This post contains my winning entry into a national essay competition co-hosted by the Festival of Public Health UK and Manchester Global Health Society. The competition was judged by four professors of Global Health including Professor Mukesh Kapila and Dr Arpana Verma. The award was presented at the University of Manchester’s 2015 Festival of Public Health UK by the Deputy CEO of NICE, Dr Gillian Leng.
“Why is Global Health important and how should it be taught in medical school?”
“I want to help people” – a cliché that most medical students know well. For most of us, expressing this sentiment on our UCAS form marks the beginning of a well-mapped medical career, through UK-based Foundation Programme posts and speciality training.
However, as medical students, our UK-centric approach to healthcare is somewhat paradoxical. We generally believe resources should be allocated where needs are greatest, while most medical ethicists endorse utilitarianism. Indeed, the 1948 NHS constitution outlined that care should be based on clinical need, stating its intention of alleviating health inequalities. Today NICE continues this rationale with a commissioning system based on quality-adjusted life-years.
Why then, does UK medical training overwhelmingly focus on domestic healthcare? Relative to the global population, the UK enjoys high quality of life (ranked 13th out of 132 countries) and one of the world’s longest life expectancies. Yet, despite our interconnected world providing the opportunity to practice abroad, universities almost exclusively prepare students for UK careers. This disparity between our ethical convictions and medical training exemplifies the importance of global health teaching.
There are practical and political considerations too; it is somewhat idealistic to expect NHS-funded medical training, costing over £250,000, to prioritise global health needs. However, not only does the UK fail to encourage medical professionals to work abroad, but it benefits from the net migration of foreign staff. A 2014 GMC report found that 26% of registered doctors were from non-EU countries. While this diversity greatly benefits the NHS, this policy has global consequences. Dependent on less wealthy countries to train its workforce, the NHS exacerbates global health inequalities by failing to provide a fair return.
Given the need to reform our approach to global health, how should the topic be taught in medical schools? There is a fine line between promoting and glamourising global health issues – the abundance of largely ineffectual and often patronising overseas gap year projects is a reminder of the risk of fostering an over-simplified saviour-complex mentality amongst eager students.
Likewise, at a time when MSF are currently being sued for reportedly not seeking patients’ consent, the importance of good medical practice, and the challenges posed by different cultural settings, shouldn’t be underestimated. Differing attitudes towards disease – perhaps best exemplified in the field of psychiatry – should also receive greater emphasis.
These are significant challenges, especially as the vast majority of clinical teaching is provided by UK staff within domestic institutions. However, perhaps a starting point is to stop grouping global health as a category defined as anything “other” than Western disease. Less economically developed countries are far from homogenous. Similarly, the increasingly interconnected challenges facing global medicine – including threat of pandemic, antimicrobial resistance and the international nature of big pharma – make it irresponsible to consider UK healthcare as an isolated issue.
Perhaps we should return to the principle that motivated us to study medicine – that of wanting to “help people”. After all, if we were truly utilitarian, the distinction between UK health and global health would be an arbitrary one.