By Richard Skolnik, MPA, Author of Global Health 101, Fourth Edition
After having taught over 40 introductory classes in global health, I have learned that it is useful to lay out a number of concepts right at the beginning of a course. Doing so helps create a better foundation for the course as a whole. Some of these concepts are discussed below and are covered in the Introduction and Chapter 1 of Global Health 101, Fourth Edition.
The first such concept is “Cultural relativism." Some students, especially those who have taken anthropology, may come to the course with the idea that one must see cultures through their own perspective and that one cannot and must not “judge” other cultures. This is an important concept. (Says one who studied anthropology with some great anthropologists many years ago!!) However, to be effective in understanding and working on global health, it is essential to understand what behaviors enable better health, what behaviors disable better health, and how better health can be promoted in different contexts.
Thus, it might be helpful very early in a course to help students consider their “underlying assumptions” about “culture and health”. I would do so by conducting a poll among my students that would include questions like the following:
- How many of you believe female genital mutilation is OK?
- How many of you believe that Saudi women should not be allowed to drive?
- How many of you believe that it is OK for an Afghan girl to be stoned to death because she spoke to a young man?
- How many of you believe it is OK for girls in the US to be married under 16 years of age, as some states allow?
My students would immediately recognize after the poll that they tend to have strong beliefs about certain “rights”. They would also quickly realize that thinking about and engaging in global health work is different than carrying out ethnographic work.
I would then help students understand, through brief discussions of several types of global health work, the importance of cultural competence and cultural humility in working in global health.
Another important concept on which I would focus early attention is that: Global health is intersectoral and people who work in it need to think as much like a minister of finance as a minister of health. To help students understand this concept, I would ask them about the determinants of health and key risk factors for a number of health conditions. I would then ask them which government agency is responsible for dealing with such determinants and risk factors:
- Why do children in Liberia get diarrheal disease? Which agency of government is responsible for enabling better water and sanitation? For promoting better hygiene?
- What are the key risk factors for young children being undernourished? Which agencies of government are responsible for nutrition education? Agricultural policy, prices, and markets? The education of females?
- What are the key risk factors for HIV? Which agencies of government are responsible for health messages on HIV? Enhancing educational and economic opportunities for girls to help them stay in school, reduce transactional sex, and enable girls to have more negotiating power in sexual relations?
Such questions help students understand immediately that – to exaggerate greatly – living next to a hospital is among the least important things needed to attain good health. Rather, enabling better health requires work across many aspects of society and a range of government agencies.
The last concept I would introduce in the first class is: If you want to be effective in understanding and working on global health, you need to throw away ideology and lots of fundamental assumptions and work on the basis of evidence and context. To help students think about this point, I would ask:
- How many of you believe that all people in Bangladesh deserve access to safe drinking water?
- How many of you believe the Government of Bangladesh has an obligation to enable such access?
- How many of you believe the Government of Bangladesh is competent to carry out satisfactorily the quest for safe drinking water? I would then tell them that, despite my affection for Bangladesh, that the country has succeeded in many ways despite government, rather than because of it.
- I would then ask them if the government is not competent in these domains, how will Bangladesh get water to all of its people? Can the government finance the effort but contract the work to the country’s remarkable NGO sector? I would then tell them about the NGO BRAC and help them understand that contracting out services in such a setting may be the most cost-effective and equitable approach. I would then ask them not to see this approach in terms of a right/left debate in their own country, etc. Finally, I would remind them that the answers they will get to different problems will depend on the questions they ask. In this case, for example, I would encourage them to ask what is the fairest and most cost-effective approach for the government to ensure its people get access to safe drinking water? I would discourage them from asking how the government could directly provide drinking water to all of its people.
Each instructor will have their own ideas about concepts that are central to the study of global health. I have found the three above to be among the most important to help students understand as they launch their global health studies.
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.