To the Editor: Along with views toward social responsibility in medicine, global health equity, and addressing health disparities, the interest of U.S. medical students and residents in global health activities has increased. However, many training programs developed to respond to this interest focus on international experiences1 and overlook valuable domestic opportunities to address and teach global health.
Currently, the non-U.S.-born percentage of the population is 12.5%,2 with 7% to 11% reporting a history of torture.3 Also, millions of undocumented immigrants and tens of thousands of refugees arrive annually. However, most practitioners lack sufficient training to address their needs and therefore miss the opportunity not only to serve these underserved populations properly but also to better prepare themselves for the international health setting.
I propose comprehensive domestic global health training for medical students and residents that covers the global burden of disease, immigrant and migrant health, and the health of refugees and survivors of torture and sex trafficking, and addresses core competencies in health disparities, cultural competency, health and human rights, and tropical and travel medicine.
The curriculum should include didactic sessions using real case studies with interactive discussions of the demographics, sociocultural factors, health care barriers, clinical presentations of diseases, and epidemiological and public health issues. Also, there should be clinical exposure that is systematic, ongoing, and with proper supervision and resources, complemented by practical experience working with grassroots organizations to address social determinants of health.
Such a comprehensive curriculum could help trainees gain cultural competency skills by addressing different health perceptions and sociocultural barriers, and by teaching clinical skills to diagnose and address unfamiliar diseases and travel health issues. The curriculum would (1) help trainees recognize the broader sociocultural and political factors that cross the boundaries of countries and affect the health of populations, (2) foster trainees’ understanding of the relevant public health and epidemiological issues, and (3) help trainees develop skills in collaborating with community organizations to improve access to health care. Such teaching would also provide them opportunities not only to address health disparities domestically when they are unable to travel internationally but also to better serve other vulnerable populations in this country.
Ramin Asgary, MD
Assistant professor, New York University School of Medicine, Department of Medicine, New York, New York; [email protected]
1. Drain PK, Primack A, Hunt DD, Fawzi WW, Holmes KK, Gardner P. Global health in medical education: A call for more training and opportunities. Acad Med. 2007;82:226–230
2. United States Census Bureau. . Current population survey—March 2010. http://www.census.gov/population/foreign/data/cps2010.html
. Accessed February 25, 2013
3. Crosby SS, Norredam M, Paasche-Orlow MK, Piwowarczyk L, Heeren T, Grodin MA. Prevalence of torture survivors among foreign-born patients presenting to an urban ambulatory care practice. J Gen Intern Med. 2006;21:764–768