NHS: Global Health

Lord Crisp Excerpts

Monday 20th December 2010 Lords Chamber

Tabled by

[Lord Crisp]

To ask Her Majesty’s Government how they will ensure that the subject of global health is included in the education of all health professionals.

[Lord Crisp]

My Lords, it is a great pleasure to be able to open this debate. I am delighted to see how many noble Lords have decided to take part in it, and I know that a number of others, for reasons of snow and the fact that we already had a large list, have decided not to take part. There is a lot of interest in this subject, and it is something on which there is a great deal of agreement both in your Lordships' House and outside. That agreement is partly the point of the debate, because what we need now is some action.

Professional education in the 20th century has done a wonderful job, not least in the United Kingdom. Life expectancy in the world as a whole has doubled in the century, but the outside world has changed, which means that there is a need for a change in education. There is a broad consensus on what needs to happen, and we can see it happening in many of our leading schools already. As Richard Horton, the editor of the Lancet, has put it:

“health professionals today are not adequately prepared to address the present and coming health challenges—aging populations, chronic diseases, cultural diversity and higher public expectations”.

It is, if you like, the necessary move from a purely doctor and hospital-based model to something much more diverse and local, more community and more person-based. That was a goal of the last Government and I know that it is a goal of this Government. The difficulty as always is to make it happen.

This Question is about global health and the emerging new discipline of global health. Let me explain why I think it is relevant here. I am talking about global health, not international health, which is what we talked about in the last century when we talked about the health of other people. Global health is about the health of all of us—all the issues that affect us all, wherever we are in the world. It is about our interdependence in terms of disease and how it can fly around the world very quickly; in the 14th century, it took three winters for the Black Death to get across Europe, whereas it took three days for SARS to get around the world earlier this century. We are also interdependent in our use of the same staffing and resources and interdependent in terms of the environment and climate change. All kinds of issues affect our health and we began to understand them much better in this past decade than we ever did before.

The second reason is that the diseases from which we suffer have been changing. There are many more non-communicable diseases, and in that context context itself is vital. We are beginning to understand better the social, behavioural, cultural and economic aspects of global health, and the emerging discipline is about taking on these issues and about understanding and acting on the wider determinants of health. Education needs to do this as well.

Thirdly, global health is about recognising that health is about health systems and how healthcare is delivered to individuals and populations. It is not just the theory of the laboratory and lecture room but the reality of the clinic and the community.

The fourth point that drives very many people is that experience in other countries is extremely valuable to us in the UK. Many who are involved in global health are driven by a passion to do something in poorer countries, but it is good for the UK as well. It develops people personally and they can learn from new examples and new experiences, and of course learn about some of the people living in their own country whose origins may have been far away.

Let me refer to the recent Lancet commission report that was published at the end of November, called Health Professionals for a New Century: Transforming Education to Strengthen Health Systems in an Interdependent World. The commission was chaired by Julio Frenk of the Harvard School of Public Health, and by Lincoln Chen of the China Medical Board, of which I was privileged to be a member. This was the first such attempt to look globally, with a global set of commissioners, and to learn from innovation everywhere in the world—not just Europe and America—and to do so across all professions on which we could collect data. It draws out some key lessons about how education needs to happen in the future: about how it needs to be interprofessional and transprofessional, going across disciplines and outside them to involve the public. Education needs to be competence-based, systems-based and IT-enabled.

The report also shows how our institutions need to change, breaking down barriers and connecting not just across disciplines but going outside health across locations and countries. Let me mention just one example that brings it alive: the IHI Open School. There are now 80 chapters in universities across world in 28 countries. This is a coming together of medical students to learn via the internet about subjects that are not covered in traditional courses: quality improvement, systems thinking and such like. They are studying in one school, maybe in the UK, but adding to it from elsewhere. This is the sort of model that I think we will continue to see.

The final point about the report is that it talks about transformational education: the effort to create professionals who are able to lead and make change in today's changed world. A brief illustration of the wide-ranging thinking on this in this country can be seen from the activities of two groups: Alma Mata and Medsin. Alma Mata is a 1,000-strong group of junior doctors and young health professionals from other disciplines. Medsin is also about 1,000-strong and made up of medical students. They advocate precisely that global health should be included in the syllabus and set out their vision for the doctor of the future, which is very important as they are the doctors of the future.

It is encouraging to see that the establishment is responding, including the Royal Colleges—and we have two former presidents of Royal Colleges speaking in this debate. To take one example, the Royal College of Obstetricians and Gynaecologists is very concerned about the lack of support for junior doctors who want to work overseas and who want to include that in their training and not be disadvantaged in their careers by doing so. There are also organisations such as the London International Development Centre, which works with six London institutions and runs, among other things, courses of students as global citizens. There is a very much wider view here about what needs to change. Indeed, developments in partnerships between institutions are very ably supported by THET, and I am delighted to know that Her Majesty’s Government through DfID have launched an even more substantial scheme to promote these partnerships.

There is a lot happening in the UK, but this is a worldwide phenomenon and things are moving faster in the US and Scandinavia than here. I can imagine the Minister saying, “Very good, we’re happy to encourage this, but what has this got to do with Government and the Department of Health?”. My answer is that it really does have an impact on us. I stress that this sort of activity is not just for the benefit of foreigners; it is about creating better health professionals who are better able to care for people of this country with our 21st-century diseases and lifestyles.

I suggest three actions. The first is extremely practical. I ask officials in the noble Earl’s department to report to him on what more can be done to help trainee doctors to spend some time abroad as part of their training and to do so in some numbers, not with the odd one or two who take a risk with their careers. That would make this much more mainstream and much more positive.

Secondly, the Minister’s department should meet the universities and the professional education schools of medicine and nursing and the wider health schools to consider the findings of the Lancet commission and decide what action might jointly be taken to develop the education of health professionals and to get some impetus and coordination behind the moves that are happening all over this country.

My third request is that the Minister’s department provides active support for the involvement of NHS people and organisations in the DfID programme of partnership, recognising that this is a difficult time for the NHS but making it clear from the top that this is good thing for people to be engaged in. It is about the future, and there may even be ways of looking at things like the newly announced early retirement scheme, which might actually help in developing these sorts of programmes.