Elsevier

Public Health

Volume 129, Issue 6, June 2015, Pages 797-809
Public Health

Original Research
Global health education in the United Kingdom: a review of university undergraduate and postgraduate programmes and courses

https://doi.org/10.1016/j.puhe.2014.12.015Get rights and content

Highlights

  • 15 universities in the UK offered 25 P/G and 6 U/G global health programmes in 2012–13.

  • 16 ‘core’ competencies for a medical and non-medical student constituency were identified.

  • There is a need to critically engage with the distinction between international and global health when developing curricula.

  • There is a need to better understand the profile of future global health students and their specific educational needs.

  • There is a need to consider effective ways of improving equity of access to GHE.

Abstract

Objectives

This study reviews the current state of global health education (GHE) in the United Kingdom (UK) through the collation and synthesis of data on undergraduate and postgraduate global health degree programmes. It examines both the curriculum provided and profile of the student currently studying global health in the UK.

Study design

Descriptive, case study design.

Methods

A systematic review of the literature identified a set of global health ‘core competencies’ that students could acquire through their chosen programme of study. Those competencies were synthesized and then compared to core and elective courses currently offered by global health degree programmes at UK universities. A questionnaire was designed and sent electronically to all global health Programme Directors requesting generic information regarding the profile of their global health students.

Results

Fifteen universities in the UK, based in England and Scotland, offered twenty-five postgraduate and six undergraduate global health degree programmes in 2012–13. Two Universities were developing a full, three-year, undergraduate degree programme in global health. Sixteen core competencies for a medical and non-medical student constituency were identified. Of these, just three ‘core competencies’ – epidemiology of tropical diseases, health systems (including health system management), and health care services – corresponded directly to core and elective courses offered by >50% of UK universities. The five most frequently offered subjects were: health systems (including health system management), research methods, public health (including specialisations in prevention, treatment and care), epidemiology, and health economics.

Conclusions

GHE in UK universities has seen comparable growth to North American institutions, becoming Europe's regional hub for undergraduate and postgraduate courses and programmes. As with the US and Canadian experience, GHE at the undergraduate level is offered primarily to medical students through intercalated degree programmes. At the postgraduate level, there is more innovation in content and mode of delivery, with a small number of UK universities providing students from a diversity of backgrounds the opportunity to study global health from multidisciplinary perspectives. Distance learning is also seeking to make the delivery of GHE truly global, with a growing number of universities recognizing its potential to further innovate in global health pedagogy. While demand for GHE is predicted to remain robust, to ensure the needs of students and practitioners are met, more critical reflection on global health curricula, the desired profile of graduates, and equity of access is required.

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;

References (20)

  • C. Bateman et al.

    Bringing global issues to medical teaching

    Lancet

    (2001)
  • N. Low et al.

    Global issues in medical education

    Lancet

    (2002)
  • J.P. Koplan et al.

    Towards a common definition of global health

    Lancet

    (2009)
  • M. Arthur et al.

    Teaching the basics: core competencies in global health

    Infect Dis Clin N Am

    (2011)
  • N.L. Eckhert

    Getting the most out of medical students' global health experiences

    Ann Fam Med

    (2006)
  • E.R. Houpt et al.

    Three domains of competency in global health education: recommendations for all medical students

    Acad Med J Assoc Am Med Coll

    (2007)
  • J.M. Hatfield et al.

    Building global health research competencies at the undergraduate level

    J Stud Int Educ

    (2009)
  • R. Battat et al.

    Global health competencies and approaches in medical education: a literature review

    BMC Med Educ

    (2010)
  • O. Johnson et al.

    Global health education in U.S. medical schools

    BMC Med Educ

    (2013)
  • J.A. Hall et al.

    Fit for the future? The place of global health in the UK's postgraduate medical training: a review

    JRSM Short Reports

    (2013)
There are more references available in the full text version of this article.

Cited by (0)

View full text