Attention to health concerns outside the United States continues to grow. Reasons commonly cited include economic globalization, worldwide news coverage, and the ease with which an epidemic in a distant land can now affect us within hours. There also exists a heartening sense of caring that motivates some individuals to respond with compassion and action to those who are suffering, regardless of their distance.
The academic community has also responded to international health concerns, often in answer to the enthusiastic prompting by health profession students. A growing number of academic institutions now offer students and residents opportunities to augment their understanding through conferences, specialized courses, longitudinal study groups, and study abroad. Encouragingly, research demonstrates that such students are indeed more likely to incorporate international service into their later careers.
But enormous deficiencies remain. Nursing schools, for example, seldom give academic credit for students who study abroad. Of 159 schools of medicine and osteopathy in the United States, only some 40 percent offer any study opportunities in developing nations. Of 446 family medicine residencies, only about 20 percent have residents actively participate in international electives. Why such deficiencies? A significant reason stems from the legitimate concerns of educators to assure academic excellence. As with any other subject, they want to verify that students are achieving defined learning objectives. This in turn forces educators to define the field of international medicine.
How do we define the field that pertains to health in other nations? Nations, and communities within nations, are so varied in terms of health status, medical and public health resources, and underlying culture and policy that it is difficult to define what is truly happening. Nevertheless, sincere efforts are being made at assigning appropriate names for the field, resulting in such varied terms as tropical medicine, global health, international health, international public health, international medicine and medical missions. Each of these terms implies certain nuances, and they have considerable overlap with one another. The terms will continue to be useful, though none fully satisfy.
In an effort to better define the field of health in other nations, l suggest we begin by stating that we are usually not referring to health care in developed nations. While it may be useful to study health in Germany, Singapore or urban South Africa, most of us drawn to the field instead focus on health in developing nations, regions or communities – sometimes also referred to as low-resource, resource-poor, or resource-deficient nations, regions or communities.
Low-resource communities are generally beset by deficient nutrition, education, employment, and public infrastructure. As a result, predictable diseases – diseases of poverty such as tuberculosis and intestinal parasites – plague these communities. Interventions to reduce these diseases and to improve the overall health of such communities are also hampered by low resources.
In an effort to more clearly define international medicine, it may be best to simply follow the advice of Mark Twain, “I have never let my schooling interfere with my education,” and describe exactly what we mean: promoting health in low-resource communities. While such a definition lacks the familiarity of more commonly used terms, it removes some of their ambiguity. As for the unfamiliarity of the new phrase, usage alone will dissolve this obstacle.
Regardless of the exact term one uses for promoting health in low-resource communities, health professionals benefit from a core knowledge that is especially germane to the field:
• Determinants of Health – An orientation to the main factors influencing health in low-resource communities; including nutrition, contraception and obstetric care, infectious diseases prevention, injury prevention, and provision of medical care
• Diseases of Poverty – An understanding of those medical conditions that are most frequently associated with low-resource communities, including their epidemiology, prevention and management
•Cross-Cultural Skills – Those tools necessary to work effectively with people of diverse values and world-views
• Health Leadership – How health professionals can work in cooperation with communities to design and lead effective health systems
Mastery of this core knowledge is essential for effective study of and service within such communities. Educators do well to define appropriate learning objectives for this core knowledge. Health profession students and graduates do well to master the subjects and apply the skills through actual service. Regardless of medical or economic advances, the poor will always be among us in a world that is ever contracting in size. We should, therefore, continue to define, refine and develop the unique knowledge and skills to necessary to promote health in low-resource communities.