Global Health

Original Editor - Laura Ritchie

Top Contributors - Laura Ritchie, Kim Jackson, Admin, Uchechukwu Chukwuemeka, Evan Thomas and Rishika Babburu  

What is Global Health?

The concept of Global Health has been defined in various ways. Beaglehole and Bonita (2010) define Global Health as, “collaborative trans-national research and action for promoting health for all.”  It has also been defined as, “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 inter-disciplinary collaboration; and is a synthesis of population-based prevention with individual-level clinical care.” (Lancet 2009). Global health actions may be in response to some of the world's major health burdens such as injury and non-communicable disease (cardiovascular disease, diabetes, cancers and chronic respiratory diseases), which occur in various magnitudes across many countries, regardless of level of development.  

How Do Physiotherapists Fit Into Global Health Initiatives?

According to Mickan et al (2010), “there is a clear requirement for collaboration among health workers from different professional backgrounds as no one person is able to deliver care to meet the complete needs of the patient.”  Collaborative Practice is noted to “[occur] when multiple health workers provide comprehensive services by working together synergistically along with their patients, their families, carers and communities to deliver the highest quality of care across settings.” 

Physiotherapists are key members of collaborative inter-professional teams due to their broad scope of practice. As is typical with varying locales, the specific role of a physiotherapist varies according to the needs of the specific population in question. At the First Physical Therapy Summit on Global Health in 2007, the overarching roles of the physiotherapist as an “Agent of Change” and “Health Advocate” were discussed.  Some of these roles include:

• Members of inter-disciplinary health teams for the provision of direct service  
  
• Educators and Mentors related to 

1. Prevention and management of non-communicable diseases and lifestyle-related conditions (e.g. obesity, diabetes, heart disease). This was a notable priority for all geographic regions represented at the 2007 Summit. 
2. Prevention of incidents such as workplace injuries
3. Increasing physical activity levels
4. Infection control
5. Maternal and child health

• Advocates to establish and/or develop education and healthcare programs that maximize local resources to ensure sustainability
• Screeners (e.g. for physical and/or sexual abuse, lifestyle conditions, HIV/AIDs, mental health conditions) 
  
• Referees i.e. identify conditions that require referral to other health practitioners 
  
• Consultants (e.g. to urban planners and government)  
• Leaders and active participants in health policy decision-making 
  

Barriers and Solutions for Global Health Initiatives

Many barriers can limit the effects of Global Health initiatives, with considerable regional variation. The following challenges were discussed at The First Physical Therapy Summit on Global Health in 2007;

• Lack of access to physiotherapists, particularly in rural areas
• Lack of understanding of cultural differences
• Logistical barriers such as bad roads, lack of clean water supply, lack of appropriate waste management, poor electricity supply
• Insufficient research into population-specific health conditions and best practices
• Insufficient or delayed knowledge translation of existing research
• Discrepancy between current entry-level curricula, research and the most prevalent and/or serious region-specific health conditions. o For example, there is much focus on musculoskeletal (MSK) conditions in university programs and in research circles, yet such conditions are not a leading cause of mortality. In the statistics shown at the 2007 Summit, Ischaemic Heart Disease and Cardiovascular Disease were the first and second causes of mortality in four of the five geographic regions. Only Africa did not follow this pattern. There, the primary cause of mortality is HIV/AIDs, with Ischaemic Heart Disease and Cardiovascular Disease ranking 5th and 7th in the top ten, respectively. Accidents (including Road Traffic Accidents) were ranked the 7th leading cause of mortality in the Asia Western Pacific region, the highest position calculated for that category. Although Accidents can obviously result in MSK injuries, the rankings presented at the Summit relate to mortality thus the types of MSK injuries that physiotherapists typically see would unlikely factor in to these figures. Therefore, the disproportionate dominance of MSK conditions in regards to research and physiotherapy education do not seem to be in the best interests of Global Health.
• Insufficient recognition of and research into differences between health and health care of indigenous versus non-indigenous populations, rural versus urban populations as well as factors affecting immigrant populations
  

The Summit also proposed the following recommendations;

• Increase number of training institutions that offer the appropriate degree award
• Allocate an appropriate proportion of university curricula for region-specific conditions
• Accept internationally-trained physiotherapists for clinical shadowing experiences to promote exposure to facilities and therapeutic studies
• Establish local Centres of Excellence through the World Health Organization and/or World Confederation for Physical Therapy,
• Promote more research into Global Health issues, particularly where region-specific research is lacking
• Expedite knowledge translation once research is performed

Others have proposed additional ways to enhance Global Health.

• “Recognise chronic non-communicable diseases as a major impediment to development”  and provide sufficient leadership, advocacy, organizational cooperation, political backing, financial support, industrial change and research to counter these epidemics  
  
• International service-learning – “a structured learning experience that combines community service with explicit learning objectives, preparation and reflection….a philosophy of educations that ‘emphasizes active, engaged learning with the goal of social responsibility.’” 
  
• Open online courses – For example, Physiopedia has run several accredited Massive Open Online Courses to provide free quality educational opportunities for physiotherapists who can then apply their new knowledge and skills in their own communities. “Perhaps the greatest value of MOOCs in the future will be for providing a means for tackling large global problems through community action” 
  

Potential Concerns of Global Health Initiatives

“Voluntourism” is a term that has taken on a negative connotation because of the often disingenuous, condescending and ultimately short-sighted and ineffectual work that volunteers often perform in the name of Global Health.   Even with the best of intentions, there is a risk of a negative impact to on the very community that the volunteer is trying to help. Appropriate reasons to volunteer include trying to form global partnerships and to learn from the opportunity (e.g. about historical and sociopolitical impacts on health or the role of rehabilitation professionals working in the area of global health). Inappropriate reasons include using the experience as a vacation or to look impressive on a resume. As well, it is important to understand the cultural context in which a volunteer will be working to avoid the expectation that he/she will effect fast or sweeping changes by knowing a ‘better’ way to do things.  Following guideline or framework can help volunteers and organizations working in Global Health ensure the work they do is meaningful and socially responsible. An example of such guidelines can be found here.

Global Health Initiatives and Organizations

Global Health Division of the Canadian Physiotherapy Association

The Global Health Division (GHD) was created in 2004 as a result of the growing interest in International Health by Canadian physiotherapists. The vision of the GHD is to be a reliable and influential resource and a strong advocate group for the importance of physical therapists in the area of global health. Focusing on countries with developing and transitional economies, the GHD facilitates access to a broad range of information ranging from global health and disability issues to volunteer opportunities. The GHD harnesses the passion, interests and energy of its members from across Canada and works in collaboration with colleagues from around the world. The mission of the GHD of the CPA is to educate, advocate and motivate physical therapists from across Canada regarding Global Health.

Canadian physiotherapists have been actively engaged in global health initiatives in a variety of settings on many of the world's continents. Some examples of these initiatives include the International Centre for the Advancement of Community Based Rehabilitation (ICACBR) at Queen's University supporting work in the Balkans among other countries, as well as at Dalhousie University whose physiotherapists have worked in Kuwait for a number of years. These are only a few examples of Canadian Physical Therapy organizations and universities, who have made an impact at the global level. These institutional examples are of course in addition to the numerous individual physiotherapists who have independently contributed to international health in various capacities.

For further information, please visit http://physioghd.com.

References

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