Five Powerful Myths of Undergraduate Global Health Education

Undergraduate education in global health (GH) is, in many ways, a very young field. Although GH has roots in long-established disciplines such as epidemiology, biology, anthropology, sociology, communication, and economics, the interdisciplinary interweaving of these areas of study into a coherent curricular approach to health at the undergraduate level is quite recent. Indeed, the first undergraduate majors in GH are fewer than ten years old. This issue of Diversity & Democracy highlights some of the innovative thinking and creative problem solving that characterize programs in undergraduate GH education.

As with any interdisciplinary endeavor or emerging field, those working within GH education, particularly at the undergraduate level, have had to battle a number of misconceptions and mischaracterizations that can hinder the development of effective programs and student experiences. In this essay, we consider five of the most powerful myths that continue to affect the design, development, and implementation of GH education.

Myth 1: “Global” means only international.

This is one of the most common misconceptions facing GH educators and students. As educators based in the United States, we find that the common and limited understanding of “global” to mean only the study of health outside the United States illustrates a number of related problems. First, and perhaps most significantly, it positions the United States as the center of the world and of GH study, with US scholars and institutions presumed to be “reaching out” to the rest of the world through their involvement with GH education. This problematic positioning of Western conceptions of health, medicine, and education as the standard permeates many of the discourses of GH—from the delegitimization of field experiences within the United States as not “really” GH work, to the assumption that the United States represents the pinnacle of GH practice and training (when in fact hundreds of health metrics and indices show the United States is well below other high-income countries and even many low- or middle-income countries), to the exclusion of voices from the Global South or other regions in larger conversations about the field. This mind-set is found throughout many high-income countries and remains one of the most intractable legacies of colonialism and imperialism, which should not be perpetuated in curricular programs.

We can see a clear example of this issue by looking at problems with experiential learning opportunities (ELOs) in certain settings. Many institutions and students inaccurately see domestic ELOs as less valuable than those that take place abroad. Yet domestic ELOs within GH programs can be highly impactful, as showcased in the powerful reflective essays presented by Merrill and by Edmunds, Henry, and Kovalesky in this volume. In addition, the centering of the US perspective feeds into a “savior complex,” the artificial belief that lower-income peoples around the world need assistance from researchers and students from higher-income institutions, which can be deeply problematic both for students and for the communities taking part in ELOs. (For a student reflection on such assumptions, see Devenney’s article.) Programs that do not consciously challenge such beliefs may conduct research or provide volunteers while simultaneously undermining local infrastructural changes and accomplishments and reducing the empowerment and development of local human capital.

At the institutional level, the interpretation of “global” as “international” can hinder broader interdisciplinary collaborations, especially when faculty and professionals doing domestic health-related work are unaware that their expertise could fit under the GH umbrella. And more narrow definitions of “health” can preference natural and biological sciences while precluding the engagement of programs that address ethics, mental health, social health, and community design. In this issue, West and Montgomery detail the idea of “structural competency” as a powerful frame to help students grapple with and understand these pervasive problems.

Myth 2: Undergraduate global health is a fad.

As we noted earlier, undergraduate programs in GH are quite young relative to the fields upon which they draw. This can cause concern in some quarters that the “global health” model of undergraduate education may not stand the test of time—that perhaps, like some short-lived educational trends, undergraduate GH programs will lose their luster and be replaced by the next shiny new thing.

While no one can predict the future, we argue that the foundation of undergraduate GH is deeply grounded in the fundamental nature of liberal education more broadly. GH programs ask students to think deeply about complex problems, to work collaboratively, and to draw creatively on a wide range of perspectives and ways of knowing. In other words, undergraduate GH programs position students to enter a range of health-related fields with a greater awareness of how their particular work depends upon and intersects with the work of others. The persistent and complex health-related challenges facing people around the world today indicate that we need more people trained in such interdisciplinary ways.

Institutions committed to engaging their undergraduates in the study of GH have a range of options, including curricular majors or minors, tracks within existing programs, and summer or short courses designed to introduce foundational GH concepts. Institutions can choose programs or activities that draw on existing institutional strengths. In this volume, we showcase both a reflexive assignment that could fit within a single GH course (see Rodriguez’s essay) and a semester-long multicourse collaborative exercise (the World Café) that engages students and faculty across disciplines in an in-depth discussion of a particular health problem (see Sage, Prichard, and Finnegan’s article).

Myth 3: Global health education is just public health rebranded.

Some institutions respond to the perceived novelty of undergraduate GH by assuming that global health is merely another name for public health, which has been clearly defined by professional organizations such as the Association of Schools and Programs of Public Health. What these institutions miss when they draw such an equivalency, however, is how different the missions of public health programs, which are designed as professional training programs, are from the missions of undergraduate GH programs. Undergraduate students with GH training are attuned to a wide range of factors that affect contemporary understandings of health, expertise, and responsibility in ways that are essential to enacting meaningful change. A personal reflection by Sarkar explores the sorts of broader learning made possible by GH experiences.

At the undergraduate level, GH is fundamentally a liberal approach to education, exposing students to a range of ways of knowing and learning about the world so they can engage problems from many perspectives, from the economic to the ecological to the political. GH education challenges students to think differently about the ways that health is constituted in different settings, with diverse groups of people, over time. In undergraduate GH experiences, students are taught to think about problems as complex and multifaceted, often without “right” answers. Undergraduate GH education is an area of study dedicated to producing educated global citizens who are well positioned to follow a wide range of professional and clinical pathways. As one example, Faerron Guzmán’s essay highlights a physician’s reflection on the incredible benefits that could accrue to clinicians if they had access to GH education at the undergraduate level prior to their clinical training.

Myth 4: Effective global health education programs can simply compile existing courses from established departments under a new name.

In times of tight fiscal constraints, administrators may look for low-cost and straightforward solutions to attract or retain students. One such strategy is to rebrand clusters of courses without the necessary design or intent to provide a coherent curriculum in GH (see Whitehead’s article). This approach is parallel to the way that some “pre-med” programs have been built, combining a string of unlinked courses created to fulfill medical school entrance requirements rather than designing a coherent curriculum.

Even programs that explicitly state a desire to provide an interdisciplinary approach to GH in their undergraduate curriculum may end up with a set of courses that are mostly based around electives within a range of approved disciplinary areas. Unlike the definitional question in Myth 3 above, campuses encountering this misconception may have good institutional buy-in about the interdisciplinary goals and importance of GH but lack the investment of resources needed to create and sustain a robust program. In other words, this problem is more about the practical allocation of institutional resources and governance structures than it is about intent. This problem can be found both at larger institutions where resources for interdisciplinary work tend to be allocated by program or number of enrolled students and at smaller institutions that may not have direct expertise in a particular area and thus need to draw on cognate fields.

Although GH takes an interdisciplinary approach to health problems, that does not mean that an institution can simply throw together an epidemiologist, anthropologist, economist, political scientist, and biologist and have a coherent GH program. If they want to avoid creating a collection of distinct courses that share only a common topic area, institutions need to invest in professional development focused on interdisciplinary collaboration and teaching for faculty and staff who have been trained in particular disciplinary practices.

In these amalgamated collections of courses, students often do not have clear opportunities to integrate multiple perspectives and reflect on their own practices and experiences. Although the expedient course of action to create an undergraduate GH program is just to glue together existing courses, such efforts actually hinder the development of GH education as a distinctly interdisciplinary way of teaching students to engage with their world.

And of course, as we address below, faculty labor is not the only labor needed to create and sustain such programs. GH programs require a great deal of staff support for students, particularly for ELOs, internship development, and professional networking. These efforts are likely to fail if the needs of GH students are simply added into the workload of full-time faculty (see Rusk’s article) or support and administrative staff members who already have a full load of other responsibilities.

Myth 5: Field experience is a luxury, not a necessity.

Because of the high costs associated with field experiences, many programs designate them as optional. Institutions often ensure that some ELOs are available but may not provide the necessary scaffolding within GH contexts, or may encourage interested students to seek out their own opportunities from private providers. In both of these instances, ELOs are presented as luxury opportunities available only to certain individuals.

We acknowledge that institutions require extensive human capital to design, maintain, and administer effective ELOs: time to identify appropriate community partnerships, time to work with partners to help shape the experiences to benefit both the student and host organizations, time to prepare the students before the experience, time to work with the students while they are engaged in their experiences, and time to help the students reflect on their experiences. One important strategy is to utilize existing tools and resources to help achieve program goals. In their essay, McCunney, Reynolds, Sabato, and Young detail one tool (the Global Engagement Survey) that can facilitate student reflection and cultivate the cultural humility that is so essential to the effective cross-cultural work of ELOs.

The costs of ELOs are high not only for institutions but also for students—who, in addition to paying the fees for the program, may also be losing an opportunity to earn money. Thus, even scholarships designed to ease the burden on lower-income students may not adequately address the true costs of participation. However, when colleges and universities ignore the enormous benefits that accrue from these experiences, they end up magnifying existing disparities in students’ preparation for any career or academic pathway by the end of their college years, since those with means still recognize the benefits of these ELOs and take advantage of them, even without any programmatic oversight. Institutions building GH programs have a responsibility to work to address structural inequalities that exist for many of their students—in fact, for the “new majority” of students as discussed by McGrath.

Conclusion

Although this list is certainly not exhaustive, the five myths we discuss here raise issues ranging from broad, philosophical questions facing any institution or individual working within undergraduate GH to some of the practical concerns that institutions must recognize and address for a program to succeed. As higher education in general, and liberal education in particular, have come under increasing public criticism, undergraduate GH education provides a vital and vibrant approach to the foundational principles of liberal learning that equips students to engage effectively with our complex and rapidly changing world.


Vesta Silva is Associate Professor of Communication Arts and Global Health Studies and Caryl Waggett is Associate Professor of Global Health Studies, both at Allegheny College.

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