By Richard Skolnik, MPA, Author of Global Health 101, Fourth Edition
Chapter 20 of Global Health 101, Fourth Edition, addresses the types of players in global health employment and the kinds of knowledge, skills, and experience that one needs to work in the global health field. This post highlights some of the ethical issues that arise in experiential learning in global health and how such experiences might best be structured.
One of the pre-requisites for effective work in global health is an understanding of:
- The health conditions people face in different settings globally
- A range of cultures
- The social, religious, political, and economic settings in a variety of countries
- How different health systems are organized, managed, and operate to address local health conditions
As Global Health 101 makes clear, it is essential if one is to gain such understandings that learners engage in field experiences in global health. Ideally, those interested in pursuing work in global health will have a number of opportunities during their training to undertake such experiences.
Yet, experiential learning in global health, at every level, raises a host of ethical issues. Some of the most fundamental such issues include:
- The relationship between the sending and receiving institutions
- The clarity of goals of the experience to be undertaken
- The extent of the participants’ preparation for the experience and the attitudes and behaviors of proposed participants
- The possibility that participants will engage in actions that exceed their competence and can cause harm to the local community
- The relative costs and benefits of the experience to all involved parties and the clarity and transparency with which they are understood, acknowledged, and paid for
The manner in which institutions, faculty, and participants should approach experiential learning in global health and the ethical issues that relate to it has been the subject of considerable discussion and literature. Faculty and students who are involved in experiential learning in global health are encouraged to scan this literature.
In addition, given the growth of global health courses, the expansion of experiential learning in global health, and the ethical issues involved in such learning, it is essential that those involved in such experiences take a principled approach to them.
The most widely accepted “guidelines” for experiential learning in global health are those published in 2010 by an international “Working Group on Ethics Guidelines for Global Health Training (WEIGHT)”:
Crump, John A., Jeremy Sugarman, and the Working Group on Ethics Guidelines for Global Health Training. 2010. “Ethics and Best Practice Guidelines for Training Experiences in Global Health.” The American Journal of Tropical Medicine and Hygiene 83 (6): 1178–82. This article can be found online for free at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2990028/
The WEIGHT guidelines focus on:
- the need for well-structured programs between partners
- the importance of accounting for all program costs
- the goal of mutual and reciprocal benefit
- the value of embedding short-term experiences in long-term partnerships
- the centrality of preparation of trainees, their attitudes and behavior, and the characteristics they need to succeed in their training
- trainee safety and the characteristics of programs that merit support by sponsors
- the importance of adequate mentorship and supervision for trainees
Those organizing, managing, and participating in experiential learning in global health will want to carefully consider the WEIGHT guidelines.
In addition, they will want to pay special attention to pre-departure training of all participants. There are a range of approaches to and offerings of such training. These come up immediately when one searches for such information. Unfortunately, however, there has been very little evidence-based research about either specific programs or about the relative costs and benefits of alternative approaches to pre-departure training.
Thus, faculty involved in developing or managing such programs may wish to examine a recent review of the literature on such programs:
Kalbarczyk, A., Nagourney, E., Martin, N.A. et al., Are you ready? A systematic review of pre-departure resources for global health electives. BMC Med Educ 19,166 (2019) doi:10.1186/s12909-019-1586-y
They may also wish to explore, among other things, the case-based training that Johns Hopkins and Stanford Universities developed for global health field experiences: http://www.ethicsandglobalhealth.org/
It is important to stress to those who seek experiential learning opportunities in global health that they should carefully examine the structure of any programs in which they might participate, how a program looks in light of the WEIGHT guidelines, and the type of pre-departure preparation in which they will be involved.
A number of thoughtful articles have been written about the risks of such programs, the harm they can do, and the lack of partnership as their underpinning. Professor Madhukar Pai, at McGill University, has written widely on this and related issues. Those considering experiential learning should be sure to review some of these articles, including:
Dr. Greg Martin’s You Tube channel – “Global Health with Greg Martin” - contains a range of additional information about working in global health and gaining appropriate field experience:
In addition, Child Family Health International has been a leader in helping to place interested learners in global health field experiences and those interested may wish to examine their program, among others. https://www.cfhi.org/
Richard Skolnik would like to thank Rebecca Baggett, Madhukar Pai, and Greg Martin for their thoughtful comments on the draft of this note.
For more information about Global Health 101, Fourth Edition visit www.globalhealth101.com
About the Author
Richard Skolnik, MPA - Yale, School of Public Health, New Haven, Connecticut
Richard Skolnik has spent more than 40 years working on international development and global health and was formerly a lecturer in the Yale School of Public Health, the Yale School of Management, and the George Washington University School of Public Health.