There is little doubt that many in the world lack access to adequate public health systems, and we know that good global health work can help these individuals.
Fortunately, institutions and individuals are becoming increasingly interested in contributing to the field of global health. In fact, global health has become increasingly integrated into medical schools, so even tertiary care centers with little-to-no public health offerings afford their students opportunities to go abroad.
Whether this trend was sparked by the popularization of giants like Dr. Paul Farmer and Dr. Jim Kim, or simply the more practical emergence of budget airlines with international destinations, the number of opportunities for U.S. health care workers and trainees alike to partake in global health work has more than quadrupled since 2003.
However, the growth of opportunities for individuals to partake in global health programs has not been without critique. Largely, arguments have been made about the West’s savior complex, the nonprofit-industrial complex and the shortcomings of “voluntourism.” At the heart of these critiques is the idea that without empowering those actually living a certain undesirable health experience, global health efforts are much less effective than they might otherwise claim to be.
With the rise in number of individuals taking part in isolated global health projects, another caution is warranted. That is, medical peers and health care institutions must put into perspective the amount of social capital afforded to these part-time global health practitioners with the impact said individuals are having.
In both the nonprofit and health care sectors, outcomes have become king. In health care, a push for big data, mining electronic medical records, and tracking HCAHPS scores is commonplace; similarly, for nonprofits, the rise of effective altruism, or using key performance indicators to document impact for investors, has birthed an entire data-driven movement. At the nexus of these two fields, that is, as clinicians or medical trainees who partake in nonprofit global health work, rewards are handed out in the absence of any of the data that characterizes the sectors individually.
There is currently little accountability for individuals who dabble in global health, which presents ethical and health challenges. Consider first the ethical considerations: one must be critical of giving social capital to anybody who works with disadvantaged populations, for the line between being a collaborator for health promotion and building one’s career off of the backs’ of the poor is thin.
Such a quandary is an especially important one to consider for medical students. While professional health care providers already have their careers set, medical students, who as a group are still competing for entrance into their desired field, stand to gain much if they can spin impressive-sounding tales of time spent abroad.
Whether it is for an award, as a component of the residency application, or simply the centerpiece of dinner conversation, global health experience pays dividends. With so much to gain, it is odd that so much deference is given to the anecdote of the supposed doer of global health good. The way we afford social and professional capital to medical trainees for global health work is akin to allowing pharmaceutical companies to have approval for their drugs following a simple qualitative description of why they think their drug is effective — special points given if they can make the story a tear-jerker.
If such a lack of scrutiny existed for drug companies or hospitals more generally, it is not difficult to imagine how people might be hurt. Similarly, affording individuals with little experience in global health the ability to amass as much expertise as they believe they have, whether maliciously or subconsciously, can also have deleterious impacts on health. In a world of limited resources, these individuals often ask for what might otherwise be given to groups that are proven to do good. This is in addition to the havoc and miscommunication that can result when less-than-experts are given responsibility for global health work after they are assigned more than their self-described experience allows them to handle. This leads to less effective global health programming, which drains resources and robs those needing help of the effective solutions they deserve.
For the part-timers, which includes American health care workers who do minimal work abroad as well as the growing number of medical trainees who are grasping opportunities to travel beyond their health institution’s walls, it is important to remember that there exist real global health professionals. There are nurses who accompany the poor every day, not just for a week or two at a time. There are physicians who go where the need is, not where the best sightseeing opportunities are. Most notably, there are the individuals from the disadvantaged communities themselves who have much more than future job prospects riding on if they can help their people to lead healthier lives.
Shadowing a physician does not make an individual a health care worker, and, similarly, spending a short amount of time on a global health trip does not make an individual truly knowledgeable about global health. To claim any sort of semblance of expertise, or for potential employers or peers to apply any similar label, risks invalidating the experience of the true professionals.
None of this is to say that those from the field of medicine in the U.S. cannot or do not have a positive impact on global health. After all, the aforementioned giants Dr. Paul Farmer and Dr. Jim Kim are themselves health care providers. However, these individuals are the exception, not the rule. Students and professionals alike should not stop trying their hardest to impact global health positively, but they should do so with positive health gains in mind. Similarly, those in the position to award capital, whether it be social or professional in nature, to those trying to cash in on global health experiences, must be more scrupulous.
Those involved with health care are already used to having their work critically appraised, and it is time to have the same meticulous attitude towards evaluating those with global health experience. Whether it’s during dinner conversation or a job interview, it’s important to question, ask for evidence, and give deference only after being convinced of the good that’s been done. Doing so will help ensure that the global health movement helps the right people.