An international dimension in European Medical Education

A. Torres (Madrid, Spain) and H. Rosling (Stockholm, Sweden)

Introduction

Probably one of the most distinctive characteristics of our society today is the globalisation of all social, cultural and biological dimensions of human activity. The globalisation of human phenomena has crucial implications for medical practice, the contents of medical disciplines and medical education. It also represents a major challenge for setting priorities for the international health research agenda.

The European population together with the other industrialised countries represent less than one fifth of the World total population, and they suffer less than one tenth of the overall mortality and morbidity's. Out of the 40 million deaths which occurred in developing countries in 1996, about half of them are attributable to infectious diseases, including childhood illnesses, tuberculosis, malaria, maternal and perinatal causes.

European health professionals are physically closer to and need to be ready to respond to health problems and health conditions from beyond European borders. In fact, recent, and well known epidemics show us that the whole idea of "national borders" is fairly elusive from a public health perspective.

As the "global village" progressively becomes a well established reality, the European health professionals of the XXI Century will need to be up to the challenges they will confront. The challenge for the medical education at the end of the XX Century is to provide medical practitioners of the next Century with that crucial global dimension to their education and practice.

Why is International Health relevant to European Medical Education today?

The general principles presented above have important implications for medical practice.

First of all, globalisation means larger "mobility" of people, which implies, for instance, that millions of Europeans travel every year to zones with epidemiological patterns radically different to ours. Many of them are exposed to the risk of contracting diseases that are foreign to the traditional health practitioner back home. The average European health professional is confronted to exotic diseases, traditionally referred to as tropical diseases, and for which he or she will have had very limited education and practice. The European medicine also confronts the threats posed by old and re-emergent conditions (Tuberculosis is a good example of those diseases that have been long thought to be under control but are now increasing), and, the now regular appearance of new threats, newly identified viruses, and so on.

Human migration has also transformed Europe a multiethnic society. Medical education has to ensure an ethnically and culturally sensitive educational process, to enable the understanding of heterogeneous society and to respond appropriately to new needs. Dealing with other cultures and being able to understand and communicate is an increasing demand for medical education. Therefore, keeping the European populationhealthy in the future requires that medical practitioners are able to understand and respond to the global dimensions of health, incorporating international health at the undergraduate and postgraduate levels.

The role of International Health in European Medical Education

International Health has two major contributions for European Medical Education. First of all, its focus, that is, the study of the determinants of the distribution of health and disease in poor populations in developing countries, and the identification and evaluation of effective health interventions. International Health focuses on the most prevalent, serious and preventable conditions at a global level, in order to study their determinants, and to identify and evaluate appropriate control measures. It makes specific emphasis on the need for interdisciplinary and intercultural approaches to health and disease.

Secondly, the analysis of health and its relation with socio-economic determinants in different countries and cultural groups constitutes an extremely useful contribution to understand the nature of health and disease. Therefore, from a purely scientific view point, an international dimension has to be incorporated into medical education to be reflected in all medical disciplines, and in order for medical students to understand the continuum of health disease. We may, therefore, conclude that the issue is not "if", but rather, to what extent and how medical education may include global health issues.

How may international health be incorporated in Medical Education in Europe?

The Theme Group on International Health of the Medical Education and Didactic Network is currently revising international health efforts on Medical Education in Europe. What follows are the main findings and conclusions of the working group.

a. Undergraduate education
Although very little systematic work has been done on an inventory of current International Health undergraduate education at the European level, specific examples from some European Universities show that there are already significant and very relevant experiences in European Institutions. In some medical schools in Europe up to 30% of all students spend some months, as elective, in clinical or community based work in developing countries. But as a general rule, and in contrast with most disciplines, Medical Education has strong domestic bearings.

It is evident, that, as in most other professional education's, medical education should in addition to the main core of European relevant issues, incorporate an understanding of the global health situation, and therefore broaden its scientific knowledge base. Global analyses should be incorporated in most medical subjects.

In addition, there is also a need for specific modules on international health. Those modules are already being taught in several European Universities, and may provide a basic knowledge about global health variations and inter-cultural aspects of health. Such a module should cover demography, mortality and morbidity indicators as well as new tools, such as disability adjusted life years for measuring disease burden, and it must go beyond education on diseases to incorporate their underlying environmental, cultural and socio-economic factors.

b. Postgraduate education
International Health education at postgraduate level has a long standing tradition in Europe. The European Network for International Health Education (also known as TropEDeurop) currently incorporates among its members the most prestigious Training and Research European Institutions on International Health and Tropical Medicine. The aims of TropEDeurop are: a) to promote excellence in education and training in International Health in Europe, b) to foster mobility and exchange of teachers, students and educational experiences among European institutions, and c) to contribute to sustainable human resource development in Europe and in the Southern Hemisphere. A detailed account of TropEDeurop objectives, and members may be found on http://www.troped.org.

MED-NET and the International Health dimension for European Medical Education

The proposal of the Working Group on International Health is to seek ways to incorporate and expand the international health dimension on to the European Medical education at under and postgraduate levels.

The Working Group on International Health seeks to conduct an inventory of current international health education activities in Europe and provide a platform for the exchange and transfer of information, knowledge and skills between European Institutions on global education.

References

The World Bank. Investing in Health. World Development Report, 1993. Oxford University Press.
World Health Organisation. Investing in Health Research for Development. WHO, 1996.
TropEDeurop Profile, 1997. Report of the TropEDeurop Steering Committee, International Health Education in Europe (http://www.troped.org)

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