Global health programs are becoming increasingly prevalent at academic health centers. These programs range in scope from comprehensive, multidisciplinary, multi-professional initiatives – with patient care, research, and education components – to individual courses. The larger initiatives may involve collaborative efforts among schools of medicine, public health, nursing, and dentistry, and may have alliances with schools outside the health professions. This growth in the number of programs is accompanied by a surge of interest in every facet of global health among health science students and trainees. Thus, it is timely for Academic Medicine to publish this theme issue on global health initiatives at academic health centers.
But why, now, are we seeing a rapidly growing interest in matters of world health by students and residents, as well as by leaders of medical schools and teaching hospitals? You may say it’s because we now live in a small world. But, as far back as I can remember, people have been saying that the world is getting smaller. My generation, the Baby Boomers, were the rising generation when it was first possible to see how little the earth looked from space. And with more reliable cars at our disposal, a new and effective interstate highway system, and reliable air travel, we could transport ourselves to other places more quickly than could generations before us. So we had good reason to believe the world was shrinking.
However, current students and residents, who are “Millennials” – Generation Y – believe that the world the “Boomers” thought was small is becoming even smaller. The Millennials are the first generation to grow up seeing the world via the World Wide Web. By looking through a computer window, they are able, instantaneously, to see almost any place, to connect to almost any person, and to access information about almost any concept that has existed since people began to write down their ideas in the fourth millennium BCE. The space in which they move around, as if it were their own room, is the entire world and all of recorded history. With Internet capabilities, wireless communication devices, and text messaging, one can connect with other persons and places far more quickly than any prior generation could. These relatively new capabilities not only engender the sense that the world is smaller, but also foster feelings of increased global connectedness.
I believe it is this feeling of enhanced connectedness on a global scale – the sense of global community—that is leading students and residents in record numbers to seek educational experiences that enrich their understanding of other cultures and health care systems. Learners gain exposure to a wider variety of diseases and can observe the manifestations of disease both earlier and later in the course of illness than might be possible in their own countries. Such experiences also provide opportunities to engage their commitment to social justice, help develop credentials for career advancement, and combine travel with learning. Leaders at medical schools and teaching hospitals are also increasingly interested in global health efforts because the resulting initiatives are both socially beneficial and foster institutional growth and development. And both learners and institutions gain from a greater awareness of global health issues, since that helps improve thinking about local issues in their institutions and communities, both of which are becoming more global as the population continues to diversify.
These and other factors have led academic health centers to pursue a number of important initiatives in global health and global health education, as illustrated by the articles in this issue of Academic Medicine. Crone and Williams and their respective colleagues lead off by describing international collaborations–including institution-level decisions, processes, innovations, partnerships, and outcomes–that have potential consequences for health care both here and abroad. The articles by Koplan, Quinn, Babich, Haq, Vermund, Guerrant, Debas, and colleagues describe their institutions’ respective global health initiatives and their strategies for administering, funding, and implementing outreach and education around the globe. These authors also examine the effects of their programs on students and trainees, home institutions, collaborating universities, and/or health service providers in various parts of the developing world, and on patients and health care workers in those locales. Sande and Ronald, in turn, offer the perspective of the work of a private foundation, the Academic Alliance Foundation, initiated by physician scientists, that is committed primarily to AIDS-related training, research, prevention, and care in nearly half of the countries in Africa. Finally, Saba and Brewer and Izadnegahdar and colleagues close the issue with two perspectives on global health education and initiatives in Canada – one a program description of McGill’s outreach efforts, and one a research report detailing the global health educational opportunities available at each of the 17 medical schools in Canada.
In sum, the relatively new ability to connect, in the blink of an eye, to individuals and places and information anywhere in the world, to view current conditions in real time via a Webcam, and to keep up with ongoing events via listserves and blogs, not only makes the world seem smaller, but fosters the ability—indeed, the necessity—to think in a global sense and on a worldwide scale. The exemplary initiatives described on the pages of this issue of Academic Medicine tell us that this kind of thinking is thriving in North American medical schools and teaching hospitals. And clearly, the smaller the world becomes, the more important it is to pursue global health.
I wish to thank Lisa Dittrich, the journal’s former managing editor, for organizing this collection of articles, and Jennifer Gross, a member of the journal’s editorial staff, for coordinating the review and revisions processes and for shepherding the articles through editing and production. Since there was no guest editor for this collection of articles, Lisa and Jennifer “took up the slack,” and their extra efforts deserve special mention.
Steven L. Kanter, MD