“LEARNERS CULTIVATING EQUITY IN THE WORLD AND OUR BACKYARD” Can anadi adian an Conf nference erence on n Med edical cal Ed Educ ucation ation 2012 Ban anff, ff, Alb lber erta April l 16, , 2012 Rober ert t F W F Wool oollar lard d MD CCFP FP FC FCFP FP
OBJECTIVES Define “Global Health” Pr Provide vide co cont ntext xt for th three ee plena lenaries ries Ex Explore lore rela lationship tionship of equity ity an and heal alth th Consi onside der th the respon sponsibil sibilities ities of educational ucational institutions titutions Pr Present sent glo loba bal l an and lo loca cal l exa xamples ples an and how w th they y intera eract ct Pr Provide vide qual alif ified ied hope pe for th the e futu ture re
GLOBAL HEALTH “The gl global bal in global health refers to the scope of problems, not their location. Thus — like public health but unlike international health — global health can focus on domestic health disparities as well as cross-border issues. Global health also incorporates the training and distribution of the health-care workforce in a manner that goes beyond the capacity-building interest of public health.” Consor orti tium um of Uni Univer ersit itie ies for Global bal Hea ealth h Exec ecutiv utive e Board
GLOBAL HEALTH Focus cuses es on is issues es that di direc ectly ly or in indi direc ectly ly affec ect t hea ealth h but that t can transce cend d natio ional bounda dari ries es Devel elopme opment nt an and impl d implem emen entation tation of solution utions s often en requi equire res s gl global l cooper operation ation Embrace races s both h pr preven ention ion in in po popu pulati tions ons and c d clin inic ical car are e of in indi divid idua uals Hea ealth h equi equity y among g natio ions and d for r all pe peopl ple e is is a a major jor object jectiv ive Hig ighly y in inter erdi disci cipl plin inary y and d multi ltidi disci scipl plin inary y wit ithin in and b d beyond d hea ealth h scie ience ces
WHY ARE WE HERE? “ The The tw twentie ntieth th ce centur ntury will will be be chiefly hiefly remembered remembered by by fut future ure genera generations tions no not as as an an era ra of of political political conflicts conflicts or or tec echnical hnical in inventions, entions, but but as as an an age age in in whi which human human soci society ty dared dared to to think think of of the the welfar elfare of of the the whole whole human human race ce as as a practical actical ob objectiv ective. ” - Arnold Toynbee
THE LATE 20 TH CENTURY The Development of the idea of “the social ocial acco coun untabi ability lity of medica edical l schools” (1995) The he format rmatio ion n of Towards ards Uni Unity ty for r Healt lth h (TUFH) UFH) and nd the he Netw twork ork TUFH FH The he develop lopment ment of global obal coll co llabo borati ations ns to to inf nflue luenc nce e medic edical l educa cati tion: n: World orld Feder Federat ation ion for or Me Medic dical al Educat ucation WONCA FAIM AIMER etc tc
THE HE EARLY Y 21 ST ST CENTUR NTURY The he prof ofessio essiona nali lizatio tion n of of me medical ical educa ucati tion on Ob Obje jectiv ctives es, , com ompeten petencies cies, , eval alua uati tion, on, acc ccounta ountabil bility ity, , etc tc Ris ise e of of rele levanc ancy, , effect ectiv iven eness ess and nd im impac act The he con onver ergen ence ce of of soc ocia ial l acc ccounta ountabil bility ity and nd im impac act t on on th the e he heal alth th of of peop ople le — why hy we are e he here e tod oday! y!
Key y reco comme mmendatio ndation n of the e Marm rmot Revie iew − There is a social gradient in health – the lower a person’s social position, the worse his or her health. Action should focus on reducing the gradient in health. − Health inequalities result from social inequalities. Action on health inequalities requires action across all the social determinants of health. − Focusing solely on the most disadvantaged will not reduce health inequalities sufficiently. To reduce the steepness of the social gradient in health, actions must be universal, but with a scale and intensity that is proportionate to the level of disadvantage. We call this proportionate universalism.
Key y reco comme mmendatio ndation n of the e Marm rmot Revie iew − Red educi cing g hea ealth h in inequa equalit itie ies s wil ill requi equire re actio ion on six ix po polic icy y obje jecti ctives es: • Giv ive e e ever ery chil ild d the e bes est start t in in lif ife • Ena nable e al all chil ildre dren n youn ung g pe peopl ple e an and ad d adul ults to maxim imis ise thei eir capa pabil ilit itie ies s and h d have c e contr trol over er thei eir liv ives es • Crea eate e fai air empl employme yment nt an and go d good d work rk for al all • Ensure e hea ealth thy y standa dard d of liv ivin ing g for all • Crea eate e and d de devel elop p hea ealthy y and d susta tain inable ble plac pl aces es an and c d communi mmuniti ties es • Stren engt gthe hen the e role e and d impa impact t of il ill hea ealth h preven pr ention ion
GRADIENT EFFECT “…the difference in equity of income and resource distribution is one of the principal determinants of differing health status among wealthy societies. Countries with highly unequal income distributions have poorer health status than those with more equitable income distributions.” -Pu Publ blic ic Health alth Agency ency of Can anad ada
HEALTH GRADIENTS AND RURAL POPULATION HEALTH Statistics Canada reports that, on average, residents of rural regions have the lowest “disability -free life expectancy” in Canada.
THE CHALLENGE IN 21 ST CENTURY Medical schools in the 21 st century face a series of challenges: improving quality, equity, relevance and effectiveness in health care delivery; Reducing their mismatch with societal priorities; redefining roles of health professionals; and providing evidence of impact on people’s heath status.
IN INEQU EQUITIE ITIES S IN IN HEA EALTH TH AND HEA EALTHC THCARE ARE
“WHAT GOOD DOES IT DO TO TREAT PEOPLE’S ILLNESS AND THEN SEND THEM BACK TO THE CONDITIONS THAT MADE THEM SICK?”
Why now? “ The cri risis is of of ou our ti time me relat lates no not to to tec echni hnica cal com compe peten ence, e, but but to to a loss loss of of th the so social ial and and his istor oric ical pe perspect pectiv ive, e, to to the the dis disas astro trous us div ivor orce of of com ompe petenc nce from from con onscie ienc nce. ” - Ernest est Boyer er AAMC MC
It is the curse of humanity that it learns to tolerate even the most horrible situations by habituation. Physicians are the natural attorney of the poor and the social problems should largely be solved by them. - Rudolf Virchow
THE RESPONSE To To addr ddress ess th those ose cha hall llen enges es 130 30 orga organiza izati tions ons an and in indi divid idua uals ls fr from om ar arou ound th the wor orld ld with ith resp responsib onsibil ilit ity for or hea ealth lth educa ducatio tion, n, prof ofess essiona ional re regula lati tion on an and pol olicy icy-mak makin ing par partici ticipat pated for or eight ight mo mont nths hs in in a th three-roun ound Delp lphi hi stu tudy dy lea leadin ding to to a thr three ee-da day faci cili lita tated co consensus nsus de develo lopme ment co confere renc nce.
www.healthsocialaccountability.org
IMPLEMENTATION OF GCSA Spain • Bangladesh Tunisia • Nepal • South Africa Saudi Arabia • India France • Sweden (WFME) Brazil • Canada SEARO • USA EMRO • Austria (Network TUFH) Indonesia • Int’l Webinar (AMEE) Italy (AMSE) • Thailand (GHWA)
GCSA COLLABORATIONS World Federation for Medical Education Assn for Medical Education In Europe (ASPIRE) The NETWORK-TUFH TheNET Association of Francophone Deans FAIMER Fellows SA SEARAME Other national and sub-national organizations
THE E FUTURE TURE OF MED EDIC ICAL AL ED EDUCA UCATION TION IN IN CA CANAD ADA Reco comm mmenda dati tion on I: Add ddress ss Indi divid idual l and d Com ommu munit ity Needs ds “Social responsibility and accountability are core values underpinning the roles of Canadian physicians and Faculties of Medicine. This commitment means that, both individually and collectively, physicians and faculties must respond to the diverse needs of individuals and communities throughout Canada, as well as meet international responsibilities to the global community .”
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