Building a Global Prevention Network to Share Knowledge and Wisdom Global Health Global Health Network Supercourse Project, University of Pittsburgh “An ounce of prevention is worth a pound of cure” Henry De Bracton, 1240   With this famous saying we started our Golden lecture of Prevention in 2003. This 2007 follow up lecture is dedicated to Global Health, a theme very close to the theme of prevention. This lecture was coordinated through the Global Health Network Supercourse Project, housed at the Department of Epidemiology, University of Pittsburgh. Millions of people—most of them children—die each year in developing and developed countries from diseases that are preventable and treatable. Moreover, tragically little research is done to prevent or cure some of the world’s biggest killers, such as malaria and tuberculosis. The focus of this lecture is to demonstrate how the world can become healthier through improved information sharing. The focus of this lecture is the science of global health and what future surgeons, epidemiologists, and other health professionals can do to improve health in their community and the world. Golden lecture of Prevention can be accessed at http://www.pitt.edu/~super1/lecture/lec10511/index.htm Building a Global Prevention Network to Share Knowledge and Wisdom

Mission of this lecture Teach every medical, public health and nursing student in the world about global health Develop a global health network for students to tackle local to global health problem.

International Health International health refers to the interlocking and interrelated health status of people throughout the world and to efforts to improve the health of all people of every country. Last, Foege International health cannot be viewed disease specific or country specific. We need to examine all transboundary and transdisciplinary conditions that affect health. The word "international" is literally defined in terms of national borders, whereas the word "global" encompasses the entire world. If medical, public health, and nursing students work together, we can change global health. This collaborative effort in global health research will help us to cross geographic, economic, and all other boundaries that divide our fields. International health lectures in the Supercourse: http://www.pitt.edu/~super1/lecture/lec10931/index.htm

Global health is an important new term, and an important new concept Global health is an important new term, and an important new concept. The Institute of Medicine refers to global health as "health problems, issues, and concerns that transcend national boundaries, may be influenced by circumstances or experiences in other countries, and are best addressed by cooperative actions and solutions." However, it is not just health problems that cross borders or are common to countries around the world; solutions to these problems can also cross borders and be shared, regardless of level of development. All countries can both learn from other countries and also share their own experiences and information. An enlightened new definition of global health paints the picture of a two-way street: Shared problems, sharing solutions. This new definition is very important for the science of global health, as global health is portray as a road of sharing (a good description can be found at http://www.globalhealth.gov/faq.shtml)   Visit the Supercourse Global Health Crisis lecture at: http://www.pitt.edu/~super1/lecture/lec4041/index.htm

Why should medical students learn about global health As of today, medical schools have very few lectures on global health is their curricula Health is becoming a global problem, with chronic diseases being a number one killer around the globe By learning more about global health research, medical students will be better equipped to face the challenges of their unique profession This lecture has been designed for faculty members and students at medical schools and schools of public health around the world.  

What should medical students know about global health Know the differences between global and international health research Identify key challenges to global health Recognize the importance of information sharing in the area of global health Recognize the importance of preventive activities in improving global health Recognize the need for global networking to improve global health locally and globally Global health is an important concept that medical students need to understand. Global health is not about a single health problem such as malaria, TB, or AIDs, no matter how serious the problem is. Global health is not about the health of one country or region. Global health transcends boundaries and regions and encompasses all the factors that comprise our health.   Global health is everywhere-in your clinics, in you communities, and in your countries. Visit the Supercourse Global Health Preparation Lecture at: http://www.pitt.edu/~super1/lecture/lec8211/index.htm

Local health International health Global health Many health efforts, even international health programs, concentrate on health in one or several regions of the world. We would like to change the philosophy of “global health” by emphasizing the importance of health efforts globally. We need to better define the discipline of global health.   The philosophy of the new global health would include the importance of information sharing. The world is huge and health challenges are diverse, depending on the region. Thus, research is important for meeting the health challenges in both the developing and developed world.

In the past 100 years, life expectancy has been on the rise both in the majority of developing and developed countries. We are healthier today than we have ever been in the history of mankind. This improvement in life expectancy has been achieved due to improved prevention, information sharing, and global health.   Visit the Supercourse Epidemiologic transition lecture at http://www.pitt.edu/~super1/lecture/lec19181/index.htm 

Smallpox vaccination: the case of global health effort in disease eradication You as doctors will never see a case of Smallpox- this is very different than in your great grandfather’s era. Clinicians worked together with public health workers and global health scientists to eradicate one of the most deadly diseases know to man. We can continue the success of Smallpox if we work together on other local problems, we can have an enormous global impact.   The history of the rise and fall of Smallpox is a success story for "modern“ clinicians and public health alike. Millions of people died in Europe and Mexico as a result of widespread smallpox epidemics. The fall of Smallpox began with the realization that survivors of the disease were immune for the rest of their lives. This led to the practice of variolation - a process of exposing a healthy person to infected material from a person with Smallpox in the hopes of producing a mild disease that provided immunity from further infection. The next step towards the eradication of Smallpox occurred with the observation by English physician, Edward Jenner, that milkmaids who developed cowpox, a less serious disease, did not develop the deadly smallpox. In 1796, Jenner took the fluid from a cowpox pustule on a dairymaid's hand and inoculated an 8-year-old boy. Six weeks later, he exposed the boy to smallpox, and the boy did not develop any symptoms. Jenner coined the term "vaccine" from the word "vaca" which means "cow" in Latin. His work was initially criticized, but it soon was rapidly accepted and adopted. By 1800, about 100,000 people had been vaccinated worldwide. In 1967, the World Health Organization (WHO) started a worldwide campaign to eradicate Smallpox. This goal was accomplished in 10 years due in a large part to massive vaccination efforts. The last endemic case of Smallpox occurred in Somalia in 1977. On May 8, 1980, the World Health Assembly declared the world free of smallpox. Global health research and information sharing played a very important role in the eradication of Smallpox. As the result of this global effort and research collaboration of global clinicians, medical students today is not seeing any cases of smallpox. From http://dermatology.about.com/cs/smallpox/a/smallpoxhx.htm For more information about Dr. Edward Jenner, visit Wikipedia http://en.wikipedia.org/wiki/Edward_Jenner

Most important problems of global health today Communicable, maternal, perinatal and nutritional conditions Noncommunicable diseases Injuries What are some of the most important problems in global health today? The landmark 1996 publication, “The Global Burden of Disease”, presented data from 1990 with data projections out to 2020 for three broad cause groups of health problems that, collectively, constitute the world's total disease burden. These are: Group 1, communicable, maternal, perinatal and nutritional conditions; Group 2, noncommunicable diseases; and Group 3, injuries. Within each of these broad groups are more specific conditions.   The 15 leading individual problems, based on DALYs (disability-adjusted life years) , were: (1) lower respiratory infections; (2) diarrheal diseases; (3) conditions arising during the perinatal period; (4) unipolar major depression; (5) ischemic heart disease; (6) cerebrovascular disease; (7) tuberculosis; (8) measles; (9) road traffic accidents; (10) congenital anomalies; (11) malaria; (12) chronic obstructive pulmonary disease; (13) falls; (14) iron-deficiency anemia; and (15) anemia. Non-communicable diseases are the most widespread diseases seen by the majority of medical students in their practice. We need to work together to share our knowledge about these conditions for prevention and cure.

There are many challenges to global health with different professionals emphasizing different diseases. Interdisciplinary approaches are needed to ease the burden of both communicable and non-communicable diseases Professionals from different professionals working together eradicated smallpox. If a challenging disease like smallpox could be eradicated, similar collaborative efforts could prove to be successful for eradicating other diseases and challenges to global health.      

Although many international programs and initiatives target problems including AIDS, Malaria, and TB, chronic disease becomes a major threat to human health as the countries move through the epidemiologic transition.   Visit the Supercourse lecture on Epidemiologic transition at http://www.pitt.edu/~super1/lecture/lec19181/index.htm    

Digital divide: gap between haves and have nots One of the biggest global health challenges is access to information In addition to different diseases, we would like to argue that one of the biggest challenges to global health is access to information. We need to share information in the area of global health research across the digital divide. Much of clinical practice and prevention is the sharing of knowledge. If we can harness the information revolution we can have a profound effect with our patients and with the people of the world.    When Internet came into our lives in the 1990’s, we thought that this was the luxury that only few people could afford. As of 2007, Internet is a necessity as it becomes widespread in the majority of developing and developed nations. The internet is becoming as valuable to clinical medicine as the stethoscope.

The importance of knowledge, learning, innovation, and IT “The most fundamental resource in modern economy is knowledge and, accordingly, the most important process is learning” Lundvall, Bengt-Åke (1992) National Systems of Innovation. Towards a Theory of Innovation and Interactive Learning. Pinter, London and New York, pp. 342 The new philosophy of global health will include information sharing- one of the most important means to improve health globally.   Global health is a knowledge organization, with multiple different disciplines tied together by lines of communication to attack global problems. New achievements in the field of information technology are helping to exchange information rapidly and at minimal cost. The Internet revolution allows us to effectively share global health research information across the globe. Palm pilots, iPods, cell phones, and other technologies hold a great potential to improve information delivery to remote regions. If knowledgeable about global health, medical students could play a major role in sharing public health and medical information and improving health around the world. It is critical to take our scientific knowledge and to translate this into the global community. The new information systems are a million times more powerful than they were but 40 years ago. Combining Prevention, research, education, IT is a powerful prevention stew, perhaps the most powerful for nourishing global health. Visit the Supercourse lecture “Knowledge access and sharing. An overview of access models.” at http://www.pitt.edu/~super1/lecture/lec14521/index.htm

Last Biomedical Journal                                                            University of Khartoum, Sudan Last Biomedical Journal 1990 In developing countries, there is very little current literature. The Supercourse serves to deliver new scientific information to developing countries and will likely be the main source of scientific information. Lecture sharing will help the experienced teachers and junior instructors, teachers from developing and developed countries, as well as medical and public health students.  When considering international research one is confronted in both developed and developing countries that are quite different than doing work within ones own country. Often Investigators are interested in doing International research, but do not realize that the rules and medical systems are different. Misperceptions can taint research, and in fact destroy research. It makes little sense as the system we have now where all new international research starts anew, without using learning from the many mistakes that we all have made. International research needs to “stand on the shoulders of those who went before”, as through connection and dialogue we can help others to not make the same mistakes as we. We need to move from International research to Global research. Global research is about communication. Medical students are important conduits for global health research sharing. Cuttington University, Liberia

How can you become involved with Global Health? The Supercourse SUPERCOURSE-global library of lectures on prevention and public health, shared for free by the best faculty in the world. Supercourse currently has over 3,200 lectures shared by over 42,000 faculty members in 151 countries. Supercourse is a teaching supplement model, where the teachers of the world share their best lectures. A Growing number of the Supercourse lectures are dedicated to the theme of global health research.   Medical students can learn directly from the lectures. They can also use the lectures and slides for presenting to their patients, the community or their own students. Visit the Supercourse overview lecture at http://www.pitt.edu/~super1/lecture/lec6961/index.htm www.pitt.edu/~super1

Circle of Learning Education in Medicine Biomedical and Public Health Research Education in Medicine and Public Health Our project is translational research and focuses on translation of information from the scientist to the classroom. Now it takes about 5-6 years for scientific information to work its way into the classroom. If the scientific information was immediately put into PowerPoint, instead of years, it would take days to translate.   The fundamental underlying concept of the research center is that of telepreventive medicine. The birth of the discipline started a few years ago and has mushroomed in interest in a very short period of time. The British Medical Journal article our group published recognized its importance. In the health arena, telepreventive medicine will form the backbone of our international health crossroads being build. Telepreventive medicine has a great potential to improve global health. Many important medical discoveries are not readily shared with medical students, simply because it takes 5-10 years for information to migrate into medical school textbooks. Through the Supercourse, information can be shared more rapidly with medical students through their instructors. Visit the Telepreventive Medicine Supercourse lecture at http://www.pitt.edu/~super1/lecture/lec10431/index.htm Instructions on how to provide a lecture for the Supercourse http://www.pitt.edu/~super1/lecture/lec0391/index.htm

Global Health Information Sharing: Supercourse CD/DVD Supercourse CDs are gifts that are meant to be given. We give out the free Supercourse DVDs so that they could be shared with 5 students and libraries.    Medical students across the world need to be better networked to face the global health challenges of the 21st century.  By using the network of clinicians and public health professionals, Supercourse developers were able to produce Just in Time lectures on Bam Earthquake, SARS, Katrina, and other hot topics within several days after the events happened.    All Just in Time lectures of the Supercourse library can be accessed through http://www.pitt.edu/~super1/jit/jit.htm Distributed to over 10,000 individuals around the globe

Conclusion Global health is important, as similar conditions plague people in developed and developing countries alike Life expectancy in the 20th century was improved due to successes in global health efforts Medical students need to know more about global health research and form networks to share important global health knowledge There are many important organizations working in the area of global health. They include: World Health Organization, the Pan American Health Organization, the World Bank, UNICEF, UN High Commissioner for Refugees, the UN Foundation, the Bill and Melinda Gates Foundation, CARE International, the Global Health Council, and many others. The Supercourse group at the University of Pittsburgh is excited to have you in the Global Health Family. Supercourse can be accessed at www.pitt.edu/~super1 Supercourse developers include: Ronald LaPorte, PhD, Faina Linkov, PhD, Eugene Shubnikov, MD, Mita Lovalekar, MD, MPH

Additional Readings Open Source http://www.pitt.edu/~super1/lecture/lec6921/index.htm Supercourse and Disaster Management Training http://www.pitt.edu/~super1/lecture/lec21601/index.htm Social Epidemiologic Methods in International Population Health and Health Services Research http://www.pitt.edu/~super1/lecture/lec17561/index.htm Principles of Research Synthesis http://www.pitt.edu/~super1/lecture/lec9611/index.htm Please visit the Global Health Network Supercourse Project for additional lectures www.pitt.edu/~super1 This lecture has been developed by Faina Linkov, Ronald LaPorte, Eugene Shubnikov, Mita Lovalekar and the Global Health Network Supercourse team. Please e-mail super1@pitt.edu to contact the developers. Join the Supercourse by visiting http://www.pitt.edu/~super1/assist/join.htm