Internationalization, Social Transformation and Global Citizenship: An Evaluation of Global Health

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Internationalization, Social Transformation and
Global Citizenship An Evaluation of Global
Health

• Lori Hanson, M Sc. PhD (candidate)
• Department of Community Health and Epidemiology,
  College of Medicine, University of Saskatchewan
• Madeline Johnson MSc (candidate)
• Research Assistant

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• What are the curriculum implications of adopting
  a social transformational model of
  internationalization?
• What do we know and what might we learn from
  Global Health as an example? Does it work? How?

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Why does it matter?

• In the worlds richest countries, the income gap
  between the top and bottom quintiles sits at a
  ratio of 741, a change from the 601 ratio in
  1990 and an incredible jump from the 301 ratio
  30 years earlier (Global Health Watch, 2005).

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Why does it matter?

• In health, the gap between developed and LMIC
  countries mirror this trend. The gap in child
  mortality, for example, increased from a 10-fold
  to 14-fold difference between 1990 and 2000
  (Victora, 2005) and with the global spectrum of
  poverty-related diseases such as HIV/AIDS, there
  is now an alarming 48 year discrepancy between
  life expectancy in the richest and poorest
  nations on earth (Marmot, 2005).

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Outline

• Background and concepts (as we are
  operationalizing them)
• Internationalization Three Models
• Social transformation, Social Accountability and
  the College of Medicine at the U of S
• Global Citizenship
• Transformative Learning
• The Class Evaluation Global Health and Local
  Communities Issues and Approaches and Global
  Health II Selected Issues in Nicaragua
• Methods, Results, Lessons learned
• Implications for Internationalizing Curriculum
  in ST Model

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Background

• Internationalization
• Market Model
• Liberal Model
• Social Transformation Model
• (Warner, 1991)

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Internationalization in the COM

• Social accountability vision of medical schools
  (WHO, 1995 Health Canada, 2001)
• Internationalization would support
  inter-disciplinary teaching and research
  approaches that seek socially just and
  sustainable solutions to the North-South divide
  in health
• a reciprocal process, where communities and
  institutions locally and internationally seek to
  share insights and knowledge and to learn from
  the experience, cultures and research of each
  other
• Ultimately, internationalization was to foster
  personal and professional development of capable,
  globally responsive and caring citizens.
  (College of Medicine Integrated Plan 152).

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Global Citizenship

• Citizenship is as much about obligations as it is
  about rights... (Byers, 2005)
• A global citizenship perspective involves not
  only recognition of global interdependence, but
  also awareness of and commitment to societal
  justice for marginalized groups, grassroots
  empowerment, nonviolent and authentic democracy,
  environmental care, and North-South relations
  based on principles of equity, respect and
  sharing" (Toh, 1996 185).

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Global Health and Local Communities Issues and
Approaches

• Sr. undergraduate inter-disciplinary class of
  CHEP created by activists and academics 9 yrs
  ago
• Topics global health issues, population health,
  people-centered development and primary health
  care etc. focusing on local global links
• Transformative learning methods used
• Participatory learning methods
• Community Volunteering for academic credit
• Simulation of Praxis (reflection-action-reflection
  cycles)
• Facilitator vs. Lecturer

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Global Health II Selected Issues in Nicaragua

• six ten week experiential field study
• Similar topics and structure, but in-depth focus
  on Nicaraguas particular health and development
  trends and issues
• cycles of active and experiential learning, and
  reflective sessions
• volunteering with community organizations and
  NGOs (can extend for one month)
• Immersion in rural community

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The evaluation

• Questions
• In what ways is the personally transformative
  potential of GH and GH II a) discussed /
  identified and b) manifest by students who have
  graduated from the class?
• How do GH and GH II contribute to global/local
  citizenship?
• What elements of the classes appear to matter
  most?
• Methods Focus Groups, written surveys, follow-up
  class evaluations by RA
• Participants gt one year since graduating from
  class

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The evaluation findings

• 1) Personal Transformation
• the most valuable part of this course is not
  what we read or what we hear. It is the
  encouragement to improve our skills of critical
  analysis and reflection, to not accept everything
  at face value and to dig deeper to find the
  underlying reasons why things are the way they
  are.
• The course really taught me to keep things in
  perspective Also that it is OK to not know the
  answer etc. It is important to take the time to
  reflect.
• The class helped me to not feel self conscious
  or shy about advocacy this helped give me more
  confidence personally.

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The evaluation findings

• 2) Global Citizenship inward and outward
  dimensions
• by making volunteering with local NGOs a part of
  the class requirements -- That really did break
  the cant participate barrier for a lot of
  people.
• I was apprehensive at first, but now I have lots
  of experience. It began a huge line of
  volunteerism for me.
• The class was the first impetus to evaluating my
  role as a global citizen. I realized the world
  is here Saskatoon too.

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Connections

• If we see profs live out their philosophical
  stances, this makes a huge impact. This prof did
  not set herself up at a higher level than her
  students... I saw her as a fellow learner She
  encouraged participation in class which
  overflowed to participation in Saskatoon
  communities.
• I manifest my values on a daily basis. I try to
  reduce harm socially and environmentally and help
  others do the same.
• I found a new way to look, a new perspective. It
  opened up my eyes to differences and similarities
  between somewhere else and here. I realized you
  dont have to go away to have an impact.

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Implications

• There is just too much information out there
• The university should serve communities through
  outreach and engagement the U of S is
  recognizing this with their foundational
  documents they are trying to go in this
  direction but it should filter through the
  whole university system classes, research,
  experiences, volunteerism, professional
  development. These classes are a great example
  of what the university is trying to do service
  learning, community speakers/perspectives, making
  connections.
• For the instructor It takes a lot of energy to
  be participatory in the class. It takes far more
  teaching time and focus to do that. Its always
  a new experience. You cant just give the same
  lecture over again. So I think its a lot more
  challenging. They the university dont allow
  time. You have to go crazy above board its
  hard.
• Professors should spark you to think, but the
  older profs on tenure teach in the old school
  style of just a paper and an exam this promotes
  students who are unthinking and unquestioning
  consumers

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Take Home Messages

• Internationalization of global health
  curriculum ought to be about more than adding
  global examples - it can ought to be
  transformative
• We can foster global citizenship (where that
  caring community-involved critically aware
  citizens)
• Transformative Learning Theory offers potential
  as a strategy for personal and social
  transformation and a way to help students
  (re-)make needed connections.
• Universities need to support innovation in
  teaching and learning strategies to keep pace
  with growing global health needs, growing global
  disparity and growing interconnections

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But how?Participatory education and
Transformative learning/ed

• Social change education is NOT
• Banking education (Freire)
• Neutral
• Only about structural changes, but also personal
  / cultural change
• TE addresses the other side of the coin, direct
  intervention by the educator to foster the
  development of the skills, insights, and
  especially dispositions essential for critical
  reflectionand self-reflectionon assumptions and
  effective participation in critical-dialectical
  discourse (reflective judgment)essential
  components of democratic citizenship (Mezirow,
  2003)