2001-2002 Challenges of Health in a Borderless World
First NCS Global Health Summer Course

"Globalization and Public Health in Latin America" Cuernavaca, Mexico
August 11-15, 2003

The First Fulbright New Century Scholars (NCS) Global Health Summer Course: "Globalization and Public Health in Latin America" was held in Cuernavaca, Mexico, August 11th through the 15th. Coordinated by NCS Scholar Dr. Nelly Salgado de Snyder, the course occurred as part of the Mexican National Institute of Public Health's (INSP) annual international Summer Program on Actualization in Public Health and Epidemiology.

Participants from 17 Latin American countries and NCS faculty for the summer course in Mexico.

The convening of health specialists from 17 Latin American countries, Cuba and the U.S for this innovative introduction to global health studies stemmed from recommendations made at the plenary session of the Fulbright New Century Scholars Program, "Challenges of Health in a Borderless World: New Directions in Cooperation," held in November 2002. One of the most popular offerings in the summer program, the one-week intensive course was team taught by eight NCS Scholars South and North America, Africa and Australia, along with representatives from the Pan American Health Organization and INSP. The diverse range of participants included faculty, researchers, and graduate students in public health; representatives from health ministries and NGO's throughout the region; and various other health professionals and specialists. Throughout the week, participants explored many current key issues in global health studies -- global trade and public health policies, global governance and health, health transitions in world regions, research issues in global health, the global economy, technology and health, global environmental change and health, social disruption and global health, and information for decision-making in health.

NCS Faculty: Seggane Musisi, Uganda, Richard Scott, Canada, Gabriele Bammer, Australia and in the background Marcos Cueto, Peru.

The course encouraged cooperation and collaborative thinking by engaging participants in interactive discussion and debate. For many attendees, attendance in the course was a unique, once-in-a-lifetime experience. By addressing the treatment of public health through an interdisciplinary approach and in the context of globalization, participants had the opportunity to initiate new "global health" networks throughout the region. In recognition of the challenges of global health and the need to assess both local and international responses to global health issues, participants discussed plans to implement courses in other venues throughout the region - for example, in Lima under the sponsorship of the Andean Organization of Health. It is also anticipated that INSP will include the course as a regular component of its summer program. In order to establish an on-going network of Latin American health experts, participants created an electronic forum to maintain communication and share ideas on new directions in research and training in the field of public health.

The continuing impact of this first summer course on global health launched through the initiative of the Fulbright New Century Scholars Program is already evident in the establishment of new trans-regional, trans-national linkages. These linkages, in turn, will promote on-going dialogue and innovative thinking about meeting the challenges of health at the global and local levels fostered by the New Century Scholars.

A subsequent NCS summer course is planned for the summer of 2004 in Uganda.

INSTITUTO NACIONAL DE SALUD PÚBLICA, MÉXICO
PROGRAMA DE ACTUALIZACIÓN EN SALUD PÚBLICA Y EPIDEMIOLOGÍA
VERANO 2003
Globalization and health challenges in Latin America
La globalización y los retos de la salud en Latinoamérica
August 11-15, 2003 / Agosto11 -15, 2003

MONDAY, AUGUST 11 / LUNES 11 DE AGOSTO

9:00-13:00 ILONA KICKBUSCH

Introduction to global health studies
Introducción al campo de estudios sobre salud global

15:00-19:00 HOWARD WAITZKIN

Global Trade and Public Health Policies
Políticas de salud e intercambio global

TUESDAY, AUGUST 12 / MARTES 12 DE AGOSTO

9:00-13:00 ANN MARIE KIMBALL
Global governance and health: The global and local interface
Gobernabilidad global y salud: La interfase de lo local y lo global.

15:00-19:00 MARCOS CUETO
Health transitions in World Regions
Transiciones de salud en las regiones del mundo

WEDNESDAY, AUGUST 13 / MIERCOLES 13 DE AGOSTO
9:00-13:00 GABRIELE BAMMER
Research issues in global health I
Investigación en salud global

15:00-19:00 V. NELLY SALGADO DE SNYDER
Research issues in global health II
Investigación en salud global II

THURSDAY, AUGUST 14 / JUEVES 14 DE AGOSTO
9:00-13:00 RICHARD SCOTT
Global economy, technology and health
Economía global, tecnología y salud

15:00-19:00 ENRIQUE CIFUENTES
Global environment change and health
Medioambiente global y salud

FRIDAY, AUGUST 15 / VIERNES 15 DE AGOSTO
9:00-13:00 SEGGANE MUSISI
Social disruption in world regions in the context of global health
Las crisis sociales en el mundo en el contexto de la salud global

15:00-19:00 ULYSSES PANISSET
Information for decision making
Información para la toma de decisiones en salud

COURSE COORDINATOR / COORDINADORA DEL CURSO
DRA. V. NELLY SALGADO DE SNYDER
INSTITUTO NACIONAL DE SALUD PÚBLICA, MEXICO
AVENIDA UNIVERSIDAD 655
COLONIA SANTA MARIA AHUACATITLAN
CUERNAVACA, MOR. 62508
MEXICO
nsnyder@correo.insp.mx

Dr. Ilona Kickbusch, Fulbright Distinguished Scholar Leader, Yale University, U.S

Dr. Nelly Salgado de Snyder,Fulbright New Century Scholar and Summer Course Coordinator, National Institute of Public Health, Mexico

Dr. Gabriele Bammer, Fulbright New Century Scholar, Australian National University, Australia

Dr. Enrique Cifuentes, Guest Faculty, Nacional Institute of Public Health , México

Dr. Marcos Cueto, Fulbright New Century Scholar, University Cayetano Heredia, Peru

Dr. AnneMarie Kimball, Fulbright New Century Scholar, University of Washington, Seattle, U.S.

Dr. Seggane Musisi, Fulbright New Century Scholar, Makerere Univeristy, Uganda

Dr. Ulysses Panniset, Guest Faculty, Pan American Health Organizeion, Washington, D.C.

Dr. Richard Scott, Fulbright New Century Scholar, University of Calgary, Canada

Dr. Howard Waitzkin, Fulbright New Century Scholar, University of New Mexico. U.S.

The first cohort of Fulbright New Century Scholars met for their final plenary session "Challenges of Health in a Borderless World: New Directions in Cooperation" at the Pan American Health Organization in November 2002. At the meeting, they proposed an agenda for improving health by advocating innovation in public health policy and practice on a global level. Acting as advocates for knowledge production and dissemination in the areas of research, training and capacity-building, community involvement/service and policy, the NCS Scholars recommended the implementation of a series of innovative summer courses that would make available to health specialists at the local levels new perspectives and approaches to global health education and training.

Thanks to support from the ECA of the US Department of State, COMEX, the US Public Affairs Office in Mexico, and the Mexican National Institute of Public Health (INSP), the first such summer course "Globalization and Public Health in Latin America" took place at INSP in Cuernavaca, Morelos, Mexico, August 11-15, 2003. The course was superbly organized by NCS Scholar Dr. Nelly Salgado de Snyder as part of INSP's well-known annual international "Summer Program on Actualization in Public Health and Epidemiology." The INSP summer program consists of approximately 40 separate one- or two-week intensive courses focused on public health, infections diseases, health systems, epidemiology, occupational and environmental health, and biostatistics.

Faculty for the NCS global health summer course included the NCS Distinguished Scholar Leader, Ilona Kickbusch, and several NCS Scholars from South and North America, Africa and Australia, along with representatives from PAHO and INSP. Participants in the course came primarily from Mexico and sixteen other countries in Latin and South America, as well as from the U.S., UK, and Cuba. The course attracted more applicants than any other course offered in INSP's summer program, while the final 50 selected participants far outnumbered the average thirty-person class size. The make-up of course attendees was diverse and included faculty, researchers, and graduate students in public health; representatives from health ministries and NGO's throughout the region; and various other health professionals and specialists.

During the intensive one-week course, participants were introduced to current key issues in global health studies -- global trade and public health policies, global governance and health, health transitions in world regions, research issues in global health, the global economy, technology and health, global environmental change and health, social disruption and global health, and information for decision-making in health. The sessions were highly interactive and provided substantial opportunity for the NCS lecturers to engage course attendees in meaningful discussion and debate. Participants were clearly eager to share and discuss with colleagues throughout the region ways in which the various issues in global health they were learning about, many for the first time, impacted their own countries and what they might learn from one another's experiences.

At the conclusion of the course, participants were unanimous in their evaluation of it as extremely valuable, stimulating and thought provoking. For many of them, the treatment of public health within the context of globalization and from an interdisciplinary perspective was an entirely new approach. Numerous participants commented on the novelty of many of the topics and the importance of the interactive discussions with the NCS lecturers and colleagues from other Latin American countries. Many of them noted that they had never had a similar experience before, that is not only exposure to a very diverse group of leading international health experts but the unique opportunity to interact intensively with a health specialists from so many other diverse Latin American countries and to initiate new "global health" networks throughout the region. Participants viewed their experience with the summer course as instrumental for the development of new directions in their own thinking about the challenges of health on the local and global levels. Many of them hoped to incorporate and implement some of what they had learned into their own teaching and/or practical experience in the area of public health. Many of them expressed the intention to explore possible collaborative activities across institutions, organizations and regions

Most gratifying, in terms of the regional impact of this first NCS summer course, were the plans announced at the conclusion of the course to replicate it in other venues throughout the region, as well as in the U.S. INSP indicated that it will include the course as a permanent component of its summer program, and the Executive Director of the Andean Organization of Health in Lima announced his intention to organize and fund a similar course in Peru. Representatives from the University of North Texas, where Dr. Salgado de Snyder has an adjunct appointment, also shared plans to work with the University of Texas at Arlington to duplicate the course for U.S. graduate students, inviting NCS Scholars as lecturers. A number of other participants who managed their own local events or programs in public health discussed plans for adding a global health component and involving colleagues they had met at the course. For example, the Director of the Ecuadorian Health Foundation indicated he would add a component on health and globalization to an international meeting on health management he is in the process of organizing. Finally, several participants talked about adding a more globalized perspective to the courses they teach.

Besides plans for implementing courses on global health studies throughout the region, participants discussed ways in which they could remain a cohesive group. Many of them saw themselves as participants in an "historic" event and pioneers who would be bringing new ways of thinking about health back to their own institutions and countries but who would also encourage regional cooperation and sharing of expertise as a result of their experience with the summer course. To this end, on the last day of the course, they discussed creating an electronic forum to maintain contact with one another. The enterprise will be a shared responsibility with the participant from Bolivia creating the forum, the participant from Ecuador assuming responsibility for the site's contents, and a participant from Peru agreeing to be the tech support. The group also decided that these responsibilities would rotate every six months among all the participants. They viewed this electronic forum as the first step in forming a network of globalization in Latin America and possibly as the precursor to forming a regional association. At the time of this report, the E- group had already been set up on Yahoo (globalizacion_y_salud group) and members were engaged in communicating through the site.

The one-week course concluded with a farewell dinner for the lecturers and participants. The dinner was also attended by Dr. Miguel Angel Gonzalez-Block, Manager of the Alliance for Health Policy and Systems Research, World Health Organization, and an alumnus of the Fulbright Border Program; Arturo Borja, Executive Director of COMEXUS; Ms. Marjorie Coffin, CAO at the U.S. Embassy, and Ms. Araceli Partearroyo, Director of Academic Programs, U.S. Embassy. Harriet Fulbright gave a talk on Senator Fulbright after dinner.

INSP conducts its own formal evaluation of all the courses included in its summer program. The NCS summer course received the highest rankings in all the evaluation categories (contents, format, adequacy of subject matter, qualifications of professors, time management, organization and logistics) of any of the thirty-seven courses offered during the program.

In sum, the first NCS summer course on global health studies was an unqualified success. It would be difficult to overestimate its impact on the individual participants from the 17 Latin American countries, Cuba and the U.S. or the significant role the course has played in creating a regional network. The comments of Dr. Paneque Estrada, a professor of pediatrics and health administration from Cuba, eloquently reflected what the mood of the group was at the end of the weeklong course:

"We have gained an experience in learning and exchange, we have learned about all the challenges of health around the world and we have gained friends in many ways. We are making history because we are beginning to break the barriers of political ideologies, and we have learned two very important things: that we are diverse but united and that together we can work across borders to create a better world for everyone."