Students Passionate for Global Health - Dental Schools Beginning to Respond

A web-based survey of US dental school deans was conducted by the American Dental Association’s (ADA) international staff in 2009 (www.ada.org/international). It indicated that about half of the 47 responding schools had offered international volunteer opportunities, and another 17% were planning to do so. While there was no intent at the time to assess the quality of those opportunities and the links to appropriate curricular content to prepare students for volunteer assignments abroad, there was a clear indication of interest. What is unclear, because of the deficit of research on the subject, is whether there is a systematic approach to building educational modules for careers in global oral health. While we are at the beginning stages of potential new career pathways, the challenge ahead is to be able to craft culturally appropriate and sensitive curricular materials and experiences that cover such subjects as the global burden of diseases, including oral diseases and disorders, programs linked to sustainable systems that meet the challenges of the burden, and appropriate public policies to support prevention, diagnosis, and treatment requirements of various communities in need. This is a heavy-duty challenge going forward, and, as editor of this column, I am confident Rick Valachovic’s views provide an insightful sense of where the next steps might be.

— Lois K. Cohen, PhD

We hear the words “global health” more and more these days, but I am guessing that many people wonder what that phrase means exactly. The Consortium of Universities for Global Health (CUGH), a group of major higher education institutions with programs in global health, was started in 2008 to support the growth of global health as an academic field of study. It uses the following working definition articulated by Dr. Jeffrey Koplan of Emory University and his co-authors in a 2009 issue of The Lancet: “Global Health is a field of study, research, and practice that places a priority on achieving equity in health for all people. Global Health involves multiple disciplines within and beyond the health sciences, is a synthesis of population-based prevention with individual level of clinical care, promotes interdisciplinary collaboration and emphasizes transnational health issues and determinants.”

So what does that mean for an association rooted in North America such as ADEA? To start, its latest www.adea.org/about_adea/Documents/adea_strategicDirections.pdf Strategic Directions prioritize providing “access to ADEA’s programs, products, and services to the global dental education community to strengthen the quality of dental education worldwide.” Further, ADEA’s institutional members are situated within universities, which are increasingly emphasizing global health. What started as a group of discrete courses in a variety of curricula is rapidly becoming a field unto itself. At last count, more than 290 North American universities had some sort of global health activity; more than 80 of these had education programs spanning multiple schools with research and service components and a long-term relationship with an academic partner institution in a low- or middle-income country. The first two graduate programs in global health were launched in 2009, and a CUGH survey currently underway will certainly discover more.

Global health is intrinsically interprofessional, drawing on fields such as engineering and agriculture in addition to all of the health professions. Dental education will become increasingly involved as global health programs evolve and the field becomes more established. This is why I attended the 3rd annual meeting of CUGH in Montreal, where an impressive 1,400 participants from 62 countries gathered. Although most attendees were health professionals or students of global health, a great deal of attention was focused on other issues that impact health such as climate change and violence against women, as well as more traditional health topics like AIDS, infant mortality, and food security.

At the CUGH meeting, the dental community took a concrete step toward addressing one facet of the world’s health problems with the inaugural meeting of the Global Oral Health Interest Group (GOHIG). GOHIG aims to advance oral health worldwide in concert with the mission of its parent organization: “The Consortium of Universities for Global Health (CUGH)…builds collaborations and exchange of knowledge and experience among interdisciplinary university global health programs working across education, research, and service. It is dedicated to creating equity and reducing health disparities, everywhere. The Consortium also promotes mutually beneficial, long-term partnerships among universities in resource-rich and resource-poor countries, developing human capital, and strengthening institutions.”

Those attending the business meeting agreed that GOHIG would advocate and work actively for inclusion of global oral health issues in all CUGH activities. Given this ambitious agenda, I was especially pleased by the group’s decision to begin its work with the development of global oral health competencies, something that will immediately benefit ADEA’s members and, over time, the public at large. ADEA’s Strategic Directions make a commitment to working with dental programs throughout the world. This represents a natural outgrowth of ADEA’s past involvement with global dental education efforts. In addition, the focus in recent years on making ADEA’s resources more broadly available to and user-friendly for members has made them more accessible to colleagues abroad.

The Journal of Dental Education (JDE) has made it easier for scholars outside North America to contribute and for reviewers from Asia, Europe, South America, and Australia to lend their regional perspectives to the appraisal of international submissions. In the coming year, the JDE plans to begin translating its abstracts into other languages, further expanding its reach and impact. ADEA has also seen an increased use of MedEdPORTAL resources by educators outside of North America, with users in 123 countries accessing dental curricula in the past year alone. Editor’s Note: Additionally, the ADEA Curriculum Resource Center is a valuable resource providing learning materials that can be easily incorporated into faculty-developed courses.

The timing of these developments could not be better. Just 1 year ago, The Lancet published an influential report titled Health Professionals for a New Century: Transforming Education to Strengthen Health Systems in an Interdependent World (available for free). The report articulates a vision of education for the health professions that requires “three fundamental shifts: from isolated to [harmonized] education and health systems; from standalone institutions to networks, alliances, and consortia; and from inward-looking institutional preoccupations to harnessing global flows of educational content, teaching resources, and innovations.” These are precisely the types of transformations that ADEA, GOHIG, and the universities affiliated with CUGH are trying to facilitate.

A 2009 report on global health published by the Center for Strategic and International Studies (CSIS) makes clear that US universities are uniquely positioned to be major players in “shaping the emerging field of global health [and] solving some of the most pressing health issues facing humanity today…. By enlisting multiple disciplines to unravel the complex determinants of health, by harnessing the passion and energy of students who benefit from formative global health education and service opportunities, and by being on the forefront of scientific discovery and healthcare delivery, universities are poised to change the landscape of global health and ultimately improve the human condition.”

These changes within universities will also change the landscape of dental education. As the CSIS report points out, student awareness of the world’s interconnectedness is one of the drivers of this movement. Taking steps to integrate oral health into global health within our institutions or through participation in groups such as GOHIG are clearly worthwhile for their positive impact on people’s health, but such gains will take time. In the short term, this integration will have a more parochial benefit: making dental education more responsive to the current generation of students, who are eager to play a role on the international stage. For both reasons, I am glad to see dental education getting in step with global health.

— Richard W. Valachovic, DMD, MPH

Related content: For more information, read Educating Future Leaders of the Oral Health Community at dentalaegis.com/go/cced167

Lois K. Cohen, PhD
Paul G. Rogers Ambassador for Global Health Research

Richard W. Valachovic, DMD, MPH
Executive Director, American Dental Education Association