Editorials

Global Health: It Matters Now More Than Ever

 

Am Fam Physician. 2015 Aug 15;92(4):254-258.

As the recent Ebola epidemic demonstrated, the world is not only smaller than ever, but it is also more intricately connected. Exotic diseases once confined to the third or developing world are now everyone's concern. Global has truly become local.

Having some knowledge of and competencies in global health is not only relevant, but also essential, for every family physician. Many family physicians work in remote areas of the world delivering direct patient care, teaching, promoting the specialty of family medicine, and designing regional and national health care systems. Many more work at home with multicultural, socioeconomically diverse patient populations. A survey of U.S. clinicians in various specialties noted respondents' beliefs that global health work is “synergistic with physicians' work in the United States,” and can inform and enhance their work domestically.1  Table 1 provides resources for opportunities in global health. Family physicians may also want to consider attending a global health conference or meeting for networking purposes; resources are provided in Table 2. Table 3 lists nongovernmental and other organizations that offer service trips or networking opportunities.

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Table 1.

Resources for Opportunities in Global Health

OrganizationResourceWebsiteComments

AAFP

Center for Global Health Initiatives

http://www.aafp.org/about/make-a-difference/global-health.html

Multiple resources and links to global health opportunities

Member interest group: global health

http://www.aafp.org/about/member-interest-groups/mig/global-health.html

Listserv with postings about opportunities and training

World Health Mapper

http://www.aafp.org/mapper/global-mapper.html

Interactive atlas that allows searches of family medicine programs around the world

AAFP Foundation

Family Medicine Cares International

http://www.aafpfoundation.org/online/foundation/home/programs/humanitarian/familymedicinecares/fmcinternational.html

Program that delivers patient care and provides medical resources for persons in need around the world

Society of Teachers of Family Medicine

Group on Global Health

http://www.stfm.org/group/international.cfm

Listserv with postings about opportunities and training

WONCA

Global Family Doctor

http://www.globalfamilydoctor.com/

Links to family physicians practicing around the world


AAFP = American Academy of Family Physicians; WONCA = World Organization of Family Doctors.

Table 1.

Resources for Opportunities in Global Health

OrganizationResourceWebsiteComments

AAFP

Center for Global Health Initiatives

http://www.aafp.org/about/make-a-difference/global-health.html

Multiple resources and links to global health opportunities

Member interest group: global health

http://www.aafp.org/about/member-interest-groups/mig/global-health.html

Listserv with postings about opportunities and training

World Health Mapper

http://www.aafp.org/mapper/global-mapper.html

Interactive atlas that allows searches of family medicine programs around the world

AAFP Foundation

Family Medicine Cares International

http://www.aafpfoundation.org/online/foundation/home/programs/humanitarian/familymedicinecares/fmcinternational.html

Program that delivers patient care and provides medical resources for persons in need around the world

Society of Teachers of Family Medicine

Group on Global Health

http://www.stfm.org/group/international.cfm

Listserv with postings about opportunities and training

WONCA

Global Family Doctor

http://www.globalfamilydoctor.com/

Links to family physicians practicing around the world


AAFP = American Academy of Family Physicians; WONCA = World Organization of Family Doctors.

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Table 2.

Annual Global Health Conferences and Meetings

OrganizationWebsiteComments

American Academy of Family Physicians (Global Health Workshop)

http://www.aafp.org/events/global-health.html

Provides global health–themed sessions, lectures, and workshops, as well as networking opportunities with current and aspiring leaders and experts in global health

Consortium of Universities for Global Health

http://www.cugh.org/events/conference2015

Hosts clinicians, researchers, trainees, and academics from around the world; held in the spring

Family Medicine Education Consortium

http://www.fmec.net/regionmeetings.htm

Offers global health content, speakers, and networking opportunities; global health blog: http://www.fmec.net/Globalhealthblog.htm

Society of Teachers of Family Medicine

http://www.stfm.org/Conferences

Often offers global health content and networking opportunities

Unite for Sight (Global Health and Innovation Conference)

http://www.uniteforsight.org/conference

One of the largest global health conferences; held in New Haven, Conn., in the spring

University of Toronto Faculty of Medicine (North American Refugee Health Conference)

http://www.northamericanrefugeehealth.com/

One of the largest conferences for persons working with refugee populations; meeting held in June and location alternates between New York and Canada

Western Regional International Health Conference

http://2015.wrihc.org

Conference on the advancement of global health and social justice; held on the West Coast in the spring

Table 2.

Annual Global Health Conferences and Meetings

OrganizationWebsiteComments

American Academy of Family Physicians (Global Health Workshop)

http://www.aafp.org/events/global-health.html

Provides global health–themed sessions, lectures, and workshops, as well as networking opportunities with current and aspiring leaders and experts in global health

Consortium of Universities for Global Health

http://www.cugh.org/events/conference2015

Hosts clinicians, researchers, trainees, and academics from around the world; held in the spring

Family Medicine Education Consortium

http://www.fmec.net/regionmeetings.htm

Offers global health content, speakers, and networking opportunities; global health blog: http://www.fmec.net/Globalhealthblog.htm

Society of Teachers of Family Medicine

http://www.stfm.org/Conferences

Often offers global health content and networking opportunities

Unite for Sight (Global Health and Innovation Conference)

http://www.uniteforsight.org/conference

One of the largest global health conferences; held in New Haven, Conn., in the spring

University of Toronto Faculty of Medicine (North American Refugee Health Conference)

http://www.northamericanrefugeehealth.com/

One of the largest conferences for persons working with refugee populations; meeting held in June and location alternates between New York and Canada

Western Regional International Health Conference

http://2015.wrihc.org

Conference on the advancement of global health and social justice; held on the West Coast in the spring

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Table 3.

Organizations That Offer International Service Trips or Networking Opportunities

OrganizationWebsite

Child Family Health International

http://www.cfhi.org

Doctors for Global Health

http://www.dghonline.org

Global Health Service Partnership

http://www.peacecorps.gov/volunteer/globalhealth/

Health Volunteers Overseas

http://www.hvousa.org

Himalayan Health Exchange

http://www.himalayanhealth.com/

Polaris (a new global health movement for new and future family physicians)

http://www.aafp.org/about/make-a-difference/global-health/polaris.html

Shoulder to Shoulder

http://www.shouldertoshoulder.org/

The Network Toward Unity for Health

http://www.the-networktufh.org

The World Medical Association

http://www.wma.net

Table 3.

Organizations That Offer International Service Trips or Networking Opportunities

OrganizationWebsite

Child Family Health International

http://www.cfhi.org

Doctors for Global Health

http://www.dghonline.org

Global Health Service Partnership

http://www.peacecorps.gov/volunteer/globalhealth/

Health Volunteers Overseas

http://www.hvousa.org

Himalayan Health Exchange

http://www.himalayanhealth.com/

Polaris (a new global health movement for new and future family physicians)

http://www.aafp.org/about/make-a-difference/global-health/polaris.html

Shoulder to Shoulder

http://www.shouldertoshoulder.org/

The Network Toward Unity for Health

http://www.the-networktufh.org

The World Medical Association

http://www.wma.net

More than 40 million immigrants have made the United States their home for a variety of reasons, including those that are economic- and education-based.2 More than 3 million refugees have arrived in the United States since 1975,3 with nearly 90,000 persons seeking asylum in 2012 alone,4 and almost 70,000 new refugees arriving in 2013 as part of the U.S. Department of State's resettlement program.5  Family physicians and family medicine residents will encounter persons from these international populations who bring with them a wide variety of health practices, risks, and conditions, similar to those that their colleagues are seeing in other parts of the world, such as Africa, Asia, or the Middle East. Table 4 provides resources for working with international populations domestically. Moreover, Americans, numbering in the tens of millions, travel overseas every year for business, pleasure, or to visit family and friends, potentially being exposed to endemic infectious diseases.6

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Table 4.

Resources for Working with International Populations Domestically

Centers for Disease Control and Prevention refugee health guidelines

http://www.cdc.gov/immigrantrefugeehealth/guidelines/refugee-guidelines.html

EthnoMed toolkit for primary care clinicians treating refugees

https://ethnomed.org/clinical/refugee-health/toolkit

Mishori R, Winklerprins V, Otubu O. Working with international populations—abroad or in your own backyard. Fam Pract Manag. 2013;20(5):27–30.

http://www.aafp.org/fpm/2013/0900/p27.html

Table 4.

Resources for Working with International Populations Domestically

Centers for Disease Control and Prevention refugee health guidelines

http://www.cdc.gov/immigrantrefugeehealth/guidelines/refugee-guidelines.html

EthnoMed toolkit for primary care clinicians treating refugees

https://ethnomed.org/clinical/refugee-health/toolkit

Mishori R, Winklerprins V, Otubu O. Working with international populations—abroad or in your own backyard. Fam Pract Manag. 2013;20(5):27–30.

http://www.aafp.org/fpm/2013/0900/p27.html

Global health exposure internationally and locally helps develop a broader health system perspective, greater attention to the social determinants of health, and an understanding of population health concepts. Engaging in global health can bolster cross-cultural competencies, along with the desire to work in resource-poor settings. Additionally, it can strengthen skills and passion to care for underserved populations domestically.711 A few studies have even suggested an association between global health experiences and an increased interest in primary care.12,13

According to some surveys, volunteering overseas may offer additional benefits. A Scandinavian study documented several themes for clinicians' motivation to work globally, which included a desire to contribute, and a search for personal development and self-knowledge, new experiences, and more satisfying and stimulating work compared with their routine jobs.14 Similar sentiments related to giving back to the world have been noted in other articles and include sharing skills and knowledge, learning about different cultures, addressing job dissatisfaction, providing opportunities for charity work, and increasing personal growth. The rewards of volunteering in these settings have often been described as “gaining more than giving.”1521

Interest in global health has been increasing steadily among family physicians and family medicine trainees. There is a growing realization among family medicine leaders and colleagues that family physicians are uniquely poised to contribute to health access, equity, and capacity building. Family physicians' broad skill set, community orientation, focus on prevention, and education that stresses the incorporation of social determinants and community health into clinical decision making give them an advantage in global health efforts at home and abroad.22 From a systems perspective, family medicine's emphasis on team models of care, integration of population health with individual clinical care, and increasing access and cost-effectiveness are exemplary of global health in action.22

Another area in which family medicine is uniquely positioned to contribute globally is advocacy. The professional identity of family physicians makes them champions of international health policy reform, of global workforce enhancements, and of shifting research agendas and practice models that put the well-being of all patients and communities first. Family physicians provide a focus on the whole patient within the context of family, community, and, ultimately, the world.

These are among the key features that make family medicine stand out on the global stage, as highlighted in 2013 by Dr. Margaret Chan, general director of the World Health Organization. In her keynote address at World Organization of Family Doctors' (WONCA's) 2013 annual meeting in Prague, Chan declared, “Primary care is our best hope for the future. Family doctors are our rising stars for the future.”23 For many, the future is already here.

Address correspondence to Ranit Mishori, MD, MHS, FAAFP, at mishorir@georgetown.edu. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

REFERENCES

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2. Zong J, Batalova J. Frequently requested statistics on immigrants and immigration in the United States. February 26, 2015. Migration Policy Institute. http://www.migrationpolicy.org/article/frequently-requested-statistics-immigrants-and-immigration-united-states. Accessed April 12, 2015.

3. Inkpen C, Igielnik R. Where refugees to the U.S. come from. July 28, 2014. Pew Research Center. http://www.pewresearch.org/fact-tank/2014/07/28/where-refugees-to-the-u-s-come-from/. Accessed April 12, 2015.

4. Asylum levels and trends in industrialized countries, 2013. United Nations High Commission on Refugees (UNHCR). http://www.unhcr.org/5329b15a9.html. Accessed April 12, 2015.

5. Morse J. U.S. welcomes record number of refugees. October 23, 2013. IIP Digital. http://iipdigital.usembassy.gov/st/english/article/2013/10/20131023285033.html#axzz3X7hpvnnz. Accessed April 12, 2015.

6. National Travel and Tourism Office. Profile of U.S. resident travelers visiting overseas destinations: 2013 outbound. U.S. Department of Commerce. http://travel.trade.gov/outreachpages/download_data_table/2013_Outbound_Profile.pdf. Accessed April 12, 2015.

7. Thompson MJ, Huntington MK, Hunt DD, Pinsky LE, Brodie JJ. Educational effects of international health electives on U.S. and Canadian medical students and residents: a literature review. Acad Med. 2003;78(3):342–347.

8. Ramsey AH, Haq C, Gjerde CL, Rothenberg D. Career Influence of an International health experience during medical school. Fam Med. 2004;36(6):412–416.

9. Godkin M, Savageau J. The effect of medical students' international experiences on attitudes toward serving underserved multicultural populations. Fam Med. 2003;35(4):273–278.

10. Federico SG, Zachar PA, Oravec CM, Mandler T, Goldson E, Brown J. A successful international child health elective: the University of Colorado Department of Pediatrics' experience. Arch Pediatr Adolesc Med. 2006;160(2):191–196.

11. Liaw W, Bazemore A, Xierali I, Walden J, Diller P, Morikawa MJ. The association between global health training and underserved care: early findings from two longstanding tracks. Fam Med. 2013;45(4):263–267.

12. Bruno DM, Imperato PJ, Szarek M. The correlation between global health experiences in low-income countries on choice of primary care residencies for graduates of an urban US medical school. J Urban Health. 2014;91(2):394–402.

13. Rhee DS, Heckman JE, Chae SR, Loh LC. Comparative analysis: potential barriers to career participation by North American physicians in global health. Int J Fam Med. 2014. http://www.hindawi.com/journals/ijfm/2014/728163/. Accessed April 12, 2015.

14. Bjerneld M, Lindmark G, McSpadden LA, Garrett MJ. Motivations, concerns, and expectations of Scandinavian health professionals volunteering for humanitarian assignments. Disaster Manag Response. 2006;4(2):49–58.

15. Kelly NA. Career pulse: deciding to become an overseas volunteer. Hospital Physician. 2000;36(part 6):72–78.

16. Woods JE, Kiely JM. Short-term international medical service. Mayo Clin Proc. 2000;75(3):311–313.

17. Bartels-Rabb L. To the service of humanity: volunteering in the third world. The Bulletin. 1996;40:71–77.

18. Setness PA. A flood of rewards: volunteers set an example for all of us. Postgrad Med. 1997;102(1):13–16.

19. Elseed E. Volunteerism among physicians: motivational causes and reaped benefits. Outstanding Honors Theses, University of South Florida. 2012. http://scholarcommons.usf.edu/honors_et/89. Accessed April 12, 2015.

20. Mitka M. Volunteering overseas gives physicians a measure of adventure and altruism. JAMA. 2005;294(6):671–672.

21. Vu MT, Johnson TR, Francois R, et al. Sustained impact of short-term international medical mission trips. Med Teach. 2014;36(12):1057–1063.

22. Jogerst K, Callender B, Adams V, et al. Identifying interprofessional global health competencies for 21st century health professionals [published ahead of print March 21, 2015]. Annals Glob Health. http://www.annalsofglobalhealth.org/article/S2214-9996%2815%2901156-X/abstract. April 23, 2015.

23. Chan M. The rising importance of family medicine. Key note address. World Health Organization. http://www.who.int/dg/speeches/2013/family_medicine_20130626/en/. Accessed April 12, 2015.


 

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