- 1 What is Global Health?
- 2 How Do Physiotherapists Fit Into Global Health Initiatives?
- 3 Barriers and Solutions for Global Health Initiatives
- 4 Potential Concerns of Global Health Initiatives
- 5 Global Health Initiatives and Organizations
- 5.1 Canadian Association for Medical Relief
- 5.2 CURE International
- 5.3 Global Health Division of the Canadian Physiotherapy Association
- 5.4 Global Health Special Interest Group of the American Physical Therapy Association
- 5.5 Medical Ministry International
- 5.6 Terre Sans Frontières – Physiothérapie Sans Frontières
- 5.7 Work the World
- 5.8 World Confederation of Physical Therapists
- 5.9 World Health Organization
- 6 References
What is Global Health? 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.”  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  
- 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. 
- Prevention of incidents such as workplace injuries
- Increasing physical activity levels
- Infection control
- 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. 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 into these figures. Therefore, the disproportionate dominance of MSK conditions in regards to research and physiotherapy education does 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 the 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 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
Canadian Association for Medical Relief
"The Canadian Association for Medical Relief (CAMR), founded in 2002 by Dr Rand Askalan, is a not-for-profit organization that provides medical services in developing countries. These services may be in the form of:
- Offering financial and social support to patients coming to Canada for medical treatment *Improving the quality of care by sending medical equipment and supplies
- Sponsoring Canadian physicians to offer free medical care
- Supporting students during their medical training in Canada
- Organizing educational seminars for local community physicians"
For more information, please visit: http://camr.ca/index.html
"A non-profit organization that operates charitable hospitals and programs in 30 countries worldwide where patients experience the life-changing message of God’s love for them, receiving surgical treatment regardless of gender, religion, or ethnicity." 
For more information, please visit https://cure.org/
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 advocacy 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 more information, please visit http://physioghd.com.
Global Health Special Interest Group of the American Physical Therapy Association
"Promoting Social Responsibility & Community Engagement at Home & Abroad"
"Mission: To provide resources, information, and support to SIG, Section, and APTA members regarding global health, health disparities, cultural competency, disability, and service-learning in resource-limited settings."
"History: Ronnie Leavitt and Karin Schumacher co-founded the Cross-cultural and International Physical Therapy Interest Group in 1986. The group was officially recognized as a special interest group within the Health Policy and Administration Section in 1996. To reflect member interests in health equity, cultural determinants of health, and service-learning both in the United States and abroad, the group changed its name to the Global Health SIG."
For more information, please visit http://www.aptahpa.org/?page=GlobalHealthSIG
Medical Ministry International
"Each year, over half a million people benefit from the compassionate and quality care of our Health Centers, Project Teams, and Residency Training Programs. Founded in 1968, MMI works in over 23 countries around the world. In 2014 we provided health care services worth US$177,519,522 to 668,475 people throughout the world who typically would have had limited or no access to medical services. Our business model is unique in that we utilize volunteers both medical and non-medical to bring life-changing services to the poor. We seek to eliminate a “welfare” mentality by asking that the patients contribute to their services. This contribution may be a little, but we have found over time that if someone has invested in their care, they will follow the doctor's direction and get healthy. Gone are the days of people just throwing money a problem and then those who receive the gift tossing it aside because they think its not worth something."
For more information, please visit: https://medicalministrytrips.org/
Terre Sans Frontières – Physiothérapie Sans Frontières
"Terre Sans Frontières is an international cooperation organization that supports and strengthens its southern education and community development partners; it matches Canadians—in particular specific segments of the population—with initiatives fostering the wellbeing of underprivileged individuals both in Canada and farther south. Founded by the Brothers of Christian Instruction, Terre Sans Frontières has always had a close relationship with Canadian religious communities." 
For more information, please visit: http://terresansfrontieres.ca/en/
Work the World
"Work the World provides highly tailored clinical internships across the developing world. Every intern's aim is different, so we tailor each and every aspect of your placement to your own individual needs. Whether you're interested in paediatric physical therapy in Sri Lanka, or geriatric rehabilitation in Kathmandu, we'll be able to create the perfect placement for you."
For more information, please visit http://www.worktheworld.com/
World Confederation of Physical Therapists
"Founded in 1951, the World Confederation for Physical Therapy (WCPT) is the sole international voice for physical therapy, representing more than 350,000 physical therapists worldwide through its 112 member organisations. The confederation operates as a non-profit organisation and is registered as a charity in the UK."
"WCPT believes that every individual is entitled to the highest possible standard of culturally appropriate healthcare delivered in an atmosphere of trust and respect for human dignity, and underpinned by sound clinical reasoning and scientific evidence. It is committed to furthering the physical therapy profession and improving global health through:
- encouraging high standards of physical therapy research, education and practice
- supporting the exchange of information between WCPT regions and member organisations
- collaborating with national and international organisations" 
For more information, please visit: http://www.wcpt.org/
World Health Organization
"When diplomats met to form the United Nations in 1945, one of the things they discussed was setting up a global health organization. WHO’s Constitution came into force on 7 April 1948 – a date we now celebrate every year as World Health Day."
For more information, please visit http://www.who.int/en/
- Beaglehole R, Bonita R. What is global health? Glob Health Action. 2010; 3: 10.3402/gha.v3i0.5142.fckLRPublished online 2010 Apr 6.
- Koplan JP, Bond T, Merson M, Reddy K, Rodriguez M, Sewankambo N. Towards a common definition of global health. Lancet. 2009;373(9679):1993–5.
- Beaglehole R, Ebrahim S, Reddy S, VoÛte J, Leeder S, on behalf of the Chronic Disease Action Group. Prevention of chronic diseases: a call to action.fckLRLancet. 2007; 370: 2152–57.
- Geneau R, Stuckler D, Stachenko S, McKee M, Ebrahim S, Basu S, Chockalingham A, Mwatsama M,fckLRJamal R, Alwan A, Beaglehole R. Raising the priority of preventing chronic diseases: a political process. Lancet. 2010; 376: 1689–98.
- Noncommunicable diseases factsheet. World Health Organization. Available at http://www.who.int/mediacentre/factsheets/fs355/en. Last accessed 01/05/2016.
- Global Health Division. What is the definition of global health? Accessible at http://www.physioghd.com/about-us/definitionofglobalhealth. Last accessed 01/05/2016.
- Mickan S, Hoffman SJ, Nasmith L; World Health Organizations Study Group on Interprofessional Education and Collaborative Practice. Collaborative practice in a global health context: Common themes from developed and developing countries. J of Interprofessional Care. 2010 24(5): 492-502.
- The First Physical Therapy Summit on Global Health: Implications and Recommendations for the 21st centuryfckLRPhysiotherapy Theory and Practice: An International Journal of Physiotherapy. 2011; 27(8).
- Alappat C, Siu G, Penfold A, McGovern B, McFarland J, Raman S, Landry MD. Role of Canadian Physical Therapists in Global Health Initiatives: SWOT Analysis. fckLRPhysiotherapy Canada. 2007; 59(4): 272-285.
- Global Health Division. Developing sustainable programs in rural India: vlog with Andrea Mendoza. Available from: http://www.youtube.com/watch?v=DrQu9AQXfKg [last accessed 15/05/16]
- Pechak CM, Thompson M. A conceptual model of optimal international service-learning and its application to global health initiatives in rehabilitation. Phys Ther. 2009; 89(11):1192-204.
- Bates AW. Teaching in a digital age. Available at http://opentextbc.ca/teachinginadigitalage/part/chapter-7-moocs. Last accessed 0105/2016.
- Global Health Division. Voluntourism - January Vlog with Shaun Cleaver. Available from: http://www.youtube.com/watch?v=wNFKYdnXU3M [last accessed 15/05/16]
- Mohamud O for Africa on the Blog, part of the Guardian Africa Network. Beware the voluntourits intent on doing good. 2013. Available at http://www.theguardian.com/world/2013/feb/13/beware-voluntourists-doing-good. Last accessed 01/05/2016.
- Seymour B, Benzian H, Kalenderian E. Voluntourism and global health: preparing dental students for responsible engagement in international programs. J Dent Educ. 2013;77(10):1252-7.
- International Centre for Disability and Rehabilitation, University of Toronto. Going for the right reasons: Is an ICI right for you? Available at http://icdr.utoronto.ca/students/students/going-right-reasons-ici-right. Last accessed 01/05/2016.
- Canadian Association for Medical Relief website. Available at: http://camr.ca/about.html. Last accessed 21/05/16
- CURE International website. Available at: https://cure.org/. Last accessed 15/05/16
- Global Health Division. What Does Global Health Mean to You? Available from: http://www.youtube.com/watch?v=um39qmns7Cw [last accessed 15/05/16]
- Global Health Division website. Available at: http://physioghd.com. Last accessed 15/05/16
- Global Health Special Interest Group website. Available at: http://www.aptahpa.org/?page=GlobalHealthSIG. Last accessed 21/05/16.
- Medical Ministry International website. Available at: https://medicalministrytrips.org/. Last accessed 21/05/16
- Terre Sans Frontieres website. Available at: http://terresansfrontieres.ca/en. Last accessed 21/05/16
- Work the World website. Available at: http://www.worktheworld.com/. Last accessed 15/05/16
- World Confederation of Physical Therapists website. Available at: http://www.wcpt.org/. Last accessed 21/05/16.
- World Health Organization website. Available at: http://www.who.int/en/. Last accessed 15/05/16