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Teaching global health –so what
for Canada
• Let me share experience of the arguments
used in the strategic discussion at the U
of Ottawa for IPH [Institute of
Population Health] to make a
meaningful contribution to Global
Partnerships esp CCGHR and
Education/ Knowledge Translation
Context
Opportunity and timing for IPH and Uottawa to
make a meaningful contribution to the Candian
Contribution for teaching Global Health !
1. University of Ottawa Commitment .
. Faculty of Medicine Office of Global Health
. Uottawa has identified International Education and
Research as key component of Vision 2010
[Drs Gilles Breton and Hamid Jorjani]
Context
1. Uottawa has identified International Research as key component of Vision 2010 –[Dr Hamid
Jorjani]
2. The WHO has ‗discovered‘ evidence !
Knowledge for action
― The goal is not an academic
exercise, but to marshal
scientific evidence as a lever
for policy change — aiming
toward practical uptake
among policymakers and
stakeholders in countries‖.
WHO Director-General Jong-Wook
LEE, address to the World Health
Assembly, May 2004
World Health Report 2006,7
Realisation that money is not the major
problem
Health workers and their education is!
“The world community has sufficient financial
resources and technologies to tackle most of [the
world’s] health challenges; yet today many
national health systems are weak, unresponsive,
inequitable – even unsafe.”
Context
1. Uottawa has identified International Education and Research as key component of Vision 2010
–[Drs Gilles Breton and Hamid Jorjani]
2. The WHO has ‗discovered‘ evidence !
3. Ministers of Health in LMICs asked for help in
developing capacity in evidence at Mexico
Ministers Mtg 2005. Next opportunity in
Bamako later in 2008
WHO
PARTNERSHIPS
• ―Partner Institutions and NGOs between partner countries― contributing to implementing, positioning health as a cross-governmental goal.
KNOWLEDGE AND EVIDENCE
• ― The goal is not an academic exercise, but to marshal scientific evidence as a lever for policy change‖
• Knowledge consolidated and gaps identified for action.
• Evidence incorporated into national plans and policies.
• Civil society mobilized for evidence-based action for improving health.
• Evidence incorporated into WHO policy dialogue and technical work.
Mandate for CCGHR Task Force :Education/Knowledge Translation
Context
1. Uottawa has identified International Education and Research as key component of
Vision 2010 –[Drs Gilles Breton and Hamid Jorjani]
2. The WHO has ‗discovered‘ evidence !
3. Ministers of Health in LMICs asked for help in developing capacity in evidence at
Mexico Ministers Mtg 2005. Next opportunity in Bamako later in 2008
4. Canadian Global Coalition for Health Research
CIDA,CIHR,HC,IDRC, [linked also to CHSRF]
committed.
Education - Knowledge Translation identified as a
priority – KT Taskforce
Take Home Message for this talk today! :
Health Inequalities in Canada and Abroad
• How do we use experiences such as I have described for the CCGHR Education/Knowledge Taskforce?
• McGill and other universities in Canada have many, many similar projects !
• Please join us in building commitment across Faculties, Departments, Disciplines !
• Please email me with 1 suggested action we need to take
At the University Level
At the Faculty Level
At the Student Level
Canadian Global Coalition for
Health Research
PRIORITIES :
Several but 2 are :
• Partnerships
• KT Taskforce Education - Knowledge
Translation
EDUCATION/KT/PARTNERSHIPS
EXAMPLE
GAP-ACANGO PROJECT
EDUCATION/KT/PARTNERSHIPS
EXAMPLEGAP-ACANGO PROJECT
Peter Tugwell, Peter Walker, Carol Amaratunga, Rosie Goldstein, Betsy Kristjansson, Wendy Muckle, Vic
Neufeld, Annette O’Connor, Jeff Turnbull,
Jil Beardmore, Alex ter Kuile,Vivian Robinson, Jessie McGowan, Nancy Santesso
Overseas Partners
Consultant : Don Simpson
EDUCATION/KT/PARTNERSHIPS
EXAMPLE
GAP-ACANGO PROJECT
GAP= GLOBAL ACADEMIC PARTNERSHIPS
International Meeting
June 24th, 2004
The Beginning of the ACANGO
Concept
ACADEME
1. Reflection and Introspection
2. Longer view- alliances can last longer thangovernments
3. Commitment to knowledge generation
4. Methods for assessing the evidence ofKnowledge Transfer
5. Research Credibility
6. Grant competitiveness
7. Career development
8. Academic skill building
9. Access to students
10. Credit for research and publications
NGOs
1. Concreteness
2. A style which is guided by values and beliefswith an action-orientation
3. External Focus
4. Responsive to RFP’s
5. Produces reports more than publications
6. Shorter term projects
7. Credibility as experts in capacity building
8. Access to additional funding and grants as anexecuting agency
9. Skill concentration
10. Opportunities for trainee placement
11. Credit for action
ACANGOan experiment in global partnership
ACANGO
– Dialogue
– Learning Across Borders and Disciplines
– Living Lab for Innovation
– Action Orientation
Uniting evidence focus of Academics with action focus of NGOs
“GAP SCENARIO”
CAME FROM
INTERNATIONAL CAMPAIGN TO REVITALISE
ACADEMIC MEDICINE[BMJ;Milbank; PLOS Medicine; 2007 ]
PARTNERSHIPS AND EDUCATION/KT :
2004 :BMJ and Lancet Editors were hearing much about the problems of
academic medicine
Put out a call for ideas for a campaign to tackle this.
Originally wanted this to be just for the UK – but received 48 pages of rapid responses that urged a global campaign
BMJ and Lancet Editors were joined by 20 other journals
Put out a call for ideas for a campaign to tackle this.
Terms of reference :
• Developing a vision of how academic medicine
should look in 2020-that incorporates views of
both stakeholders[5Ps] and academics.
BMJ and Lancet Editors were joined by 20
other journals
Put out a call for ideas for a campaign to
tackle this.
My proposal :
• Burning Platform
• Campaign through journals
• Problem based
• Working Party of students/junior/mid level
• 50% women
• 50% from Lower/Middle Income Countries
WORKING PARTY:
20 members, representing 14 countries.
All under 45 [ students/junior/mid level]
50% women
50% from Lower/Middle Income Countries
• Tahmeed Ahmed -Bangladesh
• Shally Awasthi- India
• Mark Clarfield - Israel
• Lalit Dandona - India
• Amanda Howe - England
• John Ioannidis - Greece
• Edwin Jesudason – England
• Youping Li - China
• Juan Manuel Lozano -Columbia
• Ana Marusic – Croatia
• Idris Mohammed - Nigeria
• Gretchen Purcell - United States
• Sachi Sivananthan –Sri Lanka/UK
• Karen Sliwa-Hahnle - South Africa
• Sharon Straus - Canada
• Tessa Tan Torres –Philippines, Switzerland
• Tim Underwood - England
• Robyn Ward - Australia
• Michael Wilkes - United States
• David Wilkinson - Australia
ICRAM CAMPAIGN OBJECTIVE
• 6 ACTIONABLE RECOMMENDATIONS TO BRING ACADEMIC MEDICINE INTO THE 21ST CENTURY
• USE ‗FUTURES SCENARIOS‘ TO ACHIEVE THIS [SEE HANDOUT]
– Why scenarios?
What are scenarios?
• possible future environments
• alternative stories
• using relevant, uncontrollable uncertainties
• not predictions, but plausible
Surprises
• Japanese economies
falter
• Explosion of internet
• Road rage
• Computers transform
Fleet Street
Failed forecasts
• Leisure society
• Paperless office
• Demographic time
bomb
• Death of the
book/cinema
“640kb ought to be enough for anybody”
Bill Gates 1981
WHY SCENARIOS?
Scenario planning
simplifies the avalanche
of data into a limited
number of possible
states.
Wild ideas from 5 ‗P‘s
If you had total control , what one thing
would you do to improve academic
Medicine 100 ideas
• Make patients chairs of boards & governors of academic medical institutions
• Academic Peace Corps:10% of time in al academics in HIC committed to Global Equity-10/90 Gap
• Pharma donating 10% of profits
• Equal weight given to teaching & public service & recognized in tenure guidelines with merit based Parity in pay
Five Scenarios to 2020
Fully engaged
Global Academic
Partnership
In the
Public Eye
Reformation
Academic Inc
Five Futures for
Academic Medicine
Reformation
• All teach, learn, research, and improve (The death of academic medicine)
Academic Inc.
• Academic medicine flourishes in the private
sector
In the public eye
• Success comes from delighting patients and
the public, and using the media
Global academic partnership
• Academic medicine for global health equity
Nicholson of "The Australian" newspaper: www.nicholsoncartoons.com.au
“The poor are getting poorer, but with the rich getting
richer it all averages out in the long run.”
The Problem with Averages
Global academic partnership
What would it look like in 2020 ?Academic medicine for global health equity
• The world began to find the growing gap between the rich and poor unacceptable.
• The concern was driven partly by the media and global travel bringing the plight of the poor in front of the eyes of the rich, but it was also driven by anxieties over global security.
• Terrorism was recognised to be fuelled by the obscene disparities between rich and poor.
• Global policy makers also understood better that investment in health produced some of the richest returns in economic and social development.
• Health care was a ―must have‖ not a ―nice to have.
[BMJ;Milbank; PLOS Medicine; 2007 ]
Global academic partnership
• The primary concern and resources of academic medicine were to improve global health
• A global health focus offered academics intellectual stimulation and prestige
• Academics championed human rights, economics, and the environment as key determinants of health
• Basic science remained important because of emerging global diseases
[BMJ;Milbank; PLOS Medicine; 2007 ]
Global Academic Partnership
• The G8 governments signed an accord that prohibited recruitment of academic health professionals from developing countries
• Universities in the North committed 10% of faculty time to the South
• North-South and South-South academic partnerships and networks flourished
• The 90:10 gap narrowed rapidly
• GAP was idealistic and suffered because political will and global cooperation were often lacking
[BMJ;Milbank; PLOS Medicine; 2007 ]
GAP Scenario
[Global Academic
Partnership]• Academic medicine for global health equity
Encouragement by the ‗Future Directions
Committee‘ of the U of O Faculty of
Medicine to integrate this with ACANGO
to form
―GAP-ACANGO Program―
linked to CCGHR Education/ KT Taskforce
GAP-ACANGO Partnerships :What have we done ?
Partnerships
Needs driven by the South
• Partnerships with:• Africa :Afri-Afya, Nairobi;Kenya Methodist University,
Meru
• Pontificia Universidad Católica de Chile, Santiago
• Chulalongkorn University, Bangkok, Thailand
• Split University of Zagreb, Croatia
• Ottawa : Homeless Program
Education Aspects of these Partnerships
•Ehouse
•Equity Evidence Aid :Stories
EHOUSE
Action Learning in the eHouse
Action Learning in the eHouse
• Harm Reduction
• Health Systems and HIV/AIDS
• The Role of NGOs in Revitalising
Academic Health
• Learning within the Network
• Community Health Workers and Maximally
Assisted Treatment for HIV/AIDS
―Equity Evidence Aid :Stories‖
CIHR Grantt
Narrative/storytelling to enhance equity –
• Programming
• Evaluation
• Knowledge translation
Partners: AfriAfya
OICHI
AfriAfya
CIHR Equity Evidence Aid :Stories
Harnessing ICTs and Stories for Community Health
Esp HIV
ICT and Stories need tailoring for: – Patients
– Practitioners
– Policymakers
OICHI – Ottawa Inner
City Health Initiative
Managing Alcohol Addiction through
Harm Reduction
– Practice ChallengeAltering behaviour of homeless individuals to reduce the
harm caused by alcohol addiction
– Policy ChallengeEngaging policy makers in order to create policy that
reflects the importance and benefit of harm reduction
in treating alcohol addiction
CIHR Stories/Narratives Project
Conclusion:
Health Inequalities in Canada and Abroad
• How do we use experiences such as I have described for the CCGHR Education/Knowledge Taskforce?
• McGill and other universities in Canada have many, many similar projects !
• Please join us in building commitment across Faculties, Departments, Disciplines !
• Please email me with 1 suggested action we need to take
At the University Level
At the Faculty Level
At the Student Level
