N. Ben Fredrick Penn State U. College of Medicine nfredrick@psu.edu Teaching global health in medical education: Focus on health care disparities N. Ben Fredrick Penn State U. College of Medicine nfredrick@psu.edu

Conflict Declaration Nada.

Learning Objectives Restate and affirm the core value of health equity in global health and in family medicine Recognize the value of global health experiences in teaching future physicians about health disparities Recognize health care disparities as a particular subset of health disparities, and describe common contributors to health care disparities

Audience Participation! What of global health should we be teaching future physicians (e.g. medical students, residents)? Audience Participation!

Another way to ask it… How does global health make better physicians? How does it help institutions (medical schools and residencies) in particular?

What of global health should we be teaching future physicians? My Answer: health equity, health disparities, and health care disparities in particular Aligns with FCM, with GH, with student interest, with medical education competencies and LCME etc. Intercultural adaptation (cultural competency) Health disparities (specifically, health care disparities) Social determinants of health and societal problems Health systems learning Medical humanities

So many things to choose from…. “global health is an area for study, research, and practice that places a priority on improving health and achieving equity in health for all people worldwide. Global health emphasises transnational health issues, determinants, and solutions; involves many disciplines within and beyond the health sciences and promotes interdisciplinary collaboration; and is a synthesis of population-based prevention with individual-level clinical care.” Koplan et al. Towards a common definition of global health. The Lancet. 2009 …a priority on improving health and achieving equity in health for all people worldwide.

This is what Physicians tend to see… Hard to tell if it’s unfair or just bum luck…so we need data to look for significant differences

Substitute end of the race with…health care factors such as access, quality care, morbidity, mortality… They are not equal. But is it unfair?

Point #1: Striving for health equity is a major reason for doing what we do. Global health opportunities abound to illustrate health disparities. 4 billion 1.5 billion I’m assuming that I don’t need to convince you of this… Bottom billion

Something IS wrong here. This is a racial disparity

Point #2 We need to help our learners connect to health disparities right here at home

Point #3 Health care disparities are a subset of health disparities, and are within the purview of physicians. “Health disparity” --a higher burden of illness, injury, disability, or mortality experienced by one population group relative to another.1  Health Disparities

Health Care Disparities Point #3 Health care disparities are a subset of health disparities, and are within the purview of physicians. “Health care disparity”-- differences between groups in health insurance coverage, access to and use of care, and quality of care. (KFF.ORG) Health Disparities Health Care Disparities

Health and health care disparities often refer to differences that cannot be explained by variations in health care needs, patient preferences, or treatment recommendations. 

We are concerned about health inequities and global health experiences provide powerful teaching opportunities Health care disparities in particular are within physicians’ sphere of influence. We need to teach our learners to identify and address health care disparities, here and abroad [Thus, the GHSP…]

PSU-COM Global Health Scholars Program

NOTICING 13 sessions + trip Contributors to health care disparities while abroad: Oneself, another culture, the social and environmental context of health and health care in another country, another health care system RE-FRAMING 14 sessions Contributors to health care disparities back home: One’s commitments, one’s own culture, the social and environmental context of health and health care in one's own community, our own health care system PRACTICING 18 sessions Identifying and addressing health care disparities back home: addressing Intercultural communication, identifying and addressing biases, identifying and addressing patient barriers to health and health care including social and environmental aspects, health system disorders (quality and/or access) PERFORMING Trip Identifying and addressing health care disparities at home and abroad: Identifying personal (internal) clues that reduce opportunity to explore and problem solve systems and psycho-social-cultural barriers affecting patient outcomes, identifying patient clues to social, structural, and health systems issues involved in influencing patient outcomes. Year 1 Year 2 Year 3 Year 4

Health disparities and Health Equity are linked "Health disparities will be eliminated when health equity is achieved,"  Camara Jones, M.D., M.P.H., Ph.D., 

Health equity is at the heart of global health and family medicine Global health experiences are optimal for teaching future physicians about health disparities Health care disparities as a particular subset of health disparities. Many contributors to health care disparities are within the purview of physicians ….whether here or abroad.

Resources Health Affairs, Pursuing Health Equity, June 2017; Volume 36, Issue 6 National Healthcare Quality & Disparities Reports CDC, Strategies for Reducing Health Disparities website RootsofHealthInequity.org Beyond Flexner Alliance--movement focused on health equity and the education of health professionals

Comments/Questions?

Health Inequity

Wonder/Be curious…when you see a patient PROGRESS Place (e.g. geography) Race/ethnicity (culture, language) Occupation (e.g. manual labor, health insurance) Gender/sex Religion Education status Socioeconomics Stressors (e.g. disability, age-related)