Original ResearchGlobal health education in the United Kingdom: a review of university undergraduate and postgraduate programmes and courses
Introduction
Scholarly attention to international and global health, measured by published articles listed in PubMed using either term in the title or abstract, has grown exponentially since 1970 (Fig. 1). In 2001, Bateman et al. observed that only ‘a few medical schools around the world’ had begun to teach global health, and called on ‘global issues’ to be incorporated into medical teaching.1 At the time, global health curriculum usually consisted of a one-day topic for senior medical undergraduates.2 Global health education (GHE) has since grown exponentially although concentrated in the United States (US) and Europe, notably the United Kingdom (UK) (Table 1).
The growth in GHE has elicited several reviews that have sought to identify ‘core competencies’ and learning outcomes.3, 4, 5 Methods employed include systematic reviews,6 iterative discussion,7 institutional surveys,8, 9 and interviews with global health leaders.10 One important finding has been the lack of consensus about what constitutes a global health curriculum, stemming in large part from variation in definitions of global health in terms of geographical focus, subject matter and normative frameworks.11, 12 This has been recognized in North America where the Association of Schools of Public Health (ASPH), Global Health Education Consortium (GHEC)c, Association of American Medical Colleges' International Opportunities in Medical Education (IOME), and Association of Faculties of Medicine of Canada (AFMC) have sought to advance core curriculum guidelines appropriate for medical students.13 Table 2 summarizes efforts to date to define GHE core competencies.
A second finding concerns the intended student of GHE. Most studies focus on the needs of medical students, with the more specific term global medical education (GME) used. The core competencies put forth have thus reflected the needs of medical practitioners.7 For example, Farmer describes three chief categories of research, training and service action for medical students that should be found in global health curricula.14 But as Pfeiffer et al. argue:
The bottom line is, because of this complexity, who is needed for global health is a new generation that has multi-talents, that is not coming from one brand of training, that is not coming from a biomedical background or a public health background or an “X” background. To train the global health leaders of the future we need [practitioners with] a complex set of abilities who understand economics and the political scene and the culture and the social, as well as the scientific (p5).10
A few institutions have sought to strengthen the ‘global competence’ of all graduates,15 with global health taught as a component of ‘global citizenship’.16 However, there has been little study to date of the appropriate curriculum for this more diverse cohort.
This study reviews the current state of GHE in the UK through the collation and synthesis of data on undergraduate and postgraduate degree programmes and coursesd currently offered. In reviews of UK GHE to date, no study has examined undergraduate and postgraduate curricula in detail. Little is also known about the profile of students studying at UK universities and, in particular, the degree to which there is diversity of backgrounds. This paper seeks to document the curriculum currently provided and who is studying global health in the UK. It then draws conclusions about the nature of GHE in the UK, and reflects on the extent to which GHE and practice are aligned.
Section snippets
Methods
A literature review of the database Web of Science was conducted in November 2013 using the search string ‘global health education’. The search was then expanded to include additional databases (Medline, Applied Social Sciences Index and Abstracts, and Education Resources Information Centre) using the revised search string ‘global’ and ‘health’ and ‘learning’ or ‘education’ or ‘curricul*’ or ‘teach*’ or ‘public’ or ‘medic*’. Peer-reviewed journal articles and book chapters in English were
Results
The initial search of the database Web of Science retrieved thirty-seven hits. Expanding the search to other databases yielded four hundred and seventy-three (Medline), three hundred and ninety-six (Web of Science), three hundred and nineteen (ASSIA), and forty-four (ERIC) additional hits. Content review, application of exclusion criteria, and removal of duplications left twenty-five studies for detailed analysis. Four additional studies were identified from the bibliographies of these studies,
Discussion
The variability of global health curricula in the UK is indicative of the continued, perhaps irresolvable, differences in the definition of global health. In some cases, this reflects a move by some UK universities to capture the demand for GHE by rebranding existing degree programmes and courses, with limited or no engagement in the distinction between international and global health. In this respect, the UK is no different from institutions elsewhere seeking to attract students. Hatfield
Ethical approval
None sought. The main objective of the study was to collect information on course and programme content, and human subjects were not involved. A questionnaire was used but it contained no sensitive questions that participants might have felt uncomfortable answering.
Funding
KL is funded in part by the National Cancer Institute, US National Institutes of Health, Grant No. R01-CA091021. This funder had no role in the study design; collection, analysis and interpretation of data; writing of the manuscript;
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