King Holmes of U of Washington welcomed more than 800 attendees to the second annual meeting of the CUGH.
Haile Debas of UCSF awarded Tachi Yamada of The Bill and Melinda Gates Foundation with the CUGH Leadership Award
Debas continued with an update on the state of the CUGH over the past 12 months. He reported the membership has increased to 60 universities.
First Plenary: Building Academic Partnerships for Global Health
Global Health 4.0
Peter Piot, of the London School of Hygiene & Tropical Medicine, took us through a history of global health education, from an early focus on tropical medicine to the emerging Global Health 4.0. The tension between what exists and what is emerging is shaped by the context of a changing world: in the next decades three of four of the world’s top economies will be in Asia. Competition for energy, land, water, and commodities will increase; population growth and demographic change/aging will continue, as will with the growing pandemic of non-communicable diseases.
Piot argued for expanding the concept of global health to be based on interdisciplinary action focused on ending health disparities. Global health is not a geographic concept but a field of inquiry that must address health disparities everywhere. Its center of gravity must move from universities in North America and Europe to a truly global network of centers of excellence. “Are we North American or European institutions with a global mission or global institutions…?” he asked.
Global Health 4.0 must also move from focusing almost exclusively on infectious disease to dealing with broader health issues; and from addressing individuals and populations, to addressing individuals, populations and the environment. And it must complete the unfinished health agenda, which includes resolving the dilemmas of high maternal mortality and child health; lapsed reproductive health and family planning; high malnutrition; limited access to primary health care and continuing major health disparities.
How to do it in the context of the skyrocketing cost of higher education? It’s a challenge, yet the debate and decisions made today should move us to Global Health 4.0.
Developing Medical Education in sub-Saharan Africa
Studies were a hot topic of discussion during the opening session, “Building Academic Partnerships for Global Health.” Fitzhugh Mullan, of the George Washington University Department of Health Policy, reported on a Bill & Melinda Gates Foundation-funded two-year study on medical education in sub-Saharan Africa. The study set out to answer the question: if one was to fund medical education in Africa, where would one begin? What principles, areas, schools, and educational interventions should be supported? The study used a survey (72% response rate) and conducted week-long site visits to 10 of Africa’s 164 medical schools. Among the findings: of all medical schools, 20 percent are private; for most schools, tuition is less than $1000 a year; five years after graduation, the largest grouping of graduates are working outside their home country.
Mullan focused on some of the implications of those findings: the need to grow and support faculty in African medical schools; to build medical educational infrastructure, from dorms to bandwidth; and the need to fund research that both generates new knowledge relevant to the country and which advances faculty development. But it was the “brain drain” of talent from developing to developed nations that Mullan focused on most.
He urged adoption of the principle of United States self sufficiency in health care provider and the adoption of policies that will increase the number of medical and nursing school graduates in the U.S. The point prompted a question later in the evening: Why focus on closing the drain rather than opening the faucet? Why not invest on increasing the supply of physicians in those countries, rather than decreasing the number of people leaving?
Mullan replied that it’s not easy to produce physicians. “Does it make sense for a struggling organization in the U.S. to train physicians? It’s not a simple proposition.” Piot favored supporting countries who are willing to tackle the challenge of training.
A graduate student originally from Zambia posed the questions: I am done with my studies. I want to go back home and work. How do I do it?
At the Cusp of Medical Education Reform
We are at the cusp of fundamental reform of the medical education system, according to Lincoln Chen, President of the U.S.-based China Medical Board. Chen reported on a monumental study, now in press, on the state and direction of medic al education.
Designed to provide a forward look at professional medical education for the 21rst century, the study considered physician training, nursing and public health. “We asked not only what or how to teach, but also where to teach,” Chen said. It looked at the interaction of the education and health systems.
One of the findings: the 2,400 medical schools in the world are poorly aligned in terms of their physical location and the burden of disease. In fact, there is a “gross mismatch between institutional capacity and burden of disease.”
Furthermore, most curriculums are not needs driven. “The needs of society should determine competencies and shape the curriculum,” Chen said.
There must be mutual sharing of ideas. Faculty and students from the developed world should go to poor countries to train. One example of the power of sharing ideas and experiences is oral rehydration solution for the treatment of severe childhood diarrhea. Chen pointed out that ORS would never have been invented as a treatment for childhood diarrheal disease in the United States, because this country has plenty of intravenous fluids and the means of delivering them.
Solutions to the current dysfunction on professional medical education lie in harnessing the power of global knowledge and resource flows for the promotion of equity.
Among the world’s 200 countries, the difference in per capita income is 100 fold. The difference in healthcare expenditures, from the largest to the least, is 1000 fold. – Lincoln Chen, President, China Medical Board