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Retrospect: How do academic medical centers around the world deal with global health?

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Panelists from four continents share and discuss experiences with the audience at the World Health Summit

Deans, professors, lecturers and students from different parts of the world discussed about Global Health in Academic Health Centers at the World Health Summit. The session “How to Develop Global Health in Academic Medical Centers” on October 16th, 2018, featured university representatives from the US, Iran, Uganda, and Germany. Together, they spoke about drivers, models and challenges.

At US universities, global health has been an important topic for more than a decade. In the last years, scholars have successfully developed a joint understanding of what it means to teach and “do” global health. They have also built partnerships and infrastructures around the world. Prof. Dr. Michael Merson (Duke University), who chaired the session, and Prof. Dr. Judith Wasserheit (University of Washington) have been among the drivers of these developments. Nowadays, a lot of US universities have dedicated centers and programs of global health, partly with their own faculty and specific programs for different target groups across disciplines and career levels. Funding of these centers and programs comes from universities, health systems, grants from US government agencies, and philanthropy. They have even founded a network, the Consortium of Universities for Global Health (CUGH).

In Germany, students have asked for global health education opportunities long before universities started creating dedicated programs, as Karin Geffert from the German Medical Students Association (bvmd) reports. A specific working group of the bvmd was initiated nine years ago, advocating for more global health educational offerings and for including global health education in any public health and global health strategies. After all, young people will be the future practitioners and policymakers. They want to go abroad, but they also want to learn about social determinants of health. The offerings have since doubled or event tripled, but they are still often based on voluntary contributions of lecturers or even the students themselves, which makes them unsustainable.

In parallel to an increasing student demand, the stronger engagement of the German government for Global Health over the last years has led to a rising need for scientific expertise and policy advice. Several universities have therefore positioned themselves. Prof. Dr. Axel Pries, Dean of the Charité, presented the platform “Charité Global Health” which was created just a few weeks ago. It aims at bundling the existing activities of individual researchers, physicians and students, at facilitating the exchange of information, increasing visibility, consolidating projects and strategies and improving access to funding.

At the Teheran University of Medical Sciences, Global Health is perceived as an important topic as well. One of the reasons and drivers are the frequent man-made and natural disasters in the region. New teaching formats and research approaches have been developed in global health in cooperation with international partners. Prof. Dr. Ali Jafarian pointed out that universities have to provide solutions to acute problems that are often very specific to the region they are located in, so programs need to address these particular requirements.

Makerere University in Uganda has also made efforts to educate students in a way that enables them to respond to the challenges of a globalized world, including ethics and computer skills. Another example is a problem-based, interdisciplinary curriculum where students of the health sciences help to solve problems in the communities in cooperation with their fellow students from other disciplines, such as social sciences and engineering. Working with people in the community is important, since “local problems can quickly become global problems”. Prof. Dr. Charles Ibingira furthermore reported that Makerere hosts about 500 students and physicians in training each year from their partner universities in the US and Europe who do clinical rotations and undertake research projects in the teaching hospitals and rural communities in Uganda.

Given the large numbers of students and trainees from the Western world who go to the Global South for rotations and internships, it is very important that North-South university partnerships are equitable and beneficial for both sides. Prof. Dr. Asghar Rastegar from Yale presented some approaches how this can be achieved. Over the years, Yale has established partnerships (with Makerere, among others) which aim at improving quality and quantity of the education of health professionals. Initial focus areas were expanded over time. Regularly, students and young physicians from the partner universities are invited to train at Yale. When they go back, they apply and pass on their knowledge to their colleagues. To prevent brain drain, it is critical to select participants that will most likely go back, for example because there is a job waiting for them.

In response to the constraints mentioned by several speakers, Prof. Dr. Oliver Razum added that even schools that may not be able to offer programs exclusively dedicated to global health should develop a minimum content that adds a global outlook to their medicine and health programs. Refugee health is just one example of a global challenge that directly relates to local healthcare systems and practitioners. Moreover, opening up horizons for their students is part of a university’s core mission. Health and the other Sustainable Development Goals are a good anchor for that.

Prof. Dr. Judith Wasserheit explained the concept of a tiered curriculum or pyramid model: an entry-level curriculum should be offered to all medical students to give them an appreciation of issues such as the role of geography and poverty in global health, infectious and tropical diseases, non-communicable diseases, maternal and child health, nutrition, global climate change, and refugee health. Interested students should have the opportunity to study global health more in depth, including international rotations. Specialized programs, e.g. postgraduate programs, are of interest mostly for those students who are pursuing a career in global health.

The participants vividly discussed the question of whether and how to define global health. Is Global Health the same as Public Health or Tropical Medicine? Is a definition essential to create a curriculum or a funding program? Or does a fixed definition build new walls between disciplines and stifle innovative, cooperative approaches? Generally, participants agreed that Global Health is more than medicine abroad and that it should be defined broadly to include the social, economic, environmental and other determinants of health and other issues.

Undoubtedly, one of the big challenges of global health as an interdisciplinary field are the different cultures, worldviews, funding models and incentives of the disciplines involved. Some participants reported that funding can be a challenge in medical schools, especially since medical education is heavily regulated and global health is often not part of formal medical education and training.  

This makes it all the more important to join forces and stress the importance of global health vis-à-vis policymakers and funding agencies, so that universities, their members and graduates can do their share in contributing to the Sustainable Development Goals.

Der World Health Summit is one of the most imporant strategic forums for global health. Charité, Makerere University and Tehran University of Medical Sciences are members of the M8 Alliance, the academic think tank of the World Health Summit.



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