Neil Arya

Developing a curriculum framework for global health in family medicine: emerging principles, competencies, and educational approaches

BackgroundRecognizing the growing demand from medical students and residents for more comprehensive global health training, and the paucity of explicit curricula on such issues, global health and curriculum experts from the six Ontario Family Medicine Residency Programs worked together to design a framework for global health curricula in family medicine training programs.MethodsA working group comprised of global health educators from Ontarios six medical schools conducted a scoping review of global health curricula, competencies, and pedagogical approaches. The working group then hosted a full day meeting, inviting experts in education, clinical care, family medicine and public health, and developed a consensus process and draft framework to design global health curricula. Through a series of weekly teleconferences over the next six months, the framework was revised and used to guide the identification of enabling global health competencies (behaviours, skills and attitudes) for Canadian Family Medicine training.ResultsThe main outcome was an evidence-informed interactive framework http://globalhealth.ennovativesolution.com/ to provide a shared foundation to guide the design, delivery and evaluation of global health education programs for Ontarios family medicine residency programs. The curriculum framework blended a definition and mission for global health training, core values and principles, global health competencies aligning with the Canadian Medical Education Directives for Specialists (CanMEDS) competencies, and key learning approaches. The framework guided the development of subsequent enabling competencies.ConclusionsThe shared curriculum framework can support the design, delivery and evaluation of global health curriculum in Canada and around the world, lay the foundation for research and development, provide consistency across programmes, and support the creation of learning and evaluation tools to align with the framework. The process used to develop this framework can be applied to other aspects of residency curriculum development.

Enter at your own risk: government changes to comprehensive care for newly arrived Canadian refugees

On June 30, 2012, most refugees to Canada, including those who arrive seeking asylum, had major cuts to health insurance coverage provided by the Interim Federal Health Program. Coverage for many is now limited to conditions deemed a public health or public security concern. At the eleventh hour,

The roles of the health sector and health workers before, during and after violent conflict.

Starting with a view of war as a significant population health problem, this article explores the roles of health workers in relation to violent conflict. Four different roles are identified, defined by goals and values – military, development, humanitarian and peace. In addition, four dimensions of health work are seen as cross-cutting factors influencing health work in violent conflict – whether the health worker is an insider or outsider to the conflict, whether they are oriented to primary, secondary or tertiary prevention of the mortality and morbidity of war, whether they take an individual clinical or a population health approach, and whether they are oriented to policy and whole-sector change or not. This article explores the nature of these roles, the influence of these cross-cutting dimensions, the challenges of each role and finally commonalities and possibilities for cooperation between roles.

Advocacy as medical responsibility

In his weekly paper, Die Medizinische Reform, Rudolf Virchow termed physicians “natural attorneys of the poor.” In lay terms, advocacy involves an entity of greater power (which physicians with wealth, education and status represent) speaking out for one with lesser power, often for social

General Practitioners’ responses to global climate change - lessons from clinical experience and the clinical method

BackgroundClimate change is a global public health problem that will require complex thinking if meaningful and effective solutions are to be achieved. In this conceptual paper we argue that GPs have much to bring to the issue of climate change from their wide-ranging clinical experience and from the principles underpinning their clinical methods. This experience and thinking calls forth particular contributions GPs can and should make to debate and action.DiscussionWe contend that the privileged experience and GP way of thinking can make valuable contributions when applied to climate change solutions. These include a lifetime of experience, reflection and epistemological application to first doing no harm, managing uncertainty, the ability to make necessary decisions while possessing incomplete information, an appreciation of complex adaptive systems, maintenance of homeostasis, vigilance for unintended consequences, and an appreciation of the importance of transdisciplinarity and interprofessionalism.SummaryGeneral practitioners have a long history of public health advocacy and in the case of climate change may bring a way of approaching complex human problems that could be applied to the dilemmas of climate change.

From darkness to light-Robert J Lifton's the climate swerve - understanding human nature to avert global catastrophe

In 2011 Stephen Greenblatt, Professor of Humanities at Harvard, used the concept of a swerve to describe a major historical phenomenon where a haphazard shift in human consciousness occurs in response to increased sociopolitical understanding. Greenblatt applied this change in how people collectively perceive the world, to the rediscovery of Lucretius’s De rerum natura in 1417, which he argues led to the Renaissance and modern world. In his most recent work, The Climate Swerve: Reflections on Mind Hope and Survival (Lifton 2017), 90-year-old psychiatrist Robert J Lifton has adopted his colleague’s term. In his own words, it ‘is a book about climate change but not a detailed study of its ubiquitous effects, or of its political requirements. Rather it is an exploration of mind and habitat, a meditation on what I call the climate swerve, our evolving awareness of our predicament.’ (Lifton 2017, 9) Beginning with a quotation from the American poet, Theodore Roethke, ‘In a dark time, the eye begins to see’ Lifton goes on to describe how the Paris Accord and Pope Francis’ Laudato Si could represent a global swerve of a ‘collective structured understanding that as a species we are in such great trouble giving us a start in the ability to ‘extricate ourselves from extreme climate catastrophe’ (Lifton 2017, 11). There are signs that our collective fragmentary awareness of events: hurricanes, Arctic ice melting, sea level rising, coral bleaching, certain infectious diseases increasing, migration of species, may be gradually shifting to formed awareness, of a cohesive narrative, with appreciation of cause and effect. Attention to climate change spiked recently in response to the extensive flooding in Kerala, India, droughts in Australia, massive fires in North America and unusual warming in the Arctic. Whether this will translate into an accepted cohesive narrative is yet to be seen, but

Preventing war and promoting peace: a guide for health professionals

Before beginning this review, I should issue a disclaimer. I was asked to contribute to this book (declined) and a few chapters in this volume cite work I have authored. Further, I am part of the P...

Renewing the call for public health advocacy against nuclear weapons

While the Cold War was raging in the 1980s, getting public health schools in the Global North to take a position against nuclear weapons, and to advocate for inclusion of the arms trade and violence in medical and public health curricula, was far easier than it is today. A million-person demonstration in Central Park included the prominent participation of Physicians for Social Responsibility (Kramer 1982). The Institute of Medicine and National Academy of Sciences produced a volume on The Medical Implications of Nuclear Weapons (Solomon and Marston 1986). In 1984 and 1987, the World Health Organization issued reports that presented evidence on radiation, firestorms and climatic effects of nuclear war on health and health services. It found that ‘the only approach to the treatment of the health effects of nuclear explosions is ... the primary prevention of atomic war’ (WHO 1984/1987). The American Public Health Association (APHA) led a demonstration to the Nevada nuclear test site that resulted in high profile arrests and free publicity (Applebome 1986). Throughout the 1980s, scores of Deans of medical and public health schools endorsed the abolition of nuclear weapons. Achieving such organizational endorsement today is far more challenging. Some may believe that the battle is won, others that this threat is of lesser priority, and some still believe that there is no role for public health in political or military matters. This paper is meant to rebut these arguments, to provide a historical perspective, and to renew the case for public health advocacy on nuclear weapons.

Hatred-a public health issue

Hatred may be defined as a ‘negative emotion that motivates and may lead to negative behaviours with severe consequences’ (Halperin 2008). Though these sentiments might accompany it, hatred is not synonymous with extreme dislike, aversion, resentment, anger, or rage. Hatred includes an intense and chronic feeling, a judgment (of its object as ‘bad, immoral, dangerous’ (Navarro, Marchena, and Inmaculada 2013)), and a tendency, desire, or intention to be violent, often to the extreme of destroying its object. Most alarmingly, hatred involves the dehumanisation of the other (Halperin 2008; Harris and Fiske 2009; Sternberg 2005), which serves as a gateway through which moral barriers can be removed and violence can be perpetrated. From a peace studies point of view, hatred might be seen as a prime and extreme, enabler of direct, structural and cultural violence. As such, when contextualised within conflict, hatred may manifest as massive violence, mass murder, and genocide. Whether it engenders widespread physical, psychological, or political violence, each will result inevitably, in equally widespread health consequences. Many of the current violent civil or civil-military conflicts across the globe are either based on, or fuelled by, hatred. Hatred self-perpetuates, usually through cycles of hatred and counter-hatred, violence and counter-violence (sometimes as revenge) (Figure 1).

The Palestinian–Israeli conflict: a disease for which root causes must be acknowledged and treated

Abstract Fourth of June 2017 marks a half century of the Six Day War, three decades post the first Intifada, seven decades post the Palestinian Nakba (catastrophe), the 70th anniversary of Israeli Independence, and one century post the Balfour Declaration. Both Palestinians and Israelis remain occupied. Five million Palestinians remain sick with hopelessness and despair rendered by years of subjugation. Israelis are stuck, occupied by their historical narrative and transcendental fears. Over two decades have passed since the Oslo accords, which both Israelis and Palestinians hoped might be a historic turning point. This was supposed to put an end to the chronic disease of protracted conflict, allowing Palestinians to enjoy freedom in an independent state side by side to Israel and Israelis to live within peaceful, secure borders with the respect of the international community. Palestinians were ready to give up 78% of their land. Free Palestine would be in the remaining 22%, with East Jerusalem as the capital and a satisfactory solution to the Right of Return. The patient’s diagnosis and seeking therapy has been delayed by greed, ignorance, ideology, violence and fear. Accurate diagnosis is needed to successfully heal the wounds and cure this chronic disease.