Peter H. Koehn

Transnational Competence in an Emergent Epoch

The article elaborates a framework for understanding the relevance of transnational competence to the dynamics that mark the transformations of our time. Nongovernmental stakeholders interacting through dense civil-society networks that permeate domestic-foreign frontiers bear increasing responsibility for the course of events. Based on linked interests, interorganizational knowledge generation and aggregation, partnerships, and interpersonal/intercultural interactions, they are deeply involved in addressing the many challenges posed by an ever more interdependent world. Transnational competence lubricates transterritorial networks and projects. Here, the authors extend earlier work that posited a worldwide skill revolution both by developing explicit dimensions of transnational competence and by introducing a behavioral component. The new framework provides analytical groundwork for explaining why some people, groups, and networks are more effective than others in forging meaningful transnational solidarities, negotiating and benefiting from the intensifying experience of globalization, and waging successful transnational campaigns. The article also probes how the spread of transnational competence is being facilitated by global migration and transmigration trends. The final section explores the governance implications of expanding transnational competency for the emergent epoch.

Medical education for a changing world: moving beyond cultural competence into transnational competence.

Given rapidly changing global demographic dynamics and the unimpressive evidence regarding health outcomes attributable to cultural competence (CC) education, it is time to consider a fresh and unencumbered approach to preparing physicians to reduce health disparities and care for ethnoculturally and socially diverse patients, including migrants. Transnational competence (TC) education offers a comprehensive set of core skills derived from international relations, cross-cultural psychology, and intercultural communication that are also applicable for medical education. The authors discuss five limitations (conceptual, vision, action, alliance, and pedagogical) of current CC approaches and explain how an educational model based on TC would address each problem area. The authors then identify and discuss the skill domains, core principles, and reinforcing pedagogy of TC education. The five skill domains of TC are analytic, emotional, creative, communicative, and functional; core principles include a comprehensive and consistent framework, patient-centered learning, and competency assessment. A central component of TC pedagogy is having students prepare a “miniethnography” for each patient that addresses not only issues related to physical and mental health, but also experiences related to dislocation and adaptation to unfamiliar settings. The TC approach promotes advances in preparing medical students to reduce health disparities among patients with multiple and diverse backgrounds, health conditions, and health care beliefs and practices. Perhaps most important, TC consistently directs attention to the policy and social factors, as well as the individual considerations, that can alleviate suffering and enhance health and well-being in a globalizing world.

Underneath Kyoto: Emerging Subnational Government Initiatives and Incipient Issue-Bundling Opportunities in China and the United States

At present, progress in mitigating global GHG emissions is impeded by political stalemate at the national level in the United States and the Peoples Republic of China. Through the conceptual lenses of multilevel governance and framing politics, the article analyzes emerging policy initiatives among subnational governments in both countries. Effective subnational emission-mitigating action requires framing climatic-stabilization policies in terms of local co-benefits associated with environmental protection, health promotion, and economic advantage. In an impressive group of US states and cities, and increasingly at the local level in China, public concerns about air pollution, consumption and waste management, traffic congestion, health threats, the ability to attract tourists, and/or diminishing resources are legitimizing policy developments that carry the co-benefit of controlling GHG emissions. A co-benefits framing strategy that links individual and community concerns for morbidity, mortality, stress reduction, and healthy human development for all with GHG-emission limitation/reduction is especially likely to resonate powerfully at the subnational level throughout China and the United States.

Globalization, migration health, and educational preparation for transnational medical encounters

Unprecedented migration, a core dimension of contemporary globalization, challenges population health. In a world of increasing human mobility, many health outcomes are shaped by transnational interactions among care providers and care recipients who meet in settings where nationality/ethnic match is not an option. This review article explores the value of transnational competence (TC) education as preparation for ethnically and socially discordant clinical encounters. The relevance of TCs five core skill domains (analytic, emotional, creative, communicative, and functional) for migration health and the medical-school curriculum is elaborated. A pedagogical approach that prepares for the transnational health-care consultation is presented, with a focus on clinical-clerkship learning experiences. Educational preparation for contemporary medical encounters needs to include a comprehensive set of patient-focused interpersonal skills, be adaptable to a wide variety of service users and global practice sites, and possess utility in addressing both the quality of patient care and socio-political constraints on migration health.

Transforming the Boundaries of Health Care: Insights from Somali Migrants

Despite its growing practice, transnational medical care has not yet been embedded as a critical component of health research, professional practice, or analyses of changes in the social determinants of health. Biomedical practitioners in Finland have failed to take into account the transformative role of transnational health care. Consequently, Somali migrants do not receive informed advice on how to incorporate distant practices into physical and mental health plans. By connecting here-and-there (Finland and Somaliland) studies involving outlooks on and experiences of illness, healing, and interactions among Somali migrants and their medical providers, we show how transnational connections augment personal resilience.

Great-Power Decentralization and the Management of Global/Local Economic Policy and Relations: Lessons in Fluidity from the People's Republic of China

This article compares the practice of great power federalism in terms of global/local economic policy and relations in a context of expanding regional influence and transcontinental reach. The authors contrast Chinas recent decentralization experience with that of the FRG and the United States with respect to management of productive ventures, regulation of the economy, trade and commerce, fiscal relations, monetary policy and labor mobility. The three great-power states manage their complex and far-reaching economies through systems of multi-level governance that exhibit elements of convergence at the same time as each is headed in a defining direction. German federalism is making room for supranational involvement, US federalism emphasizes new managerialism at all levels of government and Chinas post Mao de facto federalism is launching provincial and sub-provincial governments on a booming economic trajectory. Chinas recent performance is particularly impressive given the size of its population and the extent to which its economy has been transformed and energized. In key respects, Chinas administrative system is the most decentralized and fluid. The effective participation of Chinese sub-national entities in transterritorial economic undertakings is particularly striking. Chinas experience suggests that the requisite energy and capacity to tackle trans-national economic challenges might lie at the sub-national level. Given the shifting nature of global pressures and local priorities, the extra-organizational sensitivities and linkages of sub-national public managers must include proximate and distant economic conditions, central government overseers and trans-national actors. In this dynamic context, the most fluid forms of federalism are likely to have an edge.

State Land Allocation and Class Formation in Nigeria

The distribution of land-use rights both defines and shapes African political economy. Control over land can be utilised in various ways to accumulate capital for either autonomous or comprador investments in the domestic economy. The acquisition of official titles to land concomitantly affords the holder opportunities to exploit those who do not possess this valuable resource. For these reasons, command over land offers the state a powerful means of regulating access to the dominant class. This study focuses on the ways in which allocations of statutory certificates of occupancy have affected the on-going process of class formation in two northern States of Nigeria: Kano and Bauchi. We are particularly interested in identifying, through information collected from a sample of application files, those elements of the population who were admitted and denied access to the dominant class through the land-allocation process during the late military-rule period, 1976–9.

Enhancing International Research and Development-Project Activity on University Campuses: Insights from U.S. Senior International Officers.

In the interconnected world of the UN Decade of Education for Sustainable Development, the ability of higher-education institutions to contribute to and benefit from international research undertakings, sustainable-development-project activity, and capacity-building endeavors requires transnational involvement. While the potential benefits are many, universities in the global North face institutional and financial constraints that limit their involvement in cross-border ventures. The article explores and places in comparative perspective the views of 40 U.S. senior international officers (SIOs) on changes they believe would enhance their university’s involvement in international research and overseas development-assistance projects. One important objective of this report is to generate awareness and further discussion regarding ways in which higher-education administrators can promote institutional involvement in international research and development projects. While a majority of the SIOs at non-Ph.D.-conferring institutions and at universities with enrollments of 15,000 and less believe that improvement in some dimension of their external environment would be most helpful in encouraging greater involvement in international research and development-project activity on their campus, three-fourths or more of their counterparts at Ph.D.-conferring institutions and at universities with enrollments that exceed 15,000 students identified an internal change as most needed. Viewed in totality, these exploratory findings suggest the need for diversified and long-term additionality in both internal and external financial support for campus-based international research, development-project, and capacity-building initiatives. Additional campus-based and external support will enable planned international research and development initiatives in less-connected regions of the world, such as Africa, to go forward.

Indigenous studies and intercultural education: the impact of a place‐based primary‐school program

The article presents a student‐impact assessment of a model two‐year place‐based intercultural approach to indigenous education. Students at Lewis & Clark Primary School in Missoula, Montana, connected face‐to‐face with tribal educators and members residing in the nearby American Indian reservation. The program’s learning outcomes included impressive gains in knowledge of Montana tribes, fewer stereotypical images, enhanced consciousness about the histories and cultures of the place in which students’ reside, heightened appreciation for and connectedness with Native Americans, and increased cultural awareness. The power of the place‐based intercultural‐education approach is that K‐5 students can acquire cultural knowledge, break stereotypes, and develop new appreciation for, and interest in, diverse peoples and issues by directly experiencing the local context in which diversity resides.

Clinician/Patient Connections in Ethnoculturally Nonconcordant Encounters With Political-Asylum Seekers: A Comparison of Physicians and Nurses

The article compares the ability of nurses and physicians to connect with patients in ethnoculturally nonconcordant clinical encounters with 41 randomly selected political-asylum seekers (PAS) residing at five Finnish reception centers in summer 2002. Doctors and nurses were equally unlikely to draw congruent assessments of the patient’s past and present health condition, mixed use of biomedical/ethnocultural practices, adherence with medication and eat/drink instructions, (dis)satisfaction, and future confidence in recommended biomedical and ethnocultural approaches. Nurses were considerably more likely to hold views that were congruent with the patient’s reported health care effectiveness in Finland. The findings suggest that doctors should request and place special weight on the insights of the principal attending nurse when assessing the potential contributions of personal, family, and host-society health care assets and inhibitors to a migrant patient’s overall health plan. The results also suggest that culturally sensitive health care training offers specific advantages to nurses who attend to PAS.