Rede Unida, 10º Congresso Internacional da Rede Unida


Tamanho da fonte: 
Global Health Education in Italy: the experience of Riisg (Italian network for Global Health teaching)
Ardigò Martino, Chiara Bodini, Alessandro Rinaldi, Giulia Civitelli, Brigida Lilia Marta, Ilaria Camplone, Alice Fabbri, Chiara Digirolamo, Angelo Stefanini

Resumo


Globalisation processes, the growing complexity of European society and the yet largely untackled issue of health inequalities are increasingly questioning the capacity of medical education institutions to prepare health professionals capable of addressing current health challenges. From many sides, a call for a greater focus on the social determinants of health and on the global scenario is revitalising the claim for a transformation of conventional health training. In Italy, students have been leaders in advocating for such change, finding in the emerging field of global health (GH) suitable theoretical and practical tools. Due to the innovative view and aims of GH, training health professionals in it is a crucial issue. Teaching can be seen both as a GH activity (therefore reflecting the tight combination of practice, knowledge and ethics that informs this particular field), and as a tool aimed at contributing to the overall goal of health promotion. Paraphrasing Rudolf Virchow, we could say that – in the GH perspective – medicine is a social (con)science, therefore medical education should be driven and informed by the aim of reducing inequalities and improving society as a whole. All institutions involved in training of health professionals, at both under and postgraduate level, should be aware of their responsibility and of the key role they are called to play. With the aim of improving knowledge, attitude and practices of health professionals Public health academics have followed, as well as NGOs, leading in 2009 to the creation of the Italian Network for GlGlobalisation processes, the growing complexity of European society and the yet largely untackled issue of health inequalities are increasingly questioning the capacity of medical education institutions to prepare health professionals capable of addressing current health challenges. From many sides, a call for a greater focus on the social determinants of health and on the global scenario is revitalising the claim for a transformation of conventional health training. In Italy, students have been leaders in advocating for such change, finding in the emerging field of global health (GH) suitable theoretical and practical tools. Due to the innovative view and aims of GH, training health professionals in it is a crucial issue. Teaching can be seen both as a GH activity (therefore reflecting the tight combination of practice, knowledge and ethics that informs this particular field), and as a tool aimed at contributing to the overall goal of health promotion. Paraphrasing Rudolf Virchow, we could say that – in the GH perspective – medicine is a social (con)science, therefore medical education should be driven and informobal Health Education (RIISG). The main objective of RIISG is to improve population health and to reduce health inequalities through improving knowledge, attitude and practices of health professionals. To accomplish this, RIISG aims to foster public and academic debate on GH issues , promote GH teaching at the academic and professional level to fill the gap of present medical curriculum, training professionals to become ethically aware of the commitment needed to improve individual and community health and encourage the dialogue among different disciplines and stakeholders. In its view, GH is meant to be a new paradigm for health and health care, grounded in the theory of health determinants. Such an approach, based on the principles stated in the Alma Ata declaration and backed by broad evidence, can be applied to disease prevention and treatment, as well as to health promotion, for both individuals and populations. The main focus of GH concerns the health status of world population and its socio-economic, political, demographic, juridical and environmental determinants, as well as the relationship between globalisation and health in terms of equity, human rights, sustainability and international diplomacy. Due to the complexity of such issues, the GH approach is necessarily a trans-disciplinary and multimethod one, built on the contribution of natural and social sciences and the humanities. Adopting a transnational view, GH points out health inequalities both within and among countries, framing them through the lens of social justice. GH is not merely an academic field: fostering an ethics of social accountability for institutions, professionals and individuals involved, it encompasses the fields of research, practice and education. Driven by ethics and oriented to the needs of the population, in particular marginalised groups, it aims at producing change in the community and in the whole society, bringing evidence into practice thus reducing the know-do gap. The founding principle of RIISG is the coherence of its practice with the values of GH. The network is participatory and horizontal, avoiding to reproduce the power imbalance that affects Italian university, leaving students, young scholars and civil society out of the decision making process. Innovative actions carried out to create, share and disseminate knowledge include drafting of GH learning objectives open to public consultation, organising of training of trainers, promoting teaching methods designed to foster the active engagement of participants. With the aim of promoting GH teaching at the academic and professional level, and to increase the number of Global Health courses, the Italian Network for Global Health Education developed a proposal for a common syllabus, which includes six teaching modules: Health and its determinants The origins and development of health systems. Health as a human right Globalisation and health Inequalities in health and in health care assistance Immigration and health International health cooperation Introducing new topics such as GH in the Italian old fashioned, often conservative and severely under financed Universities can be extremely difficult. Moreover, the strict legislative organisation doesn’t presently allow the introduction of new compulsory courses within Medical Schools' curricula. Due to these circumstances, we propose practical and alternative strategies in order to spread GH teaching in the Medical Faculties: Introduce some of the suggested topics in related courses (e.g. Hygiene and Public Health, Infectious Diseases, etc). This option gives all medical students the opportunity to be exposed to GH issues, however the poor flexibility of the teaching programmes doesn’t allow an in-depth analysis of the above mentioned topics. Furthermore, it relys on the good will of individual professors, who have to be interested in and committed to GH. Enforce Public Health elective programmes. This approach allows a greater independence in the course planning, such as the adoption of alternative teaching methods (e.g. peer-led learning in small groups, problem based learning, case studies, role playing). However, in this way GH can’t be spread through the whole students’ community because of the optional nature of the course. While we encourage a dynamic debate on these proposals and strategies, we would also like to raise some significant issues that remain open: Explore the possibility of introducing GH topics within post-graduate training paths, as well as in higher education outside the medical sector. Ensure that teaching methods are coherent with the messages conveyed (health promotion, multisector collaboration, community participation, equity). Experiment with innovative teaching methodologies (problem based learning, role plays, case studies, etc.). Develop adequate evaluation tools, for both students and courses (e.g. monitoring of satisfaction and participatory evaluation which involves students and teachers). RIISG activities have been carried out in connection with similar networks from other European countries (UK, Ireland, Germany). Thanks to the EU sponsored project “Equal Opportunities for Health, action for development”, RIISG will in the next three years operate also in connection with academic and civil society partners from Eastern European countries. This will provide the ground for a further dissemination of the experiences made, towards a broader European engagement in the GH field.