SocialMedicineReferenceToolkitCassidyStevens,LeighForbush,MPH,&MichelleMorse,MD,MPH

2

TableofContents

ContentsIntroduction__________________________________________________________________ 4

BestPractices:DevelopingaSocialMedicineEducationProgram________________________ 5

DefinitionofSocialMedicine ___________________________________________________ 10

KeyTermsinSocialMedicine___________________________________________________ 13

KeyThemesinSocialMedicineCurricula__________________________________________ 18

SocialMedicineConsortiumMemberPrograms–EducationalProfiles......................................28

EqualHealth-Haiti......................................................................................................................28

FacultédeMédecineetdePharmaciedel’Universitéd’Etatd’Haïti/ZanmiLasanteNursingProgram-Haiti.............................................................................................................................32

FacultédeMédecineetdePharmaciedel’Universitéd’Etatd’Haïti/ZanmiLasanteMedicalProgram–Haiti............................................................................................................................35

CompañerosenSalud-Mexico....................................................................................................38

UniversityofRwanda/InshutiMuBuzimaCommunityMedicineCourseRotation-Rwanda.....42

UniversityofRwanda/InshutiMuBuzimaiSOCO-Rwanda.........................................................46

SocMed–Uganda........................................................................................................................54

HarvardMedicalSchool–UnitedStates......................................................................................57

HarvardUniversityCaseStudiesinGlobalHealth:BiosocialPerspectives–UnitedStates.........61

PartnersInHealthEngage–UnitedStates..................................................................................64

UCSFHEALBootcamp–UnitedStates.........................................................................................67

NewYorkUniversitySocialEmergencyMedicine–UnitedStates..............................................69

CambridgeHealthAllianceInternalMedicineSocialMedicine&ResearchBasedHealthAdvocacyCurriculum–UnitedStates..........................................................................................71

UniversityofMinnesotaGlobalHealthinaLocalContext–UnitedStates.................................74

UniversityofNorthCarolinaChapelHillSocialMedicine–UnitedStates...................................80

Resources __________________________________________________________________ 84

AccessandUniversalHealthCoverage........................................................................................84

Economics....................................................................................................................................84

Gender.........................................................................................................................................84

GlobalHealth...............................................................................................................................84

HealthDisparitiesintheUnitedStates........................................................................................85

HealthServicesandSocialJustice................................................................................................86

3

DiversityandMedicine................................................................................................................86

HistoryofMedicine......................................................................................................................87

HRHandMedicalEducation.........................................................................................................87

HumanRights...............................................................................................................................88

RaceGenetics...............................................................................................................................88

ResearchEthics............................................................................................................................88

SocialDeterminantsofHealth.....................................................................................................88

SocialMedicineMedicalEducation.............................................................................................89

StructuralRacism.........................................................................................................................91

StructuralViolence.......................................................................................................................91

ViolenceandConflict...................................................................................................................91

4

Introduction

WelcomefromDr.MichelleMorseandDr.MichaelWesterhausDearFriendsandColleagues,Atatimewhenwearefacingtheerosionofhumanrights,athomeandabroad,wearecalledtoraiseourvoicesthroughourteaching,ourpractice,ourresearch,ouradvocacyandouractivism.TheSocialMedicineConsortiumwascreatedtoaddresstheneedforamoreholisticandcomprehensiveapproachtotheteachingandpracticeofthepreceptsofsocialmedicineduetotheongoingmiseducationofhealthprofessionalsabouttherootcauseofillness.ThetimeforactionisnowintheUnitedStatesandglobally.TherecentAmericanpresidentialelectionleavesnoquestionaboutthedirectionoftheAmericangovernmentwithregardtotheideathathealthisahumanright.WeattheSocialMedicineConsortiuminviteyoutojoinustogrowthesocialmedicinemovementinresponsenotjusttotheAmericanelections,buttothehundredsofyearsofoppressionthathavecreatedthehealthinequitiesthatwefacetoday.Ourcollectivevoicesandactionsarerequiredtoserveasacounterweighttotheforcesthatwoulddenythesemostbasichumanrights.Wearecountingoneachandeveryoneofyoutolendyourvoicesandattentiontothesocialmedicinecause,whichismoreurgentthanever.Webelievethatthistoolkitwillserveasacompellingreferenceforthoseinterestedinsocialmedicineeducation,andwillfacilitatedialogueandadvocacyaroundsocialmedicineeducationthateachofyouwillleadinyourrespectivecommunities.Wehopethatitreflectsthecollectivevoicesandvisionofglobalcolleaguesaroundsocialmedicineeducation,whichhavebeenexpressedduringmanymonthsofdialogueandmanyyearsofteachingsocialmedicine.Ourhopeisthatyouwillusethistoolkittoconvincestakeholdersoftheneedforsocialmedicineeducation,recruitmorefriendsandcolleaguestothesocialmedicinemovement,andinspireinstitutionalandstructuralchangeinyourworldtocorrectthemiseducationofhealthprofessionals.WenowturntowardsChicago,wherewewillhostoursecondannualSocialMedicineConsortiumconference,entitled“BeyondReimagining,AcceleratingPraxis:SocialMedicineInPracticeToday”onApril27to29,2017.Weinviteyoutostandtogether,walktogether,andfindthewaywithus.Onwardandupward,MichelleMorse,MD,MPHandMichaelWesterhaus,MD,MA

5

BestPractices:DevelopingaSocialMedicineEducationProgramLeighForbushandCassidyStevensThiscompilationofbestpracticeswasdevelopedthroughacomprehensivereviewofsocialmedicineliteratureandaqualitativesurveyofsocialmedicineprofessionalswithintheSocialMedicineConsortium.

DefinitionofSocialMedicine

SocialMedicineisthepracticeofmedicinethatintegrates:1.Understandingandapplyingthesocialdeterminantsofhealth,socialepidemiology,andsocialscienceapproachestopatientcare;2.Anadvocacyandequityagendathattreatshealthasahumanright;3.Anapproachthatisbothinterdisciplinaryandmulti-sectoralacrossthehealthsystem;4.Deepunderstandingoflocalandglobalcontextsensuringthatthelocalcontextinformsandleadstheglobalmovement,andviceversa(learningandborrowingfromdistantneighbors);5.Voiceandvoteofpatient,families,andcommunities.

Whatshouldasocialmedicineprogramaccomplish?

Aclinicaltrainingprogramwithsocialmedicineasacoreprogramelementshouldproduceprofessionalsthathave:

• Developedwaystorecognizeandchallengetheirownbiases,sourcesofpowerandprivilege.1,2

• Learnedhowtoworkcollaborativelywithotherprofessions.3-9

• Understoodtherelationshipbetweentheindividualandpopulationandhowthisrelationshipisaffectedandshapedbysocialandsystemicforces.2,4-5,7,10-14,19

• Recognizedthatinterventionsandstrategiesaremeaninglessunlesstheymatchlocalneedsandconditions.3,8,10-11

• Practicedskillsthatchallengeandcorrectsocietal,structural,andpoliticalforcesthatcreatehealthdisparities.5,7,12

• Advocatedforpatientsandthecommunitytoimprovethesocialdeterminantsofhealth.1,6,10,13,15-16,19

Howshouldsocialmedicinebeintegratedintoaclinicaltrainingprogram?

6

Ifpossible,socialmedicineshouldbefullyintegratedintocurriculumatboththeundergraduateandgraduatelevels.9-11,17Duringpreclinicalyears,socialmedicineshouldbeatheoreticalframeworkrootedinpraxis,whichiseducationcombinedwithaction.2Duringclinicalyears,traineescanpracticesocialmedicinetoolsaspartofrotations,suchasnarrativemedicine,expandedsocialhistories,advocacytraining,andcommunityorganizing.12,18

Withsocialmedicineasacorepartofthetrainingprogram,traineeshaveadequatetimetodevelopself-awarenessandcommunity-basedcompetenciesthatarekeytotheirsuccessasadvocatesfortheirpatientsandcommunity.8,15Toachievehealthequity,residentsmustunderstandhowbothclinicalmedicineandhealthsystemsaffectpatients.Ultimately,traineesrecognizethatsocialmedicineisn’tjustan‘addon’orelective,butacentralpartoftheirtraining.11

Howcaninstitutionalandcommunitysupportbegainedtobeginorstrengthensocialmedicinecurricula?

Institutionalsupportfortheintegrationofsocialmedicinecanbedifficultinanenvironmentthatfocuseson‘hardscience’.11Somewaystogainsupportforsocialmedicineinclude:

• Highlightingtheresearcharoundtheimportanceofsocialdeterminantsofhealth9

• Attainingthesupportandbuy-inofcurriculumcommitteesatyourinstitution9,11

• Developingalargercommunityofdepartments,organizationsandindividualsthatbelieveinabroad,multidisciplinaryapproachtohealth9,10

• Implementingbothbottom-upapproachesthatbeginwithresidents,faculty,andpatientsandtop-downapproachesthatincorporatesocialmedicineeducationintotheaccreditationprocess10

Communitysupportisalsoacrucialpieceofanysocialmedicineprogram.Itisidealtofirstusecommunity-basedparticipatoryresearchtounderstandthecontext,needs,andstrengthsofthecommunity.2,7,12Youracademicinstitutionshouldalsomeetwithlocalleadersanddiscusswhattheirfeltneedsare.4Oncekeycommunitystakeholdersandcommunityneedsareidentified,youracademicinstitutionshouldbeginbuildingthesocialmedicinecurriculumincollaborationwiththesestakeholdersandlocalcommunitygroups.8,10,12Stakeholdermeetingsshouldalsooccuratallsiteswheretherewillbetraineeplacement,toensurethereisanunderstandingofthepurposeoftheplacementandtherolethatthetraineeshouldhavewhilethere.Additionalstakeholderconsultationslikemeetings,workshopsandfollow-upcommunicationshouldhappenthroughoutthelifeofthesocialmedicineprogramtoadjustcourseifneededandadapttonewlyidentifiedneeds.

7

Whatshouldthedemographicsoftraineesandfacultybetofosteraproductivelearningenvironment?

Adiversesetoffacultyandtraineesarefundamentaltoasuccessfulsocialmedicineprogram.Diversityshouldexistateveryaxispossibleincludinggender,sexuality,race,socioeconomicstatus,immigrationstatus,andmore,becausethatistherealityofpatientpopulations.9Socialmedicinereliesondiscussionsandexperiencesthatchallengeprivilege,powerandbias.Ifyourfacultyandtraineesaresimilarinbackgroundandlifeexperience,yoursocialmedicineprogramislesslikelytofosteranenvironmentofself-reflectionthroughchallengingconversations.Itisrecommendedthatthefacultyisnotonlycomprisedofclinicians,butalsoincludespublichealthpractitionersandsocialscientists.11Onewaytoensureadiversesetoftraineesandfacultyisthroughexchangeprogramswithotheracademicinstitutions,althoughthisisnotalwayslogisticallyandfinanciallyfeasibleforeverysocialmedicineprogram.3

Additionally,itisimportantthatclinicianswithwhomthesocialmedicinetraineesworkmodelsociallyresponsivepracticestoreinforceskillsandattitudesfosteredintheirsocialmedicinetraining.15Withouttheopportunityfortraineestoapplywhattheyarelearning,andseeothersdoingthesame,theyarelesslikelytopracticesocialmedicineuponcompletionofthetrainingprogram.1

Whatarethebestteachingmethodologiesforsocialmedicine?

Socialmedicineisbesttaughtwithasmallclasssizethatallowsforrichdiscussion.Asuccessfulsocialmedicinetrainingprogramshouldcombinethefollowingthreeelements:classroom-basedlearning,community-basedexperientiallearning,andreflection.12,15,17

Classroom-BasedLearning

Itisrecommendedthattraineesbeintroducedtosocialmedicinetheory,howeverbriefly.12Tothisend,ratherthanusingdidacticteachingmethodologies,facultyshouldincorporateinteractiveawareness-buildingactivitiesintotheirclassroom-basedlearning:guestspeakers,roleplaying,viewingmultimedia,readinggroups,andsmallgroupdiscussions.5,19Guestspeakersmightincludejournalists,policymakersandpoliticians.2Theclassroom-basedlearningshouldbestudent-directedratherthanteacher-directed,andbeheldinaspacethatallowsformovementandopen,inclusivediscussion.8,17Thesocialmedicinecourseshouldincorporatetheuseofteamsorsmallgroupswithintheclasstofacilitatedialogueandensureeveryonehasachancetobecontinuallyparticipating.

8

Casestudiesareanothercommonmediumtospurdiscussionanddebate,especiallywhengroupsmusttakedifferentpositionsonanissuethantheywouldnormally.However,itisimportantthatcasestudiesnotonlyfocusonpatientsandtheirlives,butalsoonthetraineesandtheirunderstandingandperceptions.Casesshouldexisttoevokereflection,ratherthanserveasamediumtoteachtopicalcontentaboutanindividualorgroup(likeaminorityculture)whichcanreinforcestereotypesandleadto“othering”.1,14

Community-BasedExperientialLearning

Itisvitalthattraineesbecomeengagedinthecommunityissuestheyarelearningabout–whetherthrougharotationatacommunityclinic,communityqualityimprovementprojectorplacementatacommunityorganization.Thelocalcontextshoulddrivethetrainee’sactivities.7,11Akeycompetencythatthetraineeshouldgainistheabilitytoadvocateandincreaseadvocacymechanismsinthecommunityinwhichtheyareworking.5Thisadvocacyshouldberootedinasynergisticunderstandingoftheassets,strengths,andcapacityidentifiedbythecommunity.

Additionally,communityrotationsprovideuniqueopportunitiesfortraineestoobserveandlearnclinicalskillsfromthelocalpopulation,suchasnarrativemedicineandinterdisciplinarycollaboration.7,12Thetraineeshouldbeplacedinanenvironmentinwhichthereisproblem-basedlearningforallpartiesinvolved–thetrainee,thecommunityandotherhealthprofessionals.10Theseservicelearningactivitiesshouldstressthereciprocityandinterdependencebetweenacademicinstitutionsandcommunity.8,10

Reflection

Reflectionshouldbeperformedthroughoutthesocialmedicinetraining,bothduringtheclassroom-basedlearningandcommunity-basedexperientiallearning.Studentsneeddedicatedtimetolistentoothers’reflections,examinetheirownbeliefsandbiaseshonestly,practiceskillsforcriticalself-awarenessandunderstandhowtheirvaluesandassumptionsaffectthecareoftheirpatients.1-2,7,11Therealsoshouldbefocusedreflectiononthesystemsandsocialforceswithinacademia,hospitalsandcommunitiesthatarebarrierstoeffectivecareandsocialjustice.5,7

Reflectionshouldhappenonanindividualbasisandinmixeddisciplinegroups,withtraineesfromvariousyearsgroupedtogetherifpossible.4,17Reflectionactivitiesmayincludereflectivejournaling,small-groupdiscussion,letterwritingtolocalofficials,role-playingorformsofartisticexpression.5Reflection,particularlyafterthecommunity-basedexperientiallearning,shouldbesupportedbyconcretewaystocontinuetakingaction.

9

References1Beagan,B.L.(2003).Teachingsocialandculturalawarenesstomedicalstudents:“It'sallverynicetotalkaboutitintheory,butultimatelyitmakesnodifference”.AcademicMedicine,78(6),605-614.

2Hudon,C.,Loignon,C.,Grabovschi,C.,Bush,P.,Lambert,M.,Goulet,É.,...&Fournier,N.(2016).Medicaleducationforequityinhealth:aparticipatoryactionresearchinvolvingpersonslivinginpovertyandhealthcareprofessionals.BMCmedicaleducation,16(1),1.

3Frenk,J.,Chen,L.,Bhutta,Z.A.,Cohen,J.,Crisp,N.,Evans,T.,...&Kistnasamy,B.(2010).Healthprofessionalsforanewcentury:transformingeducationtostrengthenhealthsystemsinaninterdependentworld.Thelancet,376(9756),1923-1958.

4Gonzalo,J.D.,Haidet,P.,Papp,K.K.,Wolpaw,R.,Moser,E.,Wittenstein,R.,&Wolpaw,T.(2015).Educatingforthe21st-centuryhealthcaresystem:aninterdependentframeworkofbasic,clinical,andsystemssciences.AcadMed,1-5.

5Hixon,A.L.,Yamada,S.,Farmer,P.E.,&Maskarinec,G.G.(2013).Socialjustice:Theheartofmedicaleducation.SocialMedicine,7(3),161-168.

6Karnik,A.,Tscahnnerl,A.,&Anderson,M.(2016).Whatisasocialmedicinedoctor?.SocialMedicine,9(2),56-62.

7NationalAcademiesofSciences,Engineering,andMedicine.(2016).Aframeworkforeducatinghealthprofessionalstoaddressthesocialdeterminantsofhealth.NationalAcademiesPress.

8TheTrainingforHealthEquityNetwork.THEnet’sSocialAccountabilityEvaluationFrameworkVersion1.MonographI(1ed.).TheTrainingforHealthEquityNetwork,2011.

9Westerhaus,M.,Finnegan,A.,Haidar,M.,Kleinman,A.,Mukherjee,J.,&Farmer,P.(2015).Thenecessityofsocialmedicineinmedicaleducation.AcademicMedicine,90(5),565-568.

10Boelen,C.(2010).[Globalconsensusonsocialaccountabilityofmedicalschools].Santépublique(Vandoeuvre-lès-Nancy,France),23(3),247-250.

11Cuff,P.A.,&Vanselow,N.(Eds.).(2004).Improvingmedicaleducation:Enhancingthebehavioralandsocialsciencecontentofmedicalschoolcurricula.NationalAcademiesPress.

12Gregg,J.,Solotaroff,R.,Amann,T.,Michael,Y.,&Bowen,J.(2008).Healthanddiseaseincontext:acommunity-basedsocialmedicinecurriculum.AcademicMedicine,83(1),14-19.

13Gruen,R.L.,Pearson,S.D.,&Brennan,T.A.(2004).Physician-citizens—publicrolesandprofessionalobligations.JAMA,291(1),94-98.

10

14Metzl,J.M.,&Hansen,H.(2014).Structuralcompetency:Theorizinganewmedicalengagementwithstigmaandinequality.SocialScience&Medicine,103,126-133.

15Huish,R.(2009).HowCuba'sLatinAmericanSchoolofMedicinechallengestheethicsofphysicianmigration.Socialscience&medicine,69(3),301-304.

16Zakaria,S.,Johnson,E.N.,Hayashi,J.L.,&Christmas,C.(2015).GraduatemedicaleducationintheFreddieGrayera.NewEnglandJournalofMedicine,373(21),1998-2000.

17Flinkenflögel,M.,KalumireCubaka,V.,Schriver,M.,Kyamanywa,P.,Muhumuza,I.,Kallestrup,P.,&Cotton,P.(2015).ThedesiredRwandanhealthcareprovider:developmentanddeliveryofundergraduatesocialandcommunitymedicinetraining.EducationforPrimaryCare,26(5),343-348.

18Vanderbilt,A.A.,Baugh,R.F.,Hogue,P.A.,Brennan,J.A.,&Ali,I.I.(2016).Curricularintegrationofsocialmedicine:aprospectiveformedicaleducators.Medicaleducationonline,21.

19Basu,G.,Pels,R.,Stark,R.,Jain,P.,Bor,D.,&McCormick,D.(2017).Traininginternalmedicineresidentsinsocialmedicineandresearch-basedhealthadvocacy:Anovel,in-depthcurriculum.AcademicMedicine.

DefinitionofSocialMedicineLeighForbushAlthoughsocialmedicinehasbeenaroundforover150yearswithmanydefinitionaliterations,itsintegrationintohealthcaredeliveryisstillarevolutionaryconcept.1Biomedicineanditsemphasisonmicrobes,pathology,andnaturalsciencehaslongbeenthecruxofmedicaleducationandpractice,andthisistrueacrosshealthcareprofessions.Despitetheincreasingevidenceassertingthathealthandillnessareundeniablylinkedtothesocialcontextsinwhichtheyexist,thewidespreadintegrationofsocialmedicinetrainingintomedicaleducationhasbeenminimal.

Socialmedicinechallengesustothinkbeyondprolonginglifeandcuringdisease.TheSocialMedicineConsortiumhasdefinedsocialmedicineas:

1. Understandingandapplyingthesocialdeterminantsofhealth,socialepidemiology,andsocialscienceapproachestopatientcare

11

Thesocialdeterminantsofhealtharetheforcesbeyondbiology,whichimpacthealthoutcomes,suchaseducationalstatus,physicalenvironment,income,etc.ToaddressthesocialdeterminantsofhealthwemustfocusonfiveareasbasedontheRioPoliticalDeclarationincluding1)adoptingimprovedgovernanceforhealthanddevelopment,2)promotingparticipationinpolicy-makingandimplementation,3)furtherreorientingthehealthsectortowardspromotinghealthandreducinghealthinequities,4)strengtheningglobalgovernanceandcollaboration,and5)monitoringprogressandincreasingaccountability.Socialmedicineconsistsofintegratingandapplyingthesedisciplinestoensureaneffectiveandholisticresponsetopatient,family,andcommunityneeds.

2. Anadvocacyandequityagendathattreatshealthasahumanright

Socialmedicineconsidersandadvocatesfortheholisticneedsofpatients,families,andhealthsystemswitharights-basedapproachthatpushesaggressivelyforglobalhealthequity.Socialmedicinepractitionersensurehealthcaredeliverythatcorrectsinequitiesandhumanandsystemsgaps,andstrivestoattaintheobjectiveofqualityhealthcareincludingsafety,effectiveness,patientcenteredness,timeliness,efficiency,andequity.

3. Anapproachthatisbothinterdisciplinaryandmulti-sectoralacrossthehealthsystem

SocialMedicinecombinesbothinterdisciplinaryandmulti-sectoralapproachestostrengthenthehealthsystemandtobettersupportthehealthsystembyengagingallrelevantstakeholders.Todoso,itrequiresamultidisciplinaryapproachwithintheheathsystemwhiletakingintoaccountperspectivesfromallsectors,whichhaveadirectorindirectimpactonhealth.

4. Deepunderstandingoflocalandglobalcontextsensuringthatthelocalcontextinformsandleadstheglobalmovementandviceversa

SocialMedicineisrootedinadeepunderstandingoflocalcontextstobetterinformandleadtheglobalmovementtowardsimprovedhealthandhealthequity.Itensuresthatthepracticeofmedicineisbasedonthecontextualknowledgeofthepeopleandcountriesofinterest.Itensuresthattheglobalmovementisinformedbylocalknowledgeandexpertise.

5. Voiceandvoteofpatients,families,andcommunities

Socialmedicineprioritizesengagingcivilsociety,ensurescommunityownershipofhealthinitiatives,andvaluesactiveparticipationofpatients,families,andcommunitiestowardseffectivehealthcaredeliveryandhealthsystemsstrengthening.Advocatingforintegration

12

ofthevoiceandvoteofourpatients,families,andcommunitiesmeansactivatingandexpandingtheirinfluencetoensurethathealthcaremeetstheirneedsandrights.

References

1Rosen,G.(1974)Frommedicalpolicetosocialmedicine:Essaysonthehistoryofhealthcare.ScienceHistoryPublications,58-119.

13

KeyTermsinSocialMedicineDevelopedbyTheaLacerte,CassidyStevens,MichelleMorse,MD,MPH,HugoFlores,MD,MikeWesterhaus,MD,MA&AmyFinnegan,PhD,MALD

GuidingPrinciplesforDefinitions• Thesetermsweredevelopedcollaborativelytoserveasastartingpointforcritical

dialogueamongstsocialmedicineleaders,educators,traineesandotherconstituents.• Ourgoalisnotforallprofessionalstoadoptthesedefinitionswholeheartedly.Thisisa

setofwell-referencedtermswefoundtobehelpfulinourconsensusestablishingprocess.

• Wehopethateducatorsandstudentsdiscussanddebatethesedefinitionsintheircommunitiesasanearlystepinsocialmedicinemovementbuildingandcourseworkinordertohaveessentialbutdifficultconversationsaboutsomeofthemostchallengingtopicsinsocialmedicine.

• Weaskthatconstituentsconsiderhowthesetermsmaybeedited,adapted,andappliedintheirprospectiveteams,communities,andinstitutionstoreflectthevaluesofsocialmedicine.

KeyTerms

1. Structuralviolence:Thesocial,economic,andhistoricalforcesthat‘structurerisk’forsuffering(fromdiseases,hunger,torture,etc.)andconstrainagencyofcertainpeople.Itisaformofviolencethatisinvisible,embedded,andnormalized.Likedirectviolence,thereisclearharmandidentifiablevictims,butthereareoftennotphysicalactsofaggressionoraclearperpetrator.16

2. Prejudice:Anunfavorableopinionorfeelingformedbeforehandorwithoutknowledge,thought,orreason.4

3. StructuralCompetency:Trainedabilitytodiscernhowahostofissuesdefinedclinicallyassymptoms,attitudes,ordiseases...alsorepresentthedownstreamimplicationsofanumberofupstreamdecisionsaboutsuchmattersashealthcareandfooddeliverysystems,zoninglaws,urbanandruralinfrastructures,medicalization,orevenabouttheverydefinitionsofillnessandhealth12

4. Structuralanalysis:Amethodinwhichhealthprofessionalsconsiderallofthesocialstructures/institutionsthatareaffectingapatient’shealthandeffectiveinterventionstocounteracttheeffectofthesestructures12

5. CenteringattheMargins:Inordertoeradicateandcorrecttheinequitableconsequencesagainstthosepeoplewhohavebeenhistoricallydisadvantagedthroughstructuralviolenceandpolicies,itisnecessarytocenterthosewhohavebeenpushedtothemargins.Itsgoalistocentertheexperiencesoftheoppressed,havetheirvoicesinpositionsofleadership,andtoshapethemovement.2

14

6. StructuralHumility:Thetrainedabilitytorecognizethelimitationsofstructuralcompetency.Acknowledgmentmeantthatmanyoftheresponsestomitigatethestructuraleffectsofhealtharebeyondthenetworkandskill-setofmanyclinicians12

7. SocialVulnerability:Thedistinctlikelihoodoffacingforcesthatmayhavenegativeeffectsonhealthoutcomesduetoeconomicandpoliticalsituations12

8. SocialExclusion:Thesocietywide,multi-dimensional,lackordenialofresources,services,rights,goodsthatareavailabletomostpeople-altersthelifeoftheaffectedindividualandthesocietyasawhole.Thisunequalaccessleadstohealthcareinequalities14

9. Stigma:Amarkofdisgraceassociatedwithaspecificperson,circumstanceorquality.Inconsideringhealtheffectsandstigmaitisimportanttoconsiderthestigmaswithindifferentculturesofvarioushealthconditions,butamorerobustapproachofunderstandingthestructuralcomponentsthatcreatethishealtheffectareessential-cliniciansmustacknowledgehowstigmaandstructuralsystemsco-existtoeffecthealth12

10. Privilege:Anunearnedadvantagegrantedtocertainmembersofasocietytothedisadvantageofothers;Whiteprivilegespecificallypertainstoadvantagesandimmunitiesenjoyedbypeopleracializedaswhite;thisisanimportanttopictoconsiderwhenconsideringhowprivilegeaffectshealthoutcomesandhowaccesstotheseprivilegesinsocietyarelargelystructural4

11. Stereotype:Astandardizedmentalpicturethatisheldincommonaboutmembersofagroupthatrepresentsanoversimplifiedopinion,attitude,orunexaminedjudgment,withoutregardtoindividualdifference.4

12. HealthDisparities:Thedifferencesbetweenthehealthofonepopulationandanotherinmeasuresofwhogetsdiseases,whohasadisease,whodiedfromdisease,andotheradversehealthconditionsthatexistamongspecificpopulationgroupsintheUS.1

13. Healthinequity:Thedifferencesinhealthstatusorinthedistributionofhealthdeterminantsbetweendifferentpopulationgroups,andthesedifferencesaresystematic,avoidable,unfairandunjust,andarerootedinracial,socialandeconomicinjustice,andareattributabletosocial,economic,andenvironmentalconditionsinwhichpeoplelive,workandplay.7

14. Healthequity:Theopportunityforeveryonetoattainhisorherfullhealthpotential.Nooneisdisadvantagedfromachievingthispotentialbecauseofhisorhersocialposition(e.gclass,socioeconomicstatus)orsociallyassignedcircumstance(e.grace,gender,ethnicity,religion,sexualorientation,geography,etc.)4

15. SocialMedicine:Thepracticeofmedicinethatintegrates:understandingandapplyingthesocialdeterminantsofhealth,socialepidemiology,andsocialscienceapproachestopatientcare;anadvocacyandequityagendathattreatshealthasahumanright;anapproachthatisbothinterdisciplinaryandmulti-sectoralacrossthehealthsystem;deepunderstandingoflocalandglobalcontextsensuringthatthelocalcontextinformsandleadstheglobalmovement,andviceversa(learningandborrowingfromdistantneighbors);voiceandvoteofpatient,families,andcommunities.6Inshort,howtoaddressthestatement,“inequitykills.”

16. SocialJustice:Thestruggletowardsacknowledgmentandattainmentofdignityandautonomyforallmembersofsociety,regardlessofgender,race,ethnicity,religion,

15

sexualorientation,language,geographicorigin,orsocioeconomicbackground.10Socialjusticeisoftenunderstoodtorequirea“historicallydeep”andgeographicallybroad”analysis.17Itrecognizesthatsufferingisoftenduetostructuralcausesandseekstoaddressitbyattackingunderlyingstructuresthatperpetuatesufferingandjustice.

17. Medicalization:Theprocessbywhichhumanconditionsandproblemsaredefinedandtreatedasmedicalconditions.Adoptingamedicalframeworktoaddressaproblem.11

18. SocialDeterminantsofHealth:Thecircumstancesinwhichpeopleareborn,grow,live,work,play,andagethatinfluenceaccesstoresourcesandopportunitiesthatpromotehealth.Thesocialdeterminantsofhealthincludehousing,education,employment,environmentalexposure,healthcare,publicsafety,foodaccess,income,andhealthandsocialservices4

19. RacialJustice:Thecreationandproactivereinforcementofpolicies,practices,attitudes,andactionsthatproduceequitablepower,access,opportunities,treatmentandoutcomesforallpeople,regardlessofrace.4

20. Race:Asociallyconstructedwayofgroupingpeople,basedonskincolorandotherapparentphysicaldifferences,whichhasnogeneticorscientificbasis.ThissocialconstructwascreatedandusedtojustifysocialandeconomicoppressionofpeopleofcolorbyWhites.4

21. PeopleofColor:ApoliticalconstructcreatedbyWomenofColorattheNationalWomen’sConferenceintheUnitedStatesin1977toexpresssolidarityamongpeoplewhowouldgenerallynotbecategorizedasWhiteandacknowledgetherelationaldynamicbetweenoppressedpopulationsglobally.3

22. RacialDiscrimination:Theunfairtreatmentbecauseofanindividual'sactualorperceivedracialorethnicbackground.4

23. ImplicitBias:Thelearnedstereotypesandprejudicesthatoperateautomatically,andunconsciously,wheninteractingwithothers.Alsoreferredtoasunconsciousbias.Whenaperson’sactionsordecisionsareatoddswiththeirintentionsthisisimplicitbias.4

24. Racism:Asystemofadvantagebasedonrace4i. InternalizedRacism:Asetofprivatebeliefs,prejudices,andideasthat

individualshaveaboutthesuperiorityofWhitesandtheinferiorityofpeopleofcolor.Amongpeopleofcolor,itmanifestsasinternalizedracialoppression.AmongWhites,itmanifestsasinternalizedracialsuperiority4

ii. Interpersonalracism:Theexpressionofracismbetweenindividuals.Theseareinteractionsoccurringbetweenindividualsthatoftentakeplaceintheformofharassing,racialslurs,ortellingofracialjokes4

iii. Institutionalracism:Discriminatorytreatment,unfairpoliciesandpractices,andinequitableopportunitiesandimpactswithinorganizationsandinstitutions,basedonrace4

iv. StructuralRacism:Racialbiasacrossinstitutionsandsocietyovertime.Itscumulativeandcompoundedeffectsofanarrayoffactorssuchaspublicpolicies,institutionalpractices,culturalrepresentations,andothernormsthatworkinvarious,oftenreinforcing,waystoperpetuateracialinequity4

25. Whitesupremacy:Whitesupremacyisahistoricallybased,institutionallyperpetuatedsystemofexploitationandoppressionofcontinents,nationsandpeoplesofcolorby

16

whitepeoplesandnationsoftheEuropeancontinent;forthepurposeofmaintaininganddefendingasystemofwealth,powerandprivilege.4

26. Sexism:Prejudice,stereotyping,ordiscrimination,typicallyagainstwomen,onthebasisofsex;forourcontextwewillconsidertheeffectsofinstitutionalsexismonwomen’shealth.4

27. Patriarchy:Asystemofsocietyorgovernmentinwhichmenholdthepowerandwomenarelargelyexcludedfromit.4

28. Misogyny:Ingrainedprejudiceagainstwomen429. Feminism:Political,economic,andsocialequalityofthesexes1530. Intersectionality:Themannerinwhichmultipleformsofinequalityandidentity

interrelateindifferentcontextsandovertime,forexample,theinterconnectednessofrace,class,gender,disability,etc.8

31. Classism:Prejudiceagainstorinfavorofpeoplebelongingtoaparticularsocialclass,forourpurposewewillconsidertheeffectsofclassismonhealth.5

32. Classsystem:Thesystemthatstratifiespeopleaccordingtotheirincomesectorthatdoesnotnecessarilydependonindividualmerit.Peopleareusuallyborninoneclassanddieinit.Peoplealsohavefriends,workandmarrywithinthesameclass.5

33. SocialMobility:Theabilityofpeopletomovebetweensocialclasses.Itisverylimitedandhappensbyaccidentalormultifactorialconditions.Itusuallycannotbeachievedbyindividualeffort.5

34. Neoliberalism:Aneconomicandpoliticalphilosophythatsuggeststhatfreemarketsleadtoopenandfreegovernments.Itisanideologythatemphasizestheprinciplesoffreemarkets,smallergovernment,deregulation,andprivatization.18Neoliberalpolicieshavefacilitatedtheextremeaccumulationofwealthbyveryfewindividuals.Today,8menhavethesamewealthasthepoorest50%ofthepopulation.9

35. Gender:Thestateofbeingmaleorfemalethatissociallycreatedandisnotbiological436. Transgender:Whenthegenderapersonfeelstheyarediffersfromthesextheir

parentsweretoldatbirth.Genderidentityisfluid;apersoncanidentifyasbothmaleandfemaleoridentifywithneither.4

37. Homophobia:Fearanddiscriminationagainstgayandlesbianpeople438. Heterosexism:Systematicdiscriminationorprejudiceagainstnon-heterosexualpeople

ontheassumptionthatheterosexualityisthenormal/onlysexualorientation.439. Climatejustice:Recognitionthatclimatechangesolutionsmustbecommunity-ledand

centeredonthewellbeingoftheglobalpoor,indigenouspeoples,biodiversity,andecosystems.13

40. Minority:Agroupthatisoppressedbythemajority.Itcanbeofanykindandthesamegroupcanbeamajorityinoneplace,andaminorityinadifferentplace.5

41. Enormity:Whenaidworkersrealizethattheproblemsoftheworldorcommunitiestheyworkinarehugeandtheimpactthemselveshaveislimited,theycanbecomediscouraged,cynical,depressed,etc.,thismomentiswhentheyfacetheenormityanditissomethingweneedtoprocessbyre-definingourconceptoftheworldandtheuniverse,andourrolesinit.5

42. Poverty:Aconditionofscarcitythatdetrimentshumanhealth,developmentandopportunities.Itisstructuralandcreatedbyexploitationofsomegroupsoverothers,andpeoplecanhardlyescapeitthroughindividualmeans.5

17

43. Geosentiment:Identificationfelttowardone`shomecity,country,etc.Geosentimentpresentsinmanyforms:geopolitics,geoeconomics,geopatriotism,georeligion,etc.5

44. Ethnosentiment:Identificationfelttowardone’sethnicgroup.545. Sociosentiment:Identificationfelttowardone'sownfamily,nation,orothersocial

grouping(economic,linguistic,religious,political,andsoon).546. Praxis:FromtheworkofBrazilianeducatorPaoloFriere,praxisistheiterationbetween

reflectionandaction.19Bygivingthetitle“AcceleratingPractice”tothisconference,wearereferringtobuildingmomentuminreflectivepractice.

References1Bharmal,N.,Derose,K.Felician,M.(2015)Understandingtheupstreamsocialdeterminantsofhealth.EncyclopediaofPublicHealth:RANDHealth.2Black,R.,&SabheelRahman,K.,(2017).CenteringtheMargins.FamilyCenteredSocialPolicy.3Carastathis,A.(2016).Intersectionality:Origins,contestations,horizons.Lincoln,Nebraska:UniversityofNebraskaPress.4DevelopedbyAbbyOrtiz,MSW,MPHatSouthernJamaicaPlainHealthCenter5DevelopedbyHugoFlores,MD,MPH6EstablishedbyaSocialMedicineWorkingGroupinOctober2015comprisedofglobalhealthleadersandpartners.7“FactFileonHealthInequities.”(2016).WorldHealthOrganization.8Gillborn,D.(2015)Intersectionality,criticalracetheory,andtheprimacyofracism:Race,class,gender,anddisabilityineducation.QualitativeInquiry21(3).9Hardoon,D.(2017).Aneconomyforthe99%:Oxfambriefingpaper.OxfamInternational.10Kumagai,A.,Lypson,M.,(2009)BeyondCulturalCompetence:CriticalConsciousness,SocialJustice,andMulticulturalEducation.AssociationofAmericanMedicalColleges.11Halfmann,D.,(2011).RecognizingMedicalizationanddemedicalization:Discourses,Practices,andidentities.Sage.12Metzl,J.M.,&Hansen,H.(2014).Structuralcompetency:Theorizinganewmedicalengagementwithstigmaandinequality.SocialScience&Medicine,103,126-133.13Pettit,J.(2004),ClimateJustice:ANewSocialMovementforAtmosphericRights.IDSBulletin,35:102–106.14Popay,J.et.al.(2008).UnderstandingandTacklingSocialExclusion.WorldHealthOrganizationCommissiononSocialDeterminantsofHealth.15Watson,E.(2014)Genderequalityisyourissuetoo.UNWomen:HeForShe.16Galtung,J.(1969)Violence,peace,andpeaceresearch.JournalofPeaceResearc.167-191.17FarmerP,KimJ,KleinmanA,BasilicoM.(2013).ReimaginingGlobalHealth.Berkeley,CA:UniversityofCaliforniaPress.18Keshavjee,S.(2014)Blindspot:Howneoliberalisminfiltratedglobalhealth.Berkley,CA:UniversityofCaliforniaPress.19Friere,P.(1968).PedagogyoftheOppressed.NewYork,NY:SeaburyPress.

18

KeyThemesinSocialMedicineCurriculaAlexisSteinmetz,MAandRayGao

Review:AnalysisofThemesinSocialMedicineEducationProgramsSowhatservestobegainedfromaparadigmshiftwherehealthandillnessareviewedasinherentlybiosocialasopposedtopurelybiomedical?Theapplicationofsocialmedicinetocaredeliverycreatesamoreeffective,efficient,andequitablesystemforbothindividualsandcommunities.Recognizingthis,institutionsaroundtheworldhavebeguntodevelopsocialmedicinetrainingforhealthcareprofessionalsofalllevels.Astheneedforsucheducationalprogramscontinuestogrow,itisbecomingincreasinglyapparentthatthereisnotyetaconsensusonwhatorhowtoteachwhenteachingsocialmedicine.

Bycomparing12socialmedicinecurricula,thisreportattemptstoassesswhatrolesocialmedicineeducationcurrentlyservesfordifferentaudiencesandmembersofhealthcaredeliveryteams.Itrepresentsanessentialstepindeterminingthenecessityforastandardizedframeworkaroundwhichsocialmedicinemightbestbetaught.

Thisreportalsohighlightsthepotentialneedforagreementonthepurposeofsocialmedicinetraininggloballyandintermsofspecificpartsofthehealthcaredeliverychain.Whatobjectivesandcoursecontentshouldbeuniversal?Whataspectsshouldbecateredtospecificaudiences(cliniciansvs.non-clinicians,healthprofessionstraineesvs.workingprofessionals)?Howmuchshouldasocialjusticeandhumanrightsagendabeingrainedintosocialmedicinetraining?Continuedexplorationofthesequestionswillallowforthedevelopmentofeducationalprogramsthatcollaborateandworkinconcerttowardsasharedgoal:establishingasocialmedicinescaffoldinallaspectsofhealthcaredelivery.

Programs

Table1liststhe12socialmedicinecurriculaincludedinthisreport.Itisimportanttonotethattheseprogramswerenotrandomlyselectedandthatthisanalysisdoesnotincludeallsocialmedicineprograms.

Programsweredividedintofourcategoriesaccordingtotheleveloftrainingofparticipants:(1)university,(2)undergraduatemedical,(3)graduatemedical,and(4)continuingeducation(Table1).

A.ThematicCategories

19

Uponreviewofcourseobjectivesandcontent,severaldifferentthematicperspectivesthroughwhichsocialmedicineiscurrentlybeingtaughtemerged.Courseobjectivesandcontenttopicsfromallprogramswereplacedintooneofthethreecategoriesdescribedbelow.Howdifferentprogramspulledfromthesecategoriesintheirobjectivesandcontentwillbereviewedthroughoutthisreport.

Thesethematiccategoriesweresomewhatarbitraryandarenotmeanttobeexactormutuallyexclusive;instead,theyserveasabaselineforevaluatingsimilaritiesanddifferencesacrosscurricula.Therefore,datareportedshouldbeunderstoodasameansofshowingtrendsratherthanprecisequantitativemeasures.Itisalsoimportanttorememberthatjustbecauseacoursedoesnotlistsomethingintheirstatedobjectivesorcontenttopicsdoesnotmeanitisnotembeddedwithinthecourse;thisisanimportantlimitationofcomparingprogramsbasedonwrittendescriptionswhichmaynotfullyillustratethebreadthordepthofthecoursework.

1. PatientCare.Theseobjectivesandcoursetopicsareconcernedwiththeclinicalapplicationofsocialmedicinewithregardstoindividualpatents;theyreflectaholisticapproachtomedicalcarewherethepatientisviewedwithinhis/hersocialcontext.

Examples

Objectives:Diseasemanagement,communicationskills,primarycareprovision

Topics:Healthpromotion/diseaseprevention,ruralhealthcare,healtheducation,clinicaltopics

2. LocalSystemsforCare.Theseobjectivesandtopicsstressthecomprehensionoflocalhealthsystems,programs,policies,andplayers.Broadlyspeaking,mostofthesearerelatedtounderstandingandprovidingcountry-specificpublichealthandpopulationcareatthecommunitylevel.

Examples

Objectives:Publichealth,communitylevelcare,localhealthcaresystems/policy

Topics:Populationhealth,modelsofhealthfinancing,localprograminterventions,researchprocesses

3. BigPicture.Thiscategoryofobjectivesandtopicsfocusedonhigher-levelassessmentthatexaminesthedeterminantsofhealthandillnessaswellasthepracticalactionstepstoaddressingthesefactors.

Examples

20

Objectives:Globalcontextofissues,understandingcaredelivery,analyzingglobalhealthinterventions,advocacy

Topics:Qualityofcareimprovements,healthcaresystemstrengthening,programdesign,healthvalue,healtheconomics,healthandhumanrights

B.CourseObjectives

Nosingleobjectivewassharedacrossallprograms,although11outof12(92%)curriculaspecificallyincludedsocialdeterminantsofhealthandillnessintheirlistedobjectives.TheonlyprogramthatdidnotwastheGlobalHealthDeliveryLeadership,whichmayhaveassumedthatknowledgeorembeddeditdirectlyintoitslearningmodules.Severalotherobjectiveswerecommon,irrespectiveoftheaudience.Mostprograms(83%)emphasizedcountry-specifichealthissues(the2thatdidnotwereuniversitycourses)andamajority(58%)includedhealthissuesinaglobalcontext(the5thatdidnotwereallundergraduatemedicalprograms).Interestingly,howmuchahumanrightsagendawaswovenintocourseobjectivesvariedgreatlyacrossprograms,irrespectiveofaudience.Advocacywasmentionedin50%ofprograms’objectives,andhealthequitywasonlymentionedin25%ofthem.

Thedegreetowhichindividualprogramsdrewtheirremainingobjectivesfromeachofthe3categoriesofPatientCare,LocalSystemsforCare,andBigPicturewas—notsurprisingly—largelyreflectiveofaudiencetype.Forexample,undergraduatemedicalprogramstendedtodrawobjectivesthatrevolvedaroundPatientCareandLocalSystemsforCare,whereascontinuingeducationprogramsdrewmorefromtheBigPicturecategory.Itwasclearthatthereweresomeoverarchingthemesthatwereimportantforspecificaudiences.

However,thiswasnotstrictlytrue,andtherewereotherglobaldifferencesthatcouldnotalwaysbeaccountedforbasedonaudience.Inotherwords,theoverallapplicationofsocialmedicinewasclearlydifferentformedicalstudentsthanforworkingprofessionals,butevenwithinthosegroupingstherewassomeadditionalunexpectedvariation.Thiswillbedescribedinmoredetailbelowinaudiencespecificsections.

C.CourseContent

Aswasthecaseforcourseobjectives,somecoursecontentacrosssocialmedicineprogramswasuniversal,irrespectiveofcourseaudience.Socialdeterminantsofdiseasewereincludedin92%curriculacontenttopics(itwasagainGHDLthatdidnotincludeit).Modelsofpaymentandhealthfinancingweretaughtin66%ofprograms.HarvardMedicalSchoolteacheshealthfinancingaspartoftheirprogram,eventhoughitwasnotlabeledspecificallyas“socialmedicinecontent”intheircoursebreakdown.Also,thefourprogramsthatdidnotincludeitin

21

theirlistedcontentwereallundergraduatemedicalprograms.Populationhealthandresearchwerelesscommonbutstillrepresentedinoverhalfoftheprograms(58%).

Sincethethematicobjectivesguidedprogramcontent,categoriesofcontenttopics(PatientCare,LocalSystemsforCare,andBigPicture)roughlyfollowedpatternsofobjectives.However,individualcoursecontentiswherethenatureofsocialmedicineteachingreallybegantovary,evenmoresothanwithobjectives.Specificcontentvariedwidelyandwasmuchlesspredictablethanobjectivesbasedonaudience.Therewasalsoadifferenceintheapproaches—theamountoftheoreticalvs.practicalknowledgecontentandtrainingdifferedbothacrossandwithinaudiences.

22

D.TeachingMethods

Tenoutof12(83%)programsusedacombinationofdidacticlecturesandgroupdiscussionwithorwithouttutorials/fieldexperiences.ThetwoexceptionswereCESMexico,wherethesocialmedicinesectionconsistsentirelyofgroupdiscussions,andPIHEngage.Althoughthesedataprovidesomeinsightintooverallmethodology,teachingstyleandfacilitationmethodsbetweenprogramscouldnotbefullyappreciatedfromsyllabiorcoursedescriptions.Forexample,it’scertainlytruethat“GroupDiscussion”inCESMexicoandinPIHEngagemeantwoverydifferentthings.Reportsof“tutorialandfieldsessions”donotdifferentiatethesignificantlydifferentmethodsof,say,bedsideteachingvs.groupvisitstoahealthcenter.Theseareimportantconsiderationsthatwarrantfurtherexaminationelsewhere.Also,inthecaseofCES,thereisanimportantclinicalproportionoftopicsthatarecoveredinsmallgrouplecture/discussionsandcasepresentations.

AnalysisbyAudience

A.University

Thereweretwoprogramsthatweretaughttouniversityundergraduates,HarvardUniversityandPIHEngage.Harvard’scourseservestoprovidestudentswith“atoolkitofanalyticalapproachestoexaminehistoricalandcontemporaryglobalhealthinitiativeswithcarefulattentiontoacriticalsociologyofknowledge”.ThesecondprogramisPIHEngage,whichisPIH’scommunityorganizingprogram.Thisisanoptionalcurriculum—moresoasetofresources—thatteamleadersfromchaptersofvolunteersalloverthecountrycansharewiththeirteamtobetterunderstandthePIHphilosophyofcaredeliveryasahumanright.

Bothofthesecurriculaareintroductoryglobalhealthcoursesthatstudysocialdeterminantsofhealthinabroadcontextofsocialtheoriesandhealthequity.Theprogramsactuallysharedmostoftheirobjectives,allofwhichweredrawnfromtheBigPicturecategory(e.g.globalcontextofhealthissues,understandingcaredelivery,healthadvocacy).NeitherofthemhadstatedcourseobjectivesrelatedtoLocalSystemsforCareorPatientCare.

Despitethesesharedobjectives,someoftheirspecificcontentvaried.Whilebothprogramsutilizedahealthandhumanrightsagendatodiscusshealthfinancingandpopulationhealthinlocalandglobalcontexts,Harvard’sundergraduatecoursegoesmoreintoglobalhealthplayersandtheirroles.PIHEngagefocusedinsteadonprogramdesign,leadership,politicalengagement,andresearch.

Bothcourseswerelargelytheory-basedandneitherhadafieldorpracticalcomponent.TheHarvardsemester-longcourseistaughtthroughdidacticsessionsbyleadersinglobalhealthwithasmallcomponentofopendiscussion.Conversely,PIHEngage’scurriculumispurelygroupdiscussionfacilitatedbyteamleaders(whoarenotglobalhealthprofessionals).

23

B.Undergraduatemedicaleducation

Theprogramsprovidingsocialmedicinetrainingforundergraduatemedicaleducationrepresented7curriculaintotalfromHarvardMedicalSchool,SocMed,EqualHealth,ZanmiLasante(2separatecurriculafornursingandmedicalstudents),andUniversityofRwanda(oldandrevisedcurricula,bothcurrentlyinuse).

AsEqualHealthwasdevelopedasasiteexpansionofSocMed,theseprogramsareverysimilarintheiroverallstructuralframework.Thesenon-profitorganizationsprovideoptionalrotationsforstudentsinterestedinworkinginglobalhealthsettingsandacceptapplicationsfrombothlocalandinternationalstudents.Theyfocusontheoreticalframeworksofsocialmedicine,globalhealth,socialjustice,advocacy,andpatient-centeredmedicine.TheirobjectivesandcontenttopicsfellintoallthreecategoriesofPatientCare,LocalSystemsforCare,andBigPicture.

ThesetwoprogramsdifferfromtheZanmiLasanteandUniversityofRwandacourses,whicharetaughtasrequiredrotationsformedicalstudentsandfocusonthepracticalapplicationofsocialandcommunitymedicineinprimarycare.Thecombined4curriculaofthese2institutionshavesimilarobjectivesofprovidingstudentswiththepracticalandtheoreticalskillsforsocialandcommunitycare,especiallyinruralpopulationswithintheirrespectivecountries.Thereismuchlessofanemphasisonglobalhealth.UnliketheSocMedandEqualHealth,neitherUniversityofRwandacoursesnorZanmiLasantecoursesincluded“BigPicture”objectives(althoughtheydohaveBigPicturecontentintheircoursetopics).

Notably,theUniversityofRwandaprogramistheonlylongitudinalcoursethatisintegratedthroughmultipleyearsofmedicalschool.Itwasdevelopedunderthepremisethatcontinuedexposuretosocialmedicineconceptswouldallowstudentstogainagreaterappreciationforitsrelevanceinthepracticeofmedicine.Also,socialmedicinecanbeusedastheplatformtoteachotherimportantcontentsuchasprofessionalism,research,etc.

HarvardMedicalSchooloffersarequiredrotationforHarvardstudentsandrepresentssomesortofcombinationofthetwogroupingslistedabove.ItisperhapsmoresimilartotheEqualHealth/SocmedmodelasitusesabroadconceptualframeworktopreparestudentstomeetthechallengesofpracticingmedicineintheUSandelsewhere.However,theincludedcoursecontentthatisnotspecificallylabeledas“socialmedicinecontent”includesmuchofthepracticalknowledgethatZanmiLasanteandUniversityofRwandaemphasizetotheirstudents.Overall,HarvardusesBigPicturethemesasawaytoteachstudentstounderstandandworkwithintherealmofindividualpatients.TheHarvardprogrampushesstudentstothinkbothabstractlyandpracticallyinordertoapplylessonsfromthesocialsciencestopragmaticsolutionstoimprovingpatientcare.

24

Therewereseveralotherobservationsthatareworthnotingabouttheseprograms.Sixoutofsevenutilizedacombinationofdidacticlectures,groupdiscussion,andcommunityactivities(thoughitisunclearhowindividualstudentparticipationineachofthesevaried).TheHarvardprogram,basedonitssyllabus,didnotincludebedsideteachingoroutingswithhealthcareworkersastheotherprogramsdid.Alloftheprogramsincludedmedicalstudents.EqualHealthincludedotherhealthprofessionalstudentsinthesamecourse,andUniversityofRwandaincludedsomepharmacystudentsinthefirstyearofitsnewlongitudinalcurriculum.ZanmiLasantewastheonlyprogramtohaveaseparateprogramfornursingstudents.SocMed,EqualHealth,andUniversityofRwandaeachallowedforeignvisitingstudentstoapplytotheirprograms.

25

C.GraduateMedicalEducation

CompañerosEnSalud,thesisterorganizationofPartner’sInHealthlocatedinMexico,providesacertificatecoursewithaGlobalHealthandSocialMedicinecomponentandrepresentstheonlycourseforgraduatemedicaltrainingthatwasincludedinthisanalysis.ThecourseistaughttoMexicanphysiciansandnursesduringtheircompulsorysocialserviceyear.Physiciansaretaughttoviewglobalhealthasaseriesofproblemsacrossdisciplines,andtheoverarchinggoalistohelpthesenewdoctorstobecomechangeagentsforMexico.

Likealmostallprograms,CESMexicohadsocialdeterminantsofdiseasewovenintoitsobjectivesandcoursetopics.Thegoalofthiscourseistogetphysicianstothinkbroadlyandtobecomeadvocatesforahealthandhumanrightsequityagenda.TheotherobjectivesforCESdrewfromtheLocalSystemsforCarecategoryandtheBigPicturecategory.Thisisamajordifferencebetweenthisprogramandmostoftheundergraduatemedicaleducationprogramsthatemphasizetheuseofsocialmedicineinone-on-onepatientinteractions.Moreover,CESfocusedonmedicineasanavenueforsocialchange,whilemostundergraduatecoursesfocusedmoreonthepracticalapplicationofsocialmedicinefortheaveragephysicianorhealthcareprofessional.TheCESprogramcontenttopicsdrewfromeachcategoryofPatientCare,LocalSystemsforCare,andBigPicture.

Thiscurriculumisuniquefrommostoftheothersinthatitincludesnodidacticcomponentandreliesontransformativelearningentirelythroughdynamicexercises.AnotheruniqueattributeisthatCESmakesitapointtosurroundthesetraineeswithmentorsinthefieldsotheycanseefirsthandwhatitmeanstodelivercareasahumanright.Theprogramhasbeensuccessfulinmotivatingphysicianstopursuecareersinglobalhealth.Inspiredtoparticipateintheshapingandcreationofadifferentsystem,manyofthegraduatesofthisprogramhavegonetograduateprogramsinglobalorpublichealth,departingfromtheregulartracktodoresidencyandprivatemedicineaftercompletingthesocialserviceyear.ThisisveryunusualinMexico.

D.ContinuingEducation

ThereweretwoprogramsthatconstitutedContinuingEducationwhichwerecreatedforsignificantlydifferentaudiences.TheHEALInitiativeBootcampprovidesanintensiveorientationtoglobalhealthequitytophysicians,pharmacists,nursesandotherhealthcareprofessionalswhohavebeenselectedas2-yearHEALinitiativefellows.Theprogramaimstoequipparticipantswith“practicalknowledgeandskillsneededtoworkinlow-resourcesettings,whilesimultaneouslypromotingcriticalthinking,andfosteringcollaborationacrossallHEALsites”.TheGlobalHealthDeliveryLeadershipprogramwascreatedforhighpotentialdirectorsandmanagers(cliniciansandnon-clinicians)atPIHtogainpracticalexperiencewithleadershipandprojectdevelopment.

26

Thesedifferingprogramprioritieswerereflectedintheobjectivesandtopicsforeachoftheprograms.HEALobjectivesandtopicsfellintoall3thematiccategorieswhileGHDobjectivesdidnotincludeanyPatientCareones(whichmakessense,becauseGHDLincludednon-clinicians).AlthoughthereissomeoverlapintopiccategoryofBigPicture(e.g.bothprogramsteachprojectdesigntheoryandleadershipskills),theyalsohavedifferentspecificfocuses.HEALemphasizedqualityofcareimprovements,politicalengagementandadvocacy;GHDLstressedmonitoringandevaluatinghealthprograms,prioritiesandhealthvalues,andhealtheconomics.

TheHEALprogramwasa140hourcoursewithafairlyevendistributionofdidactic,groupdiscussion,andfieldactivities.GHDincluded30hoursof“coursework”,2/3ofwhichweredidacticlectures,alongwithachallengeprojectthattakesplaceoverseveralmonthswithprogramsupervision.

Conclusion

Althoughitmaybepossibletodefinesocialmedicine(asstatedinthebackgroundsectionofthisreport),itisyettobeseenhowthatdefinitionwillcontinuetotranslateintoeducationalprogramsforindividualsworkinginhealthcaredelivery.Asseeninthisreport,therearesomeverydifferentobjectiveframeworksthatcanbeusedtoteachthesamecontent.Forexample,onecantakeeitheraPatientCareoraBigPictureapproachtoteachingmodelsofhealthfinancing.Moreover,asingleframeworkofpatientadvocacycanbeusedtoteachverydifferentBigPicturecontent,fromthepracticalapplicationsofprogramdevelopmenttoatheoreticalunderstandingofstructuralsystemsthatimpacthealth.Inmanycases,suchasinleadershipcoursesorinundergraduatemedicaleducationcoursesthathaveotherpriorities,socialmedicineactslesslikeadisciplineandmorelikeabackdropforteachingotherskills.Overall,thisreportisapreliminarystepindeterminingtheneedfor:

1. AnoverarchingSocialMedicineframeworkthatcontext-specificandaudience-specificcurriculacouldfitinto;

2. Apackageofcontenttopicsthatrepresentsasortof“socialmedicinecore”thatgoesbeyondbasicsocialdeterminantsofdisease;

3. A“bestpractice”fortransformativelearningofthesetopics.

Understandinghowprogramprioritiesandteachingmethodscan(andcannot)beadjustedforspecificaudienceswillallowforthecontinuedexpansionofsocialmedicineineducation—andtherefore,inhealthcaredelivery—aroundtheworld.

27

Table1.SocialMedicineprogramsincludedinthisanalysis.

Program Location Audience

HarvardUniversity USA Undergraduate(andgraduateuniversityStudents)

PIHEngage USA Undergraduateuniversitystudents(alsoasmallernumberofhighschoolstudentsandyoungprofessionals)

EqualHealth Haiti Medical,nursing,publichealthstudents

FacultédeMédecineetdePharmaciedel’Universitéd’Etatd’Haïti/ZanmiLasante

Haiti Medicalstudents

FacultédeMédecineetdePharmaciedel’Universitéd’Etatd’Haïti/ZanmiLasante

Haiti Nursingstudents

HarvardMedicalSchool USA Medicalstudents

SocMed Uganda MedicalandNursingstudents

SocoMed(oldcurriculum) Rwanda Medicalstudents

iSOCO(newcurriculum) Rwanda Medical,Dental,Pharmacystudents

CompañerosEnSalud Mexico Firstyearphysicians(interns)

GlobalHealthDeliveryLeadership

PIHsites(Boston,Rwanda,Haiti)

HighpotentialdirectorsandmanagersatPIH

UCSFHEAL

USA Physicians,pharmacists,nursesandotherhealthcareprofessionals

*HarvardUniversity’scoursealsoallowsgraduateuniversitystudents,andPIHEngageistechnicallyopentoanyPIHEngagevolunteer,includinghighschoolstudentsandyoungprofessionals.Bothoftheseincludepredominantlyundergraduatestudentsanddidnotfitothercategories.

28

SocialMedicineConsortiumMemberPrograms–EducationalProfilesThisisanoverviewofSocialMedicineeducationprogramswithintheSocialMedicineConsortiumthathavebeendevelopedaroundtheworldoverthepastfewyears.ItisnotrepresentativeofallSocialMedicineprograms,butismeanttoserveasalearningtoolforeducatorsandtraineeswhoareinterestedindevelopingaSocialMedicineprogram.ThisisalivingdocumentandweintendtocontinuetorevisethisoverviewofprogramsasmoreorganizationsjointheSocialMedicineConsortiumandbringtheirexpertiseintoimplementingSocialMedicineprograms.EqualHealth-HaitiI.BriefOverview

Thiscourserepresentsthefirstsiteexpansionofacoursethathasbeenofferedsince2010inGulu,UgandabySocMed.EqualHealthisanon-profitorganizationdedicatedtoempoweringHaiti’snextgenerationofhealthprofessionalsthroughprofessionaldevelopmentandcontinuingeducation.TheHaiti-basedcoursesharesacorecurriculumwiththeSocMedUgandacourse,withafocusonthetheoreticalframeworksofsocialmedicine,socialjustice,advocacy,andpatient-centeredmedicine.Additionally,theHaiti-basedcoursefocusesonthehistoryofHaiti,themodern-dayeconomicpoliciesthatimpactit,andtheroleofNGOsinHaiti,particularlyaftertheJanuary2012earthquake.

Ataglance:

• Medical,nursing,publichealth,andotheralliedhealthprofessionstudents

• 20students

• 3-weeklongcourse

• Started2013

Website:http://www.equalhealth.org/socialmedicine

II.Objectives

1. Topromoteinternationalsolidarityandpartnershipforgeneratingsolutionstoglobalhealth

2. TofosterreflectivedialoguebetweenHaitianandinternationalmedicalstudentsasameansofstrengtheningtiesbetweenthenextgenerationofHaitianhealthprofessionalsandaglobalnetworkoftheirpeers

29

3. Toprovideastructuredglobalhealthexperienceformedicalstudentswithdedicatedsupervisionandteachinginclinicalmedicineandsocialmedicine

4. Tostudyissuesrelatedtoglobalhealthinaresource-poorsettingwithanemphasisonlocalandglobalcontext

5. Tofostercriticalanalysisofglobalhealthinterventionsinresource-poorsettings

6. Tofacilitatethedevelopmentofaclinicalapproachtodiseaseandillnessusingabiosocialmodelthroughstructuredsupervisionandteaching

7. Tobuildanunderstandingandskillsetassociatedwithphysicianadvocacy

III.Structure&Methodology

A.CourseBreakdown

120hourstotal=70hoursdidactic+50hourstutorial/field

Overallstructureincludesacombinationoffieldvisits,classroom-basedpresentationsanddiscussions,groupreflections,studentpresentations,films,andbedsideteaching.Participantsinclude10studentsfromHaitianmedicalandnursingschools,and10otherstudentsfromaroundtheworld.

B.TrainingLocation.

ThecoursehasbeenheldonthecampusattheUniversityoftheAristideFoundation,thePartnersinHealth/ZanmiLasantehospitalinCange,andtheCulturalCenterinMirebalais.Futurelocationswilldependonpoliticalclimateandspaceavailability.

C.Materials

Readings,film(Pleaseseeappendixforspecifics)

IV.Content

CourseCurriculum.Thecoursestructurebringstogetherdiverseteachingsinfieldssuchashistory,economicsandcommunityorganizingalongwithclinicalperspectives.Thecurriculumisroughlydividedintothefollowingparts:

Part1–DeterminantsofHealthBeyondBiology:SocialandEconomicCausationofDisease

Part2–GlobalHealthInterventions:ParadigmsofCharity,Humanitarianism,andStructuralChange

Part3–SocialJusticeinHealthInterventions:ModelsofCommunity-basedHealthcare

Part4–HealthandHumanRightsandtheHealthcareWorkerasAdvocate

30

Part5–ToolsforEffectiveApplicationofGlobalHealthExperience:Writing,Photography,Research,andPoliticalEngagement

Clinicaltopicswillincludecholera,tuberculosis,HIV/AIDS,andotherrelevantdiseasesimplicatedinsocialdeterminantsofhealth.

31

V.MeansofEvaluationandAssessment

A.GroupProjectEvaluation

Basedonthethefollowingcriteria:

1.Applyingtheconceptsofsocialmedicinecourse

2.Creativity

3.Thefeasibilityoftheproject

B.Participationgrade(reflectsengagementinclassprojectanddiscussions,fieldvisits,etc)

C.NarrativeMedicinePaper

VI.CourseFaculty|Rolesandresponsibilities

AgroupofcourseleadersfromboththeU.S.andHaitiwithexpertiseintropicalmedicineandpublichealthmakeupthecorefaculty,andwillteachthecourseinFrench.

32

FacultédeMédecineetdePharmaciedel’Universitéd’Etatd’Haïti/ZanmiLasanteNursingProgram-HaitiI.BriefOverview

ThisisrotationfornursingstudentsatoneofthefivemedicalschoolsinHaiti,FacultédeMédecineetdePharmaciedel’Universitéd’Etatd’HaïtiinpartnershipwithPIH’ssisterorganizationZanmiLasante.ThismodulesetsanoverallobjectivetointroducestudentstocommunityhealthandthepracticalandtheoreticalskillsforthesocialandcommunitycareinruralHaiti.

Ataglance:

• Finalyear(thirdyear)nursingstudents

• 2groupsof18students

• 2-weeklongcoursepergroup

• Establishedin2012

II.Objectives

Generalobjectives

1. Helppublichealthinstitutionstoenhancelearningabilitiesofnursingstudentswithinternshipopportunitiesincommunityhealthandsocialmedicine.

2. Facilitatenursingstudentstoexperienceruralpractice.

3. CreateaspaceforinteractionbetweenstudentsandhealthcareprovidersinthefieldthroughtheeverydaypracticeandimplementationofsomepriorityprogramsMSPPsuchastuberculosis,HIV,thenationalimmunizationprogram,themalnutrition,andreproductivehealth

4. Introducestudentstofieldresearchmethodologiesbydocumentaryresearch,quantitativeandqualitativemethod,actionresearch,qualityimprovementmethodologiesandcommunitydiagnosticapproaches.

Attheendofthecoursestudentswillbeableto:

• Makeacommunitydiagnosis

• AmplydiscussthestrengthsandweaknessesoftheHaitianhealthsystem

• Understandtheroleofthenurseincommunitycare

33

• UnderstandthevariouspriorityprogramsoftheMinistryofPublicHealthandPopulation

• Analyzethemoralandethicalaspectsofthemedicalprofessionandnursinginparticular.

III.StructureandMethodology

A.CourseBreakdown

80hourstotal=20hoursoflecturesand60hoursoftutorials

20hoursoftheoryclasseswillbefilledthroughparticipatorypresentations.Theremaining60hours will be filled by tutorials, and community intervention, or clinical observation andaccompanimentonasubjectthatstudentswillchooseandpresentendofthecourse.

B.TrainingLocation

Thecoursewillbeconductedprimarily inHinche, ina servicecareunitof theHospitalofSt.TeresaHincheDepartmentalHospitalCentre.Forpedagogicalreasons,thiscoursecanbedonein other departments or hospitals Zanmi Lasante /MSPP in the departments of Centre andArtibonite.

C.Materials

Readings,film

IV.Content

Topicscovered:

• PriorityProgrammeforMSPP

• TBprogram

• MonitoringandEvaluationofprograms(HIV/TB,Malnutrition)

• HIVProgram

• ReproductiveHealthProgram

• Vaccinationprogram

• Malnutritionprogram

• SocialMedicine

• Homevisit

34

• SomeindicatorsofHealthtomaster

• TakingoverPsychosocial

• Preandpost-testcounselingforHIVtestingandsyphilis

• Researchmethodology

• CommunityDiagnosis

V.MeansofEvaluationandAssessment

StudentswillconducttheirtrainingundertheguidanceofmanagersandinstructorsZanmiLasante.ThiscoursewillleadtoavalidatingassessmentbasedonanevaluationsheetpreviouslydesignedbytheDirectorateofENIP,dulysignedandsealedbytheHeadofthetrainingcourse.Theevaluationwillinclude:

• Studentrelationship-Monitor

• Student’sparticipationandintegration

• Noteontheresearchworkonasubjectrelatingtotheobjectiveofthecourse.

• Oralpresentationofresearchwork

• Thestudentpaperoraplacementreport

• Thetheoreticalcourseposttest

ThevalidationofthecoursewillbegivenbytheDirectorateofENIP.

VI.CourseFaculty

ForZanmiLasante:

• EtienneVernet,MScEd.DirectoroftheNationalTrainingCentre

• KerlingIsrael,MDDirectorofMedicalEducationatZL

• RalphTernier,MD,HeadoftheDepartmentofCareandSupportCommunity.

TotheNationalSchoolofNursesofPort-au-Prince:

• MireilleSylvain,DirectorENIP

• ChristineD.Neptune,AssistantDirector

35

FacultédeMédecineetdePharmaciedel’Universitéd’Etatd’Haïti/ZanmiLasanteMedicalProgram–HaitiI.BriefOverview

ThisisarequiredrotationforoneofthefivemedicalschoolsinHaiti,FacultédeMédecineetdePharmaciedel’Universitéd’Etatd’HaïtiinpartnershipwithPIH’ssisterorganizationZanmiLasante.Itservestoenhancelearningabilitiesofgraduatingstudentsin6thyearofmedicinewithinternshipopportunitiesinCommunityHealthandSocialMedicine.

Ataglance:

• 6thyearmedicalstudents

• Groupsof6-8students

• 3weeksduration

• Established2011

II.Objectives

Generalobjectives

1. Enablemedicalstudenttoreceivepracticaltraininginruralareas

2. Provideanideallearningenvironmenttoaddresshealthproblemsspecifictounderdevelopedcountriesandmarginalizedpeople.

3. Createaninteractivespacebetweenstudentsandfieldcaregivers,especiallycommunityhealthworkersandattendants.

4. FacilitateunderstandingandcontactwithsomeinternalpriorityprogramssuchMSPPNACP,NTP,EPI,malnutritionandreproductivehealth.

5. Encouragethecomprehensivepracticeofmedicineincludingallrelevanthealth.

6. Createopportunitiestohelpstudentsmakeacommunitydiagnosis.

7. Tointroducestudentstoresearchandscientificpresentations.

36

III.StructureandMethodology

A.Coursebreakdown:

120hourstotal=20hourstheory+100hourstutorial/field

B.TrainingLocation

• CangeandNationalTrainingCenter(CNF/CHART)

Thecoursewillbeconductedoncampus,inaservice/careunitoftheHospitalGoodSaviorofCangeorattheNationalTrainingCenterinHinche.

• InanotherinstitutionnetworkZanmiLasante/MSPP

Forpedagogicalreasons,thiscoursecanbedoneinotherservicesorZanmiLasantehospitalsinCentraldepartmentsandArtibonite.

C.Materials

Readings,film

IV.Content

20hoursoftheoryclasseswillbefilledthroughparticipatorypresentations.Thefollowingtopicswillbecoveredbutcanbeaddressedinothercontextsthroughoutthecourse:

• Thesocio-economicdeterminantsofhealth.

• Globalhealthinitiatives(eg.PEPFAR,GlobalFund)

• MakingModelsupportscommunity-based.

• Planningandimplementationofcommunityactivities

• ResearchMethodology.

• Improvingthequalityofcare(HealthQual,CYPRESS)

• HealthInformationSystemandnotifiabledisease.

TheemphasiswillbeontheillustrationofthecomprehensivemanagementofHIVinfection,cholera,tuberculosis,cervicalcancerandreducingmaternalandinfantmortality.

Theother100hourswillbefilledbytutorials(communityeducation,mobileclinic,healthcampaignactivity)andalsoconductingaresearchonatopicchoseninconsultationwiththetutorinrelationtoobjectives.

37

V.MeansofEvaluationandAssessment

ThiscoursewillleadtoavalidatingassessmentbasedonanevaluationsheetpreviouslydesignedbytheDean'sOffice,dulysignedandsealedbythedirectorofthetrainingcourse.

Itwillfocuson:

• Therelationshipbetweenstudentandpatients/populations

• Thestudent’sparticipationandintegrationwiththecareandserviceteam

• Attendance

• Theeffectiveacquisitionofspecificskillscoveredbytheobjectivesoftraineeship

• Theevaluationwillalsoincludeanoteontheresearchworkonasubjectrelatingtotheobjectiveofthecourse.

Theevaluationwillbebasedonthelifeskills(containing10criteriapreviouslydefinedbytheFMP/UEH)quotedat30%,thecommunitydiagnosisofdutytodutyat30%andthefinaldutyto40%research.

VI.CourseFaculty

• Directorofthecourse:• Dr.RamilusSt-Luc,RegionalCoordinatorZL/CentralPlateau(Slucram2002@yahoo.fr)

• Dr.DanielDure,DCBET(duredaniel@gmail.com)• LogisticsManager:

• JosephWilde,Asst-adm(joseph.wilde9@gmail.com)• Internshipcoordinators:

• Dr.PatrickUlysses,regionalcoordinatorZL/BasArtibonite(superning12@hotmail.com)

• NicoleEmilienNicolas,CHWtrainingcoordinator,(nicoleemiliennicolas@yahoo.fr)

Thereareseveralstagemonitorsandguestpresentersthatarealsoconsideredfaculty.

38

CompañerosenSalud-MexicoI.BriefOverview

Thecertificatecourseiscomprisedof4mainsections:aglobalhealthandsocialmedicinecurriculum(GHSM;discussedhere),amedicalskillscurriculum,ahumanisticcurriculum,andaqualitycaredeliverycurriculum.IntheGHSMthereareminimallecturesandanemphasisoninformation,formation,andtransformationasthebasisoftransformativelearning.

Ataglance:

• Graduatephysiciansandnursesdoingmandatorysocialserviceyear(pasantes)

• 16studentspercourse

• 12month-longprogram

• 12sessionsfor3hourseach(GHSMpart)

II.Objectives

1. Teachtraineestolearnbroadlyandthinkwidely:globalthinkingforglobalimpact

2. Encouragetransformativelearningbasedaroundinteractivediscussions

3. Teachparticipantstobecomeeducatorsandtobepowerfullyactiveonmanyfronts,fromservice,tosystemsdevelopment,totraining,toresearch,toadvocacy

4. Helpparticipantsdevelopabroadunderstandingofglobalhealthasaseriesofproblemsacrossdisciplines

5. Createmasterpractitionersthatwillbecomethechangeagentscreatingtheknowledge,systemsandpoliciesthatactuallymoveustowards“healthforall”

III.StructureandMethodology

A.CourseBreakdown

TheGlobalHealthandSocialMedicineportionofthecertificateprogramisaround230hours,including12individual3-hourdynamicgroupdiscussionsessions.These230hoursareembeddedwithin2000hoursofexperientiallearning.

B.TrainingLocation

Mexico.

C.Materials

39

ThePDFsofthemanualarenotpublishedinanopenaccessformat;instead,CEShopestopartnerwithinterestedprogramsandaccompanythemthroughtheprocessofadoptingandadaptingthesematerials.Thismayopenupnewopportunitiesforprogramgraduateswhowerethemosttalentedandmotivatedfacilitatorstogainemploymentinlargerglobalhealthefforts.

OurGHSMcurriculumisentirelybasedon“dinámicas,”ordynamicexercises.PowerPointisusedonlytoshowpictures,almostneverwords.Peoplelearnbytalking,playing,acting,laughing,andteachingeachother.Ourguidingtheoryisthatglobalhealthstartedas“acollectionofproblems,”andthatbetweentheseproblemswehavetheopportunitytoseenewconnectionsandnewsolutions.Toorganizethemassofthemesandideasinherenttoglobalhealthequitydelivery,wemadea“mandala”(orpictorialrepresentationofourphilosophyinaction);eachcolorhasfour3-hoursessionsfromwhichtochoose,foratotalof24individual3-hoursessions.With6colors,thecoursebeginsatmonth1of12onyellow,andthenproceedsthroughthecolorsuntilonmonth7of12thecolorsstartoveragain.Thisallowsthemestobere-exploredbyanewcohortofstudentscomingineachmonth;itallowsstudentshittingthehalfwaypointtobecometheteachersand“teach-back”whattheylearnedtothenewstudents.Indeed,thebestwaytolearnsomethingistoteachit.

Eachringgroupsaroundatheme:theinnerringliststhecomponentsofqualitycaredelivery,thenextringliststheWHO6buildingblocksofhealthcaresystemstrengthening,thenextringlistssomeofthekeyprocessesbywhichthesocialdeterminantsofdiseasecausedisease,andthefinalringgroundsthisallwithinafewkeydiseaseentitiesthatserveasexamples.Eachdynamicsessionwillleadthestudentsthroughsomeactivitythatexploresallthethemesinthewedge.Forexample,yellowsessionswillexploreeffectivehealthcare,healthservices,social

40

stratificationandinequality,epilepsy,mentalhealthdisordersindividuallyortheinteractionsbetweenthem.Anyonestudentwillseemaximum12sessionsofthe24available,butmayseelessifpriorsessionsare“taught-back”intheirsecond6-monthperiod.

IV.Content

1.-Understandingandapplyingthesocialdeterminantsofhealth,socialepidemiology,andsocialscienceapproachestopatientcare.

-Definitionsclass:socialdeterminants,socialstructure,structuralviolence,structuralvulnerability,asymmetryofinformation,privilege,naturalizationofinequity.

-InequityandOppression

-Understandingpoverty:PovertySimulation

-SocialconstructionofReality

-Culture.Elementsofethnography.Visionsonhealth,disease,healing,death.

2.Anadvocacyandequityagendathattreatshealthasahumanright.

-Discussiononhealthasahumanright.AlmaAta,comprehensiveandselectiveprimarycare.

-Discussiononsocializationofscarcityandriskinversion

-Elementsofqualityinahealthsystem.

3.Anapproachthatisbothinterdisciplinaryandmultisectoralacrossthehealthsystem.

-Internationalcooperationforhealth(NGOs,multilaterals,bilaterals,publicprivatepartnerships)

-Healthfinancing,distributionofresources,examplesofhealthsystems.

4.Deepunderstandingoflocalandglobalcontexts,ensuringthatthelocalcontextinformsand

leadstheglobalmovement.

- Globalwarming.Bigthreatstohealth.

- Globalizationandhealth–Macroeconomicinfluences(Coffee,malnutrition)

- Patentsandbigpharma,availabilityofmedications

- Policydesign,examplesoffailedpolicies(nutritionpyramid)

41

- Burdenofdisease,allocationofresources,humanresourcestraining(1st,2nd,3rdlevels),examplesofhealthsystems(DALYs).

- Valuechain

- Politicalmap(whoiswho)

5.Thevoiceandvoteofpatients,families,andcommunities.

- Biopower

- Unintendedconsequences

V.MeansofEvaluationandAssessment

Thereisnoevaluationtoolatthemoment.Theevaluationconsistsinobservingandmentoringthepasanteswhoaredoingclinicalworkthroughtheyear.Supervisorsfocusinindividualgrowth,capacitybuildingandtroubleshootingwitheachpasante,andhandinmonthlyperformanceevaluationsandSOAPforms.

VI.CourseFacultyRolesandresponsibilities

DanielPalazuelos:lessonplanandcurriculumdevelopmentforGHSMportion.

PatrickElliott:curriculumdevelopmentandoversightofclinicalportionofthecourse.

HugoFlores:lessonplan,curriculumdevelopmentandfacilitationofGHSMportion.

42

UniversityofRwanda/InshutiMuBuzimaCommunityMedicineCourseRotation-RwandaI.BriefOverview

In2014,Rwanda’smedicaltrainingbegantotransitionfroma6-yearprogramtoa5-yearprogram,withstudentsnowinbothcohorts.Forthestudentsstillinthe6-yeartrack,socialmedicineistaughtfor2weeksinyear4andagainfor1monthinyear5.PleaserefertoUniversityofRwanda’siSOCOfactsheetformoreinformationonthenewsocialmedicinecurriculumassociatedwiththe5-yearprogram.SocialmedicineprogramsarehostedbyUniversityofRwandaandsupportedbyPIH’ssisterorganizationInshutiMuBuzima.

Year4

Thisisatwo-weekmoduletopreparestudentstounderstandthebasicelementsinvolvedinmedicalcareatthelevelofthecommunityandcommunityhealthcenter.Coretopicswillbepresentedasaninitialorientationtocommunitymedicine.

Ataglance:

• 4thyearMedicalstudents

• Studentsaredividedinto13sub-groups;alsotaughtasaclass

• 2weeksduration

Year5

Thismoduleof4consecutiveweekswillpreparestudentsinsmallgroupstounderstandtheuniqueissuesandchallengesofmedicalcareatthelevelofthecommunity,communityhealthcenter,anddistricthospital,andtofunctionmoreeffectivelyinthehealthsystemofRwanda.

Ataglance:

• 5thyearMedicalstudents

• Approximately11studentsperrotation

• 4weeksduration

43

II.Objectives

YEAR4 YEAR5

Theoverallobjective:Tolaythefoundationofknowledgeandattitudesregardingpopulationbasedmedicalcareatthecommunitylevel

Theoverallobjective:TotrainRwandanphysiciansknowledgeableinsocialmedicine,andcapableofdeliveringhighqualitycommunityhealthcarethatiscontinuousandintegratedinalllevelsofcare,inordertoimprovetheoverallhealthoftheRwandancommunity.

Thespecificobjectives:1. Explaintheroleandelementsofprimaryhealth

care2. Describethedifferentresearchtechniques

availableforuseingeneralandinpublichealth.3. Understandthemethodsforinducingchanges

favourabletothepromotionofthehealthylifestylesandpreventivemeasuresofcommondiseasesinagivencommunity.

4. Utilizethebasicconceptsandtoolsofpublichealth

5. Applyeffectivecommunicationskillsinavarietyofsettings

6. Discussthecontrolofcommonepidemicorrecurrenthealthproblemswithinthecommunitycontext

7. Describepopulationbasedmethodsofpromotinghealthofacommunity

Thespecificobjectives:1. HealthSystemofRwanda2. Healthcareprovision3. Healthcareproviders4. Community health /Community and individual

people5. Socialdeterminantsofhealth6. Communicationandteambuildingskills7. Diseasepreventionandhealthpromotion8. Care delivery improvement and Community

HealthPolicy9. Managementandleadershipskills10. Specificpartsofthehealthcaresystem11. TheDesiredRwandanHealthcareprovider12. INTEGRATETHEABOVEOBJECTIVESINTOTHE

DAY-TO-DAYPRACTICEINDEALINGWITHPATIENTS,COMMUNITIESANDCOLLEAGUESINANYDISCIPLINE,ANYSETTINGANDANYLEVELOFCARE

III.StructureandMethodology

YEAR4 YEAR5

A.Duration2weeks40hourstotal=2/3lectureand1/3presentations

Methods:1.self-learningingroups.2.standardillustratedlectureanddiscussion

A.Duration4weeksApproximately150hourscontacttime:30hoursinteractivepresentations40hoursgroupdiscussions80hourscommunityactivities

44

B.TrainingLocation:RwandaC.MaterialsReadings,film(seeappendixforspecifics)

Thecommunitymedicinerotationissplitupintwoparts;3weekswilltakeplaceinRwinkwavudistricthospital,healthcentresandcommunities,1weekswilltakeintheKigaliurbancommunity.B.TrainingLocationRwinkwavuDistrictHospitalandKigaliurbansettingC.MaterialsReadings,film(seeappendixforspecifics)

IV.Content

YEAR4 YEAR5

Coretopicswillbepresentedasaninitialorientationtocommunitymedicine,andwillincludethemessuchas:• Basicelementsofprimaryhealthcare• Publichealth• Basicepidemiology• Populationhealth• Healtheducation• Commonpublichealthchallengesinthe

community• Communitybasedresearchmethodologies.

ThesetopicswillformthefoundationforfurtherdevelopmentofCommunityMedicineprincipleswhichwillbepresentedduringtheCommunityMedicineexperientialrotationoftheDocIIIyearofmedicaltraining.

InthethreeweeksthestudentsareinRwinkwavuDistrictHospital,thefocusisonhealthcareprovisionindistricthospitals,healthcentersandcommunitiesandalltheaspectsthatinfluencehealth,diseaseandhealthcaredeliveryinthecommunity.IntheoneweekinKigalithefocusisoncommunityurbanhealth,differentpartnersinhealthcaredeliveryandcommunitieswillbevisitedforstudentstoexploreandexperiencecaredeliveryfortheurbanpoor.Contentfollowsstatedobjectives:

1. HealthSystemofRwanda2. Healthcareprovision3. Healthcareproviders4. Communityhealth/Communityand individual

people5. Socialdeterminantsofhealth6. Communicationandteambuildingskills7. Diseasepreventionandhealthpromotion8. Care delivery improvement and Community

HealthPolicy9. Managementandleadershipskills10. Specificpartsofthehealthcaresystem11. TheDesiredRwandanHealthcareprovider

45

V.MeansofEvaluationandAssessment

YEAR4 YEAR5

Theevaluationandfinalmarkofthestudentswillconsistof3elements:• Attendanceandparticipationindiscussion–20%• Scoringofstudentpresentations–40%• Finalwrittenexamination–40%

Theevaluationoftheparticipantswillconsistof3elements:• Participationindiscussionduringtraining,30%• Scoringofpresentations,30%• Finalwrittenexamination,40%

VI.CourseFaculty

YEAR4 YEAR5

Principalteachers:• DrMiekeVisser(miekevisser47@gmail.com)• DrJaneFrancesNamatovu

(drnamatovu@gmail.com)Supportingteachers:• -DrMaaikeFlinkenflögel• -DrVincentCubaka• -DrClaudeUwamungu• -DrEvaArvidsson• -DrMarianHoltland• -MrEdouardMunyamaliza

Trainingmaterialdevelopment:• -DrCalvinWilsonandallteachers

• Mr.EmmanuelNgabire,PartnersinHealth,RwinkwavuHospital

• Dr.MaaikeFlinkenflögel,PartnersinHealth,RwinkwavuHospital

• Dr.MiekeVisser,PartnersinHealth,RwinkwavuHospital

• Dr.VincentCubaka,AarhusUniversity,KabgayiHospital

• Dr.MichaelSchriver,AarhusUniversity,KabgayiHospital

• Dr.EvaArvidsson,JönköpingResearchandDevelopmentUnit,Sweden

• Visitinglecturers,• GeneralPractitioners• CommunityHealthNurses• CommunityHealthWorkers

• Socialworkers

46

UniversityofRwanda/InshutiMuBuzimaiSOCO-RwandaI.BriefOverview

Asof2014,medicalschoolinRwandabegantotransitionfroma6-yearprogramtoa5-yearprogram,withstudentsnowinbothcohorts.Forthestudentsstillinthenew5-yeartrack,socialmedicineistaughtthroughoutyears1-4.SocialmedicineprogramsarehostedbyUniversityofRwandaandPIH’ssisterorganizationInshutiMuBuzima.

PleaserefertoUniversityofRwanda’sDocII/DocIIIfactsheetformoreinformationontheoldsocialmedicinecurriculumassociatedwiththe6-yearprogram.

Ataglance:

• 1st–4thyearmedicalstudents

• Allenrolledmedicalstudents

• Longitudinalcourseover4years(andcontinuationasathemeinyear5)

• 2014

II.Objectives

The overall aim of social and community medicine training in undergraduate medicalcurriculum is to develop patient-centered and community-oriented professional health careproviders. Itwillpreparestudentstounderstandthebasicprinciplesofsocialandcommunityhealthcarewhichtheywillneedwithinthepracticeofmedicine.Themoduleisdividedinto5main sections (Population Health, health systems, socialmedicine, communication skills andprofessionalism)thatarefurtherdividedinkeyelements

Fulllistofobjectivesavailableuponrequest.

III.StructureandMethodology

A.CourseBreakdown

Year1&2

100hourstotal(eachyear)=18lecture+18tutorial+18peereducation+18assignments+26self-directedlearning+2exams

Year3

150hourstotal=15lecture+38tutorial+20peereducation+15assignments+16presentationsofproject+44communitymedicinefieldvisits+2exams

47

Year4

160hourstotal=8districthospitalwardrounds+36healthcenter/OPD,socialhealthservice+8discussionwithstaff+4healtheducation+16comprehensivepresentations+12homeandcommunityvisits+20feedback/reflection+10tutorials/didactic+20peereducation+26self-directedlearning

Year5

Inyear5,ourdepartmenthasno teaching time.Butwithin theseniorclerkshipsof themainspecialties,therewillbeacontinuationoftheprinciplesandpracticesofsocialandcommunitymedicineasatheme.

B.TrainingLocation

SitesallaroundthecountrywherePIHEngagechaptershavebeenestablished.

C.Materials

Readings(Seeappendixforspecifics)

IV.Content

YEAR1:Introductiontosocialandcommunitymedicinewithinthepracticeofmedicine

Theory-based

• PopulationHealth

• Diseaseprevention/healthpromotion1,4

• HealthSystems

• Healthsystemmodels-Rwandanhealthsystem1

• Rolesandresponsibilitiesofallhealthcareworkers1

• Interdisciplinarycare

• coordinationofcare1,4

• PrimaryHealthCare1,4

• RuralHealth/CommunityHealth/DistrictHC

• referralsystems1,4

• HealthFinancing1,4

• insurancesystem1,4

• SocialMedicine

48

• Socialdeterminantsofhealth1

• Bio-psycho-socialmedicine1

• Doctor-patient-Community1

• Socialaccountability-Drasadvocate1

• Healthequity1

• Communicationskills

• Patient-centeredcommunication&consultation1,2,3,4

• Relationshipbuilding-empathy,sympathy1,2,3,4

• Interdisciplinarycommunication1,2,3,4

• Professionalism:

• Personalrole1,2,3,4

• Reflection1,2,3,4

• Feedback1,2,3,4

• MedicalEthics1,2,3,4

• Medico-legalissues1,2,3,4

• Medicalmistakes1,2,3,4

Year2:Introductiontosocialandcommunitymedicinewithinthepracticeofmedicine

Theory-based

• PopulationHealth

• Demography2

• Epidemiology2

• ResearchMethods

• Biostatistics2

• Quantitative/qualitative2

• Criticalappraisal2,3

• PatientOrientedEvidencethatMatters(EvidenceBasedMedicine)2,4

• HealthSystems

49

• Traditionalmedicine2

• QI(qualityimprovement),implementationofqiprojects2,3

• Supervisionandmentorshipofcommunityprograms2

• SocialMedicine

• Occupationalhealth2,4

• Environmentalhealth2,4

• Genderissues2,4

• Adherence2,4

• Communicationskills

• Patient-centeredcommunication&consultation1,2,3,4

• Relationshipbuilding-empathy,sympathy1,2,3,4

• Interdisciplinarycommunication1,2,3,4

• Healtheducation2,-3-4

• Teachingandmentoringskills2,4

• Professionalism:

• Personalrole1,2,3,4

• Reflection1,2,3,4

• Feedback1,2,3,4

• Rationalprescribing2

• MedicalEthics(1,2,3,4)

• Medico-legalissues(1,2,3,4)

• Medicalmistakes(1,2,3,4)

YEAR3:DevelopingpopulationhealthcareTransitionfromtheorytopractice

• PopulationHealth

• ResearchMethods

• Criticalappraisal2,3

• Diseaseprevention/healthpromotion1,3

50

• Communityorientedprimarycare(COPC)3

• HealthSystems

• QI(qualityimprovement),implementationofqiprojects2,3

• Communicationskills

• Patient-centeredcommunication&consultation1,2,3,4

• Relationshipbuilding-empathy,sympathy1,2,3,4

• Interdisciplinarycommunication1,2,3,4

• Difficultconsultations(e.g.deliveringbadnews,domesticviolence)3,4

• Healtheducation2,3,4

• Patientempowerment,patientgroups3,4

• Professionalism:

• Personalrole1,2,3,4

• Reflection1,2,3,4

• Feedback1,2,3,4

• MedicalEthics1,2,3,4

• Medico-legalissues1,2,3,4

• Medicalmistakes1,2,3,4

YEAR4:PrimaryhealthcareandcommunitymedicineinpracticeTransitionfromtheorytopractice

SimilaritieswithDocIIICommunityHealthRotationinoldcurriculum

• PopulationHealth

• PatientOrientedEvidencethatMatters(EvidenceBasedMedicine)2,4

• Diseaseprevention/healthpromotion1,4

• HealthSystems

• Interdisciplinarycare

• Coordinationofcare1,4

• PrimaryHealthCare1,4

• RuralHealth/CommunityHealth/DistrictHC

51

• Referralsystems1,4

• SocialMedicine

• Occupationalhealth2,4

• Environmentalhealth2,4

• Genderissues2,4

• Adherence2,4

• Disability4

• Communicationskills

• Patient-centeredcommunication&consultation1,2,3,4

• Relationshipbuilding-empathy,sympathy1,2,3,4

• Interdisciplinarycommunication1,2,3,4

• Healtheducation2,3,4

• Difficultconsultations(e.g.deliveringbadnews,domesticviolence)3,4

• Patientempowerment,patientgroups3,4

• Teachingandmentoringskills2,4

• Professionalism

• Personalrole1,2,3,4

• Reflection1,2,3,4

• Feedback1,2,3,4

• MedicalEthics1,2,3,4

• Medico-legalissues1,2,3,4

• Medicalmistakes1,2,3,4

YEAR5:TheprofessionalmedicaldoctorTransitionfromtheorytopractice

Inyear5,ourdepartmenthasno teaching time.Butwithin theseniorclerkshipsof themainspecialties,therewillbeacontinuationoftheprinciplesandpracticesofsocialandcommunitymedicineasatheme.

Year1to5

52

Duringthefouryearsofsocialandcommunitymedicinetraining(andcontinuationasathemeinyear5)wewillemphasizeontheoverallcreationofthe“DesiredRwandanMedicalDoctor”whoisapatient-centredandcommunity-orientedhealthcareproviderwiththeknowledgeandskills of Collaborator, Communicator,Manager, Health advocate, Scholar and Professional ashasbeendescribedinthe“UndergraduateMedicalTrainingFramework”fromtheUniversityofRwanda.

V.MeansofEvaluationandAssessment

Year1&2:

• Formativeassessment(scoringofassignments)–60%

• Summativeassessment(finalwrittenexamination)–40%

Year3

• Formativeassessment

• Evaluationofpresentationsofproposal–40%

• Continuousevaluationofindividual/groupperformance–20%

• 2.Summativeassessment

• Evaluationoffinalwrittenproposal–25%

• Individualtheoreticalexamination–15%

Year4

• Summativeassessment

• Participationindiscussionsduringthetraining–30%

• Scoringofpresentations–30%

• Formativeassessment(Finalwrittenexamination)–40%

VI.CourseFaculty

Year1&2

• Dr.AoifeKenny,Visitingteacher,UniversityofRwanda

• IbraMuhumuza,SeniorLecturer,Oralhealth,UniversityofRwanda

• Dr.IngeborgZijdenbos,Visitingteacher,UniversityofRwanda

• Dr.JeanClaudeUwamungu,PartnersinHealth

53

• Dr.MaaikeFlinkenflögel,UniversityofRwanda,PartnersinHealth

• Dr.MichaelSchriver,AarhusUniversity,UniversityofRwanda

• Dr.MiekeVisser,UniversityofRwanda,PartnersinHealth

• SaasiRajab,Lecturer,OralHealth,UniversityofRwanda

• Dr.VincentCubakaKalumire,UniversityofRwanda,AarhusUniversity

54

SocMed–UgandaI.BriefOverview

Thiscourseaimstoensurethataspiringhealthprofessionalsinterestedinworkinginglobalhealthsettings,inrichandpoorcountriesalike,areadequatelypreparedtotakeintoaccountandaddress,alongsidebiologicaldiagnosis,thecriticalsocial,economic,andpoliticalcausativefactorslinkedtoillnessandhealing.

Ataglance:

• Medicalstudents

• Approximately20students

• 1monthduration

• Establishedin2010

II.Objectives

1. Toprovideastructuredglobalhealthimmersionexperienceforhealthprofessionalstudentswithdedicatedsupervisionandteachinginclinicalmedicineandsocialmedicine

2. TostudyissuesrelatedtohealthinUgandawithanemphasisonlocalandglobalcontext

3. Tofostercriticalanalysisofglobalhealthinterventionsinresource-poorsettings

4. Tofacilitatethedevelopmentofaclinicalapproachtodiseaseandillnessusingabiosocialmodelthroughstructuredsupervisionandteaching

5. Tobuildanunderstandingandskillsetassociatedwithhealthadvocacy

6. Topromoteinternationalsolidarityandpartnershipingeneratingsolutionstoglobalhealthchallengesfacingsocietiesthroughouttheworld

III.StructureandMethodology

A. CourseBreakdown

Totalcourse:4weeks(8hrsperdayx20days=160hrs)

25%didactic

50%groupdiscussion/groupwork

25%hospital/communityactivities

55

Morningsaregenerallydedicatedtoexplicitengagementwithsocialmedicinetopics.Thesetopicsarecoveredthroughsmallandlargegroupdiscussions,panelswithinvitedguests,films,andlecturesfromindividualsactivelyinvolvedinworkrelatedtotheday’stopics.Afternoonsaregenerallydedicatedtostructuredclinicalteachinginthehospitalwardsthroughabiosocialperspectivethatlinksbiologicalunderstandingsofdiseasewiththesocialdeterminantsofhealth.Duringthefourweeks,fieldvisitsarealsoorganized.

B.TrainingLocation

Gulu,Uganda

C.Materials

Readings

IV.Content

Part1–SocialDeterminantsofHealth:AccountingforLocalandGlobalContext

Part2–HealthInterventions:ParadigmsofCharity,Development,andSocialJustice

Part3–CoreIssuesinSocialMedicine:PrimaryHealthCare,CommunityHealthWorkers,HealthandHumanRights,andModelsofPayment

Part4–MakingSocialMedicineVisible:Writing,NarrativeMedicine,Photography,Research,andPoliticalEngagement

V.MeansofEvaluationandAssessment

Duringourinauguralyear,ourcourseevaluationsdemonstratedtremendoussuccess.Themajorityofthecourseparticipantsreportedanimprovementinthelevelofknowledge/experiencewithglobalhealthandsocialmedicine.Specifically,83%oflocalstudentsmovedfromminimaltomoderate/advancedlevels,while63%oftheinternationalstudentsreportedthattheyhadimprovedtheirlevelsofknowledge.Attheendofthecourse,mostofthestudentsalsostatedthattheyhadgainedexposureandfamiliaritywithsocialjusticemodelsofhealthcareprovision.

Inadditiontopersonalreflectionsthatrevealnoteworthylearning,themembersofeachyear’scourseorganizethemselvesintosmallworkinggroupsforcontinuedcollaborationonissuessuchasdrugshortagesandmalnutrition.Furthermore:twooftheinternationalstudentsreturnedtoGuluandLacorHospitalforclinicalrotationsandtimewiththeirnewUgandanfriends;fiveUgandanstudentsalongsideoneoftheAmericaninstructorsparticipatedinfurtherhealthadvocacytrainingheldinKisumu,Kenya;andthreeforthcomingscholarlypapers,each

56

relatedtothecoursecontent,havebeenwrittencollaborativelybycourseparticipantsandinstructors.

VI.CourseFaculty|Rolesandresponsibilities

Notavailable.

57

HarvardMedicalSchool–UnitedStatesI.BriefOverview

Thecoursehasfourcomponents,whichwillruninparallel.Thesedisciplinesareinterrelatedandcomplementeachotherasappliedtoclinicalcare:ClinicalEpidemiology,SocialMedicine,HealthPolicy,andMedicalEthics.Wehavealsodesignedaseriesofsessionsthatintegratetheapproachesofthesecomponents(e.g.,socialdeterminantsofdisease,healthdisparities,responsibilityfortreatmentoutcomes).Thecomponents,andtheintegratedsessions,arevisibleonthesessiongridonthecoursehomepage.Allmaterialsneededforthecoursearealsoavailablefromthatgrid:ifyouclickonaspecificsession,you'llbetakentoapagethatprovidesbackgroundinformation,instructions,guidingquestions,andlinkstotheresourcesandreadinessassessmentexercises.

Ataglance:

• Sessionsasafullclassandothersinsmallgroupsof10-11students

• 1monthcourse

II.Objectives

Thiscoursewillallowstudentstodeveloptheskillsandperspectivesneededto:

1. Criticallyevaluatemedicalevidenceanduseitappropriatelyintheirclinicaldecisions

2. Applymultipleperspectivestounderstandthesocial,economic,andpoliticalforcesthataffectboththeburdenofdiseaseforindividualsandpopulationsandtheabilityofthehealthsystemtoamelioratethem

3. Understandthehealthpolicycontext(includinginsurance,qualitymeasurement,andcaredeliverymodels)inwhichtheywillpractice

4. Becomegroundedintheethicalprinciplesthatunderlieclinicalcare,research,andprofessionalismgenerally,withthefacilitytorecognizeandanalyzeethicalissuesinpractice.

III.StructureandMethodology

A.CourseBreakdown

4weeks=approximately90hours

Essentialsusesthreetypesofsessions.Wewillhaveafewsessionsintheamphitheater(Armenise)inwhichoneprofessorpresentsmaterialorleadsanexercisefortheentireclass.

58

MostoftheteachingforClinicalEpidemiology,andsomeoftheteachingforSocialMedicine,willtakeplaceinthelearningstudios.Ethics,HealthPolicy,andSocialMedicinewilldomuchoftheirteachinginsmallgroups(10-11studentsplusaninstructor).Herearelinkstoyoursmallgroupassignmentsandtablegroupsforthelearningstudios

B.TrainingLocation

Boston,MA(USA)

IV.Content

Thisisthecontentfortheoverallcourse.ItincludestopicsfromSocialMedicineaswellasfromClinicalEpidemiology,HealthPolicy,andMedicalEthics.

ThosethatareunderlinedbelowspecificallymakeuptheSocialMedicinecomponentofthecourse.

• BurdenofDisease

• BedsideRationing

• CriticallyAppraisingWhatWeThinkWeKnow:AssociationsandCausality

• TheSocialDeterminantsofDisease

• InterpretingStatisticsinClinicalResearch:TheBasicsI

• RaceandClass

• InterpretingStatisticsinClinicalResearch:TheBasicsII

• TheHistoryandEthicsofHumanSubjectsResearch

• ResearchEthics

• Bias,Confounding,andEffectModification

• ThePuzzlesofTreatmentEfficacy

• TheHistoryofHealthCareinAmerica

• IntroductiontoHealthPolicy

• RationingandFutility

• TheRoleofMedicine

• HealthInsurance:RoleofConsumerIncentives,MoralHazard,andBenefitDesignFeatures

• MultivariableModeling

59

• PrivateHealthInsurance:RoleoftheEmployer

• RandomizedControlledTrialsandPower

• AdverseSelectioninCompetitiveInsuranceMarkets

• DecidingforOthers

• QuizandDiagnosticTesting

• PayingProviders:IncentivesandChallengesCreated

• Screening,ThresholdsII,andSummarizingEvidence

• ProviderOrganization

• EthicalDistinctionsinEnd-of-LifeCare

• PeerReviewExercise/ApplicationofEvidencetoPatientCare

• TechnologicalInnovation,HealthCareSpendingGrowth,andtheQualityofHealthCare

• DisparitiesinTreatmentAccessandOutcome

• EliminatingHealthCareDisparities

• EthicsofDisparitiesandHealthInequalities

• AchievingValueinHealthCare

• QualityMeasuresandTheirUses

• InternationalHealthCareSystemsandLessonsfortheU.S.

• TakingMedicineBeyondtheClinic

• ReproductiveEthics

• AssessingHealthPolicyIssuesandHealthPolicyWrapUp

• ResponsibilityforDisease--ShouldThereBeConsequences?

• EthicsandGeneticTesting

• CommunicatingEvidencetoPatients

• ResponsibilityforAchievingOptimalTreatmentOutcomes

V.MeansofEvaluationandAssessment

• 15%ReadinessAssessmentExercises

• 15%SocialMedicineessays

60

• 15%Ethicsessays

• 15%ClinicalEpidemiologyquiz

• 15%HealthPolicyassignment

• 25%FinalExam

VI.CourseFacultyRolesandresponsibilities

Becauseofourcommitmenttothesmallgroupssessions,wehavemanyfacultyinvolvedinthecourse(atleast16percomponent,approximately80total).

Thecourseleadershipincludes:

• DavidJones,M.D.,Ph.D.coursedirector,A.BernardAckermanProfessoroftheCultureofMedicine(HMS/FAS),dsjones@harvard.edu

• AnthonyBreu,M.D.,InstructorinMedicine,Anthony.Breu@va.gov

• EmmaEggleston,M.D.,M.P.H.,AssistantProfessorofPopulationMedicine,emortoneggleston@partners.org

• JonathanFinkelstein,M.D.,M.P.H.,ProfessorofPediatricsandofPopulationMedicine,Jonathan_finkelstein@childrens.harvard.edu

• EdwardHundert,M.D.,DeanforMedicalEducation

• DanielD.Federman,M.D.,ProfessorinResidenceofGlobalHealthandSocialMedicineandMedicalEducation,Edward_Hundert@hms.harvard.edu

• JenniferKasper,M.D.,M.P.H.,AssistantProfessorofPediatrics,jkasper1@partners.org

• HaidenHuskamp,Ph.D.,ProfessorofHealthCarePolicy,huskamp@hcp.med.harvard.edu

• BarbaraMcNeil,M.D.,Ph.D.,RidleyWattsProfessorofHealthCarePolicy,mcneil@hcp.med.harvard.edu

• AteevMehrotra,M.D.,M.P.H.,AssociateProfessorofHealthCarePolicyandMedicine,Mehrotra@hcp.med.harvard.edu

61

HarvardUniversityCaseStudiesinGlobalHealth:BiosocialPerspectives–UnitedStatesI.BriefOverview

Thisinterdisciplinarycourseisdesignedtointroducestudentstothefieldofglobalhealth.Oneamonganumberofcoursesdiscussingglobalhealth,itaimstoframeglobalhealth'scollectionofproblemsandactionswithaparticularbiosocialperspective.Itfirstdevelopsatoolkitofanalyticalapproachesandthenusesthemtoexaminehistoricalandcontemporaryglobalhealthinitiativeswithcarefulattentiontoacriticalsociologyofknowledge.

Ataglance:

• Universityundergraduatestudents

• Coursemeetsfor3hrs/weekfor14weeks

II.Objectives

Thiscourseaddressesthefollowingquestions:

1. Whatisglobalhealth?

2. Whatisthehistoryofthefieldofglobalhealth?

3. Howisglobalhealthstudied?

2. Howisglobalhealthpracticed?

3. Whoworksinglobalhealth,andwhatdothosepeopledo?

4. Inwhatdirectionisthefieldofglobalhealthmoving,andhowcanIgetinvolved?

5. Howdoessocialtheorypracticallycontributetounderstandingspecificglobalhealthandhealthdeliveryproblems,andtherebyleadtospecificinterventions?

III.StructureandMethodology

A.CourseBreakdown

(estimationbasedoncoursedescription):

Approximately52hoursover14weeks=42hrsdidactic+10hrsgroupdiscussion

B.TrainingLocation

HarvardUniversity,USA

C.Materials

62

Readings(Seeappendixforspecifics)

IV.Content

• SoYouThinkYouHaveAPlan:UsingSocialTheorytoImaginetheUnexpectedinGlobalHealth

• TheHistoryofColonialPracticesand“GoodIntentions:”GlobalHealthfromtheColonialPeriodtothePresent

• TheBiosocial:AFrameworkforCaseStudies

• ActinginaWorldofUnintendedConsequences:CaseStudiesinGlobalHealth

• Cross-CuttingThemesinGlobalHealth

V.MeansofEvaluationandAssessment

UndergraduateGradeDistribution

• Fourshortpapers:10%each,attheendofthesemesterthepaperwiththehighestmarkwillbeweightedat15%

• In-classmidterm:20%

• Finalpaper:30%(proposal:5%.TFmeeting:5%,writtenpaper:20%)

• Attendanceandparticipation:10%

GraduateStudentGradeDistribution

• FinalPaper:70%

• Participation:30%

VI.CourseFacultyRolesandresponsibilities

• Dr.PaulFarmer,DepartmentofGlobalHealthandSocialMedicine,HarvardMedicalSchoolContact:paul_farmer@hms.harvard.edu

• Dr.ArthurKleinman,DepartmentofAnthropology,FacultyofArtsandSciencesContact:kleinman@wjh.harvard.edu

• Dr.SalmaanKeshavjee,DepartmentofGlobalHealthandSocialMedicine,HarvardMedicalSchoolContact:salmaan_keshavjee@hms.harvard.edu

63

• Dr.AnneBecker,DepartmentofGlobalHealthandSocialMedicine,HarvardMedicalSchoolContact:anne_becker@hms.harvard.edu

64

PartnersInHealthEngage–UnitedStatesI.BriefOverview

PIHEngageisPIH’scommunityorganizingprogramwiththeoverarchinggoalofadvancingtherighttohealthbyorganizing,educating,generating,andadvocating.Itismostlyundergraduatestudentsbutincludeshighschoolstudentsandyoungprofessionals.

PartoftheaimofthiscurriculumistohelpEngageteamsbetterunderstandtheworkandphilosophyofPIHanditsmodelofglobalhealthcaredelivery.Thisisanoptionalcurriculum—moresoasetofresources—thatteamleadersfromchaptersofvolunteersalloverthecountrycansharewiththeirteams.Alllessonsrevolvearoundtherighttohealthandcanbedonealoneorthroughouttheyear.

Ataglance:

• PIHengagevolunteers(mostlyundergraduatestudents)

• Smallgroups,numbersvarydependingonchaptersizeandnumberofattendees

• 15self-pacedmodules,about1houreach

• Establishedseveralyearsago;currentversion

• 2016

Website:http://engage.pih.org/curriculum

II.Objectives

Goals(oneforeachlesson):

1. ExplorethehistoryandvaluesofPIHinordertocontextualizehowPIHEngageadvancesPIH’s Mission.

2. Understandhowsocial,cultural,economic,andpoliticalfactorsinfluencehealth

3. ToinspirePIHEngagetoactinaccordancewiththesocialjusticeapproachtoglobalhealth

4. ExploreglobalhealthhistorytoinspireteamstocommittotheRighttoHealthMovement

5. ExplorehowPIHEngagewillusetheworkofPIHtoadvancetherighttohealthmovement

6. Acquireatoolkitofsocialtheoriestoreframeorcontextualizeargumentsinglobalhealth

7. Dissectthisframeworkforhealthcaredeliveryandtheimportanceofbest-practices

8. Exploretheseapproachesandhowtoovercomethechallengestheypose

9. Explorewaystobridgethe“know-dogap”whenscalingupinglobalhealth

65

10. Understandequitableglobalhealthresearchandhowresearchcanbeusedtobuildlocalcapacity.

11. Explorecaredeliveryandequitableresearchinterventionsconductedalongsidethepoor.

12. UnderstandhowtheAIDSmovementplayedacriticalroleinadvancingthefieldofglobalhealth

13. UnderstandhowadvocacyledtothesuccessoftheAIDSmovementincludingthepassageofPEPFAR

14. Questionthetermglobalhealthandexplorehealthequityinhighincomecountries

15. ExploreforeignaidandhowPIHEngagecanhelpstabilizeglobalhealthfinancing

III.StructureandMethodology

A.CourseBreakdown

15hourstotal=15modules,1houreach,meanttobedoneasdiscussionsessions

B.TrainingLocation

SitesallaroundthecountrywherePIHEngagechaptershavebeenestablished.

C.Materials

Readings

IV.Content

• FoundationalMissionandValuesofPIHandPIHEngage

• HistoryandValuesofPIH

• StructuralViolence:AddressingtheRootofIllness

• ASocialJusticeApproachtoGlobalHealth

• TheRighttoHealthMovement

• LeadershipandOrganizationintheRighttoHealthMovement

• ThePIHApproachtoHealthCareDelivery: PIHEngage’sRoletoEcho,Amplify,&Advocate

• GlobalHealth:FromTheorytoPractice

• HealthCareDelivery:Staff,Stuff,Space,andSystems

66

• HorizontalandVertical:ChallengesinApproachestoGlobalHealth

• ScalingUpinGlobalHealth:Bridgingthe“Know-Do”Gap

• EthicalGlobalHealthResearch

• CaseStudiesandGlobalHealthPriorities:ContextualizingwithHistory

• MDR-TB:RedefiningHealthCareDelivery

• TheAIDSEpidemicLaunchesGlobalHealth

• ActivistsandtheSuccessofPEPFAR

• StructuralViolenceandHealthEquityatHome

• GlobalHealthFinancing:TheNeedforAdvocacy

V.MeansofEvaluationandAssessment

None

VI.CourseFacultyRolesandresponsibilities

Teamleadersserveasgroupfacilitators.Discussionsessionsweredesignedforeasyusebyanyonewithaccesstomodulematerials.

67

UCSFHEALBootcamp–UnitedStatesI.BriefOverview

TheHEALInitiativeBootcampisdesignedtoprovideanintensiveorientationtoglobalhealthequitytophysicians,pharmacists,nursesandotherhealthcareprofessionalswhohavebeenselectedas2-yearHEALinitiativefellows.HEALfellowsincluderecentgraduatesofUSresidencyprograms(rotatingfellows)aswellasfellowsfrompartnersites(sitefellows)inNavajoNation,domesticfederallyqualifiedhealthcenters,andinternationalnon-profitorganizations.

Ataglance:

• Healthcareprofessionals

• Averageof25participants

• 3weeksduration

• Establishedin2015

Website:https://healinitiative.org/curriculum/bootcamp/

II.Objectives

HEALCoreCompetencies:

1. Provisionofhighqualitycarefocusedonlocalburdenofdisease

2. Incorporationintoandeffectiveengagementwithlocalhealthsystem

3. Demonstrationofleadershipandinterprofessionalism

4. Developmentofstronganddiverseteachingskills

5. Advocacyforcommunities,healthsystems,andpatients

6. Adherencetoprinciplesofhealthequityandethicsinclinicalandacademicwork

TheobjectiveistoequipHEALFellowswithpracticalknowledgeandskillsneededtoworkinlow-resourcesettings,whilesimultaneouslypromotingcriticalthinking,andfosteringcollaborationacrossallHEALsites.Itintroducesmanyoftheconceptsthatwillbefurtherdevelopedintheongoingcurriculumoverthe2-yearprogram.MostfellowsparticipateinanonlineMPHprogramandallfellowsparticipateinongoingdiscussions,readings,andcasepresentationsovertheir2-yearfellowship.

III.StructureandMethodology

68

AnintegralpartoftheHEALInitiativecurriculumis3weeksofintensivecourseworkatthebeginningofthefirstyearintendedforbothRotatingandSiteFellows.TheJulyBootcampconsistsofacombinationofdidacticlectures,interactivecasestudies,clinicalskillstraining,simulationsandfacilitatedmentorship.

A.CourseBreakdown

140hourstotal.Approximately1/3didactic,1/3workshop/smallgroup,and1/3simulation

B.Location

SanFranciscoBayArea

C.Materials

Readings,film(seeappendixforspecifics)

IV.Content

• Provisionofhighqualitycarefocusedonlocalburdenofdisease

• LocalBurdenofDisease

• ProvisionofCare

• QualityCareandImprovement

• Incorporationandeffectiveengagementinlocalhealthsystem

• Understandingthehealthsystem

• Engagementinthehealthsystem

• Demonstrationofleadershipandinterprofessionalism

• Developmentofstronganddiverseteachingskills

• Advocacyforcommunities,healthsystems,andpatients

• Adherencetoprinciplesofhealthequityandethicsinclinicalandacademicwork

V.MeansofEvaluationandAssessment

Fellowscompleteindividualevaluationsforeachsessionimmediately.Theycompleteacumulativeendofbootcampsurveyreviewingthewholecourse.Theyalsoreceivesurveysat6monthsand12monthstoassesseffectivenessofthecourseinthefield.

VI.CourseFacultyRolesandresponsibilities

69

• RobinTittle,curriculumdirectorandcourseleader

• PhuocLe,HEALco-founder

• SriramShamasunder,HEALco-founder

• Largecurriculumteam,includingover40instructorsfrommultipledisciplines

NewYorkUniversitySocialEmergencyMedicine–UnitedStatesI.BriefOverview

BellevueandNYUSEM(SocialEmergencyMedicine)ScholarlyAcademyprovidesexposuretosocialemergencymedicinethroughatwo-yearcurriculumwithstructuredtalks,lectures,journalclubsandworkshopsinkeytopicsofsocialemergencymedicine.Theacademyseekstoprovideresidentswithknowledge,resourcesandskillsforresidentstoapplyintheirpracticeofemergencymedicine.Residentswillgaintheskillstobecomefutureleadersinadvocacy,education,andsocialemergencymedicineresearchfocusingonthesocialdeterminantsofhealthtoimprovethelivesoftheirpatientsandcommunities.Throughthescholarlyacademy,residentswillbuildbridgeswithcommunitymembersandengagewithvulnerablepopulations.Residentswilllearnaboutsocialjusticeandhowcomplexsocialenvironmentsaffectthehealthofpatientspresentingtotheemergencydepartment.Residentswillcontinuethestruggleforahumanrightsmodelofhealthandbeattheforefrontofthehistoricalarcofjustice.

Ataglance:

• 60residents

• Six-unitcurriculumwithsessionsrangingfrom30minutesto1.5hours

• Two-yearprogram

Website:Internalwebsitebeingdeveloped.

II.Objectives

• EducateresidentstobecomefutureleadersinthefieldofSocialEmergencyMedicine• Provideopportunitiesforresidentstobecomeengagedinresearchandscholarlywork

toexpandthepracticeandknowledgeoftheSocialEmergencyMedicinefield• IncreaseknowledgeofthepracticeofSocialEmergencyMedicinesothatemergency

residentscanbecomeagentstoimprovethehealthoftheiremergencymedicinepatientsandactiviststoimprovethehealthofcommunitiesandpopulations

• MentorresidentsinthefieldofSocialEmergencyMedicineandprovidethemwiththeskillsandtoolstoincorporateSocialEmergencyMedicineintotheirpracticeandfuturecareersasemergencymedicinepractitioners

70

III.StructureandMethodology

SEMcurriculumisasix-unitcurriculumwithformallecturesandworkshopsto60residentsintheemergencymedicineprogramduringtheyear.TheSEMScholarlyAcademyisamonthlyeducationalcurriculumdesignedbyresidentsandfacultywithacurriculumthatrunsoveratwo-yearperiodwithsessionseachmonththatlastonehour.

A.CourseBreakdown

Two-yearprogram.Formallecturesandworkshops.

B.Location

NewYorkUniversity

C.Materials

Readings,conferences,journalclubs.

IV.Content

ScholarlyAcademyCurriculumTopicsInclude:

• Advocacy• SocialDeterminantsofHealth• SocialJustice• HealthRights• PrisonHealth• Research• Epidemiology• VulnerablePopulations• Homelessness• AlcoholandSubstanceAbuse• SocialJustice• HealthInequity• RacisminHealthcare• GenderandHealth• GunViolence• Prevention• ForcedMigrationandHealth

ExpectationsandRequirements:

• InvolvementofresidentsinSEMAcademyeventsbothduringWednesdayConferenceaswellasthroughouttheyearparticipatinginSEMSlackForum

71

• Participationin50%oftheScholarlyAcademyMonthlyResidentMeetings• InvolvementinascholarlyresearchSocialEmergencyMedicineactivityduringtheyear• 2ndyearresidentsareexpectedtoidentifyanareaofinterestandidentifyamentorin

theSEMacademyengaginginaproject,program,orresearchintheareaofSEM• 3rdyearresidentsareexpectedtoleadajournalclub,discussion,orreadingonatopic

fortheScholarlyAcademy• 4thyearresidentsareexpectedtosubmitanabstract,peer-reviewedarticle,blog,e-

book,orpublishedarticleattheendoftheyear• 4thyearresidentsmustcompleteaSEMScholarlyProjectandpresenttheirworktothe

residencyonScholarlyResearchDay.4thyearresidentswillalsohavetocompleteandsubmitdocumentationtoresidencyleadership

V.MeansofEvaluationandAssessment

• Collectionofresidentpreandpostdataonknowledge,behavior,andattitudefromsix-unitSEMcurriculum

• Residentqualitativereflections• Residentsmustmeetexpectationsandrequirementsaswellasmid-yearandyear

sheets

VI.CourseFacultyRolesandresponsibilities

• Dr.AaronHultgren,facultyco-director

• Dr.LarissaLaskowski,facultyco-director

• Dr.TimothyGreene,faculty

• Dr.FrancisCoughlin,residentleader

• Dr.TimothyGallagher,residentleader

CambridgeHealthAllianceInternalMedicineSocialMedicine&ResearchBasedHealthAdvocacyCurriculum–UnitedStatesI.BriefOverview

TheCambridgeHealthAllianceInternalMedicineSocialMedicine&ResearchBasedHealthAdvocacyCurriculumisarequired,longitudinalcurriculumthatwasdeveloped11yearsago.Wedeliverthecurriculumover100didactichoursincluding2immersionblocks.Itisanchored

72

aresearchbasedhealthadvocacyprojectthathasproducedsignificantscholarshipoverthelast5years.Thecoursewasinitiallydevelopedasanelectivein2006byDannyMcCormickbyresidentsinterestedintopicsinhealthdisparities.In2011,theinternalmedicineprogram,recognizingtheimportanceofhealthequitymedicaleducation,transformedthecourseintoarequiredcourseforallresidents.Thecoursereliesonmanyofourlocalexpertiseinhealthservicesresearch.itattemptstoexposeresidentstoinspiringhealthadvocacyworkingbothwithinourinstitutionanaroundBoston.

Ataglance:

• 26sessions

• Two2-weekimmersionblocks

• Didactichoursandimmersionblocksforresidents

Website:n/a

II.Objectives

• Clarifyandfurtherdevelopthevaluesthatbroughtresidentstotraininaresidencyprogramcommittedtothecareofunderservedpopulations

• Exploretherolephysicianscanplayinaddressingsystemichealthinequities• Improveknowledgeoftopicsinhealthequity,socialdeterminantsofhealth,andhealth

policy• Developskillsinresearchmethodology,leadership,andhealthadvocacy• Providementorshipandrolemodelingtosupportcareerdevelopmentthatincorporates

healthadvocacy

III.StructureandMethodology

Thereareatotalof26sessionswithtwo2-weekimmersionblocks.Ineachblock,thecourseincludesresidentsforten4hourblocks,andthenwehaveotherdidacticAMsessions.About50%ofofthecoursetimeisdedicatedintopicsonhealthequitysuchashumanrights,healthcarereform,globalhealthdelivery,andstudyofvulnerablepopulations.Theother50%isdedicatedtodevelopingandexecutingaresearchbasedhealthadvocacyproject.A.CourseBreakdown

Didactichoursandimmersionblocks.

B.Location

CambridgeHealthAlliance

73

IV.Content

TopicsInclude:

HealthEquity,SocialDeterminantsofHealth&HealthPolicy

• Healthequity• SocialDeterminantsofHealth&HealthPolicy• HealthDisparities• USHealthcareReform• MassachusettsHealthcareReform• SafetyNetHospitalFinancing• HumanRights• GlobalHealthDevelopment• Race,Policing&Health• Women’sHealth• Refugee,AsylumandImmigrantHealth• Homelessness&Health• FDA&RegulationsofDietarySupplements• HumanitarianAid&DisasterRelief• LGBTQHealth• PrisonHealth• MentalHealth&Addiction• CommunityHealth&Partnerships• CulturalAwareness• HealthLiteracy• PharmaceuticalIndustry&Health

HealthServicesResearchMethods

• IntroductiontoResearchMethods• StudyDesign• ReviewofLargeDatasetSources• IntroductiontoBiostatistics• IntroductiontoEpidemiology• IntroductiontoSPSS• IntroductiontoQualitativeMethods• IntroductiontoDedoose

SocialChange,Leadership&Advocacy

• CommunityOrganizing• PublicSpeaking• PowerMapping

74

• UsingMediaforAdvocacy• LegislativeProcessLobbying• Ethics• Leadership&Management

FieldTrips

• Media:BostonGlobeorNPR• Advocacy:PhysiciansforHumanRights• CommunityOrganizing:HealthcareNow

Government

• MeetinglegislatorsattheMassachusettsStateHouse

Lobbying

• HealthcareforAll

Advocacy

• PartnersinHealth• FXBCenterforHealthandHumanRights• HarvardSchoolofPublicHealth

V.MeansofEvaluationandAssessment

• Collectionofqualitativeevaluationsforcourse• Preandpost-testevaluations

VI.CourseFacultyRolesandresponsibilities

• DannyMcCormick,MD,MPH-coursedirector

• GaurabBasu,MD,MPH-coursedirector

• Guestlecturers

UniversityofMinnesotaGlobalHealthinaLocalContext–UnitedStatesI.BriefOverview

TheUniversityofMinnesota’sCenterforGlobalHealthandSocialResponsibility(CGHSR),inpartnershipwiththeorganizationSocMed,offersGlobalHealthinaLocalContext:SocialDeterminants,CommunityEngagement,andSocialActioninMinnesotaeachfall.Thiscourse

75

immersesstudentsinthestudyofhealthequity,thesocialdeterminantsofhealth,globalhealthinalocalsetting,andcommunity-basedhealthcare.GlobalHealthinaLocalContextmergesuniquepedagogicalapproachesincludingcommunityengagement;classroom-basedpresentationsanddiscussions;groupandindividualreflection;theater,film,andotherartforms;andprioritizationofnarrativetounderstandpatient,community,andhealthprofessionalexperiences.Thecurriculumpromotesabiosocialapproachtohealthandillness,therebydrawingonthedisciplinesofanthropology,sociology,economics,history,publicpolicy,biomedicine,publichealth,andthearts.Theseapproachescreateaninnovativeandinteractivelearningenvironmentinwhichstudentsparticipateasbothlearnersandteacherstoadvancetheentireclass’sunderstandingoftheinteractionsbetweenthebiologyofdiseaseandthemyriadsocial,cultural,economic,political,andhistoricalfactorsthatinfluenceillnesspresentationandsocialexperienceofhealthandwell-being.Inordertoexaminethesocialdeterminantsofhealth,thiscourseengageswithlocalcontextthroughin-depthstudyofparticularhistorical,political,andculturalnarrativesimportanttothelocale,inthiscaseMinnesota.Thecoursecurriculumplacesconsiderableimportanceonbuildingpartnershipsandencouragingstudentstoreflectupontheirpersonalexperienceswithpower,privilege,race,class,andgenderascentraltoeffectivepartnershipbuildinginthehealthprofessionsandhealth-relatedfields.Inthespiritofpraxis(amodelofeducationthatcombinescriticalreflectionwithaction)thesecomponentsofthecoursegivestudentstheopportunitytodiscerntheirroleashealthprofessionalsconcernedabouthealthequityandjusticethroughfacilitated,in-depthconversationswithcorefaculty,communitymembers,andstudentcolleagues.

Ataglance:

• Classroom-lessclasswithUMNStudentsandcommunitymembers• Thecorefacultyincludebothtraditionalacademicfacultyandcommunityfaculty.• Medical,publichealth,dental,nursing,andpre-pharmacystudents• Communityhealthworkers,internationalmedicalgraduates,primarycaremanagers,

educationspecialists

Website:globalhealthcenter.umn.edu/global-local

II.Objectives

Followingthiscourse,studentswillbeableto:1. Analyzeandarticulatethesocialdeterminantsofhealththatinfluencehealthoutcomes

amongstdifferentcommunitiesintheTwinCities.2. Differentiatebehavioral,societal/cultural,andstructuraletiologiesofhealthoutcomesand

explainhowandwhytheseetiologiesareattimesconflated.3. Evaluatevariousmodelsofhealthinterventiontorespondtohealthdisparitiesin

Minnesota.

76

4. Engageincriticalself-reflectiononone’spersonalrelationshipwithsocialinequitiesandone’sfutureroleinrespondingtoinequity.

5. Demonstratetheabilitytoengageindeeplistening,performaroot-causeanalysis,participateinconstructivedialogue,andgenerateastrategytoactforsocialchange.

6. Utilizeanestablishednetworkofdiversepeers,faculty,andcommunitymemberstodialogueonhealthchallengesandsolutions.

III.StructureandMethodology

A.CourseStructureThecoursecontentstructureisdividedintothefollowinginterwovenparts:

• Part1–SocialDeterminantsofHealth:AccountingforLocalandGlobalContext• Part2–HealthInterventions:ParadigmsofCharity,Development,andSocialJustice• Part3–CoreIssuesinSocialMedicine:PrimaryHealthCare,CommunityHealthWorkers,HealthandHumanRights,andHealthFinancing

• Part4–MakingSocialMedicineVisible:Writing,NarrativeMedicine,Photography,Research,andPoliticalEngagement

Theclassdeliveryconsistsoftwocomponents:• ExperientialWeeklySessions–these3-hoursessionswilltakeplaceonWednesday

eveningseachweek.Thesesessionsareheldinthecommunityandprovideexperientialopportunitiesforexploringneighborhoodsandinteractingwithpeopleandorganizationsdoingworkrelatedtothecoursetopics.

• Fulldayimmersionsessions–Twiceduringthesemester,theclassmeetsforanextendedclasssession.Thesemeetingsserveto“open”theclassbybuildingcommunity,settingexpectations,sharingauniqueexperience,andcookingfoodasagroup,andthen“close”theclassbyofferinganextendedperiodfordiscussion,reflection,next-steps,puttingconceptsintopractice,andsharingaclosingmeal.

Thisuniquecoursestructurederivesfromaphilosophicalcommitmentto:• Praxis–inspiredbyPauloFreire,webelievethatconstantinterplaybetweenreflectionandactiongeneratescriticalanalysisoftheworldanddeepensourabilitytoeffectivelyrespond.

• Personal–whoweareandwherewecomefrommatterdeeplyinhealthdelivery.Criticalself-awarenessenhancesourabilitytoundoharmfulstructuralandsocietalfactorsofwhichweareallpart.

• Partnership–community-buildingamongstindividualswithvarieddemographicbackgroundsoffersthemostinnovativeandjustmeansofmovingtowardshealthequity.

B.Location

77

Thisisaclassroom-lesscoursethattakesplaceatadifferentcommunity-basedvenueintheTwinCitieseachweek.

IV.Content(SiteLocationsandContentduringFall2016)

September:

• SewardCoopFriendshipStore/SabathaniCommunityCenter:ComplexityofCommunityEngagement

• MinnesotaDepartmentofHealthandCenterforHealthEquity:IntroductiontoSocialMedicineandtheSocialDeterminantsofHealthinMinnesota

• HmongFarmofXongMouacheupao:OurStories–WhoWeAreandWhereWeComeFrom

• WestMinnehahaRecreationCenter:RaceandRacismasaStructuralDeterminantofHealth

October:

• UMNMoosTower:NeoliberalismandHealth• CenterforSocialHealing:WhereWe’reatandWhereWe’reHeaded• FlamingoRestaurant:Behaviorvs.Structure–ThePoliticsofFood• HealthPartnersConferenceCenter:PowerandPrivilege,NoSingleStory,Charity,

Development,andSocialJustice

November:

• EastSideFamilyClinic/SoLaHmo:Community-BasedParticipatoryActionResearch• MixedBloodTheater:TheArtsasaResponsetoSocialInjustice• CommunityUniversityHealthCareCenter:PrimaryCareasaSocialChangeStrategy,The

SocialDeterminantsofMentalHealth,NarrativeHealth

December:

• CenterforSocialHealing:CommunityHealthWorkers,Accompaniment,andPragmaticSolidarity

• TheThirdPlaceGallery:EngagingOurNeighborstoBuildPartnershipsandSocialCohesion

• CenterforSocialHealing:SocialMovementsandActivism,WhereDoWeGoFromHere–StayingEngaged,MaintainingEnergy,andHarboringOptimism

Coursesessionsdrawonthefollowingbodyofliterature:1. Roberts,Maya.2006.“DuffleBagMedicine.”JAMA295:1491-1492.2. Porter,Dorothy.2006.“HowDidSocialMedicineEvolve,andWhereIsItHeading?”PLoS

Medicine3(10):e399.

78

3. CommissionontheSocialDeterminantsofHealth.Closingthegapinageneration.Healthequitythroughactiononthesocialdeterminantsofhealth.Geneva.WorldHealthOrganisation.2008.http://www.who.int/social_determinants/final_report/csdh_finalreport_2008.pdf

4. VirchowR.ReportontheTyphusEpidemicinUpperSilesia.AmJPublicHealth.2006;96(12):2102-2105.doi:10.2105/ajph.96.12.2102

5. MinnesotaDepartmentofHealth.2014.AdvancingHealthEquityinMinnesota:ReporttotheLegislature.http://www.health.state.mn.us/divs/chs/healthequity/ahe_leg_report_020414.pdf

6. Kleinman,ArthurandBenson,Peter.“AnthropologyintheClinic:TheProblemofCulturalCompetencyandHowtoFixIt.”PLoSMedicineOct20063(10):1673-1676.

7. Fanon,Frantz.1994.“MedicineandColonialism.”In:ADyingColonialism.Grove/AtlanticPress.

8. Kleinman,Arthur.2010.“FourSocialTheoriesforGlobalHealth.”Lancet375:1518-1519.9. Foucault,Michel.,1973.TheBirthoftheClinic:AnArchaeologyofMedicalPerception.

TavistockPublications,pp3-4.10. Ta-NehisiCoates.2014.”TheCaseforReparations.”TheAtlantic.11. Hardeman,R.2016.”StructuralRacismandSupportingBlackLives–TheRoleofHealth

Professionals.”NewEnglandJournalofMedicine.12. FarmerP,KimJ,KleinmanA,BasilicoM.ReimaginingGlobalHealth.Berkeley:University

ofCaliforniaPress;2013.13. Keshavjee,Salmaan.2014.“Epilogue:ReframingtheMoralDimensionsofEngagement,”

In:BlindSpot:HowNeoliberalismInfiltratedGlobalHealth.UniversityofCaliforniaPress,pp.136-144.

14. Farmer,Paul.1995.“MedicineandSocialJustice.”America173(2):13-17.15. Heywood,Mark.2009.“SouthAfrica’sTreatmentActionCampaign:CombiningLawand

SocialMobilizationtoRealizetheRighttoHealth.”JournalofHumanRightsPractice.1(1):14-36.

16. Latour,Bruno.1979.SelectionsfromLaboratoryLife:TheSocialConstructionsofScientificFacts.

17. McEwen,Bruce.1998.“ProtectiveandDamagingEffectsofStressMediators.”NEJM338(3):171-179.

18. Cueto,Marcos.2004.“TheOriginsofPrimaryHealthCareandSelectivePrimaryHealthCare.”AmericanJournalofPublicHealth94(11):1864-74.

19. DeclarationofAlma-Ata.1978.20. Bleiker,RolandandKay,Amy.2007.“RepresentingHIV/AIDSinAfrica:Pluralist

PhotographyandLocalEmpowerment.”InternationalStudiesQuarterly51(4):1003-1006.21. Pérez,Leda,andMartinez,Jacqueline.2008.“CommunityHealthWorkers:SocialJustice

andPolicyAdvocatesforCommunityHealthandWell-Being.”AmJPublicHealth98:11-14.

22. Aviv,Rachel.2015.“TheRefugeeDilemma.”TheNewYorker.December7,2015.23. Sampson,RobertJ.,Raudenbush,StephenW.,andEarls,Felton.“Neighborhoodsand

ViolentCrime:AMultilevelStudyofCollectiveEfficacy.”Science277(5328):918-924.

79

V.MeansofEvaluationandAssessment

1. Studentsareexpectedtocommunicatewiththeleadinstructoriftheywillneedtomissaweekofclass.Missingmorethantwoclassmeetingswillresultinaconversationwiththeleadinstructoraboutparticipationexpectations,obstaclestofullparticipation,anddeterminingwhetheritmakessensetocontinueinthecourse.

2. ClassParticipation:20%ofgrade:Eachstudentwillearnparticipationcreditthroughfullattendance,beingontime,participatingregularlyinclassdiscussionsandactivities,bringingcoursereadingsintodiscussion,actingcourteouslytowardsothers,andthroughfollowingdirections.Beingrespectfulofdifferentlearningstyles,wearemindfultonotdistributeparticipationpointssolelyonhowoftenyouspeakinclassbutratherthequalityofyourengagement.Studentsareexpectedtomissnomorethantwoclasssessions.

i. SmallDiscussionGroups–Eachstudentwillbeassignedapartnertoworkwiththroughoutthesemester.Partnerpairswillthenbecombinedintosmallgroups(4-6students).Eachweek,theinstructorswillprovidegroupswith1-3discussionquestionsconnectedtotheweek’sreadings.Groupsareexpectedtomeet(inpersonorremotely)anddiscussthereadings/discussionquestions.Groupsshouldcometoclasspreparedtosharetheirdiscussionsummariesifcalledupontodoso.

3. Bi-WeeklyJournal:15%ofgrade:Eachstudentwillrespondtojournalpromptsprovidedbythecourseinstructorsthatpromotedeeperreflectiononcoursethemes.Studentswillsubmitjournalreflectionseverytwoweeks,dueonSept20;October4&18;Nov1,15,&29;andDec13.

4. KnowingYourselfandOthers–BuildingSocialCohesion:25%ofgrade:Eachstudentwillparticipateinaseriesofguidedactivitiesthatdeepenknowledgeofselfandothers.Theseactivities,drawingontheworkofstreetphotographerWingYoungHuie,aimtoprovideaframeworkforincreasingsocialcohesion,whichhasbeenshowntostrengthenneighborhoodhealth.Activitiesrelatedtothiscomponentofthecoursewilltakeplacebothinandoutsideofclass.Evaluationwillbebasedonfullparticipationintheactivities,theabilitytoidentifyhowthesocialdeterminantsofhealthandsocialcohesioninteract,andsharingyourexperienceoftheseactivitieswiththeclass.Concretedeliverablesinclude:

i. Photographofsomethingfamiliarandsomethingunfamiliarinyourneighborhood,eachwithaone-paragraphdescription(DueSept16)

ii. “Chalktalk”photographinyourneighborhoodwithtwo-paragraphdescriptionandin-classsharing(DueDec13)

iii. FinalReflectivePaper(max1000words,dueDec16)5. RefugeeHealthandAdvocacyProject(Team-based):25%ofgrade:Studentswillbe

connectedtorefugeeresettlementagenciestowitnesstherefugeeresettlement

80

experience.Thisactivitywillprovidetheopportunitytoparticipateinsupportingnewlyarrivedrefugees(airportpick-ups,housingset-up,culturalorientationclasses,etc.)aswellashealth-relatedexperiencesrelatedtorefugeecare(visittorefugeeclinic,visittotheMNStateRefugeeHealthOffice).Baseduponthoseexperiences,studentswillworkinteamstoanalyzetheimpactofonesocialdeterminantofhealthonrefugeehealthanddevelopanadvocacystrategybasedonthatanalysis.Teamsof4-6learnerswillbeassignedbytheleadinstructor.Teammemberswillnotberequiredtoattendrefugeeresettlementactivitiestogether,butwilldrawontheirindividualexperiencestogenerateacollectiveunderstandingofthesocial/structuraldeterminantsofrefugeehealth.Concretedeliverablesexpectedasagroupinclude:

i. Social/StructuralDeterminantsRingandRootCauseAnalysis(wallchart,DueOct25)

ii. AdvocacyStrategyProposal(maximum1000words,DueDec6)6. FinalExam:15%ofgrade:Eachstudentwilltakeamultiplechoiceandshort-answer

examattheendofclass,immediatelyprecedingtheImmersionDay2onDec16.Thepurposeoftheexamistoevaluateyouracquisitionofthebodyofknowledgeassociatedwithsocialmedicine.

VI.CourseFacultyRolesandresponsibilities

ACoreteamoffaculty(3-4)comingfromacademicsettingsandthecommunityorchestratethecourseandoverseecontentdelivery.Numerousguestspeakersalsoparticipateinclasssessions.Thecorefacultytypicallymeetwitheachweek’steachingteam5-6daysinadvancetoplanthesessionandpromoteasmooth,high-impactdeliveryofcoursecontent.Inaddition,thecorefacultyworkconstantlytostretchpedagogicalboundaries.

UniversityofNorthCarolinaChapelHillSocialMedicine–UnitedStatesI.BriefOverview

Thecoursebeganin1979-80asSocialandCulturalIssuesinMedicalPracticeinitscurrentformat--weekly,2semesters,required,teamtaughtbyclinicianandsocialscience/humanitiesfaculty.In1992-3thecoursewasrenamedMedicineandSociety.Thecoursetitlewaschangedto'ProfessionalDevelopment'aspartofamajorcurriculumrevisionin2014.TheSelectiveSeminarsbeganin1979andcontinueinthesameformatasPD3.Throughout,weofferelectivestointerestedstudents.Beginningin2017,afourthyearScholarlyConcentrationinSocialMedicinewillbelaunchedforstudentswhoapplywithaspecificareaofinquiryinmind.Year1PD1ProfessionalDevelopment:SocialDimensionsofIllness&DoctoringPD2ProfessionalDevelopment:MedicalEthics&theHealthCareSystemYear2

81

PD3ProfessionalDevelopment:AdvancedSeminarsintheMedicalHumanities&SocialSciencesYear3IntensiveIntegration:Reflection,Interprofessional,CriticalAnalysis,Ethics(RICE)Year4IndividualizationPhaseScholarlyConcentrationinHumanitiesandSocialSciencesHumanitiesandSocialSciencesCoilBehaviorSciencesCoil

Ataglance:

• 15studentsperseminar• Onefacultymemberperseminar• 28sessions,80minuteseach

Website:http://www.med.unc.edu/socialmed

II.Objectives

1.Todemonstrateknowledgeofandanalyzethewaysinwhichsocialandculturalcontextsaffectdisease,experiencesofillness,androlesofphysicians;2.Todemonstrateknowledgeofandanalyzethehistorical,educational,andethicalforcesthatshapephysiciansanddoctor-patientrelationships;3.Todemonstrateknowledgeofandcriticallyevaluatethesocial,political,andeconomicforcesthatinfluenceorganizationanddeliveryofmedicalservices,andopportunitiesforhealthcarereform.

III.StructureandMethodology

Weengageissuesthroughreadings,discussions,andalecture.Thecoreofthiscourseisthedirecteddiscussionthattakesplaceinseminargroups.Weexpectstudentstoreadcarefullyandcriticallyallassignmentsmadebyseminarinstructor/s,andtocometoclasspreparedtodiscusstheissuesfullyandfreely.Weinvitestudentstobringexamples,experiences,andknowledgetobearinaddressingissuesandassignedmaterials.A.CourseBreakdown

Readings,discussions,andlectures.

B.Location

UniversityofNorthCarolinaChapelHillMedicalSchool

82

IV.Content

PD1-2• SocialandCulturalFactorsthatinfluencehealth,illness,andtreatmentofpopulations

andindividuals• HealthCareEquityandDisparity,anddeepeningmasteryofgender,race/ethnicityand

classassocialcausalinfluencesofillnessandasfactorsinclinicalcare• Historiesofmedicine,illness,andknowledgeofthebody• Ethics:foundationsofmoraltheoryandbasicsofclinicalandresearchbioethics

CategoriesofDifference:Chronicillnessanddisability,sexualities,• HealthCarePolicy:whatitis,howitworks,costsandthepoliticaleconomyofhealth

care,resourceallocationandequityissues,translationstoclinicalpractice;culturesofbiomedicine

• PhysiciansasCitizensandAdvocates:LocalandGlobalHealth• Dr/PtandDr/Familyrelationshipsincontext

PD1–2Schedule2016-20171.IntroImmunology2.ExperiencingIllnessImmunology3.CultureImmunology4.FamiliesHematology5.RaceHematology6.SexualitiesHematology7.Sex,Gender,Health&IllnessHematology8.SocialInequalitiesHematology9.SacredPracticesCardiology10.Death&CultureCardiology11.Labeling,Classification,Disability,StigmaCardiology12.EvidenceCardiology13.ClinicalLearningCardiology14.MoralReflectionRespiratory15.EthicsinMedicineRespiratory16.TruthtellingRespiratory17.Privacy&ConfidentialityRespiratory18.Coercion&Invol.TreatmentUrinary19.EthicsinMedicalResearchUrinary20.MoralManagementofDeathUrinary21.IssuesinClinicalPracticeGI22.ResourceChoicesGI23.HistoryofHealthInsuranceGI24.UninsuredLectureNeuro25.HCRE:RoleCaucusesNeuro26.HCREHearingNeuro27.BoundariesNeuro

83

PD3StudentsSelectOneSeminar:

• AmericanStruggleforHealthCareReform• ExperiencesofDeviance,DisabilityandChronicIllness• TheRevengeoftheSick:HistoryofMedicinefromthePatient’sPointofView• HealthandHumanRights• AnticipatingPersonalizedGenomicMedicine• HistoryandEthicsofHumanandAnimalExperimentation• DeathandDyinginAmerica• Pharmaceuticals,Politics,&Culture• TheEthicsandPoliticsofClinicalResearch• GlobalHealthandMedicalEthics• WritingNarrativeMedicine• HowSocialForcesShapetheFactsofBiomedicalScience

V.MeansofEvaluationandAssessment

WrittenComponent-PersonalIllnessNarrative:10%HomeVisitNarrative&Analysis:25%EthicsEssay:20%OralComponent:OverallAttendanceandParticipationinClassDiscussion:35%HealthCareReformExercise(OralPresentationandDiscussionParticipation):10%SchoolofMedicinerequiresstandardizedevaluationsofallcourses.

VI.CourseFacultyRolesandresponsibilities

Coursefacultymemberscomefromclinical,socialscience,andhumanitiesbackgrounds,andallbringtotheseminarsessionssignificantexperienceininterdisciplinaryresearchandteaching.Facultyareresponsiblefororganizingeachseminarsessionbasedonacommonsyllabusandreadingsorothermaterials,makingassignments,gradingwrittenassignments,writingnarrativeassessment,andgivingongoingfeedback.FacultyDisciplines:Anthropology,Bioethics,ClinicalEpidemiology,ComparativeLiterature,FamilyMedicine,Geriatrics,History,InternalMedicine,Neurology,Ob/Gyn,Philosophy,PoliticalScience,Psychiatry,PublicHealth,ReligiousStudies,Sociology,Psychology.ResearchAreasofFaculty:Bioethicsresearch,clinicalbioethics,clinicalteachingandpractice,advising,teachingacrossthecampusandacrossdisciplines,writingfiction,policyanalysis,engagedresearchinhealthdisparitiesandinequalities,genomicsandsociety,localandglobalconsultationandresearchcollaboration,healthjusticeadvocacyandresearch,scienceandtechnologystudies,disabilitystudies

84

ResourcesThefollowinglistofkeysocialmedicinearticlesshouldbeusedasareferenceforthoseseekingtomoredeeplyexplorevarioussocialmedicinetopics.Thislistisnotexhaustive,butweintendtoaddtothelistasSocialMedicineConsortiummembersidentifynewresources.

AccessandUniversalHealthCoverageBerkowitz,A.(2015).Allforone.JAMA,314(13),1341-1342.Woolhandler,S.et.al.(2003).CostsofhealthcareadministrationintheUnitedStatesand

Canada.TheNewEnglandJournalofMedicine,349(8),768-775.WorldHealthOrganization.(2008).Nowmorethanever.TheWorldHealthReport.EconomicsAllard,J.,Davidson,C.,&Matthaei,J.(2007).Solidarityeconomy:Buildingalternativesfor

peopleandplanet.TheUSSocialForum2007.Farmer,P.(2015).Health-carefinancingandsocialjustice.ToSaveHumanity:WhatMatters

MostforaHealthyFuture.Farmer,P.(2015)Wholivesandwhodies.LondonReviewofBooks,37(3),1-13. MassachusettsInstituteofTechnology.(2011).Thepriceiswrong:Chargingsmallfees

dramaticallyreducesaccesstoimportantproductsforthepoor.AbdulLatifJameelPovertyActionLab.

GenderKrieger,N.(2003).Genders,sexes,andhealth:Whataretheconnections–andwhydoesit

matter?InternationalJournalofEpidemiology,32,652-657.GlobalHealthCrump,J.A.,Sugarman,J.,&WorkingGrouponEthicsGuidelinesforGlobalHealthTraining

(WEIGHT)(2010).Ethicsandbestpracticeguidelinesfortrainingexperiencesinglobalhealth.TheAmericanJournalofTropicalMedicineandHygiene,83(6),1178-1182.

Farmer,P.(2004).PoliticalviolenceandpublichealthinHaiti.TheNewEnglandJournalof

Medicine,350(15),1483-1486.

85

Frieden,T.R.(2015).Thefutureofpublichealth.NewEnglandJournalofMedicine,373(18),1748-1754.

Hayward,A.S.,Jacquet,G.A.,Sanson,T.,Mowafi,H.,&Hansoti,B.(2015).Academicaffairsand

globalhealth:howglobalhealthelectivescanaccelerateprogresstowardsACGMEmilestones.Internationaljournalofemergencymedicine,8(1),1.

Holmes,S.M.,Greene,J.A.,&Stonington,S.D.(2014).Locatingglobalhealthinsocial

medicine.Globalpublichealth,9(5),475-480.Kaplanet.al.(2009).Towardsacommondefinitionofglobalhealth.TheLancet,373,1993-

1995.AcademicPartnershipsandPitfallsBrada,B.(2011)“NotHere”:Makingthespacesandsubjectsof“GlobalHealth”inBotswana.

Culture,Medicine,andPsychiatry,35,285-312.Crane,J.(2011).ScramblingforAfrica?Universitiesandglobalhealth.TheLancet,377(9775),

1388-1390.Morse,M.(2014).Responsibleglobalhealthengagement:Aroadmaptoequityforacademic

partnerships.JournalofGraduateMedicalEducation,347-348.HSS Drobac,P.,Basilico,M.,Messac,L.,Walton,D.,&Farmer,P.(2013).BuildinganEffectiveRural

HealthDeliveryModelinHaitiandRwanda.InFarmerP.,KimJ.,KleinmanA.,&BasilicoM.(Authors),ReimaginingGlobalHealth:AnIntroduction(pp.133-183).UniversityofCaliforniaPress.

Farmer,P.(2013).Chronicinfectiousdiseaseandthefutureofhealthcaredelivery.TheNew

EnglandJournalofMedicine,369(25),2424-2436.Garret,L.(2015).HowCubacouldstopthenextEbolaoutbreak.ForeignPolicy.Retrievedfrom:

http://foreignpolicy.com/2015/05/06/cuba-ebola-west-africa-doctors/Hinshaw,D.(2014).CubandoctorsattheforefrontoftheEbolabattleinAfrica.WallStreet

Journal.Retrievedfrom:https://www.wsj.com/articles/cuba-stands-at-forefront-of-ebola-battle-in-africa-1412904212

HealthDisparitiesintheUnitedStatesChen,J.et.al.(2001).Racialdifferencesintheuseofcardiaccatheterizationafteracute

myocardialinfarction.NewEnglandJournalofMedicine,344(19),1443-1449.

86

Dickman,S.,Himmelstein,D.,&Woolhandler,S.(2017)Inequalityandthehealth-caresystemin

theUSA.TheLancet,389,1431-1441.Epstein,A.,Ayanian,J.(2001).Racialdisparitiesinmedicalcare.NewEnglandJournalof

Medicine,344(19),1471-1473.Fiscella,K.,Tancredi,D.,&Franks,P.(2009).AddingsocioeconomicstatustoFramingham

scoringtoreducedisparitiesincoronaryriskassessment.AmericanHeartJournal,157(6),988-994.

Gaskin,D.,LaVeist,T.&Richard,P.(2013).ThecostsofAlzheimer’sandotherdementiafor

AfricanAmericans.AfricanAmericanNetworkAgainstAlzheimer’s.Todd,K.,Deaton,C.D’Adamo,A.&Goe,L.(2000).Ethnicityandanalgesicpractice.Annalsof

EmergencyMedicine,35(1),11-16.Todd,K.,Samaroo,N.&Hoffman,J.(1993).Ethnicityasariskfactorforinadequateemergency

departmentanalgesia.JAMA,269(12),1537-1539. HealthServicesandSocialJusticeBradley,E.H.,Elkins,B.R.,Herrin,J.,&Elbel,B.(2011).Healthandsocialservicesexpenditures:

associationswithhealthoutcomes.BMJquality&safety,bmjqs-2010.Fisher,E.(2009).Accountablehealthcommunities:Gettingtherefromhere.JAMA,312(20),

2093-2094McGinnis,J.,Williams-Russo,P.&Knickman,J.(2002).Thecaseformoreactivepolicyattention

tohealthpromotion.HealthAffairs,21(2),78-93.Schroeder,S.A.(2007).Wecandobetter—improvingthehealthoftheAmericanpeople.New

EnglandJournalofMedicine,357(12),1221-1228.DiversityandMedicineAttiah,M.A.(2014).Thenewdiversityinmedicaleducation.NewEnglandJournalofMedicine,

371(16),1474-1476.Mason,J.(2008).Breakthroughadvancesinfacultydiversity:Lessonsandinnovativepractices

fromthefrontier.EducationAdvisoryBoard.Montenegro,R.(2016)Mynameisnot“interpreter.”JAMA315(19),2071-2072

87

Sondheimer,H.,Xierali,I.,Young,G.&Nivet,M.(2015).PlacementofUSMedicalSchoolGraduatesintoGraduateMedicalEducation,2005Through2015.JAMA,314(22),2409-2410.

HistoryofMedicineBrandt,A.&Gardner,M.(2000).Antagonismandaccommodation:Interpretingtherelationship

betweenpublichealthandmedicineintheUnitedStatesduringthe20thCentury.AmericanJournalofPublicHealth,90(5),707-715.

Brotherton,P.(2015).Healthandhealthcare:Revolutionaryperiod(Cuba).Cuba,1.Jones,D.&Podolsky,S.(2016).AveryshorthistoryofmedicineintheUnitedStates:Essentials

oftheprofession,HarvardMedicalSchool.HRHandMedicalEducationAwasthiet.al.(2005).Fivefuturesforacademicmedicine.PLoSMedicine,2(7),606-613.Carraccio,C.L.,Benson,B.J.,Nixon,L.J.,&Derstine,P.L.(2008).Fromtheeducationalbench

totheclinicalbedside:translatingtheDreyfusdevelopmentalmodeltothelearningofclinicalskills.AcademicMedicine,83(8),761-767.

Ericsson,K.(2015).Acquisitionandmaintenanceofmedicalexpertise:Aperspectivefromthe

expert-performanceapproachwithdeliberatepractice.AcademicMedicine,90(11),1471-1486.

Frenk,J.,Chen,L.,Bhutta,Z.A.,Cohen,J.,Crisp,N.,Evans,T.,...&Kistnasamy,B.(2010).Health

professionalsforanewcentury:transformingeducationtostrengthenhealthsystemsinaninterdependentworld.TheLancet,376(9756),1923-1958.

Gonzalo,J.D.,Haidet,P.,Papp,K.K.,Wolpaw,R.,Moser,E.,Wittenstein,R.,&Wolpaw,T.

(2015).Educatingforthe21st-centuryhealthcaresystem:aninterdependentframeworkofbasic,clinical,andsystemssciences.AcadMed,1-5.

Huish,R.(2009).HowCuba'sLatinAmericanSchoolofMedicinechallengestheethicsof

physicianmigration.Socialscience&medicine,69(3),301-304.Kahn,M.et.al.(2014).Acaseforchange:Disruptioninacademicmedicine.AcademicMedicine,

89(9),1-4.Pitt,M.et.al.(2016)Makingglobalhealthrotationsatwo-waystreet:Amodelforhosting

internationalresidents.GlobalPediatricHealth,3,1-7.Shields,M.(2012).Teachingwellmatters:Tipsforbecomingasuccessfulmedicalteacher.

Gastroenterology,143,1129-1132.

88

Umoren,R.et.al.(2014).Fosteringreciprocityinglobalhealthpartnershipsthrougha

structured,hands-onexperienceforvisitingpostgraduatemedicaltrainees.JournalofGraduateMedicalEducation,320-325.

Ventres,W.,&Dharamsi,S.(2015).SociallyAccountableMedicalEducation—The

REVOLUTIONSFramework.AcademicMedicine,90(12),1728.HumanRightsFriedman,E.A.,&Gostin,L.O.(2015).ImaginingGlobalHealthwithJustice:InDefenseofthe

RighttoHealth.HealthCareAnalysis,23(4),308-329.Mukherjee,J.(2013).Financinggovernments:Towardsachievingtherighttohealth.Advancing

thehumanrighttohealth,1-16.RaceGeneticsBuchard,E.et.al.(2003).Theimportanceofraceandethnicbackgroundinbiomedicalresearch

andclinicalpractice.NewEnglandJournalofMedicine348(12),1170-1175.Cooper,R.(2003).Raceandgenomics.NewEnglandJournalofMedicine,348(12),1166-1170.Kuzawa,C.W.,&Sweet,E.(2009).Epigeneticsandtheembodimentofrace:developmental

originsofUSracialdisparitiesincardiovascularhealth.AmericanJournalofHumanBiology,21(1),2-15.

ResearchEthicsBrandt,A.(1978).Racismandresearch:ThecaseoftheTuskeegeesyphilisstudy.TheHastings

CenterReport,8(6),21-29.Farmer,P.(2013).Clinicaltrialsandglobalhealthequity.TheLancetGlobalHealthBlog.

Retrievedfrom:http://globalhealth.thelancet.com/2013/07/08/clinical-trials-and-global-health-equity

Wispelwey,B.(2015).Prematureblackdeaths:TheroleofAmericanmedicine.Huffpost.

Retrievedfrom:http://www.huffingtonpost.com/bram-wispelwey/premature-black-deaths-the-role-of-american-medicine_b_8250624.html

SocialDeterminantsofHealthCarey,G.,&Crammond,B.(2015).Actiononthesocialdeterminantsofhealth:viewsfrom

insidethepolicyprocess.SocialScience&Medicine,128,134-141.

89

CommissiononSocialDeterminantsofHealth.(2008).Closingthegapinageneration:healthequitythroughactiononthesocialdeterminantsofhealth:finalreportofthecommissiononsocialdeterminantsofhealth.

Chen,L.,&Berlinguer,G.(2001).Healthequityinaglobalizingworld(pp.35-44).T.Evans,M.

Whitehead,F.Diderichsen,A.Bhuiya,&M.Wirth(Eds.).Challenginginequitiesinhealth:fromethicstoaction.NewYork:OxfordUniversityPress.

Farmer,P.(1997).Socialscientistsandthenewtuberculosis.SocSci&Med,44(3),347-358.Marmot,M.(2006).Healthinanunequalworld:socialcircumstances,biologyanddisease.The

Lancet,368,2081-2094.Stuckler,D.et.al.(2008)Internationalmonetaryfundprogramsandtuberculosisoutcomesin

post-communistcountries.PLoSMedicine,5(7),1079-1090.SocialMedicineMedicalEducationBeagan,B.L.(2003).Teachingsocialandculturalawarenesstomedicalstudents:“It'sallvery

nicetotalkaboutitintheory,butultimatelyitmakesnodifference”.AcademicMedicine,78(6),605-614.

Cash-Gibson,L.,Guerra,G.,&Salgado-de-Snyder,V.(2015).SDH-NET:ASouth-North-South

collaboration.HealthResearchPolicyandSystems,13(45),1-9.Cuff,P.A.,&Vanselow,N.(Eds.).(2004).Improvingmedicaleducation:Enhancingthe

behavioralandsocialsciencecontentofmedicalschoolcurricula.NationalAcademiesPress.

Drobac,P.&Morse,M.(2016).Medicaleducationandglobalhealthequity.AMAJournalof

Ethics,18(7),702-709.Flinkenflögel,M.,KalumireCubaka,V.,Schriver,M.,Kyamanywa,P.,Muhumuza,I.,Kallestrup,

P.,&Cotton,P.(2015).ThedesiredRwandanhealthcareprovider:developmentanddeliveryofundergraduatesocialandcommunitymedicinetraining.EducationforPrimaryCare,26(5),343-348.

Friere,P.(1968).PedagogyoftheOppressed.NewYork,NY:SeaburyPress.Gadd,A.(1973).Educationalaspectsofintegratingsocialsciencesinthemedicalcurriculum.

SocSci&Med,7,975-984.Goldberg,D.(2013).Thepreparationofasyllabusinsocialmedicine:McKeownrevisited.Social

Medicine,7(3),147-156.

90

Gregg,J.&Saha,S.(2006).Losingcultureonthewaytocompetence:Theuseandmisuseofcultureinmedicaleducation.AcademicMedicine,81(6),542-547.

Gregg,J.,Solotaroff,R.,Amann,T.,Michael,Y.,&Bowen,J.(2008).Healthanddiseasein

context:acommunity-basedsocialmedicinecurriculum.AcademicMedicine,83(1),14-19.

Gruen,R.L.,Pearson,S.D.,&Brennan,T.A.(2004).Physician-citizens—publicrolesand

professionalobligations.JAMA,291(1),94-98.Guevara,E.(1960).Onrevolutionarymedicine.SpeechpresentedtoCubanmilitia.Hixon,A.L.,Yamada,S.,Farmer,P.E.,&Maskarinec,G.G.(2013).Socialjustice:Theheartof

medicaleducation.SocialMedicine,7(3),161-168.Holmes,S.M.,Greene,J.A.,&Stonington,S.D.(2014).Locatingglobalhealthinsocial

medicine.Globalpublichealth,9(5),475-480.Honjo,K.(2004).Socialepidemiology:definition,history,andresearchexamples.

Environmentalhealthandpreventivemedicine,9(5),193-199Hudon,C.,Loignon,C.,Grabovschi,C.,Bush,P.,Lambert,M.,Goulet,É.,...&Fournier,N.

(2016).Medicaleducationforequityinhealth:aparticipatoryactionresearchinvolvingpersonslivinginpovertyandhealthcareprofessionals.BMCmedicaleducation,16(1),1.

Karnik,A.,Tscahnnerl,A.,&Anderson,M.(2016).Whatisasocialmedicinedoctor?.Social

Medicine,9(2),56-62.Kasper,J.,Greene,J.A.,Farmer,P.E.,&Jones,D.S.(2016).Allhealthisglobalhealth,all

medicineissocialmedicine:Integratingthesocialsciencesintothepreclinicalcurriculum.AcademicMedicine,91(5),628-632.

Ko,Michelle.Et.al.(2005).ImpactoftheUniversityofCalifornia,LosAngeles/CharlesR.Drew

Universitymedicaleducationprogramonmedicalstudents’intentionstopracticeinunderservedareas.AcademicMedicine,80(9),803-808.

Keck,C.W.&Reed,G.(2012).ThecuriouscaseofCuba.AmericanJournalofPublicHealth,

102(8),e13-e22.Metzl,J.M.,&Hansen,H.(2014).Structuralcompetency:Theorizinganewmedical

engagementwithstigmaandinequality.SocialScience&Medicine,103,126-133.Mullan,F.et.al.(2010).Thesocialmedicinemissionofmedicaleducation:Rankingtheschools.

AnnalsofInternalMedicine,152,804-811.

91

NationalAcademiesofSciences,Engineering,andMedicine.(2016).Aframeworkforeducatinghealthprofessionalstoaddressthesocialdeterminantsofhealth.NationalAcademiesPress.

Porter,D.(2006).Howdidsocialmedicineevolve,andwhereisitheading?.PLoSMed,3(10),

e399.Strelnick,A.et.al.(2008).TheResidencyPrograminsocialmedicineofMontefioremedical

center:37yearsofmission-driven,interdisciplinarytraininginprimarycare,populationhealth,andsocialmedicine.AcademicMedicine,83(4),378-389.

Vanderbilt,A.A.,Baugh,R.F.,Hogue,P.A.,Brennan,J.A.,&Ali,I.I.(2016).Curricular

integrationofsocialmedicine:aprospectiveformedicaleducators.Medicaleducationonline,21.

Westerhaus,M.,Finnegan,A.,Haidar,M.,Kleinman,A.,Mukherjee,J.,&Farmer,P.(2015).The

necessityofsocialmedicineinmedicaleducation.AcademicMedicine,90(5),565-568.StructuralRacismBailey,Z.et.al.(2017).StructuralracismandhealthinequitiesintheUSA:Evidenceand

interventions.TheLancet,389,1453-1463.Hardeman,R.et.al.(2016).StructuralracismandsupportingBlacklives–Theroleofhealth

professionals.TheNewEnglandJournalofMedicine,375(22),2113-2114.Wildeman,C.&Wang,E.(2017).Massincarceration,publichealth,andwideninginequalityin

theUSA.TheLancet,389,1464-1474.

StructuralViolenceFarmer,P.E.,Nizeye,B.,Stulac,S.,&Keshavjee,S.(2006).Structuralviolenceandclinical

medicine.PLoSMed,3(10),e449.Mukherjee,J.et.al.(2011)Structuralviolence:Abarriertoachievingthemillennium

developmentgoalsforwomen.JournalofWomen’sHealth,20(4),593-597.Wilkinson,A.&Leach,M.(2014).Briefing:Ebola-myths,realities,andstructuralviolence.

AfricanAffairs,1-13.ViolenceandConflictZakaria,S.,Johnson,E.N.,Hayashi,J.L.,&Christmas,C.(2015).Graduatemedicaleducationin

theFreddieGrayera.NewEnglandJournalofMedicine,373(21),1998-2000.

92