Directions in Global Public Health Graduate Education

by

Erica Di Ruggiero, Danielle MacPherson, Uttam Bajwa

• LAST REVIEWED: 29 November 2018
• LAST MODIFIED: 29 November 2018
• DOI: 10.1093/obo/9780199756797-0190

Introduction

Recent decades have seen an exponential growth in global health education programs especially in high-income country (HIC) academic institutions. Rapid globalization has fueled this growth and accelerated changes in knowledge and technological flows. The creation of new programs has also been shaped by the inclusion of health in foreign policy objectives, and moral imperatives to improve health, health systems, and health equity for all people. Global health has been defined as a field of study that encompasses the determinants of health, health equity and related interventions, transcends national boundaries and promotes interdisciplinarity. Driven by competition for attracting top talent, increased student demand, and calls for internationalization of education, academic institutions in HICs have expanded global health offerings (see Harmer, et al. 2015 cited under General Overviews). Key developments include the identification of competencies, innovative curricular and co-curricular modalities and pedagogy, increased interdisciplinary and experiential education, partnerships with academic institutions in low- and middle-income countries (LMICs), and some evaluation of these efforts. Peer and grey literatures were assessed with the following questions in mind: What are promising or best practices in global public health graduate education to effectively prepare scholars (researchers, policymakers, practitioners) for careers in global health, with particular emphasis on education programs taking an interdisciplinary and public health perspective? What competencies and skills are essential for preparing scholars for careers in global health? HIC academic institutions (particularly in North America and Europe) dominate this literature, with a few exceptions from sub-Saharan Africa and Asia. Articles include reflective accounts of program experiences, but few evaluations. As a set, this literature raises issues such as: the harmonization of standards and competencies across global health education programs; evaluations of interdisciplinarity and disciplinary diversity in training; adequacy of funding and institutional buy-in; challenges with experiential education and training accessibility; and, ethical implications of engagement with LMIC institutions. Liu, et al. 2015 (see General Overviews) identified similar gaps. This review should be of interest to educators, researchers, and administrators leading global health education initiatives. The authors hope it will encourage increased scholarship aimed at measuring the outcomes and unintended consequences of global health education and partnerships on learners and academic institutions globally.

General Overviews

Several overviews of relevance to global health education have been published in recent decades. These include commentaries on the trends and transformations in global health education from the perspectives of different regions of the world such as Europe (Bjegovic-Mikanovic, et al. 2014), North America, and the Pacific Rim (Withers, et al. 2016). One major trend is the historical shift in language from “tropical medicine” and “international health” in the 19th and early 20th centuries to “global health,” which represented a shift to interdisciplinarity, and a more genuinely “global” focus (McFarlane, et al. 2008; Rowson, et al. 2012). Of note, “global health” programs are primarily in high-income countries (HICs) because in spite of the more expansive definition of global health (compared to “international health”), the focus is still often about the health of people in low- and middle-income countries (LMICs). As a result, academic institutions in LMICs are developing various graduate training programs in health that are country or region-specific; however, these programs are underrepresented in the literature, with some exceptions. Global health is often also core to public health education. It is perhaps not surprising that some authors have claimed that the goals of public health training are indistinguishable from those of global health (Bjegovic-Mikanovic, et al. 2014). This section also highlights literature reviews. The nature and breadth of articles reflects a growing field of study, signaling emerging gaps in training areas such as data science in global health (Olayinka, et al. 2017), gaps in studies of global health education (Liu, et al. 2015) such as an imbalance in published papers on global health education between HICs and LMICs; heterogeneity in program approaches and targets; and the lack of standardization of global health curricula. This literature also outlines challenges such as the retention of high-quality personnel in LMICs through improvements in the availability and quality of in-country training opportunities (Kerry, et al. 2011).

• Bjegovic-Mikanovic, V., A. Jovic-Vranes, K. Czabanowska, and R. Otok. 2014. Education for public health in Europe and its global outreach. Global Health Action 7.1: 1–11.

  DOI: 10.3402/gha.v7.23570

  Schools of public health need to more effectively respond to global health challenges, a task complicated by the complex scope of the health sciences and diversity in public health students and professionals. Authors observe an increased use of competency-based approaches, interests in harmonization of approaches across schools, continuing education that integrates lifelong learning in interdisciplinary teams and performance-based strategies to improve critical reasoning skills, as well as an increase in the use of innovative technologies and educational partnerships within Europe and beyond.

• Harmer, A., K. Lee, and N. Petty. 2015. Global health education in the United Kingdom: A review of university undergraduate and postgraduate programmes and courses. Public Health 129.6: 797–809.

  DOI: 10.1016/j.puhe.2014.12.015

  This article describes the state of global health education in the United Kingdom by synthesizing data on undergraduate and postgraduate degree programs, and with particular attention to equity of access to programs. It is based on a systematic review of “core competencies” and a questionnaire administered with UK global health program directors about their students. Authors show that innovation in content and delivery is primarily at the postgraduate level.

• Kaffes, I., F. Moser, M. Pham, A. Oetjen, and M. Fehling. 2016. Global health education in Germany: An analysis of current capacity, needs, and barriers. BMC Medical Education 16.1: 1–14.

  DOI: 10.1186/s12909-016-0814-y

  The authors analyze global health educational capacity in Germany and identify gaps, barriers, and future strategies using landscape and stakeholder analyses. They found that of the thirty-three global health educational activities in Germany, most were located in medical schools and 92 percent of stakeholders surveyed found the activities insufficient. They suggest students and educators should advocate for more programs and discuss global health competencies and curriculum, interdisciplinary approaches, and educational formats.

• Kerry, V. B., T. Ndung’u, R. P. Walensky, P. T. Lee, V. F. I. Kayanja, and D. R. Bangsberg. 2011. Managing the demand for global health education. PLoS medicine 8.11: 1–6.

  DOI: 10.1371/journal.pmed.1001118

  While the overall demand for global health education and in-country training experiences in high-income countries are on the rise, many trainees are leaving low- and middle-income countries to seek training in better-resourced settings. Authors recommend that global health training programs prioritize capacity development and contribute to the redesign of long-term human resource strategies in LMICs. They also call for funding that cultivates high-quality personnel and evaluates the quality of trainees’ experiences in all settings.

• Lenucha, R., and K. Mohindra. 2014. A snapshot of global health education at North American Universities. Global Health Promotion 21.1: 63–67.

  DOI: 10.1177/1757975913514464

  The authors respond to a lack of studies on the content of global health courses by examining sixty-seven syllabi from twenty-seven universities to analyze topics covered in the courses. They report that though multiple disciplines were involved in teaching global health, most courses were in public health and medicine. They advocate for increased interdisciplinary training outside of traditional health disciplines, using the specific example of law.

• Liu, Y., Y. Zhang, Z. Liu, and J. Wang. 2015. Gaps in studies of global health education: An empirical literature review. Global Health Action 8.1: 1–9.

  Analyzes 238 articles on global health education to identify gaps in the literature. Four gaps were identified: the uneven amount of published papers on global health education between developed and developing countries; educational approaches to teaching global health; the lack of standardization of global health curricula, and the students/professionals global health education programs target. The authors note that increased collaboration across health disciplines internationally could aid in educational program development and standardization.

• McFarlane, S. B., M. Jacobs, and E. E. Kaaya. 2008. In the name of global health: Trends in academic institutions. Journal of Public Health Policy 29.4: 383–401.

  DOI: 10.1057/jphp.2008.25

  Authors discuss the growth of global health education programs, particularly in North America, in the context of previous programs in “tropical medicine” and “international health.” They note the absence of similar programs in developing countries and argue for the importance of relationships across geographical, cultural, economic, gender, and linguistic boundaries to develop an understanding of global health and create collaborative educational and research programs to train future global health leaders.

• Olayinka, O., M. Kekeh, M. Sheth-Chandra, and M. Akpinar-Elci. 2017. Big data knowledge in global health education. Annals of Global Health 83.3–4: 676–681.

  DOI: 10.1016/j.aogh.2017.09.005

  Increased attention toward the use of big data in global health and need for education in data science provided the impetus for this survey with members of the Consortium of Universities of Global Health. Pilot results suggest that students and professionals need skills to deploy big data tools for disease surveillance; however, few know what big data is, which calls for formalized education on the potential uses of big data in global health.

• Rowson, M., C. Willott, R. Hughes, et al. 2012. Conceptualising global health: Theoretical issues and their relevance for teaching. Globalization and Health 8.1: 1–8.

  DOI: 10.1186/1744-8603-8-36

  Authors use changing definitions of “global health” to assess the evolution of the field. They locate its origins in 19th century colonial, biomedical approaches to “international health.” In the 20th century, they describe a broadening conceptualization of “global health” to include the social determinants of health and increased exposure to different disciplinary perspectives. They argue that “equity” has significant ideological baggage and so should be excluded from global health definitions though discussion of values should continue to be a major part of global health education.

• Wernli, D., M. Tanner, I. Kickbusch, G. Escher, F. Paccaud, and A. Paccaud. 2016. Moving global health forward in academic institutions. Journal of Global Health 6.1: 1–6.

  Advances the concept of academic global health (AGH) as an implementation and integration science and intellectual space for studying complex systems in the real world. Six principles are proposed for AGH to guide its research, education, and practice from the perspective of Swiss academic institutions. These are: (1) cross-border/multilevel approach, (2) inter–/trans–disciplinarity, (3) systems thinking, (4) innovation, (5) sustainability, and (6) human rights/equity. While AGH is gaining more prominence in high-income countries, its longevity will require uptake by low- and middle-income institutions, requiring ethical bidirectional collaboration that departs from an extensive neocolonialist tradition of international and tropical medicine.

• Withers, M., D. Press, H. Wipfli, et al. 2016. Training the next generation of global health experts: Experiences and recommendations from Pacific Rim universities. Globalization and Health 12.1: 1–7.

  DOI: 10.1186/s12992-016-0162-z

  Analyzes public health programs with an emphasis on global health in Pacific Rim universities. Results suggest a notable increase within the region, suggesting a growing demand for such programs. Highlights that universities should offer more programs specifically on global health, and more undergraduate level global health courses; foster a multidisciplinary approach when teaching or forming global health programs, and that increased funding should be allocated toward resources for global health programming.