The 1910 release of the Flexner Report forced American medical education to respond to the changing societal demands. A century later, academic medicine again stands at a crossroads, as shifting priorities within medicine challenge the profession to adapt or risk irrelevance. No equivalent to the Flexner Report exists to outline the present-day impetus for reform. Yet this drive toward a rights-based approach to health is evident within the next generation of medical professionals. One need only look to the villages where medical students trade vacation for vaccination programs, to the inner city community health centers where junior residents simultaneously treat medical and social pathology, and to the classrooms and coffee shops where human rights and health diplomacy are debated alongside hematology and pharmacology.
Our generation of physicians-in-training, more broadly engaged in securing the right to health than any of our predecessors, represents the hope for future efforts in health-peace medicine—a workforce that considers the multiple determinants of health within a society and builds each into solutions for regions torn apart by conflict, war, natural disaster, and poverty. As future physician–leaders and advocates for global equity, we recognize that we must not waste this opportunity for academic medicine to harness the collective potential of our generation and direct it toward peace-building efforts.
In framing academic medicine's approach, however, it is critical to recognize that peace is not a concern exclusive to international settings. Violence, manifest in myriad forms, exists in our own backyards and clinics. Just as international conflict zones provide an entry point for physicians to rebuild health systems and societies alike, so too do low-income urban neighborhoods, the halls of Congress, and the steps of the United Nations. Broadly defining conflict to include structural violence, domestic political skirmishes, and human rights violations as subtypes of social discord aligns the aims of health-peace medicine with the varied sectors in which physicians-in-training are primary actors.
The breadth that this approach encompasses necessitates a shift in the delivery of medical education. Medical curricula focused on both social justice and human rights can educate students in the analysis of social problems that influence health and cross policy sectors, allowing for the broad applicability to the public good that a solely humanitarian or solely scientific response does not permit when rebuilding civil societies. The medical profession's increasing awareness of its role in shaping both domestic social1 and foreign policy2 only underscores the need for this paradigm shift in medical education.
Curricula that lay a foundation for peace-building via training in analytic methods, medical anthropology, social justice, health diplomacy, domestic health policy, and leadership represent the ideal training for physicians seeking to advance health, peace, and security. For most physicians-in-training, however, that ideal is unattainable. American medical schools pay little attention to educating students in social justice and rights-based approaches to medical treatment,3 both of which are crucial to translating interest in health-peace medicine into action. A handful of universities, such as Yale School of Medicine, Virginia Commonwealth University School of Medicine, and the University of California, San Francisco School of Medicine, have seen success in furthering student engagement in health and peace. Through elective coursework in the broadly defined health-peace arena, each has built cross-cultural, rights-based structures for health diplomacy and social justice that students can employ in future endeavors. If academic medicine truly seeks to build a health-peace movement, integration of these electives within the required medical curriculum is crucial.
Despite the growing will of many physicians to serve in nontraditional roles, however, academic medicine will fail to generate true public value if educational initiatives are not strategically framed to invite participation and foster creative approaches in advancing health and peace. Through delivery mechanisms ranging from longitudinal curricula to grand rounds, academia can nurture root cause analysis, policy dissection, and solution innovation while targeting multiple levels of physician engagement—a strategy that is critical to advancing both the cause and reach of health-peace medicine.
As a profession, we stand at the brink of an incredible movement, one with the potential to elevate the impact and reach of academic medicine. Medical education reform is the key to realizing that potential, with all of global society as the prospective beneficiary. As a second act to the Flexner Report, this moment is one that we should not waste.
1 Woolf SH. Social policy as health policy. JAMA. 2009;301:1166–1169.
2 Kickbusch I, Novotny TE, Drager N, Silberschmidt G, Alcazar S. Global health diplomacy: Training across disciplines. Bull World Health Organ. 2008;5:971–973.
3 Cotter LE, Chevrier J, El-Nachef WN, et al. Health and human rights education in U.S. schools of medicine and public health: Current status and future challenges. PLoS One. 2009;4:e4916.