By Deirdre Boling
Global health. Two little words that get a lot of attention. They appear in our standard tagline, a commitment to global health; in our centennial tagline Century of Commitment to Global Health; and as the name of this very publication.
We here at Global Health have been giving a great deal of thought to those two words, as has Dean Pierre Buekens. He defines global health this way: “Health issues that we have in common in the world. Health issues which transcend national boundaries that can be addressed by common actions. In other words, health issues which are important both domestically and internationally.”
He sees the increased focus on global health as balancing the school’s portfolio; taking what we have always done and making it more relevant and important to all departments, all programs, and all stakeholders of the school, and even expanding it throughout the university.
He points to just a few decades ago when infectious disease in the U.S. was considered to be “public health of the 19th century.” There was a distinct divide between what was called the developed world and the developing world. “That’s completely gone now,” he says. “Now it’s all mixed.”
It’s no secret that health issues common throughout the world are expanding. Chronic diseases like cardiovascular disease, cancer, and diabetes are increasingly being diagnosed in low- and middle-income countries even as they are diminishing somewhat in higher-income countries. Infectious diseases, once thought to be conquered in the developed world, are spreading quite easily across boundaries, across oceans, and across socio-economic groups. Some chronic diseases have even been found to have infectious causes.
Even the language has changed, Buekens points out. Rather than using terms like industrialized country and developing country, it’s much more common to hear classifications based on income – low-, middle- and high-income countries – since so much industry has moved to lower-income countries around the world.
Richard Oberhelman, professor of tropical medicine, bears witness to this shift. “In the world at large, there’s been a transition from the old paradigm back in the ‘60s and earlier when what happened in Mali, in China, in South America, was very different from what was happening healthwise back in the U.S. and in the developed world. It was a them and us mentality. Over time there’s been a transition with globalization. Now the diseases that affect us in the U.S. have their origins [in some other part of the world]. And the big diseases we worry about like HIV, like tuberculosis, they are truly global. They don’t discriminate between boundaries or between socio-economic levels.”
Frederique Jacquerioz, assistant professor of clinical tropical medicine, teaches an interdisciplinary course in global health in her role as assistant deputy director of the Office of Global Health. She compares global health to the world economy. “I emphasize that we have to work toward health equity. There’s one world in terms of economy, the global market, and we know that we are interconnected. But there’s also one health. There’s not different health in the world.”
Colleague Daniel Bausch, associate professor of tropical medicine, concurs. He suggests that “global health has opened some space for people in developing countries to chime in more than they have been able to.” He sees the discussions around global health as a reminder to researchers to consider how much of their work is in partnership with affected communities, rather than directing. “It’s not a bad reminder for everybody to have,” he says.
In environmental health sciences, like many departments, researchers frequently address health concerns that are not defined by a country’s borders. The issues, however, are becoming even more transcendent. Maureen Lichtveld, Freeport McMoRan Chair of Environmental Policy, says, “Look at industrialization, or look at diseases with no borders, disasters with no borders, pollution with no borders. The interdependence of us as a world has made a problem anywhere else, our problem. And if we in the U.S. are not awake to that, we are behind. Every problem becomes our problem.
Felicia Rabito, associate professor of epidemiology, sees global health as defining the population. “I look at it like an epidemiologist,” she says. “If it’s global health, then you’re concerned about the health of people who live on the globe – anywhere. I think people tend to think global health has to mean international health I think that’s the mistake. We used to say domestic health and international health. Global health is just the sum of the two.”
GLOBAL HEALTH AT TULANE
Jeanette Magnus, Cecile Usdin Professor in Women’s Health and chair of the Department of Community Health Sciences, agrees and feels the misperception that global health only pertains to issues outside the U.S. needs to change. Students, she says, get the distinction.
“[They] want to hear about the global contrast,” she says. “They want to contrast their experience to a different experience.”
Today’s students grew up in a diverse, multicultural world and expect the classroom to reflect that image. “They look at Tulane as a place where it’s not going to be restricted to how the U.S. does things,” says Mark Diana, assistant professor of health systems management.
“We do have…a more global perspective. I think there is a sensitivity here in this school to those kinds of issues, that there might not be in some other schools.”
Tulane has been involved in transcendent issues throughout its existence, so for many, the emphasis on global health is nothing new. “Many of us working in the school feel Tulane has been doing global health for decades,” says Mark VanLandingham, Thomas C. Keller Professor of International Health. “We’re really happy that other people have gotten interested in it but we’ve really been doing it for a very long time.”
Even in programs more focused on American systems, issues still transcend boundaries. Claudia Campbell, professor of health systems management, brings up the scarcity of physicians. “This is something affecting all countries in the world. The issues of how you attract, retain, and train the healthcare workforce are global issues.”
The return of Jane Bertrand to serve as chair of the Department of Health Systems Management points to one way that department is addressing global health. From 1994 to 1999 Bertrand served as the chair of Tulane’s Department of International Health and Development and has wide experience in global health management. Under her leadership, the master of public health in HSM will offer three different foci for prospective students, including one aimed at management in international settings. In addition, the policy focus will look at both domestic and international systems. “So in a sense we are very much and very aggressively developing the MPH in the realm of global health,” says Bertrand.
Buekens wants to make sure that all graduates are grounded in global health. “The globalization of the curriculum is important,” he says, but it’s something he is not undertaking alone. Buekens chairs the Global Health Committee of the Association of Schools of Public Health (ASPH), which is working to establish a set of competencies for a global health curriculum. The process, he says, will take at least a year, involving many stakeholders, including those outside of the ASPH. While the resulting competencies will be developed specifically for use by member schools, they will also be available for use by non-member schools and programs, he says.
A working group of the committee, including Dean Buekens, published an article in global health. In that piece, entitled “Global Health is Public Health, the authors wrote, “Public health schools remain at the forefront of efforts to educate global health experts who are prepared to confront the global burden of disease. They bring systems approaches and a focus on prevention science and evidence-based interventions to that effort, along with a multidisciplinary faculty and ties to communities, public sector agencies,non-governmental organizations, and government ministries.”
BEYOND PUBLIC HEALTH
“Another dimension to global health is that it is very multidisplinary,” says Buekens. “You need to understand the context in which you work.”
That multidisciplinarity is at the core of Tulane’s Office of Global Health, which launched the Certificate in Global Health program this year. Deputy Director Valerie Paz Soldan, research assistant professor of international health and development, says “The Office of Global Health fosters and creates an atmosphere where people from a variety of disciplines are aware of what global health is and can find a voice or a role in participating in global health activities.”
The certificate is not a stand-in for a public health degree, she cautions. “We are not trying to create public health practitioners. The certificate is not an MPH. What it does is allow students to understand conceptually the practice of public health and to find a way our discipline can be applied to their field.”
She points out that public health practitioners rarely work alone. In developing solutions to complex problems, they bring together ministries, policy makers, educators, communicators, and other professionals to effect change. Exposure to global health topics will help practitioners from a variety of settings be more informed as their work intersects with public health.
For a school that has always been global, has the push toward global health really changed much? Buekens thinks it has. “There is certainly a strong trend toward globalizing research at the school level. You see epidemiology having strong activities in Asia and Latin America. Environmental health having a lot of international activities in the Caribbean. HSM in Asia. Community health sciences also has international activities and has a program in global maternal and child health.
“At the same time, the Department of International Health and Development is increasingly active in the community in New Orleans, especially with the Vietnamese community. They are involved in minority health because migration is another component of globalization. At the school level, in research, in teaching,and in practice, you see real globalization.”