Kommalage and Ponnamperuma correctly point out that Sri Lanka has the highest health indicators in South Asia, which they attribute to the quality of medical education and the absence of private medical schools in Sri Lanka.
However, variations in the quality of medical education constitute only one factor among many in determining population health. Significant interregional, intraregional, and within-country variations in social determinants of health play an even more important role.1,2 Factors leading to these variations include the literacy rate—particularly the literacy rate of women—the fertility rate, improved sanitation and clean water, and nutritional status.1 These social determinants of health are generally stronger in Sri Lanka, for a variety of reasons that warrant further exploration.
As we have pointed out,3 private medical education is not necessarily detrimental to the quality of education. With strong accreditation systems, the high quality of both public and private schools can be enforced.3 In addition, with public policy initiatives and support, both public and private medical schools can support and strengthen the social determinants of health mentioned above through locally relevant curriculum content, education innovations, and research.4 These initiatives may include adding courses in leadership and management skills to the curriculum, greater work in and with communities, and policy advocacy to promote the strengthening of key social determinants.
Excellence in medical education can be associated with good health status if excellence is defined by how well the education system is connected with improvement of the social determinants of health. Intraregional variations in health outcomes within South Asia, as highlighted by Kommalage and Ponnamperuma, inspire us to explore the relationship between health professions education and health outcomes.
Zubair Amin, MD, MHPE
Associate professor, Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; firstname.lastname@example.org.
William P. Burdick, MD, MSEd
Associate vice president for education, Foundation for Advancement of International Medical Education and Research (FAIMER), and clinical professor, Department of Emergency Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania.
Avinash Supe, MS, MHPE
Professor and head, Department of Surgical Gastroenterology, Seth Gordhandas Dunderdas Medical College (GSMC) and King Edward Memorial Hospital, Mumbai, India, and director, GSMC–Foundation for Advancement of International Medical Education and Research (FAIMER) Regional Institute, Mumbai, India.
Tejinder Singh, MD, MHPE
Professor, Department of Pediatrics, and vice principal, Christian Medical College Ludhiana (CMCL), Ludhiana, India, and program director, CMCL–Foundation for Advancement of International Medical Education and Research (FAIMER) Regional Institute, Ludhiana, India.
2 Marmot M. Social determinants of health inequalities. Lancet. 2005;365:1099–1104.
3 Amin Z, Burdick WP, Supe A, Singh T. Relevance of the Flexner Report to contemporary medical education in South Asia. Acad Med. 2010;85:333–339.
4 De Souza PA, Zeferino AM, Ros MA. Changes in medicine course curricula in Brazil encouraged by the Program for the Promotion of Medical School Curricula (PROMED). BMC Med Educ. 2008;8:54.