Global Health als Themenfeld in der medizinischen Ausbildung – eine qualitative Studie unter Global Health-Lehrenden in Deutschland

Health and medicine in Germany are increasingly influenced by factors beyond national health systems, traditional country borders or international organisations. The flow and exchange of goods, information, human resources, patients and pathogens across countries change the way we understand health and its determinants and change the way we practice medicine. There is a growing worldwide demand to adapt the medical education to the impact of globalisation, among others by integrating Global Health into the medical curriculum. Until now there is no full consensus on the definition and understanding of Global Health. This study uses a grounded-theory methodology based mixed-method design to gain insights into GH teaching within German medical education. We conducted 10 in-depth interviews with 11 experts and an online survey for participant validation to explore the understanding, teaching contents and didactics among German GH teachers. Findings were categorised under four questions: (1) What is Global Health? (2) Which topics belong to Global Health? (3) How can Global Health be taught? and (4) What is important for the future of Global Health? Within these findings we present the historical background of Global Health, its relationship with Public Health, International Health and Tropical Medicine, contents and main goals associated with Global Health, target groups of Global Health education, teaching forms, didactic approaches, integration into the medical curriculum and ideas for the future development of Global Health in German medical education and in general. Central finding of this study is the understanding of Global Health as an umbrella term. The term was used by one interviewee and its concept reverberated in other interviews as well. Building on its metaphorical use, we developed the concept of a core and half shadow cast by an umbrella to illustrate how Global Health relates to other disciplines like Public Health and International Health or Tropical Medicine, and also how contents associated with Global Health can be part of the core aspects, that is the umbra, of Global Health or rather be part of the more diffuse penumbra. As core element of Global Health, we identified the understanding of supraterritorial determinants of health. These determinants of health go beyond traditional borders and territories and are usually not covered by traditional models of socioeconomic determinants of health. In our final model we demonstrate what this understanding of Global Health looks like and how it can be applied to Global Health training within the medical education. The globality and complexity of Global Health necessitate a transdisciplinary approach and innovative teaching forms. We show ways, how this can be integrated into the medical curriculum and how Global Health can serve the overall goal to educate medical doctors in the 21st century with an understanding for the global interdependencies that influence health, with intercultural competencies and a transformative approach that encourages responsibility and moral and political awareness. To our knowledge this is the first study using in-depth interviews with Global Health teachers in medical education to explore their GH understanding and practice. Understanding Global Health as an umbrella term is a new concept that harmonises some of the existing discrepancies in Global Health definitions. By presenting supraterritorial determinants of health as its genuine core, we distinguish Global Health from more arbitrary understandings and argue for a unique perspective that cannot be covered by existing disciplines. Based on our interviews we can show how the Global Health understanding among German Global Health teachers in medical education reflects some of the international debates surrounding Global Health’s colonial heritage and its normative demands. An awareness for these issues can be a chance to promote a broader learning and understanding in medicine by strengthening approaches from the social sciences. An analysis of the Global Health landscape in Germany and current political developments reveals its relevance for today’s society and its growing recognition in national and international policies. Understanding Global Health as an umbrella term can help shape future Global Health education, research and practice. Fostering its integration into the medical curriculum can contribute to educate medical professionals for this century equipped to meet the needs of a society in a globalised world.