Structural competency and global health education.

Structural competency is a new curricular framework for training health professionals to recognise and respond to disease and its unequal distribution as the outcome of social structures, such as economic and legal systems, healthcare and taxation policies, and international institutions. While extensive global health research has linked social structures to the disproportionate burden of disease in the Global South, formal attempts to incorporate the structural competency framework into US-based global health education have not been described in the literature. This paper fills this gap by articulating five sub-competencies for structurally competent global health instruction. Authors drew on their experiences developing global health and structural competency curricula-and consulted relevant structural competency, global health, social science, social theory, and social determinants of health literatures. The five sub-competencies include: (1) Describe the role of social structures in producing and maintaining health inequities globally, (2) Identify the ways that structural inequalities are naturalised within the field of global health, (3) Discuss the impact of structures on the practice of global health, (4) Recognise structural interventions for addressing global health inequities, and (5) Apply the concept of structural humility in the context of global health.

Innovative partnerships to advance public health training in community-based academic residency programs.

Collaborative partnerships between community-based academic residency training programs and schools of public health, represent an innovative approach to training future physician leaders in population management and public health. In Kaiser Permanente Northern California, development of residency-Masters in Public Health (MPH) tracks in the Internal Medicine Residency and the Pediatrics Residency programs, with MPH graduate studies completed at the University of California Berkeley School of Public Health, enables physicians to integrate clinical training with formal education in epidemiology, biostatistics, health policy, and disease prevention. These residency-MPH programs draw on more than 50 years of clinical education, public health training, and health services research - creating an environment that sparks inquiry and added value by developing skills in patient-centered care through the lens of population-based outcomes.

Factors Associated with Hepatitis B Knowledge Among Vietnamese Americans: A Population-Based Survey.

Vietnamese Americans have high rates of hepatitis B virus (HBV) infection but low rates of knowledge and screening. A population-based survey conducted in 2011 of Vietnamese Americans in two geographic areas (n = 1666) was analyzed. The outcome variables were having heard of HBV and a score summarizing knowledge of HBV transmission. Most respondents (86.0%) had heard of HBV. Correct knowledge of transmission ranged from 59.5% for sex, 68.1% for sharing toothbrushes, 78.6% for during birth, and 85.0% for sharing needles. In multivariable analyses, factors associated with having heard of HBV and higher knowledge included Northern California residence, longer U.S. residence, higher education, family history of HBV, and discussing HBV with family/friends. Higher income was associated with having heard of HBV. English fluency and being U.S.-born were associated with higher knowledge. Interventions to increase knowledge of HBV transmission are needed to decrease this health disparity among Vietnamese Americans.

Perspective: postearthquake haiti renews the call for global health training in medical education.

On January 12, 2010, Haiti experienced one of the worst disasters in human history, a magnitude 7.0 earthquake, resulting in the deaths of approximately 222,000 Haitians and grievous injury to hundreds of thousands more. International agencies, academic institutions, nongovernmental organizations, and associations responded by sending thousands of medical professionals, including nurses, doctors, medics, and physical therapists, to support the underresourced Haitian health system. The volunteers who came to provide medical care to disaster victims worked tirelessly under extremely challenging conditions, but in many cases they had no previous work experience in resource-limited settings, minimal training in tropical disease, and no knowledge of the historical background that contributed to the catastrophe. Often, this lack of preparedness hindered their ability to care adequately for their patients. The authors of this perspective argue that the academic medicine community must prepare medical trainees not only to treat the illnesses of patients in resource-limited settings but also to fight the injustice that fosters disease and allows such catastrophes to unfold. The authors advocate purposeful attention to building global health curricula; providing adequate time, funding, and opportunity to work in resource-limited international settings; and ensuring sufficient supervision for trainees to work safely. They also call for an interdisciplinary approach to global health that both affirms health care as a fundamental human right and explores the historical, economic, and political causes of inequitable health care.

Preferences for perinatal health communication of women in rural Tibet.

OBJECTIVE: To describe the most acceptable methods for educating women in Medrogongkar County, Tibet, about healthy pregnancy and safe motherhood. DESIGN: Focus group discussions with key informants were used to develop a quantitative, orally administered random sample survey. SETTING: Thirty-two randomly selected villages in Medrogongkar County. PARTICIPANTS: One hundred and forty-eight multigravida over the age of 18 living in Medrogongkar County. RESULTS: Most participants reported receiving pregnancy-related information either from family members (n=85, 57.4%) or from community health workers (n=81, 54.7%), while very few reported group teaching or radio/television/videos as sources. When asked what modalities of health communication are most effective for them, participants preferred discussions with family members (n=59, 39.8%), specifically their mothers (n=34, 23.0%). Community health worker teaching (n=15, 10.1%) or group teaching (n=7, 4.7%) were reported as less effective. CONCLUSIONS: Despite recent efforts in Tibet to use group teaching, television/radio programs, and health professionals visiting patients' homes as health communication modalities, participants preferred to learn pregnancy-related health messages from their close family, especially their mothers. Future health communication interventions in rural Tibet and similar communities should consider targeting close family members as well as pregnant women to maximize acceptability of advice on healthy pregnancy and delivery.

The Jade Ribbon Campaign: a model program for community outreach and education to prevent liver cancer in Asian Americans.

The Jade Ribbon Campaign (JRC) is a culturally targeted, community-based outreach program to promote the prevention, early detection, and management of chronic hepatitis B virus (HBV) infection and liver cancer among Asian Americans. In 2001, 476 Chinese American adults from the San Francisco Bay Area attended an HBV screening clinic and educational seminar. The prevalence of chronic HBV infection was 13%; only 8% of participants showed serologic evidence of protective antibody from prior vaccination. Participants reported low preventive action before the clinic, but after one year, 67% of those with chronic HBV infection had consulted a physician for liver cancer screening, and 78% of all participants had encouraged family members to be tested for HBV. The increase in HBV awareness, screening, and physician follow-up suggests that culturally aligned interventions similar to the JRC may help reduce the disproportionate burden of disease to chronic HBV infection among Asian Americans.

Public health works: blood donation in urban China.

Recent shifts in the global health infrastructure warrant consideration of the value and effectiveness of national public health campaigns. These shifts include the globalization of pharmaceutical research, the rise of NGO-funded health interventions, and the rise of biosecurity models of international health. We argue that although these trends have arisen as worthwhile responses to actual health needs, it is important to remember the key role that public health campaigns can play in the promotion of national health, especially in developing nations. Focusing on an example set by China in response to a public health crisis surrounding the national need for a clean and adequate blood supply and the inadvertent spread of HIV by way of blood donation in the early 1990's, we argue that there is an important role for strong national public health programs. We also identify the key factors that enabled China's response to this burgeoning epidemic to be, in the end, largely successful.

Informed Consent in cross-cultural perspective: clinical research in the Tibetan Autonomous Region, PRC.

Procedures of Informed Consent are considered a high priority for international biomedical research. However, informed consent protocols are not necessarily transferable across cultural, national or ethnic groups. Recent debates identify the need for balancing ethical universals with practical and local conditions and paying attention to questions of cultural competence when it comes to the Informed Consent process for clinical biomedical research. This article reports on the results of a two-year effort to establish a culturally appropriate Informed Consent process for biomedical research in the Tibet Autonomous Region in the People's Republic of China. A team of Tibetan and American researchers, physicians, health professionals and medical anthropologists conducted the research. The Informed Consent was specifically for undertaking a triple-blind, double placebo-controlled randomized clinical trial of a Tibetan medicine compared with Misoprostol for reducing postpartum blood loss. The findings suggest greater need for flexibility and cooperation in establishing Informed Consent protocols across cultures and nations.