them?
 How did the different One Health practitioners (e.g., veterinarian,
health care worker, ecologist, etc.) work together?
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Module: Culture, Values, Beliefs and Ethics
Ask the students who were in the Saluang community:
 What were your reactions to the One Health Team?
 What did the One Health Team do that made you trust them?
 What could the One Health Team have done to better gain your trust?
Ask the whole class:
 From your perspective as a One Health practitioner, what did this
activity demonstrate about working with people from a different or
new culture?
 How would the simulation have been different if this was a patriarchal
culture?
 What skills and knowledge are required before working with a local
community? How might you develop these skills or obtain necessary
information?
5 Minutes
Individual
Reflection
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Have students write down their personal reflections on the following questions
in their Student Guides.
 What surprised you about your behavior during the activity?
 What surprised you about the behavior of others during the activity?
 What are your key learnings or take-aways from the activity?
 Why did individuals keep orangutans as pets, and/or were there any
socioeconomic benefits, perceived health risks, etc.?
SEAOHUN One Health Course - Facilitator’s Guide
CULTURAL DIMENSIONS AND MODELS
Learning Objective:
Type of Learning:
Understand and distinguish different cultures and beliefs about health and
health care, animals and the environment and the impact that these beliefs have
on One Health initiatives by:
 Analyzing local cultures and their beliefs about illness, medical care and
health.
 Understanding the role of health care providers, healers and leaders in
health care decision-making within the context of a culture.
 Identifying common and specific (local/regional) cultural norms and
sensitivity issues around health/health care, animals and the
environment.
Lecture; Small and Large Group Discussions; Individual Reflection
Timing:
90 Minutes
Equipment and
Materials:





Pre-class
Assignment
Computer, LCD projector, screen/blank wall
Module PowerPoint
Student Guide
Read Article, “Cultural Health Attributions, Beliefs and Practices”
Read Article, “Indigenous Healers in Southeast Asian Refugee
Communities”
Detailed Facilitator Notes
Pre-work
30 Minutes Tell students to read the following articles prior to class:
 “Cultural Health Attributions, Beliefs, and Practices: Effects on
Healthcare and Medical Education” (Lisa M. Vaughn, Farrah Jacquez
and Raymond C. Baker)
 “Indigenous Healers in Southeast Asian Refugee Communities”
(Janey Egawa and Nathaniel Tashima)
30 minutes Understanding Culture
Open this session by asking the class: “How would you define culture?”
Lecture
Give the short lecture that reviews the following key points:
 Definitions of Culture
 The Iceberg Model
 Three Models for Understanding Culture - Hofstede, Trompenaars,
Hall
See the Facilitator Quick Notes section following this session for
background reading on the items outlined above.
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Module: Culture, Values, Beliefs and Ethics
After the presentation, guide the learners through a group discussion using
the following questions:
 Is it possible to truly understand a culture outside of your own? Why
or why not?
 In determining the behaviors and values of a culture, how can we
avoid stereotyping?
 How are the cultural models similar? Different?
 Do you think these models are applicable to gaining cultural insight
into Southeast Asian communities?
 How could you apply these models to beliefs about health/heath care,
animals and the environment?
Large Group
Discussion
15 Minutes
Individual
Reflection
My Own Iceberg
Ask students to draw an iceberg of their culture in their Student Guides. Have
them describe as many elements as possible that are above the surface, just
below the surface and at the deepest levels of their culture. They should focus
on the elements that have the most impact on their individual beliefs about
illness, wellness, health care, animals and the environment.
15 Minutes In small groups, have each student share his/her “iceberg,” focusing on
sharing beliefs about illness, wellness, health care, animals and the
Small Group
environment. Have the groups compare and contrast how each views their
Debrief
culture.
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SEAOHUN One Health Course - Facilitator’s Guide
Facilitator Quick Notes - Definitions of Culture
Retrieved from various sources
Definitions of Culture

Culture is that complex whole which includes knowledge, belief, art, law, morals, custom and any
other capabilities and habits acquired by man as a member of society. (Edward Taylor, 1871)

Culture is the capacity for constantly expanding the range and accuracy of one’s perception of
meanings. (John Dewey, 1916)

Culture consists of patterns, explicit and implicit, of and for behavior acquired and transmitted by
symbols, constituting the distinctive achievement of human groups, including their embodiment in
artifacts; the essential core of culture consists of traditional (i.e., historically derived and selected) ideas
and especially their attached values; culture systems may, on the one hand, be considered as products
of action, on the other, as conditioning elements of further action. (Kroeber and Kluckhold 1952)

Culture means the whole complex of traditional behavior which has been developed by the human
race and is successively learned by each generation. A culture is less precise. It can mean the forms of
traditional behavior which are characteristics of a given society, or of a group of societies, or of a
certain race, or of a certain area, or of a certain period of time (Margaret Mead, 1973)

Culture is the software of the mind. (Hofstede 1997)
Culture and the Iceberg Metaphor

Surface culture is above the surface, or what
we can see.

Deep Culture is just below the surface and
includes unspoken rules, behaviors and
emotions.

Deepest Culture is value-based and intensely
emotional.
Three Models by Researchers and Thought Leaders to Help Us Understand “Culture”
Geert Hofstede
Geert Hofstede is an author social psychologist, former IBM employee, and Professor Emeritus of
Organizational Anthropology and International Management at the University of Maastricht in the
Netherlands. Additional information available online at, http://www.geerthofstede.nl/.
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Module: Culture, Values, Beliefs and Ethics
Concepts Dr. Hofstede has championed include (see Topic #s 1–5 on the next page):
1. Power distance index (PDI) - “Power distance is the extent to which the less powerful members of
organizations and institutions (like the family) accept and expect that power is distributed unequally.”
Cultures that endorse low power distance expect and accept power relations that are more
consultative or democratic. People relate to one another more as equals regardless of formal positions.
Subordinates are more comfortable with and demand the right to contribute to and critique the
decision-making of those in power. In high power distance countries, the less powerful accept power
relations that are more autocratic and paternalistic. Subordinates acknowledge the power of others
simply based on where they are situated in certain formal, hierarchical positions. As such, the power
distance index Hofstede defines does not reflect an objective difference in power distribution, but
rather the way people perceive power differences.
2. Individualism (IDV) vs. collectivism – These concepts characterize “the degree to which
individuals are integrated into groups.” In individualistic societies, the stress is put on personal
achievements and individual rights. People are expected to stand up for themselves and their
immediate family, and to choose their own affiliations. In contrast, in collectivist societies, individuals
act predominantly as members of a life-long and cohesive group or organization. (Note: “The word
collectivism in this sense has no political meaning: it refers to the group, not to the state.”) People
have large extended families, which are used as a protection in exchange for unquestioning loyalty.
3. Uncertainty avoidance index (UAI) – The UAI indicates “a society’s tolerance for uncertainty and
ambiguity.” It reflects the extent to which members of a society attempt to cope with anxiety by
minimizing uncertainty. People in cultures with high uncertainty avoidance tend to be more emotional.
They try to minimize the occurrence of unknown and unusual circumstances and to proceed with
careful changes step-by-step by planning and by implementing rules, laws and regulations. In contrast,
low uncertainty avoidance cultures accept and feel comfortable in unstructured situations or
changeable environments and try to have as few rules as possible. People in these cultures tend to be
more pragmatic and they are more tolerant of change.
4. Masculinity (MAS) vs. femininity – These concepts illustrate “the distribution of emotional roles
between the genders.” Values in masculine cultures are competitiveness, assertiveness, materialism,
ambition and power, whereas feminine cultures place more value on relationships and quality of life.
In masculine cultures, the differences between gender roles are more dramatic and less fluid than in
feminine cultures where men and women have the same values emphasizing modesty and caring. As a
result of the taboo on sexuality in many cultures, particularly masculine ones, and because of the
obvious gender generalizations implied by Hofstede's terminology, this dimension is often renamed by
users of Hofstede’s work, e.g., Quantity of Life vs. Quality of Life.
5. Long-term orientation (LTO) vs. short-term orientation - First called “Confucian dynamism,”
this model describes societies’ time horizons. Long-term-oriented societies attach more importance to
the future. They foster pragmatic values oriented towards rewards, including persistence, saving and
capacity for adaptation. In short-term-oriented societies, values promoted are related to the past and
the present, including steadiness, respect for tradition, preservation of one’s reputation, reciprocation
and fulfilling social obligations.
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SEAOHUN One Health Course - Facilitator’s Guide
Alfonsus (Fons) Trompenaars
Fons Trompenaars (Born: 1953) is an author, organizational theorist, management consultant and an
expert in the field of cross-cultural communication who developed a model of national culture differences.
Additional information, available online at: http://hbr.org/web/slideshows/the-50-most-influentialmanagement-gurus/42-trompenaars
Concepts Fons Trompenaars has championed include (see Topic #s 1–7 below):
1. Universalism vs. particularism (What is more important, rules or relationships?) - Universalism
vs. particularism describes how people judge other people’s behavior. The Universalist attaches great
importance to the observance of rules. The behavior tends to be abstract. In Universalist, rule-based
societies, there are certain comprehensive absolutes. They apply regardless of circumstances or
particular situations. What is right is always right in every situation and for everybody. A Universalist
tries to apply the same rules in all situations. To remain fair, a Universalist will not make differences
between people from the narrow environment (such as family, friends or members of the so-called
‘ingroup’) and the wider community (such as strangers and members of the ‘outgroup’). Wherever and
whenever possible, personal feelings and emotions are put aside and the Universalist prefers to look
objectively at the situation. To remain always fair, everyone is equal as there are no differences. Finally,
rule-based behavior refers to the tendency that exceptions in the rule construct could lead to
weaknesses. It is feared that once exceptions are recognized, the system could deteriorate.
The Particularist always considers specific circumstances or personal backgrounds in every situation
and these dictate behavior. What is right in one situation may not be right in another. People in
particularist societies treat their family, friends and members of their ingroup best above all others and
people’s ingroups will take care of them. The in- and outgroups are clearly distinguished. A
particularist always sees differences among individuals. No one is seen as the same and everyone is
treated as unique. In practice, both kinds of judgment are used.
Countries that may be considered universalism societies: USA, Australia, Germany, Switzerland,
Sweden, United Kingdom, Netherlands, Czech Republic, Slovakia, Belgium, France. Countries that
can be seen as particularism societies: Brazil, Italy, Japan, Argentina, Mexico and Thailand.
2. Individualism vs. collectivism (communitarianism) (Do we function in a group or as
individuals?) Fons Trompenaars describes an individualistic culture as the characteristic of a
modernizing society, while communitarianism can also apply to modern society when thinking of
mass media control and populism. Both dimensions are more complementary than opposing. Each
can be effectively reconciled by an integrative process: a communitarian society that learns its
limitations from particular instances, and by the individual voluntarily addressing the need of the
larger group. Although they are complementary, there are still differences between them.
The individualist culture sees the individual as the end and improvements to communal arrangements
as the means to achieve it. The process of decision-making in individualistic cultures is usually very
short. A lonely individualist makes decisions in a few seconds. While this may make for quicker
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Module: Culture, Values, Beliefs and Ethics
deliberations, it will often be discovered, months later, that the organization has conspired to defeat
the decisions. Delays due to implementation problems are followed by short decision-making. To get
all involved people in one direction, the individualist will frequently ask for a vote. Making mistakes in
an individualistic culture means that the individualist is punished for it and therefore becomes a better
team-member.
The communitarian culture sees the group as its end and improvements to individual capacities as a
means to that end. Yet if the relationship is truly circular, the decision to label one element as an end
and another as a means is arbitrary. By definition, circles never end. Every “end” is also the means to
another goal. Further, communitarian cultures prefer plural presentations. When receiving unexpected
demands, a communitarian wishes to confer with those back home. Those communitarians at a
meeting are delegates, bound by the wishes of those who sent them. Looking at the decision-making
process, a communitarian decision takes much longer than an individualist would take. It takes so
much time because there are sustained efforts to win over everyone to achieve consensus. Usually,
there will be detailed consultations. Consensus will be achieved because of pressures to agree on
collective goals.
With regard to making mistakes, the communitarian logic is the reverse to the individualistic one.
They believe that through team membership, they support individuals so that they become better
individual workers. If a mistake is made, only the immediate group needs to know this. The
reconciliation lies in the fact that the group has taken care of the individual’s mistake and no extra
punishment is required. On closer examination, communitarian and individualistic cultures are
reconciled. This is closer to our own conviction that individualism finds its fulfillment in service to the
group, while group goals are of demonstrable value to individuals only if those individuals are
consulted and participate in the process of developing them. The reconciliation is not easy, but
possible.
3. Neutral vs. emotional (Do we display our emotions?) Trompenaars’s third dimension addresses
the importance of feelings and relationships. In a neutral culture, people do not openly express their
feelings, but keep them carefully controlled and subdued. Instrumentality and rationality are of action
in the foreground. People in such a culture are not necessarily cold or unfeeling, nor are they
emotionally constipated or repressed. The emotions they show are often the result of convention. In
neutral cultures, where emotions are controlled, irrepressible joy or grief will still signal loudly. In
emotional cultures, emotions are more immediate, open and passionate. These cultures tend to have a
wider range of facial expressions and physical gestures during conversation and emotion can be heard
clearly in changes in the choice. Emotions tend to show up as an everyday part of life.
4. Specific vs. diffuse (How separate we keep our private and working lives) This dimension is
sometimes referred to as the “concern/commitment-dimension,” which is expressed at the level of an
individual affected by a particular situation or action. In specific-oriented cultures, areas of life such as
work and family are recognized widely. A member of a specific-oriented culture is more open in the
public space, but very closed in the private one. Other characteristics of people in such a culture are
directness, being to the point and purposeful in relating. There are often principles and consistent
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SEAOHUN One Health Course - Facilitator’s Guide
moral stands independent of the person being addressed. In diffuse-oriented cultures, areas of life
such as work and family are closely linked. A diffuse-oriented person is more closed in public space,
but is very open in private space. In contrast to the specific-oriented persons, diffuse-oriented persons
are indirect, circuitous and seemingly aimless in forms of relating. High situational morality depends
upon the person and the context that is encountered.
5. Achievement vs. ascription (Do we have to prove ourselves to receive status or is it given to
us?) This dimension refers to the question of whether the status of an individual is given as a result of
religion, origin or age, or whether the status is an acknowledgement of the individual’s proven
performance. In achievement-oriented cultures, a title is used only when it is relevant to the
competence an individual brings to the task. Respect for managers is based on the individual’s
knowledge and skills. Decision-making is challenged on technical and functional grounds. In this kind
of dimension, the status of an individual refers mainly to his own performance. In ascription-oriented
cultures, a title is extensively used when these clarify you in an organization. Respect for a manager is
based on seniority and hierarchy. Decision-making is challenged by people with higher authority. In an
ascription-oriented culture, a status refers to the religion, origin or age of the individuals.
6. Sequential vs. synchronic (Do we do things one at a time or several things at once?) This
dimension deals with the question of how people in different cultures manage time. Trompenaars
defines two ways: a sequential way and a synchronic way.
Managing time sequentially means that people feel time as a series of passing events. A sequential
person has a crucial path worked out in advance with times for the completion of each stage. People
with this kind of understanding of time hate to be thrown off their schedule or agenda by
unanticipated events. They tend to schedule very tightly, with thin divisions between time slots. For
them, it is rude to be few minutes late because the whole day’s schedule is affected. Time is seen as a
commodity to be used up. Lateness deprives the other of precious minutes, like “time is money.”
In synchronic time management, events have a past, present and future, which are interrelated, so that
ideas about the future and memories of the past shape present action. People who adopt this method,
track various activities in parallel, like a juggler with six balls in the air. Looking at the various
activities, someone in a synchronic time management culture sees a final activity as a goal with
stepping stones, that are potentially interchangeable, to reach that goal. A person can skip among
these stones. Additionally, a synchronic person, who is not greeted spontaneously, even if the other
person is engaged in an activity (e.g., talking on the telephone), sees this lack of acknowledgement as a
slight. People in this kind of culture show how they value people by giving them time, even if they
show up unexpectedly.
7. Internal vs. external control (Do we control our environment or are we controlled by it?)
People in an internal control culture tend to identify with mechanisms, i.e., the organization is
conceived of as a machine that obeys the will of its operators. People in an external control culture
tend to see an organization as itself a product of nature, owing its development to the nutrients in its
environment and to a favorable ecological balance.
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Module: Culture, Values, Beliefs and Ethics
Edward T. Hall
Edward T. Hall, Jr. (May 16, 1914 – July 20, 2009) was an anthropologist and cross-cultural researcher. He
is remembered for developing the concept of Proxemics, a description of how people behave and react in
different types of culturally defined personal space. Information available online at:
http://www.edwardthall.com/.
Concepts Hall has championed include (see Topic #s 1–3 below):
1. Context
 High context: In a high-context culture, there are many contextual elements that help people
understand the rules. As a result, much is taken for granted. This can be very confusing for a
person who does not understand the ‘unwritten rules’ of the culture.

Low context: In a low-context culture, very little is taken for granted. Whilst this means that
more explanation is needed, it also means there is less chance of misunderstanding, particularly
when visitors are present.

Contrasting the two: French business contracts tend to be short (in physical length, not time
duration) as much of the information is available within the high-context French culture. This
differs in America, considered a low-context country, so contracts tend to be longer in order to
explain the necessary details. Highly mobile environments where people come and go need lowercontext culture. With a stable population, however, a higher context culture may develop. Note
the similarity of Hall’s High vs. Low Context concept, respectively with Trompenaars’s
Particularism (high context) and Universalism (low context).
Factor
High-context culture
Overtness of
Messages
Many covert and implicit messages, with
use of metaphor and reading between
the lines
Many overt and explicit messages
that are simple and clear
Inner locus of control and personal
acceptance for failure
Outer locus of control and blame of
others for failure
Much nonverbal communication
More focus on verbal
communication than body language
Visible, external, outward reaction
Locus of Control and
Attribution for
Failure
Use of Non-Verbal
Communication
Expression of
Reaction
Cohesion and
Separation of Groups
People Bonds
Level of
Commitment to
Relationships
Flexibility of
Time
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Reserved, inward reactions
Strong distinction between ingroup and
outgroup; Strong sense of family
Strong people bonds with affiliation to
family and community
High commitment to long-term
relationships; more important than task
Time is open and flexible; process more
important than product
Low-context culture
Flexible and open grouping patterns,
changing as needed
Fragile bonds between people, with
little sense of loyalty
Low commitment to relationship;
task more important than
relationship
Time is highly organized; product
more important than process
SEAOHUN One Health Course - Facilitator’s Guide
2. Time
 Monochronic time: Time, as E.T. Hall called it, means doing one thing at a time. It assumes
careful planning and scheduling and is a familiar Western approach that appears in disciplines
such as ‘time management.’ Monochronic people tend also to be low context.

Polychronic time: In polychronic cultures, human interaction is valued over time and material
things, leading to a lesser concern for ‘getting things done’—they do get done, but more in their
own time. Aboriginal and Native Americans have typical polychronic cultures, where ‘talking stick’
meetings can go on for as long as somebody has something to say. Polychronic people tend also
to be high context.

Contrasting Context and Time: Western cultures vary in their focus on monochronic or
polychronic time. Americans are strongly monochronic whilst the French have a much greater
polychronic tendency; thus, a French person may turn up to a meeting late and think nothing of it
(much to the annoyance of a German or American co-worker). Note the similarity of E.T. Hall’s
time concept of monochronic vs. polychronic compared with Trompenaars’s “sequential” vs.
“synchronic” time concept, respectively (see table below).
Factor
Actions
Focus
Attention to time
Priority
Respect for property
Timeliness
Monochronic action
Polychronic action
Do one thing at a time
Do many things at once
Concentrate on the job at hand
Easily distracted
Think about when things must be
achieved
Put the job first
Think about what will be achieved
Seldom borrow or lend things
Borrow and lend things often and easily
Emphasize promptness
Base promptness on relationship
factors
Put relationships first
3. Space
 Hall was concerned about personal space and our relationships within it. He coined the term
“proxemics” to describe differences in culturally defined personal space. We have concerns about
space in many situations, from personal body space to space in the office, parking space, and
space at home.

The need for space: Some people need more space in all areas. People who encroach into that
space may be perceived as a threat. Personal space is an example of a mobile form of territory
and people need less or greater distances between them and others, based in part on their culture.
A Japanese person who may need less personal space may thus stand closer to an American than
is expected in that culture, potentially making the American feel uncomfortable unintentionally.
The concept of personal space may differ widely based on gender, culture and/or religious
beliefs.
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Module: Culture, Values, Beliefs and Ethics

High territoriality
Territoriality could, in general, be defined as the behavior of animals or people designed to
protect a specific area, or designed to prevent others from using this area. Some people are more
territorial than others, with greater concern for ownership. They seek to mark out the areas that
are theirs and may be willing to argue or fight to protect those perceived boundaries if
challenged. At the national level, many wars have been fought over territoriality and geographic
boundaries. At a personal level, there may be territorial concerns in an office, work space or
other location.
Territoriality also extends to anything that is ‘mine,’ and ownership concerns extend to material
things. Security thus becomes a subject of great concern for people with a high need for
ownership. People with high territoriality tend also to be low context.

Low territoriality
People with lower territoriality have less concern or interest in ownership of space, and
boundaries are less important to them. They will share territory and ownership with little
thought. They also have less concern for material ownership and their sense of ‘stealing’ is less
developed (this is more important for highly territorial people). People with low territoriality tend
also to be high context.

Contrasting
For example, Australian Aboriginal people will say that they belong to the land rather than the
other way around.
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SEAOHUN One Health Course - Facilitator’s Guide
CULTURE AND GENDER
Learning Objective:
Type of Learning:
Timing:
Equipment and
Materials:
Pre-class
Assignment
Understand and distinguish the differences in cultures and beliefs about gender
and the impact that these beliefs have on One Health initiatives by:
 Examining the impact of cultural beliefs about gender and the impact
of those beliefs on health and access to health care.
 Advocating for gender equality in One Health initiatives.
Large Group Discussions and Activity
135 Minutes




Computer, LCD projector, screen/blank wall
Module PowerPoint
Student Guidebook
Read Article, “Culture: Culture, Gender Equity and Development
Cooperation” (Canadian International Development Agency)
Detailed Facilitator Notes
Prior to class, have students read and prepare to discuss the following article:
 “Culture: Culture, Gender Equality and Development Cooperation”
(Johanna Shalkwyk, CIDA)
Pre-work
10 Minutes Open the session by briefly asking for reactions to the article:
 What are your key learnings/take-aways from the reading?
 What areas would you like to learn more about?
Large Group
 How does this article connect to One Health?
Discussion
45 Minutes Culture and Gender Case Study
Read the following case study aloud and have students follow along in their
Student Guides.
Large Group
Case Study: Women in Indonesia
Discussion
Women play a major role in family nutrition and efforts to improve
nutrition. However, lower levels of female education result in a lack of
understanding of nutrition. The lower socioeconomic level of women also
has an effect on levels of malnutrition. The number of women and children
younger than 18 years of age comprises more than half of Indonesia’s
population. Many of these women and their children have been categorized
as vulnerable in the areas of health, education, employment and income.
UNICEF reports that half a million women die from pregnancy
complications each year. WHO reports that, globally, women represent
about half of people with HIV infection. Given these statistics, it has been
identified that vulnerable women need to be educated, protected and
empowered.
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Module: Culture, Values, Beliefs and Ethics
Pose the following questions to the class:
 In your community, what do you see as the most serious issue facing
women? How are the issues facing women different from those facing
men?
 How do the issues change over a women’s life cycle (e.g., infant,
childhood, adolescence, child-bearing, nursing, old age)?
 What is the impact of these challenges on women’s health?
 How do women’s health issues impact men?
 Think back to the Minangkabau people in the opening simulation:
- Would it be surprising if more women than men had evidence
of TB? Why?
- How do men and women interact differently with domestic
animals? With wildlife?
- What is the impact of deforestation on women?
60 Minutes I Am a Woman: The Relationship Between Gender, Education,
Regulation and Health
Introduce the activity to the class by saying:
Large Group
Now it is time to take a position on gender and health. We will do this in
Activity
the form of a debate; however, this debate has a twist: the male learners
will assume the role of females and will debate the topic from the
viewpoint of women, while the female learners will assume the role of
males and will debate the topic from the viewpoint of men.
Divide the class into the following two groups:
Group A
Males who will prepare for
the debate from the
viewpoint of women.
Group B
Female learners who will
prepare for the debate from
the viewpoint of men.
Ask the class to debate the following statement: “There is a difference in
health care so that women receive lesser quality health care than men receive.”
Teams will have 20 minutes to prepare their arguments for the debate. The
structure of the debate will be as follows:
 Group A will receive 3 minutes to present their case to Group B.
 Group B will receive 3 minutes to present their case to Group A.
 Each team will have 2 minutes to discuss the presentation and
prepare a rebuttal.
 The groups will each have 3 minutes to present their rebuttal in
reverse order (Group B will be first and Group A will be second).
 The final 3 minutes can be used for question and answer or for more
unstructured conversation.
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SEAOHUN One Health Course - Facilitator’s Guide
20 Minutes Debrief the debate with the following questions:
 How difficult was it for you to play the other gender?
 As you assumed the opposite role, what stereotypes did you make
Large Group
about the role you played?
Debrief
 How do these possible stereotypes become reflected in health care
systems?
 What are your recommendations for bringing more equality in health
care?
 How do men benefit when women are treated equally in a culture?
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SEAOHUN One Health Course - Facilitator’s Guide
CULTURE AND ANIMALS
Learning Objective:
Type of Learning:
Timing:
Equipment and
Materials:
Understand and distinguish the differences in cultures and beliefs about
animals and the impact that these beliefs have on One Health initiatives by:
 Examining the impact of cultural beliefs about animals and the impact
of those beliefs on human relationships with both domestic animals
and wildlife.
 Evaluating the impact cultural beliefs about animals can have on a One
Health initiative.
Large Group Activity; Large Group Discussions; Individual Reflection
90 Minutes





Computer, LCD projector, screen/blank wall
Module PowerPoint
Flipchart or whiteboard and markers
Student Guide
Article, “Food, pets or gods? Different attitudes to animals in non-western
cultures” (Dominka Lukoszek)
Detailed Facilitator Notes
30 Minutes
Large Group
Activity
Food, Pet or God
On a flipchart, whiteboard or blackboard, build the table below column-bycolumn by having students:
 First, brainstorm all domestic animals in their region;
 Then, brainstorm all the wildlife in their region; and
 Lastly, classify each animal as a food, pet or god.
Domestic Animals in
Our Region
Food
Pet
God
Wildlife in Our
Region
Food
Pet
God
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Module: Culture, Values, Beliefs and Ethics
Debrief the activity by asking the following questions:
 Why do you think we see certain animals as food or a pet or a god?
 Have you been to another culture or know about another culture that
might classify these animals differently?
 What would you do if you were in another culture and you were
given an animal as food to eat, but, in your culture, the animal is seen
as a pet or a god?
 What are the One Health implications for how different cultures view
animals differently?
Large Group
Discussion
30 Minutes
Individual
Reflection
Have students read the article by Dominka Lukoszek, “Food, pets, or gods?
Different attitudes to animals in non-western cultures.”
Then have them respond to the following questions which are located in their
Student Guides:
Activity #1:
 What animal(s) are symbols of your culture?
 What are the attributes ascribed to the animal(s)?
 Find a common graphic representation of the animal and copy it into
your Student Guide.
 How can learning about the ways that other cultures view animals
bring insight into your own culture?
 How can this insight help a One Health practitioner?
Activity #2:
 Select a culture different from your own.
 What animal(s) does the culture use as a symbol?
 What attributes are ascribed to the animal(s)?
 Find a graphic representation of the animal and copy it into your
Student Guide.
 How can learning about the ways that another culture views animals
bring insight into that culture?
 How can this insight help a One Health practitioner?
30 Minutes
Large Group
Discussion
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In a large group, have a couple of students share the animals and images they
used to describe their culture and then the animals and images they found for
another culture.
Then, discuss the following questions:
 How can learning about the ways that another culture views animals
bring insight into the culture?
 How can this insight help a One Health practitioner?
SEAOHUN One Health Course - Facilitator’s Guide
CULTURE AND THE ENVIRONMENT
Learning
Objective:
Type of Learning:
Timing:
Equipment and
Materials:
Understand and distinguish the differences in cultures and beliefs about the
environment and the impact that these beliefs have on One Health initiatives by:
 Examining the impact of culture on a community’s relationship with the
environment.
 Evaluating the impact of cultural beliefs about the environment on One
Health initiatives.
Small Group Activity; Large Group Discussion; Individual Reflection; In-Class
Reading Assignment
60 Minutes
 Computer, LCD projector, screen/blank wall
 Module PowerPoint
 Flipcharts with quotes
 Article, “Other Voices, Other Ways, Better Practices: Bridging Local and
Professional Environmental Knowledge”
 Student Guide
Detailed Facilitator Notes
Pre-Class 15 Minutes
Preparation
Instructor Pre-Class Preparation
Before the class starts, write the following quotes on flipcharts and post them
around the room (Instructor may consider asking different participants to
read each quote [proverb] aloud for the entire group).
 If there is any wisdom running through my life now, in my walking on
this earth, it came from listening in the Great Silence to the stones, trees,
space, the wild animals, to the pulse of all life as my heartbeat. – Vijali
Hamilton
 Only when the last tree has been cut down, only when the last river has
been poisoned, only when the last fish has been caught, only then will you
find that money cannot be eaten. – Cree Indian Prophecy
 We do not inherit the earth from our ancestors; we borrow it from our
children. – Navajo Proverb
 Nature does not hurry, yet everything is accomplished. – Lao Tzu
 Once a tree falls, the monkeys on it will scatter. – Unknown
 The surrounding environment is the best erudite master to teach us the
fundamental laws of nature and the basics of living in life. – Anuj Somany
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Module: Culture, Values, Beliefs and Ethics
 The earth does not belong to us; we belong to the earth. – Unknown
15 Minutes Session Introduction
Tell the learners that one way to learn about a culture’s views on nature is to
look at proverbs that are passed down from generation to generation. Have
Small Group
the learners read all of the proverbs written on the flipcharts and select one.
Activity
Divide the learners into small groups according to the proverb they chose.
Then, ask them to discuss the following questions among their group:
 What is the meaning of the proverb?
 What does the proverb say about the culture’s view of nature?
 What does the proverb say about the culture’s relationship with the
environment?
 How might the culture’s relationship with the environment impact a
One Health initiative?
Ask each group to share the proverb they selected and what they feel it means
about a culture’s relationship with the environment and its implications for
One Health initiatives.
Individual
Reflection
15 Minutes Ask students to write down their reflections on the following questions in
their Student Guide:
 What is a proverb that you remember hearing about nature that has
shaped your relationship with the environment?
 How does your view about nature/the environment shape you as a
One Health practitioner?
30 Minutes
Large Group
Discussion
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Have each learner read their proverb. Then, have them describe the impact
that it has on their perspectives about the environment and how it shapes
them as a One Health practitioner.
In concluding the session, discuss the following question with the class,
“What are the One Health implications for how different cultures view the
environment?”
SEAOHUN One Health Course - Facilitator’s Guide
CREATING TRUST ACROSS CULTURES
Learning Objective:
Type of Learning:
Timing:
Equipment and
Materials:
Pre-class Assignment
Understand how personal beliefs about health care, animals and the
environment impact the ways a community responds to emerging pandemic
threats and how, as a One Health practitioner, you can adapt One Health
interventions to be effective in local cultures and belief systems by:
 Being aware of one’s own culture and beliefs.
 Demonstrating familiarity with local languages and/or working with a
translator.
 Understanding and practicing gender diversity.
 Adapting disease management to cultures, beliefs and practices in
order to effectively involve various ethnic groups in outbreak areas.
Individual Assessment; Field Activity; Large Group Discussions
10 Hours (with option to reduce length by giving homework assignments)



Computer, LCD projector, screen/blank wall
Module PowerPoint
Student Guide

Read Article, “Other Voices, Other Ways, Better Practices: Bridging Local
and Professional Environmental Knowledge” (Kim M. Wilkinson, Susan
G. Clark and William R. Burch)
Detailed Facilitator Notes
In follow-up to the last session, have students read the following article:

Pre-work
30 Minutes
Individual
Assessment
“Other Voices, Other Ways, Better Practices: Bridging Local and
Professional Environmental Knowledge” (Kim W. Wilkinson, Susen
G. Clar, and William R. Burch, Yale School of Forestry and
Environmental Studies)
Models of Culture Self-Assessment
Have students select one of the three models on culture (Hofstede,
Trompenaars, or Hall) and self-assess where they are on the dimensions of
the model they selected. Ask them to consider the following questions:
 Where do you fit in comparison to the majority of people in your
culture?
 Where do you tend to be different from the majority of people in
your culture?
 How do these similarities and differences impact you as a One Health
practitioner in your culture?
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Module: Culture, Values, Beliefs and Ethics
30 Minutes
Large Group
Discussion
Field Assignment: Creating Trust Across Cultures
Brainstorm with the class about ways a One Health practitioner can develop
trust when working across cultures within the One Health team and within
the community they are serving. Use the brainstorming list to set
guidelines/norms for going into the field to complete the class assignment.
 Note: Portions of this assignment can be done as homework to reduce
in-class hours.
9 Hours
Field
Experience
Field Experience: Planning Phase (2 hours)
Divide learners into small teams. Have each group identify a vulnerable
group in the local community. Ask them to select one of the three models of
culture and use the model to gain insight into how the community might
view health, animals and the environment.
 Note: The field experience can be conducted anywhere: in a local
community or on a university campus. Remember that a university is a
community in and unto itself and offers opportunities to observe the
questions outlined above.
Ask students to create a checklist of what they would like to observe. The list
might include the following questions:
 How do men and women interact? How do men interact with men?
How do women interact with women? Does there appear to be a
hierarchy?
 How do men and women interact with domestic animals? Is it the
same or is it different?
 How do men and women interact with wildlife? Is it the same or
different?
 How do women and men interact with their environment? Is it the
same or different?
 Who provides health care/animal care leadership?
 What are the roles of the health care provider, traditional healers,
veterinarians and community or government leaders?
 How are decisions made about health care and wellness?
 How do people see the relationship between health/illness and the
environment?
 How might the community be culturally vulnerable to emerging
pandemic diseases? What aspects might increase risk of coming into
contact with a pandemic disease? What aspects might make disease
prevention, disease transmission or treatment of illness difficult?
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SEAOHUN One Health Course - Facilitator’s Guide
Then, ask students to consider how their group will enter the community
and approach community members to gain their trust. Have them create a
plan.
Tell students that their final goal is to create and present a 10- to 15-minute
photo essay or short documentary about their experience.
 Note: Taking photos and video will not be appropriate in all cultures or
in all facilities, such as a health center. Ensure that students incorporate
into their plan a process for gathering this form of documentation.
Field Experience: Data Collection Phase (4 hours)
Let students spend approximately 4 hours in the community conducting
their work.
Field Experience: Documenting and Analysis Phase (2 hours)
Ask students to create a 10- to 15-minute photo essay or short documentary
with their group about the experience. Each group will then present their
experience to the class.
Large Group
Debrief
Field Experience: Group Debrief and Reflection (1 hour)
Debrief the activity by leading the class through the following questions:
 Consider the presentations. What can we conclude about the
communities visited? What do they have in common? How are they
different?
 If teams selected the same group to observe, how were the
observations similar? Different? What could cause groups to see the
same community differently?
 What advice would you give a One Health practitioner to be
effective in preventing disease in the community(ies) visited? For
promoting human, animal and ecological wellness?
 Note: The session could also be used to teach students about the.
Participatory Rural Appraisal (PRA) approach. PRA is used by many
agencies operating in the international development sphere and aims to
incorporate the opinions and knowledge of rural people in the planning
and management of projects and programs. The approach offers several
effective tools and methodologies for working in communities that
might be useful and interesting to students. Additional information on
this approach can be found on websites such as www.fao.org,
www.worldbank.org and www.usaid.gov.
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SEAOHUN One Health Course - Facilitator’s Guide
PERSONAL VALUES AND PROFESSIONALISM
Learning Objective:
Type of Learning:
Timing:
Equipment and
Materials:
Define personal values, code of conduct and response to ethical situations in
order to model One Health professionalism by:
 Articulating personal values.
 Reviewing professional codes of conduct for respective disciplines.
 Identifying ethical issues that occur in One Health interventions and
determine and practice appropriate professional responses.
 Utilizing institutional and professional resources to assist with ethical issues.
Self- Assessment; Individual, Small Group and Large Group Activities; Large
Group Discussion
270 Minutes




Computer, LCD projector, screen/blank wall
Module PowerPoint
Student Guide
Internet access and computers (for students)
Detailed Facilitator Notes
45 Minutes
Individual
Assessment
Discovering Core Values
Ask students to conduct the Values Clarification: A Self-Assessment in their
Student Guides.
Values Clarification: A Self-Assessment, by A. Bronwyn Llewellyn
with Robin Holt, M.A.
Clarifying your personal values is a critical step toward understanding
your own definition of success, finding new career options, evaluating
specific organizations to work in, and understanding how to change your
current work situation to make it more meaningful and fulfilling. The
process gives you a deeper sense of what makes your life meaningful and
helps you see how certain career decisions affect your life. Knowing your
values makes you resilient. Just like that storm-lashed tree with deep
roots, a person with strong core values doesn’t bend every which way the
workplace wind blows.
This test is designed to help you identify your core values. Values are
highly individual; therefore, there are purposely no definitions given for
the words following. Each word means something different to different
people. Reflect on what each value word means to you. Think about how
these values might influence how you adapt to living and working in a
culture that is new to you.
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Module: Culture, Values, Beliefs and Ethics
Ask students to:
 Circle their ten most important values in the chart below.
 Then, select the five that are most important to them.
 Then, narrow the final list down to the three values that are core to
them.
VALUES
Accomplishment
Adventure
Affiliation
Authority
Autonomy
Balance
Beauty
Challenge
Community
Competence
Competition
Contribution
Control
Cooperation
Creativity
Curiosity
Diversity
Duty
Family
Friendship
Fun
Harmony
Health
Helpfulness
High Earnings
Honesty
Humility
Independence
Influence
Integrity
Justice
Knowledge
Leadership
Love
Loyalty
Meaning
Moderation
Nature
Obligation
Pleasure
Predictability
Recognition
Respect
Responsibility
Risk-Taking
Self-Discipline
Self-Restraint
Spirituality
Stability
Structure
Status
Teamwork
Time Freedom
Trust
Variety
Wisdom
Mapping Your Values
Provide the following instructions to your learners:
In the following ValueSearch™ Map, eight value categories are defined
and connected to a cluster of values. Read the definitions for each
category.
Most people can categorize their specific values as indicated on the map.
However, your personal experience or value definitions may reflect a
different category than those shown here. Balance, spirituality and family
are examples of values people often move to different categories.
Highlight or circle each of your top ten values in the suggested categories
only if the category represents your personal definition of the value. If
another category feels like a better fit, simply write the value word in that
category.
Now see if your values cluster in one or more categories. If they do not
cluster, go back to the value word list and select your next ten most
important values. Categorize those values on the map.
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SEAOHUN One Health Course - Facilitator’s Guide
ValueSearch™ Map
Universality
U
Benevolence
B
Tradition
T
Security
S
Power
P
Excitement
E
Achievement
A
SelfDirection
SD
Understanding, appreciation, tolerance and
protection for the welfare of people and nature.
Concern for the protection and enhancement of
the welfare of people with whom one is in
frequent contact.
Respect, commitment and acceptance of the
customs and ideas that one’s culture or religion
expects of individuals.
Desire for safety, harmony, and stability of society,
relationships and self.
Attainment of social status, prestige, influence,
authority or leadership of people and resources.
Seeks pleasure or sensuous gratification. Enjoys
unpredictability and variety in life.
Desire for personal success or accomplishments;
need to demonstrate competence in everyday life.
Pursues independent thought or action. Enjoys the
ability to choose, create and explore.
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Module: Culture, Values, Beliefs and Ethics
Values, as you now realize, strongly influence your behavior, decisions
and actions. This process of defining and mapping your values can help
you better understand how your values can influence and motivate your
career decisions. A simpler way to understand your values is to see the
map as being composed of four value types (see the following). Write the
word for the value type that most closely resembles you on the chart.
Outer Layer Definitions
Self-Transcendence: Combines values of universality and benevolence,
which motivate people to transcend selfish concerns in order to promote
the welfare of others and nature. Working on a well-functioning project
team or for a company or department with a compatible organizational
culture may satisfy these values.
Openness to Change: Combines values of self-direction and excitement,
indicating a desire by individuals to follow their own intellectual and
emotional interests in unpredictable and uncertain directions. Many
creative people fall within this category, as well as those who value
intellectual challenge and stimulation. Flexibility may be an important
factor for your satisfaction at work. You may find it appealing to have
some degree of variety or unpredictability in your life.
Conformity: Combines values of tradition and security, leading to a desire
to preserve the status quo and the predictability this provides in
relationships with other people, institutions and traditions. If your values
cluster in this area, stability may be quite important to you. You also may
need to have a clear sense of your job’s required tasks and
responsibilities.
Self-Enhancement: Combines values of achievement and power by
indicating a desire of individuals to enhance their own personal interests.
If your values fall into this category, you may need to perform a job that
is quite challenging or work where you can feel as if you are
accomplishing
something. Also,
your job
satisfaction may
be dependent on
the opportunity
for increasing
levels of
responsibility
and/or power.
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SEAOHUN One Health Course - Facilitator’s Guide
15 Minutes
Ask learners if they would be comfortable sharing their top three values. If
they are, have each student share his/her top three values and create a class
map on the flipchart or whiteboard. Discuss the following questions:
 What do you notice about where people are clustered?
 What happens when individuals working with one another have
fundamentally different values?
30 Minutes
Connecting Your Values to Your Work in a Culture that is New to You
Give learners the following introduction and instructions to the activity:
Debrief
Individual
Activity
The purpose of this exercise is to help you identify how your values may
be satisfied or challenged as you live and work in a culture that is new to
you. It also provides you with an opportunity to consider what strategies
you can use to enhance your effectiveness in this new culture.
Pick one of the communities/cultures that you learned about during the
previous session that seems to be the most different from cultures with
which you are most familiar. Based on what you learned about that
community/culture consider the following questions:
 Which of your highest priority values do you think may be tested
in the community that you selected?
 How have you felt when these priority values have been
challenged in the past?
 How have you dealt with challenges to these values in the past?
 What would you do differently if you were in this country
setting?
30 Minutes
Large Group
Discussion
Guide the class through discussions on the following questions:
 What do you think are the core values of One Health?
 How do your values align with these core values?
 As a One Health practitioner, what do you do if you perceive a ‘value
conflict’ with your values and the community that you are working in?
With the One Health values and the community that you are working
in?
 Is it difficult for one group of professionals to work collaboratively
with other professionals on important health issues? Why?
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Module: Culture, Values, Beliefs and Ethics
60 Minutes
Connecting Values to Professionalism
Ask each learner to look for a professional association in his/her discipline:
 Does this association have a professional code of ethics?
 If so, how does the professional code of ethics match your values?
 If the code of ethics does not match your values, what does this value
conflict mean to you?
 If they do not have a code of ethics, why do you think there is not
one? What are the ramifications without a code of ethics?
60 Minutes
One Health Ethical Issues
Have students create a list of potential ethical situations that they may face in
One Health initiatives. Share 2 or 3 of the following examples:
 A palm oil company is asking you to help them persuade the Salung
people to sell the company some land. They offer to fund portions of
your One Health project in the area.
 You are working in a very poor area and you see a farmer selling deer
bushmeat.
 You are in the market and see a vendor selling expired medicines at a
very low price.
 Villagers have told you that the palm oil plantation has filled the local
streams with sediments and pesticides.
 You see an orangutan tied to a tree. The animal is spluttering and
seems to be in distress. (To demonstrate orangutan distress sounds,
aaccess online at:
http://www.soundboard.com/sb/Orangutan_Sounds)
Individual
Activity
Large Group
Activity
 Note: Make sure that cross-cultural differences, bribes, etc. are included
in the list.
Small Group
Activity
In small groups, have students select one of the brainstormed issues and
develop it into a scenario that a One Health practitioner might face. Have
each group develop a creative presentation that explores the scenario and
methods for addressing the challenges. Examples of creative presentations are
videos, role plays, etc.
60 Minutes Have groups deliver their presentations. After the final presentation, ask the
large group the following question, “Consider what you heard about
responses to difficult situations in the presentations. Can we generate a list of
Presentations
rules that guide responses to ethical situations that arise in One Health
and Debrief
scenarios?”
Have students brainstorm a list of institutional and professional resources that
are available to help them think about and respond to ethical issues in the One
Health field.
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SEAOHUN One Health Course - Facilitator’s Guide
PROTECTION OF HUMAN SUBJECTS, CONFIDENTIALITY
AND VOLUNTARY PARTICIPATION
Learning Objective:
Type of Learning:
Timing:
Equipment and
Materials:
To raise awareness of health professionals about the important issues of
protecting human subjects and assuring voluntary participation in any study or
research according to the existing legal framework and consistent with the need
for involvement of Institutional Research Boards at universities, as part of the
development of One Health professionals by:
 Discussing the importance of informed consent by humans enrolled in
medical research.
 Identifying examples when human subject protection methods failed.
 Introducing examples of legal frameworks for voluntary participation,
and the need to inform both literate and illiterate persons about the risk
of procedures, medical experiments or trials, and/or research protocols.
 Identifying ethical issues that merit monitoring during field work, field
research and clinical trials involving humans, and understanding that
parallel guidelines are needed for the appropriate care and protection of
non-human animals in research.
Self- Assessment; Individual, Small Group and Large Group Activities; Large
Group Discussion
60 Minutes



Computer, LCD projector, screen/blank wall
Module PowerPoint
Student Guide
Detailed Facilitator Notes
Large Group
Discussion
Have your students read from the Helsinki Declaration handout key points
about the history of policy development and regulations governing
government- and industry-funded research on human populations, and the
need to acknowledge and organize compliance to assure the following:
 Respect for humans (“human subjects”) during any type of research.
 Need to assure any study guarantees that human subjects are
voluntary participants, and have the right to refuse treatment or
participation.
 Researchers are responsible for “protecting” human subjects, assuring
they are informed of any potential risk(s) or benefits during
participation, and that opting out of participating does not limit that
person’s access to medical care. Researchers are also responsible for
respecting the privacy of individuals and protecting all confidential
information collected as part of the research or study.
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Module: Culture, Values, Beliefs and Ethics
Historical background about the rules of conducting medical research
in human populations:
Please ask for a volunteer to carefully read aloud the following to the class:
The “Helsinki Declaration.” Based in part on medical experiments
conducted on prisoners during World War II, including testimony given
during the Nuremburg trials, a number of key legal decisions and
documents have been developed in the past 50 years which govern the
need for researchers to protect humans (“human subjects”) participating
in any type of research. In September 1946, medical associations of 31
countries were invited to a conference in London to draft a Constitution
for a new organization called “The World Medical Association” (WMA).
The WMA developed the Declaration of Helsinki as a statement of ethical
principles for medical research involving human subjects, including
research on identifiable human material and data. The Declaration is
intended to be read as a whole and each of its constituent paragraphs
should be applied with consideration of all other relevant paragraphs. The
Declaration addresses physicians, but encourages others involved in
medical research involving human subjects to adopt these principles.
Summary of General Principles (the Helsinki Declaration):
Please ask for a volunteer to carefully read the following points aloud:
1. The Declaration of Geneva binds the physician to: “The health of my
patient will be my first consideration,” and the International Code of
Medical Ethics declares that, “A physician shall act in the patient’s best
interest when providing medical care.”
2. It is the duty of the physician to promote and safeguard the health,
wellbeing and rights of patients, including those who are involved in
medical research.
3. Medical progress is based on research that ultimately must include studies
involving human subjects.
4. The primary purpose of medical research involving human subjects is to
understand the causes, development and effects of diseases and improve
preventive, diagnostic and therapeutic interventions (methods, procedures
and treatments). Even the best, proven interventions must be evaluated
continually through research for their safety, effectiveness, efficiency,
accessibility and quality.
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SEAOHUN One Health Course - Facilitator’s Guide
5. Medical research is subject to ethical standards that promote and ensure
respect for all human subjects and protect their health and rights.
6. While the primary purpose of medical research is to generate new
knowledge, this goal can never take precedence over the rights and
interests of individual research subjects.
7. It is the duty of physicians who are involved in medical research to
protect the life, health, dignity, integrity, right to self-determination,
privacy and confidentiality of personal information of research subjects.
The responsibility for the protection of research subjects must always rest
with the physician or other health care professionals and never with the
research subjects, even though they have given consent.
8. Physicians must consider the ethical, legal and regulatory norms and
standards for research involving human subjects in their own countries, as
well as applicable international norms and standards. No national or
international ethical, legal or regulatory requirement should reduce or
eliminate any of the protections for research subjects set forth in this
Declaration.
9. Medical research should be conducted in a manner that minimizes
possible harm to the environment.
10. Medical research involving human subjects must be conducted only by
individuals with the appropriate ethics and scientific education, training
and qualifications. Research on patients or healthy volunteers requires the
supervision of a competent and appropriately qualified physician or other
health care professional.
11. Groups that are underrepresented in medical research should be provided
appropriate access to participation in research.
12. Physicians who combine medical research with medical care should
involve their patients in research only to the extent that this is justified by
its potential preventive, diagnostic or therapeutic value and if the
physician has good reason to believe that participation in the research
study will not adversely affect the health of the patients who serve as
research subjects.
13. Appropriate compensation and treatment for subjects who are harmed as
a result of participating in research must be ensured.
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Module: Culture, Values, Beliefs and Ethics
The Concept of Institutional Research Boards (IRB) responsible for
oversight of Human Research:
Please ask for a volunteer to carefully read the following aloud:
Each nation has norms and regulations for “research” involving human
subjects; international guidelines also exist (see the Helsinki Declaration,
above). In the United States, for example, in 1978, the “Ethical Principles
and Guidelines for the Protection of Human Subjects of Research,” also
known as the “Belmont Report,” identified three fundamental ethical
principles for all human subjects research:
 respect for persons
 beneficence
 justice
Based on the Belmont Report, the Department of Health and Human
Services (HHS) in the USA revised and expanded regulations in the late
1970s and early 1980s to require basic protections for human subjects
involved in both biomedical and behavioral research.
For example, the Ethics Committees and Institutional Research Boards
(IRB) are governed by law (see reference below, Title 45 Code of Federal
Regulations Part 46). These regulations, for example, define IRBs and
require these for all research that receives support, directly or indirectly
from the HHS. IRBs were developed in direct response to research
abuses earlier in the 20th century. Two of the most notorious of these
abuses were the experiments of Nazi physicians on prisoners that became
a focus of the post-World War II Doctors’ Trial (in Nuremburg), and the
Tuskegee Syphilis Study in the USA, an experiment that attempted to
understand the long-term effects of syphilis on the human body.
Tragically, those men studied were not told that they had syphilis, nor
were they treated properly. IRBs also oversee clinical trials of drugs
involved in new drug applications.
15 Minutes
Ask learners to discuss why national and international standards governing
the “protection of human subjects” are important, and discuss any
developments they are aware of in their institution or country.
30 Minutes
Discuss the following questions with the class:
 How can universities with IRBs and/or Ethical Committees assure
compliance to the principles of protecting human subjects when
researchers work with human populations?
Large Group
Debrief
Large Group
Discussion
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SEAOHUN One Health Course - Facilitator’s Guide


How important is this matter, and are there examples of medical
research that caused harm to human participants?
When researchers discuss risks and benefits with potential
participants, discuss issues that might be important when working
with “high-risk” populations, which can include neonates, children or
pregnant women, or sub-groups that speak unusual dialects, or
among persons who are illiterate, or have disabilities (e.g., blindness)?
Share the following useful weblinks with staff:
 World Medical Association / Helsinki Declaration, accessed at:
http://www.wma.net/en/60about/70history/index.html
 US Government regulation regarding Human Subjects Protection
during Research, accessed at:
http://www.hhs.gov/ohrp/humansubjects/commonrule/index.html
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SEAOHUN One Health Course - Facilitator’s Guide
LEARNING REFLECTIONS AND EVALUATION
Learning Objective:
Type of Learning:
Timing:
Equipment and
Materials:
To reflect on learnings in the Culture, Values, Beliefs and Ethics Module.
To get feedback from participants on what they felt were the strengths
of the module and areas in the module that could be improved.
Individual Assessment; Group Feedback
60 minutes



Student Guide
Detailed Facilitator Notes
Evaluate/
Create
Apply
How would you rate your level of the following Culture,
Values, Beliefs and Ethics Module competencies?
Understand
20 Minutes Have your students complete the following learning assessment, which is in
their Student Guides. Ask them to rate their ability to understand, apply and
Individual
evaluate/create each of the module’s learning objectives, using the five-point
Learning
scale displayed below:.
Assessment
Identify and interpret local norms, wisdom and culture about
human, animal and environmental health.
Generate trust among the community within One Health
interventions.
Demonstrate values, ethics and professionalism in planning and
implementing One Health interventions.
Write down two or three things that you learned from the session. Think
about:
 What did you learn in this module that was new to you?
 Have the lessons in this module led you to change any previously held
beliefs?
 What are you still unsure about? Do you have any questions that still
need to be answered?
 What was interesting to you/what would you like to study in more
detail?
 Are there new behaviors that you will try based on this class?
 What topics from the class will you share with others outside the class?
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Module: Culture, Values, Beliefs and Ethics
20 Minutes In small groups, have each student share:
 Their key learnings from the module.
Small Group
 How they will apply the concepts, knowledge, skills they gained from
Discussion
the module.
Group
Feedback
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10 Minutes Ask the students:
 What is one element of the module you like/felt was strength?
 What is one thing in the module you suggest be changed?
 Any additional comments?
SEAOHUN One Health Course - Facilitator’s Guide
RESOURCES FOR STUDENTS
Included in the Resource Folder
Culture and Health Beliefs
Tashima, E. (1982). Indigenous Healers in Southeast Asian Refugee Communities . The Pacific Asian
Mental Health Research Project. Retrieved from:
http://www.oac.cdlib.org/view?docId=hb4779n92z&query=&brand=oac4.
Vaughn, L. M., Jacquez F., and Baker, R. (2009). Cultural Health Attributions, Beliefs, and Practices:
Effects on Healthcare and Medical Education. The Open Medical Education Journal 2. Retrieved from
http://www.benthamscience.com/open/tomededuj/articles/V002/SI0016TOMEDEDUJ/64TOM
EDEDUJ.pdf.
Culture and Gender
CARE International Gender Network. (2012). Good Practices Framework: Gender Analysis. Retrieved
from http://gendertoolkit.care.org/Resources/Good%20Practices%20Brief.pdf.
Canadian International Development Agency. (2000). Culture: Culture, Gender Equality and
Development Cooperation. Retrieved from: http://www.oecd.org/social/genderdevelopment/1896320.pdf.
“Gender Effects on Health,” University of Texas School of Public Health.
Culture and Animals
Dominka Lukoszek, “Food, pets or gods? Different attitudes to animals in non-western cultures.”
Culture and the Environment
Rapoport, A. (n.d.) On the Relation Between Culture and Environment. Retrieved from
http://www.cmu.edu/ARIS_3/text/text_rapoport.html.
Wilkinson, K. M., Clark S. G., Burch W. R. (2000). Other Voices, Other Ways, Better Practices: Bridging
Local and Professional Environmental Knowledge. Yale School of Forestry and Environmental
Studies, Report Number 14. Retrieved from: http://environment.research.yale.edu/publicationseries/5335.
Additional References
Dimensions of Culture: Cross-Cultural Communications for Healthcare Professionals Website.
www.dimensionsofculture.com/2010/10/traditional-asian-health-beliefs-healing-practices/.
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Handouts
Minangkabau People
Description of the society:

Matrilineal society where most decision-making is made and
approved by the matriarch.

While the community leader (penghulu) is a man, any
information and permission must be obtained from the
matriarch. The matriarch is addressed as ‘Ibu’ in the society.

A man cannot talk to a woman unless accompanied by
another man from the community.

The Minangkabau are a deeply religious Muslim population.
They believe in ‘redha,’ the concept that difficulties
(including illness), if not overcome, are meant to be.

Assign one male participant as the penghulu and one female
participate as the matriarch (ibu) of the society.
One Health Practitioners
Description of your assignment:
Your assignment is to get permission to interview each family in the
village in their home and to find out how many locals may be
vulnerable to tuberculosis (TB) infection from orangutans. You also
may need to do a TB screening exercise in the community. (This
should be coordinated with local health officials; the benefits and
possible risks of screening should be clearly explained to
participants, and participation should be voluntary.)
Notes:
1. Pulmonary TB due to infection by Mycobacterium tuberculosis
bacteria in a non-human primate, such as an orangutan, may
actually have been due to a human with active TB infection
causing infection in a pet orangutan, with subsequent spread
to susceptible contacts (including humans).
2. Health policy in some nations (based in part on WHO
recommendations designed to prevent TB) may include
childhood immunization with BCG vaccine. If screening
activities planned are based on PPD sub-dermal skin tests,
screening in an area with previous BCG vaccination may be
a high rate of false-positive PPD (i.e., BCG is responsible
for a + PPD screening test rather than due to the patient
having TB infection). Be sure to remind participants to work
with qualified, responsible health workers and officials in
areas being surveyed.
Minangkabau People
One Health Practitioners
Culture and Health Care Beliefs
Simulation
Culture and Health Care Beliefs
Simulation