Global helse i medisinsk utdanning og praksis. Rune Nilsen Professor and Director Centre for International Health University of Bergen

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2 Global helse i medisinsk utdanning og praksis Rune Nilsen Professor and Director Centre for International Health University of Bergen

3 Mitt perspektiv Fokus: 1. Gode Universiteter er ryggraden i et samfunn 2. Helse er bærebjelke for folk hverdag Erfaringsrammer: Universitetsstilling siden 1974 CIH (professor/instituttleder) Styrer og Utvalg Developmental research (NFR/UD/WB/EU inkludert NUFU/NOMA/Kvote) Rectors conference (UHR), Prorektor UiB, and European University Association (EUA)/Bologna Samarbeid og opphold i Afrika/Asia siden 1984

4 Global helse --Hvor er vi? Fra tropemedisin til Global helse Fra sjelden sykdommer til global sykdomsbyrde Fra biomedisinsk og klinisk medisin til helsesystem og intervensjonsorientert virksomhet. Fra «spesielt interesserte» til allment oppdrag Har Universitetenes prioritering og planer beveget seg? Har pensum og studieplaner fanget dette opp?

5 Disability Adjusted Life Years (DALYs) Source: Lopez et al. (2006). Lancet 367(9524) ~

6 Drug development, status 2012 «Of 1393 new chemical entities introduced between 1975 and 1999, only 16 targeted tropical diseases or tuberculosis not a single new product had been approved in the previous nine years in disease categories that include Buruli ulcer, dengue, trachoma, rheumatic fever and typhoid and paratyphoid fevers» TDR: The Global Report for Research on Infectious Diseases of Poverty 201 2

7 In areas with high malaria transmission it accounts for 40% of public health expenditure, 30 50% of inpatient admissions and up to 50% of outpatient visits

8 En historie om bevissthetsutvikling TDR David Morley Alma Ata HIV-epidemien World Development Report, «investing in Health» Paul Farmer Amartya Sen Global Forum for Health Research/COHRED Millenium Development Goals Paul Collier

10 1970 ies David Morley: Teaching Aids at Low Cost Pediatrics in devloping countries Professor London Alma-Ata Declaration Health.. A basic human right Primary Health Care focus

11 Amartya Sen We must think of it as a political issue, connected to responsibilities of government on the one side and the responsibilities of the people on the other, exerting whatever influence we can on policy-making, he said. there is a need for the right to universal access to public health care, just as the country has guaranteed the right to education for all.

12 Global Forum for Health Research /90 gap 2012 Merged with COHRED

13 Global Forum for Health Research Improving health is not only an outcome of development but also a prerequisite for development. Improving health requires the effective application of existing research. Few of the world s resources for health research are directed to solving the health problems of developing countries.

17 Global health

18 10/90 gap in health science Every year the world spends $50-60 billion for health research and development. Only 1 0% of this is used for research on the health problems of 90% of the world s people. The 10/90 Report on Health Research, 1999 Global Forum for Health Research 10/90 gap, --- ikke bare i helseforsking, men og: UTDANNING inkludert reformer i høyere utdanning Helse intervensjonsprogram / Tilgang på kunnskap

19 Norge 2012 Global helse Kunnskapsdepartementet: Lite fokus, og ikke i rapportering Lite fokus på studieplaner Lite kreditt Forskningsrådet Fin ny strategi, men lite «Main streamed» «GlobVac» orientert og avgrenset Helse og Omsorgsdepartementet: Flott strategi for WHO arbeidet Ingen mandat eller signaler til «Helse Norge» Utenriksdepartementet: Veldig fokus, men 4/96??

20 Norge 2012 Global helse Norske universiteter: Strategi og handlingsplaner for «Global kontekst»? Allokerte kjerneressurser for «Global helse»? Stillinger og drift Innhold i studieplaner Grunnstudier Spesialisering Fordypningsmuligheter Norsk helsevesen/helseforetak Mandat til Globale perspektiv?

21 NILE BASIN RESEARCH PROGRAMME Burundi D.R. Congo Egypt (Eritrea) Ethiopia Kenya Rwanda Sudan Tanzania Uganda Challenges: War and exploitation Population growth Climate change Environment degradation Exploited natural resources -by others Lack of collaboration Poverty, Poverty Outside the international knowledge society Kunnskaps Apartheid? Homelands -helse? -utdanning?

22 Seks grunnelementer for Global helse 1. Institusjonelt eierskap og prioritering av Global helse ved universitet/høgskoler, helseforetak Mandat og prioritet fra KD og HOD 2. 10/90 gapet tas alvorlig Strategi, handlingsplan og ressuser fra kjernebudsjettet 3. Kvalitet og tilgjengelighet på kunnskap globalt Del av «excellence» arbeidet Åpen tilgjengelighet, Open Access obligatorisk

23 Seks grunnelementer for Global helse 4. Institusjonelt partnerskap globalt Utveksling og samarbeid i utdanning Samarbeid i forskning og forskerutdanning («NUFU konseptet») 5. Helhetlig Norsk partnerskap i forskning, forskerutdanning, helsearbeid 6. Global helse en integrert og prioritert del av Norsk medisinerutdanning For alle Mulighet for fordypning Mulighet for forskerutdanning

25 1960 årene Maurice King: Medical Care in Developing Countries African Independence Arusha Declaration China Culture revolution village health workers (VHW) Para-medical education Basic health services Basic Needs Hit back in Malaria fight Health Services in the Developing World Increasing focus on Health system

26 1970 ies David Werner: Where There Is No Doctor Selective PHC in DC.. Julia Walsh and Ken Warren 1979, NEJM Hepatitis vaccine developed TDR programme UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR) From LEPROSY(70--) to Roll Back Malaria

27 1980 ies Reactions on Selective primary health focus.. UN report Our Common future Vertical programmes: EPI Expanded Programme on Immunization Ralph Henderson, WHO ARI Guidelines: Acute Upper Resp Infestions Frank Shann, WHO guidelines Vit. A, Al Sommer MDT/leprosy Malaria resistance spreading Water and sanitation.. Increased attention Bangladesh Nation Drug Policy 1982 Essential Drug Programs EMP World Bank Structural Adjustment Building down key structures of societies

28 1990 ies World Bank Increasing power and position Large Sector programmes World Development Report 1993 Investing in Health Increased focus on: Integration and sustainability Cost recovery Quality Increased PRIVATIZATION Starting addressing Adult health HIV shakens the world

29 1990 ies Gro H Brundtland DG i WHO Restructuring of WHO Commission on Macroeconomics in Health Special Initiatives: Roll Back Malaria, Tobacco, Stop TB The Disability Adjusted Life Year (DALY)

30 Verden etter September 11, 2001 USA: mer lukket og lite opptatt av Globalt fellesskap Fokus på TERROR Dramatisk reduksjon av prisene på AIDS medisin Sør Afrika med rettsavgjørelse mot industri AIDS og TB: globale store medikamentprogram Harvard Consensus Statement on AIDS and Infectious Diseases The Haiti Experience (PIH modellen ---Paul Farmer) MDG ---Tusenårsmålene 2000

31 World after September 11, 2001 Focus on terror Not the first 9.11 : Chile/Allende: Pinochet + USA coup 1973 Dramatic reduced prices on AIDS drugs South Africa high court decision! AIDS and TB: global large drug programmes Harvard Consensus Statement on AIDS and Infectious Diseases The Haiti Experience (Paul Farmer) The PIH model of care partnering with poor communities to combat disease and poverty MILLENIUM DEVELOPMENT GOALS

32 World Bank Jim Yong Kim Partners in Health Director of the HIV/AIDS, WHO

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