Nathan Cantley: Why is Global Health important and how is it taught in medical school?


Nathan Cantley has just successfully completed fourth year of medicine at Queen’s University, Belfast also completing an intercalated Masters degree in Translational Medicine the previous year. He has a strong interest in global health which he pursues through his involvement in the student network and charity, Medsin-UK and in academia where he started the Queens University Academic Medicine Society (QUAMS) in late 2012. Nathan is interested in the international development agenda and looks forward to seeing how the Sustainable Development Goals could have a wider impact on global health moving forward.

 2nd place in National Global Health Competition 2014/15

”Health inequalities and the social determinants of health are not a footnote to the determinants of health. They are the main issue.”

Sir Michael Marmot

Global Health is about so much more than rates of incidence of various diseases. One of the most important principles that we are taught in medical school, is that it is not the “causes” of poor health which are most important, but the “causes of the causes”. It is a fundamental topic, not just if you are a doctor or student but for politicians and businesses amongst others. It sits at the interchange between these professions exerting its influence in cause and effect.

Policies in international development very commonly (and wrongly) silo economics, employment and education away from policies relating to health systems without realising that such areas are interconnected. It doesn’t matter how many doctors you train or drugs you develop, if patients cannot effectively use or access the system due to a combination of social and economic inequalities and inequities, your health policies will be ineffective.

Furthermore, considering how many newly qualified doctors emigrate from their country of training and patient populations away from sources of natural and man-made disasters, it is more critical than ever that medical students and doctors understand how patients present differently to them in hospital and in the community from different backgrounds. Disease does not respect geographical boundaries and as such we must be equipped to fight disease where it originates again why understanding global health is important. Similarly, as Lord Nigel Crisp emphasised in his book “Turning the world upside down,” understanding health in different countries can confer the extra benefit of identifying potential innovative solutions to global health problems relevant for all countries.

I emphasise the social determinants of health (SDH) approach because typically in medical school, when global health is taught (and IF it is taught in any robust way which it isn’t in many universities), a focus is placed on the disease incidence and mortality rates of various diseases like HIV, or infant and maternal mortality rates, framing solutions devised and used commonly in western countries. This I feel is wrong.

It is my opinion that teaching about global health and the incidences of various diseases (be it communicable or noncommunicable), must be done only after first principles about SDH are taught in a comprehensive manner. This should go much deeper than simply saying “the social determinants of health are important.” Instead, a basic understanding of global macroeconomics, primary and secondary education provision across the world and how access to health systems varies (amongst other topics) must be front and centre to global health education. Knowing how each of these systems are interdependent and linked to health are crucial to truly understanding global health. This could be implemented by engaging more in interprofessional education by having lectures joint with international development or economics or global politics classes alongside more integrated public health teaching that brings basic principles about public health into a much wider context.

Nathan Cantley

The National Global Health competition 2014/15 asked the question ‘Why is global health important and how should it be taught in Medical school’. The competition was judged by Prof Tony Redmond, Prof Mukesh Kapila (CBE) and Dr Arpana Verma. The winner’s awards were presented by Dr Gillian Leung (Deputy CEO of NICE) at the International Festival of Public Health. 

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