Health Care in a Flat World

By Frank A. Acevedo, PA-C, MS
PAEA Director at Large

As I join the PAEA Board of Directors, I look forward to working with other PA leaders to meet the needs of our members. And in my role as the new board liaison to PAEA’s International Affairs Committee (IAC), I am also considering how we, as physician assistants, can meet the needs of our ever-changing world.

In his book The World Is Flat: A Brief History of the Twenty-first Century, Thomas L. Friedman presents a compelling argument: that the world has become an integrated global community where services and manufacturing are freely exchanged across international borders. Although his premise deals primarily with economics and the laws of supply and demand, it also has significant meaning when applied to global health care.

Exactly what is global health care and why should we, as PA educators, be concerned with it? The Global Health Education Consortium (GHEC, a consortium of US and Canadian faculty and health care educators, of which PAEA is a member), defines global health care as relating to “health issues and concerns that transcend national borders, class, race, ethnicity, and culture and stress a commonality of health issues that require collective (partnership-based) action.” These are issues that affect everyone, due to merging economies, the informatics revolution, and rapid international travel, which have effectively transformed the Earth into a large “village.” This global village will require the participation of PAs and will also require us as a profession to identify how best we can address the curricular and accreditation issues that will arise.

PAEA has begun to address these needs through its creation in March 2004 of the International Affairs Committee (IAC). In its brief existence, the IAC has become one of the leading international groups within the PA profession. Its efforts to date have produced significant accomplishments and include

• Guidelines for International Electives
• Physician Assistant Programs: A Guide for International Program Development
• A Report on the Findings of the Ad Hoc Committee for International Program Development
• PA International Rotation Issues
• PA International Rotation Checklist
• Sample International Rotation Release
• Global Applicability of Physician Assistants, a presentation given at a GHEC conference

Their work to date provides PA educators and programs with a framework that allows us to intelligently consider how we can participate in “village” medical care.

In March 2005, the IAC also completed a survey on PA faculty international experiences. Results from the 328 faculty respondents revealed that

1. Mexico and Central America were the countries most frequently visited by PA faculty
2. Twenty-one percent of respondents were involved in international patient care activities
3. Thirty-seven percent had experiences in immigrant or refugee health care

While such data clearly illustrate that the PA profession already has a substantial role in international health care, other issues need to be addressed if we are to continue our expansion in this arena. The Institute for International Medical Education has identified seven domains that need to be addressed for successful physician participation in the global community. These are

1. Professional values, attitudes, behavior, and ethics
2. Scientific foundation of medicine
3. Clinical skills
4. Communication skills
5. Population health and health systems
6. Management of information
7. Critical thinking and research

These areas may have significant curricular implications for us as PA educators, should we choose to include them within our current curricula in preparation for our students to take on a greater global role.

It seems likely that we will continue to see an expansion of the PA profession beyond our borders. Currently there are PA-type programs located in England, Canada, Taiwan, and the Netherlands, and further interest in the PA concept has been expressed by many other countries and individuals. Expansion of health care around the world is critical to the well-being of our planet. Previous public health lessons have shown us the undeniable link between poverty and lack of adequate health care and we, as part of a team effort, must address this. Sources like the Earth Institute at Columbia University state that one billion people — one sixth of the Earth’s population — live on one dollar or less a day. Statistics such as these, coupled with the U.S. census data that show 35 million Americans living in poverty, should serve to galvanize PAs’ global involvement in health care.

Our involvement, and that of other countries subscribing to PA-like concepts, may cause changes that none of us can predict. Current PA curricula may require inclusion of areas that are more applicable to the health care needs of developing countries. Issues such as how to best establish proper sanitation facilities, deal with tropical diseases, and locate and maintain potable drinking water are just some examples. Retooling some PA curricular components so that PA faculty and students are better prepared to deal with global health care issues is one of the challenges facing us. Regardless of what the future holds, we can be confident that the IAC and PAEA will work to ensure that the voice of the PA profession is healthy, wherever it is heard. Our “flat world” calls for it.

APAP Update - February 2006