Global health: it’s a vast topic, one that spans everything from tropical and neglected diseases, to humanitarian aid, to disaster relief, to public policy, to public health campaigns for disease prevention, and health promotion. In our increasingly globalized world, students training for careers in the health professions have become increasingly interested and engaged in health issues outside the borders of their own country.
The precise definition of ‘global health’ is elusive. It is sometimes used interchangeably with ‘international health’, however, in recent years, international health has fallen out of favor. The reasoning behind the terminology change was that ‘international health’ is felt to emphasize the differences between nations, and to imply a unilateral movement of aid from one nation to another, whereas the term global health has a more inclusive connotation and underscores the importance of a collective approach to addressing health issues.
More and more, students are seeking out opportunities for voluntary service either prior to starting their graduate studies, or during the studies. In fact, the American Association of Medical Colleges Graduation Questionnaire from 2010 revealed that 30% of students had participated in at least one global health experience. The phenomenon speaks to the commitment towards service and spirit of altruism in this generation, but it also provides unprecedented exposure for untrained volunteers in culturally and ethically complex health situations.
Students may take part in opportunities ranging from spending a day or a weekend volunteering at a clinic or providing disaster relief to taking a year or multiple years to work abroad and gain in-depth experience in a developing country. Health professionals also frequently take part in such efforts, from the young physician who flies to Haiti with the idea of providing disaster relief, to the retired surgeon who travels abroad to provide surgical care free of charge in a developing country. This is in addition to a vibrant and growing community of health professionals and researchers who have been trained in global health or humanitarian aid through formal channels, such as international fellowship programs, humanitarian studies programs, or diplomas in tropical medicine and hygiene.
These experiences have amazing potential to change careers, change hearts and passions, and ideally, to improve health on a global level. In the best cases, all of these objectives are achieved. In the worst cases, not only can such projects be uninspiring and frustrating, they can even be harmful to those they purport to serve. Sadly, potentially harmful “medical missions” and global health projects might even be in the majority. This fact is not apparent to most of the general public or those who participate in the projects. The lack of dialogue at all levels about global health ethics is a major obstacle to allowing budding humanitarians to serve others in a way that is empowering, respectful, sustainable, and compassionate.
Part of the reason for this lack of dialogue is that the questions are very difficult. In many cases, there are serious disagreements about what the right answers are. The questions involve how to prioritize one life over another, how to spend resources when there is a limit to what you can spend. Americans are not used to dealing with resource constraints in health, as the outrage whenever a politician mentions healthcare ‘rationing’ illustrates. So what happens when Americans get involved in global health and find themselves stuck in an ethical quagmire? Stay tuned – we’ll explore this question further in future columns.
Alison Schroth Hayward, MD, is a board certified emergency medicine physician currently on the faculty at the Mayo Clinic in Rochester, Minnesota. In 2003, she co-founded a nonprofit called Uganda Village Project, and currently serves as the Executive Director. Her expertise in global health ethics has mainly resulted from making all the mistakes already herself, and trying to learn from them.
Association of American Medical Colleges. 2010 Medical School Graduation Questionnaire: All Schools Summary Report. Washington, DC: Association of American Medical Colleges. Found at: https://www.aamc.org/download/140716/data/2010_gq_all_schools.pdf
Dyer, O. et al. What Is Global Health? Journal of Global Health, Spring 2011 online edition.