Perspectives on Global Health

Physiopedia is on a mission to “contribute to improving global health through universal access to physiotherapy knowledge”.  Initially the idea was to produce a free resource for our profession, a Wikipedia for physiotherapists and physical therapists, but we had to ask ourselves, why is this important? The value of this resource is in it’s ability to enable those that otherwise wouldn’t have the opportunity to further their knowledge of physiotherapy and physical therapy, to provide an education to those that wouldn’t other wise have the opportunity.  This makes a contribution to global health. It takes physiotherapy and physical therapy knowledge to places that don’t have a this profession, to those that don’t value rehabilitation as an important aspect of health care and those that would like to become a part of the profession in their local community, where ever that may me.  It also advocates for our profession on a global scale which is certainly needed in relation to some of the challenges we face today.

We (Tony and I) have just completed the open global health course at the university of geneva. There were two purposes for participating in this course.  Firstly, to be a participant on a MOOC (a massive open online course) through a respected provider to enable us to have more knowledge to lead our own open courses in Physiopedia.  Secondly,  to gain an understanding of global health from lead players in this field and to evaluate how this is relevant to Physiopedia and the physiotherapy and physical therapy profession.

So, what did we learn?

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.  Despite these two statements from the WHO Constitution in 1948 our health care systems have traditionally focused on disease care, only recently has there been an increasing focus on prevention of disease, in other words health care.

In the global health field there has been a focus on lifespan rather than the quality of life and this fails to recognise a significant part of of the definition of health provided by WHO and also under plays the importance of the role physiotherapy has to play in facilitating the optimal health of individuals. It is clear that our profession must identify with the importance of quality of life in achieving health, and the role it has in developing this.  The concept of a Disability-Adjusted Life Year (DALY) seems particularly relevant as our work strives to reduce the impact of a disease or disability on a persons health and quality of life. Our impact could be quantified using a measure such as a DALY which could be used to highlight the important contribution of the profession to policy makers, stakeholders and politicians.

There is currently much talk about the growing burden of Non-Communicable Diseases (NCDs) and I will be surprised if we don’t see these included in the  post 2015 agenda following on from the millennium development goals.  We need to be aware of the role of physiotherapy and physical therapy in managing all NCDs including diabetes, lung diseases, cancer and mental illnesses and be sure that we are included in the post 2015 agenda. Being a profession with core values in movement and exercise we are in the best position to tackle one of the key elements that underlies all non-communicable diseases – increasing an individual’s physical activity. With our long term and close patient relationships we are also in an excellent position to facilitate the adoption of other aspects of a healthy lifestyle such as quitting smoking, reducing alcohol intake and modifying diet. To do this we need to develop our role, including developing familiarity with new assistive technologies, as well-being educator and motivator of our patients in addition to being a clinical practitioner.

Serious questions have been raised about current education programmes for health care due to the changing nature of global health challenges such as ageing, changing patient populations, cultural diversity, chronic diseases, care-seeking behaviour, and heightened public expectations.  We need to ensure that we are appropriately skilled for the most important health issues facing our patient populations including non-communicable and age related chronic conditions and that this is included in our education programmes around the world. Educational reform should consider the utilisation of competency driven approaches, inter-professional and trans-professional education to reduce professional silos, utilising e-learning technologies to strengthening educational resources.

NCDs and prevention were two highlighted topics that are particularly relevant to our profession.  However, something that did’t get mentioned was the role that rehabilitation has to play in global health.

A doctor saves a life, a physiotherapist makes that life worth living.

This is a key aspect of our profession that already plays a major part in reducing the burden of many of the worlds health challenges including NCDs, communicable diseases such as TB and HIV/Aids and age related conditions.  In a recent presentation Antony Duttine, a physiotherapist and rehabilitation advisor at Handicap International, poses the question “Will global health ever pay attention to morbidity and disability?”. He concludes with a big yes but states that there is work to do, we are at a tipping point and now is the time for us to seize the moment.  We must advocate at all levels for the role of our profession in reducing these health burdens and we all have a role in doing this.

Finally we noted that the WHO 1948 constitution states that the extension to all people of the benefits of medical, psychological and related knowledge is essential to the fullest attainment of health. We hope that Physiopedia has a small but significant role to play here in the dissemination of physiotherapy and physical therapy knowledge and through providing opportunities for open global education. In developing our resources will strive to consider global health priorities as well as those that reflect the specific needs of the profession.

Mindful of the restrictions and costs imposed by conventional copyright licensing, Physiopedia will continue to make all contributed content available under a Creative Commons licence that allows sharing and adaptation for non-commercial applications. We will remain aware of the limitations and lessons presented by the unsuccessful and successful eHealth pilots in low and middle income countries when developing our own projects to support open physiotherapy education and will also recognise the benefits of south-south collaborations for low and middle income countries and design projects that encourage this type of partnership rather than focusing on high income – low income country relationships.

In relation to our first objective for taking part in this course, be a participant on a MOOC, it is obvious to us that Physiopedia is perfectly placed to offer open online courses providing physiotherapy and physical therapy related education.  In July this year , in collaboration with Michael Rowe from the University of Western Cape in South Africa, we ran the first ever physiotherapy or physical therapy open online course, an 8 week module in professional ethics.  The course was a good pilot, an unexpected success and gave us a great model for future courses.  This combined with our experience of participating in this global health MOOC we feel that we are in the perfect position to offer more open education opportunities for our profession.  This as a great way forward for open physiotherapy and physical therapy education and we are now seeking opportunities to partner with other institutions or educators to offer more open online courses.  If you’re interested please do get in touch!