Now is not the time for isolationism: integrating global citizenship into higher education for the good of global health

摘要

The future of health care in northern hemisphere nations looks bleak. Within the United States (US), much of the recent political rhetoric has centred around “America First”, and health care reform to limit social medicine. Similarly, across Europe there is increased interest in far-right nationalism and a move away from inclusion. These movements encourage a culture of individualism and isolationism. Confounding the issue is the rise of “alternative facts”, diminishing interest in scientific inquiry, and the lack of meaningful and logical debate. With specific reference to health care, isolationism, coupled with diminishing interest in scientific rigour, will have long-term detrimental implications to the health of a nation. Arguably, higher education is well poised to play a role in encouraging meaningful debate. To achieve this end, it is important that higher education institutions incorporate opportunities for fostering Global Citizenship. The goal of this commentary is not to provide a comprehensive overview regarding these topics, but rather advocate for the continued discussion. Why is isolationism bad for the health of a nation? Public health is a global issue; worldwide there were 57 million deaths in 2008, 63% of which were attributable to non-communicable diseases (NCDs) [ 1 ]. Despite the growing public awareness about NCDs and the consequences of related lifestyle choices, the incidence of NCDs continues to rise which creates a burden on global health care systems. An argument can be made that perhaps “personal responsibility” is not the answer, and that the focus should be on “global responsibility” [ 2 ]. However, “global responsibility” requires increased awareness from the individual. For example, an individual would need to be aware that his/her NCD not only affects his/her own quality of life, but also affects his/her family, community, and nation. For example, in the US, it has been estimated that the total cost of obesity, when limited to lost productivity, could be as high as US$ 66 billion annually [ 3 ]. Moreover, lifestyle choices associated with NCDs, including obesity, have been linked to climate change and subsequent biodiversity loss [ 4 ]. If individuals simply focus on themselves, the consideration of such community, national, and global costs are severely limited. Individual actions can and do have global consequences. With regards to health care reform and the debate around minimizing social medicine, it is important to emphasize that the people being targeted by - and most likely to benefit from -social medicine initiatives (eg, low socioeconomic status, the elderly) also experience the greatest health disparities [ 5 ]. These disparities place disproportionate economic burden on societies, stall national productivity, and stress under-resourced health care services [ 6 , 7 ]. While limiting social medicine may result in short-term gains such as decreased health insurance premiums and tax dollar allotment, there is great potential for a long-term consequence of decreased community- and national-level overall health. What is global citizenship and why is it important? There have been increasing calls, from both the political and academic arenas, to ensure the capacity of higher education students to think and act globally in order to effectively address political, social, economic, and environmental problems on a global scale.[ 8 ] This call should be extended to include global health, to encourage the perspective of health to be shifted from “personal responsibility” to “global responsibility”. Although global citizenship is a highly contested and multifaceted term, three key dimensions are commonly accepted [ 9 ]: (1) global awareness (understanding and appreciation of one’s self in the world and of world issues), (2) social responsibility (concern for others, for society at large, and for the environment), and (3) civic engagement (active engagement with local, regional, national and global community issues). While this definition may be imperfect, in order for an institution of higher education to identify an appropriate pedagogical model, there must first be a philosophical platform on which to place the building blocks. How do we foster global citizenship (and global health)? Given the complexity of the latent construct, global citizenship, there is unlikely to be a single pedagogical approach. Nonetheless, there is mounting evidence suggesting that international experiences provide powerful dis -orientating experiences, leading to deep reflection, critical analysis, and synthesis [ 10 - 13 ]. Support should be given to such international experiences, specifically those focused on global health issues. For example, students could use an international experience to investigate social medicine practices in other regions and how societal philosophy affects medical practice. While international exposures can provide particularly powerful dis -orientating experiences, the