Promoting Global Health: What Role Should Academic Health Centers Play?

Each of the articles in this month’s journal touches in one way or another on important issues facing academic medicine. The five by Korshum, Souba, Longnecker, Bunton, Mitsch, and colleagues should be of particular interest to academic medicine’s leaders, since they discuss the administration and management of the mission-related activities of academic health centers (AHCs). Two additional articles—one by Klasko and Ekarius, the other by Calvin—are also noteworthy, since the authors recount what happened when their institutions dealt with crisis situations. These case studies provide important lessons about the kinds of challenges that academic medicine’s leaders will continue to face. In that vein, I want to call attention to one of the serious challenges that leaders of AHCs in this country must finally address: What role should AHCs play in promoting global health? In two of this month’s articles, Houpt, Drain, and colleagues offer recommendations for how global health issues should be taught in medical schools. In a third, Kanashiro and colleagues describe how a Canadian medical school assisted in the creation of a primary care training program in a small, less-developed country in Southeast Asia (Lao). And last year, the journal published five articles and a supplement that dealt with global health issues and academic medicine both here and abroad.1–6 The appearance of all these articles in such a short period of time is one sign of a growing interest in global health issues within medical schools in this country and Canada. That interest is not new, however. For many years, individual faculty at medical schools have been deeply involved in various activities to improve global health. For example, they have developed and managed exchange programs so that health care workers from less-developed countries can spend time in a U.S. AHC acquiring skills to improve health in their home countries. At the same time, a number of U.S. faculty have spent time in those countries to help improve health care there. Finally, some U.S. faculty have been deeply engaged, both in this country and abroad, in the conduct of research focused on conditions, primarily infectious diseases, that are responsible for a great deal of the excess morbidity and mortality experienced by many in the developing world. Until fairly recently, such activities reflected the particular interests of individual faculty rather than being a manifestation of a strategic objective of their institutions. But times have changed: the increased globalization of society is directly affecting medicine. So it is only natural that academic medicine’s leaders and faculty would begin to focus more attention on the issue. For example, the health and well-being of the populations of less-developed countries directly influence the economic growth and stability of those countries. Because of globalization, such developments now have a greater effect on the economic growth and stability of well-developed countries across the globe, including the United States. Given this, it is only natural that a national interest would emerge, crossing many sectors of our society, in seeing to it that programs aimed at improving global health are established in this country. On the other hand, the general public is becoming increasingly aware that visitors to this country and recent immigrants may introduce diseases that are a threat to those living here. And U.S. citizens run the risk of contracting such diseases while traveling abroad. It is perfectly logical, therefore, that the public would have a growing interest in ensuring that U.S. physicians be educated to have a better awareness of those conditions and how they should be managed and prevented. In many respects, these views support the recommendations by Houpt, Drain, and colleagues in this issue of the journal that the global health content in the medical school curriculum should be increased and that there should be more elective opportunities for medical students to actually experience the state of health in less-developed countries. Given all of this, I return to the question I posed earlier: What role should AHCs play in promoting global health? I do not ask this question to focus attention on the kinds of excellent curriculum content issues raised by Houpt, Drain, and others. Many medical schools have developed innovative programs designed to achieve the objectives that those authors describe. Indeed, faculty from over 70 medical schools are members of the Global Health Education Consortium, an organization devoted to improving global health education in medical schools and other health professions schools. Instead, I ask this question to stimulate thinking about the kinds of programs that AHCs as institutions might develop to improve the health of populations in less-developed countries. Developing and carrying out such programs will be extremely difficult. Despite the incredible talent of the faculty and staff working in U.S. and Canadian AHCs, the challenges that AHCs will face in establishing programs to improve the health of so many populations are almost overwhelming. Perhaps the most daunting is the extraordinary shortage of health care workers in many less-developed countries. A recent report issued by the World Health Organization (WHO) states that there is a serious shortage of health workers in 60 countries across the globe, resulting in the lack of even basic health care services there.7 The report suggests that there is a need for over four million doctors, nurses, midwives, and other health care workers in those countries, especially those in sub-Saharan Africa. And in some countries, health workers frequently face social unrest, deteriorating health care infrastructures, economic hardship, violence, and premature death brought about by HIV/AIDS. So, realistically, what might AHCs in the United States and Canada do to improve global health? To explore this question, Academic Medicine will publish an issue devoted to articles on global health in March 2008. The format will be similar to that of the September 2006 issue, which was devoted to articles about major health policy issues facing this country. For that issue, the journal asked each author to propose recommendations for what AHCs might do to help solve the particular policy issue they were addressing. For the 2008 collection of articles, I am particularly pleased that we are going to collaborate with WHO and The Network: Towards Unity for Health on this effort. Lisa Dittrich, the journal’s managing editor, will serve as the guest editor for Academic Medicine’s set of articles. Lisa has already met with staff of WHO and The Network, and the plans for coordinating the publication of the journal’s collection with publications by WHO and The Network are well under way. We welcome any ideas that readers of the journal might have about this important project. Michael E. Whitcomb, MD

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