To the Editor: There has always been a huge need to address problems that affect health in the developing world. Recently, numerous factors have created extraordinary interest in addressing these problems. We are concerned, however, that the emphasis on global medicine internationally may be overshadowing the need to attend to similar issues in the United States.
We believe that physicians in training, teaching, and practice would be wise to consider the old adage of “think globally, act locally” when they ponder becoming involved in global health. Given its definition—global health is “the area of study, research and practice that places a priority on improving health and achieving equity in health for all people worldwide”1—the application of global medicine (the clinical part of work physicians do to address global health issues) is as necessary within our borders as it is outside them.
The practice of global medicine in the United States involves working with immigrants and refugees, tackling problems of economic poverty and social inequity, dealing with educational marginalization and health illiteracy, and addressing issues of maldistribution and access common in urban and rural areas alike. It much more closely resembles a sustainable practice linking primary care and public health than an episodic subspecialty model of medicine.2
Understanding the practice of global medicine in this country is ultimately about reconceptualizing boundaries. Spatially, it means opening our eyes to the needs that exist all around us, outside the periphery of medicine’s core professional consciousness. Professionally, it means looking beyond biomedicine and technology toward a practice of social medicine. Educationally, it means putting underserved on the same pedestal as global and promoting them as equal parts of the same service activity. Personally, it means recognizing that the welfare of one group is connected to the welfare of another, wherever they may be.
As physicians, medical educators, residents, and medical practitioners contemplate involvement in global health, we encourage them to look close to home for opportunities to practice and teach global medicine here in the United States. The underlying principles of global health and global medicine demand no less.
William Ventres, MD, MA
Visiting research professor, Master’s Program in Public Health, University of El Salvador School of Medicine, San Salvador, El Salvador, and clinical associate professor, Department of Family Medicine, Oregon Health & Sciences University School of Medicine, Portland, Oregon; firstname.lastname@example.org.
Tanya Page, MD
Clinical assistant professor, Department of Family Medicine, Oregon Health & Sciences University School of Medicine, Portland, Oregon.
1. Koplan JP, Bond TC, Merson MH, et al.Consortium of Universities for Global Health Executive Board. Towards a common definition of global health. Lancet. 2009;373:1993–1995
2. Scutchfield FD, Michener JL, Thacker SB. Are we there yet? Seizing the moment to integrate medicine and public health. Am J Public Health. 2012;102(suppl 3):S312–S316