In the summer of 2014, at the height of the Israeli Defence Force’s ‘Operation Protective Edge’, ... more In the summer of 2014, at the height of the Israeli Defence Force’s ‘Operation Protective Edge’, The Lancet published ‘An open letter for the people in Gaza’ signed by Paola Manduca, Iain Chalmers, Derek Summerfield, Mads Gilbert and Swee Ang, on behalf of 24 signatories. The letter denounced what it called ‘the aggression of Gaza by Israel’ and condemned the humanitarian impact of the incursion and of other Israeli actions such as the blockade on Gaza (Manduca et al. 2014a). The publication of the letter stimulated vigorous debate with a further 20 published responses equally divided either in support of, or opposition to, the original letter (Lancet 2014). The letter was branded ‘anti-Jewish bigotry, pure and simple’ by some (Marmor and Spirt 2014), while others claimed that the authors had failed to declare ‘conflicts of interest’ (Stall et al. 2014; Wolf, Brown, and Aharony 2014).
Background: Recognizing the growing demand from medical students and residents for more comprehen... more Background: Recognizing the growing demand from medical students and residents for more comprehensive global health training, and the paucity of explicit curricula on such issues, global health and curriculum experts from the six Ontario Family Medicine Residency Programs worked together to design a framework for global health curricula in family medicine training programs. Methods: A working group comprised of global health educators from Ontario's six medical schools conducted a scoping review of global health curricula, competencies, and pedagogical approaches. The working group then hosted a full day meeting, inviting experts in education, clinical care, family medicine and public health, and developed a consensus process and draft framework to design global health curricula. Through a series of weekly teleconferences over the next six months, the framework was revised and used to guide the identification of enabling global health competencies (behaviours, skills and attitudes) for Canadian Family Medicine training. Results: The main outcome was an evidence-informed interactive framework http://globalhealth. ennovativesolution.com/ to provide a shared foundation to guide the design, delivery and evaluation of global health education programs for Ontario's family medicine residency programs. The curriculum framework blended a definition and mission for global health training, core values and principles, global health competencies aligning with the Canadian Medical Education Directives for Specialists (CanMEDS) competencies, and key learning approaches. The framework guided the development of subsequent enabling competencies. Conclusions: The shared curriculum framework can support the design, delivery and evaluation of global health curriculum in Canada and around the world, lay the foundation for research and development, provide consistency across programmes, and support the creation of learning and evaluation tools to align with the framework. The process used to develop this framework can be applied to other aspects of residency curriculum development.
International Journal of Peace and Development Studies, Feb 1, 2013
Health and peace are complex ideologies that share several fundamental elements. In this paper, w... more Health and peace are complex ideologies that share several fundamental elements. In this paper, we begin by defining health and peace to better understand and appreciate their elements and how they can be promoted. Building on this, the paper tackles the determinants of peace and health at various levels: at the individual, community, and societal level by identifying barriers to health and peace promotion. Using this background, mutual determinants of peace and health are analyzed, with the goal of developing an integrated model that covers both facets of well being.
... Under-standing nonviolence, violence and conflict analyses, reconciliation and conflict resolut... more ... Under-standing nonviolence, violence and conflict analyses, reconciliation and conflict resolution/ transformation ... From anthropology case studies, key informants, partici-pant observation and focus group ... how resilience may be fostered rather than merely treating trauma in a ...
Canadian journal of public health = Revue canadienne de santé publique
The College of Family Physicians of Ontario recently released a comprehensive report on pesticide... more The College of Family Physicians of Ontario recently released a comprehensive report on pesticide exposure and health risk, concluding that various pesticides had adverse health effects. The pesticide industry says that pesticides are "safe" when used as directed because they are studied and approved by governmental agencies. Yet many municipalities, including Canada's three largest, and the province of Quebec have enacted bans on cosmetic use of pesticides, largely in response to health concerns. Reviewing the report, the status of regulation of pesticides and the limitations of studies and of regulation in Canada, it appears that on the basis of evidence available to date, public health officials should support a ban on cosmetic use of pesticides.
Http Dx Doi Org 10 1080 13623690701417311, Jun 21, 2007
This article initially examines the moral dilemmas of war from personal and family experience, fr... more This article initially examines the moral dilemmas of war from personal and family experience, from the perspective of a family doctor trained to preserve life and a member of the peace movement. It then explores Just War from religious viewpoints and the challenges to pacifism from those living in war zones, and from human rights and human security perspectives. It concludes that the Responsibility to Protect reflects sound medical principles balancing the need to make war an extreme last resort with the responsibility of the international community to assist those unable to defend themselves.
Http Dx Doi Org 10 1080 13623690208409646, Oct 22, 2007
Figures for deaths from private use of small arms, particularly in children and young people, are... more Figures for deaths from private use of small arms, particularly in children and young people, are summarized and responses to the discussion of these figures in a recent editorial in the British Medical Journal are considered. It is contended that the figures highlight a major public health problem, particularly in the United States. Further, this article emphasizes that the politicization of the debate by the US gun lobby should not be allowed to obscure the conflict-related consequences of small arms in the developing world.
This Chapter explores applications of decision-making primarily in health care but also examples ... more This Chapter explores applications of decision-making primarily in health care but also examples dealing with environmental challenges and international affairs. It gives recent evidence of failures in each of these sectors and attempts to explain how such errors recur. It then describes some medical approaches to decision-making, evidencebased medicine, guidelines, epidemiology, risk assessment, prevention and screening and how they might apply beyond the world of medicine, even to international affairs. Guidelines and decision-making in medical practice are frequently premised on fundamental logical fallacies and questionable assumptions. These include faulty end points, surrogate indicators and a failure to understand the difference between causation and association. Such mistakes, also occur in international affairs, and seem to be related to narrowly reductionist, 'scientistic' or 'Realist' approaches, which ignore biases and distortions to objective decision-making. Reasons for acceptance of such failures include perceived self-interest and various cognitive distortions promoted in each sector by corporate use of media, think tanks, key opinion leaders, consumer or citizen groups, all which appeal to fears and uncertainties. Recommendations are made for changes to achieve more robust decision-making in each of medicine, environment and international affairs.
Recent threats to the state sovereignty system may be symptomatic of an underlying malaise in Wor... more Recent threats to the state sovereignty system may be symptomatic of an underlying malaise in World Order with the current dominant 'Realist' model failing to live up to its promise. A new model based on principles from the realm of medicine is proposed. Beginning from a sound ethical base, this would redefine the primary role of government as being that of health promoters. In the domain of international affairs it would see governments approaching problems through the public health lens of Primary, Secondary and Tertiary prevention. When considering the need for an intervention, that would violate the autonomy of a 'patient' state which failed to look after the health of its citizens, the guiding principles of Responsibility to Protect seem to reflect sound medical practice and ethics. The example of US difficulties in Iraq is used to illustrate how this health model might have helped with diagnosis, assessing prognosis and determining a more effective treatment plan.
Health pro fes sion als, through their knowl edge of med i cal eth ics, pub lic health mod els, a... more Health pro fes sion als, through their knowl edge of med i cal eth ics, pub lic health mod els, and di rect ad vo cacy may suggest treat ment of the vex ing new prob lems of the 21st cen tury. The evolv ing con cept of Peace through Health en cap sulates such ac tiv i ties, and Cro atian Med i cal Jour nal's ac tiv i ties in the 1991-1995 war in Croatia is one ex am ple of such work. The Re spon si bil ity to Pro tect re port, on the duty of the in ter na tional com mu nity to pre vent geno cide and eth nic cleans ing, shows the con gru ence of med i cal ideas with the do main of in ter na tional af fairs. Col lat eral Dam age, a re port on po ten tial health con se quences of war on Iraq, is a re cent ex am ple of the in creas ing in volve ment of phy si cians in the di rect con duct of world af fairs. Pre ven tion and heal ing on a global scale re quire clear eth i cal prin ci ples for ac tion, just as they do in the per sonal prac tice of med i cine.
Peace through Health is a field of study of how health workers and methods can contribute to peac... more Peace through Health is a field of study of how health workers and methods can contribute to peace. The topic has been developed as an academic discipline and is now taught in universities in several countries. Examples of successful interventions may include humanitarian ceasefires in El Salvador, the formation of International Physicians for the Prevention of Nuclear War, the Landmines convention and the development of the Red Cross. Yet health work can also lead to harm in terms of Peace. A "Conflict analysis tool" can help reduce the chances of negative outcomes. This session is meant to explore such methods, including examples of health work which did not consider conflict analysis, which actually led to worsening of conflict.
International medical electives (IMEs) have demonstrated positive impacts on students' educat... more International medical electives (IMEs) have demonstrated positive impacts on students' education and career development, but there are growing concern about the potentially negative impact of students from higher income countries in healthcare settings in low-income countries. Within Canada, particularly at Western University, students have led development of standardized predeparture training and its evaluation. With the aid of partners from Canada and outside we have conducted a literature review and led a scan of electives offered through 14 Canadian medical schools to document all aspects of these electives and to assess the student and host experience. Preliminary results indicate much variation in the nature and scope of the placements, the pre-departure training offered, and the extent of program evaluation at the schools. We need to assess both pre-departure preparation and global health courses for effectiveness, and develop standardized procedures to prepare students f...
In the summer of 2014, at the height of the Israeli Defence Force’s ‘Operation Protective Edge’, ... more In the summer of 2014, at the height of the Israeli Defence Force’s ‘Operation Protective Edge’, The Lancet published ‘An open letter for the people in Gaza’ signed by Paola Manduca, Iain Chalmers, Derek Summerfield, Mads Gilbert and Swee Ang, on behalf of 24 signatories. The letter denounced what it called ‘the aggression of Gaza by Israel’ and condemned the humanitarian impact of the incursion and of other Israeli actions such as the blockade on Gaza (Manduca et al. 2014a). The publication of the letter stimulated vigorous debate with a further 20 published responses equally divided either in support of, or opposition to, the original letter (Lancet 2014). The letter was branded ‘anti-Jewish bigotry, pure and simple’ by some (Marmor and Spirt 2014), while others claimed that the authors had failed to declare ‘conflicts of interest’ (Stall et al. 2014; Wolf, Brown, and Aharony 2014).
Background: Recognizing the growing demand from medical students and residents for more comprehen... more Background: Recognizing the growing demand from medical students and residents for more comprehensive global health training, and the paucity of explicit curricula on such issues, global health and curriculum experts from the six Ontario Family Medicine Residency Programs worked together to design a framework for global health curricula in family medicine training programs. Methods: A working group comprised of global health educators from Ontario's six medical schools conducted a scoping review of global health curricula, competencies, and pedagogical approaches. The working group then hosted a full day meeting, inviting experts in education, clinical care, family medicine and public health, and developed a consensus process and draft framework to design global health curricula. Through a series of weekly teleconferences over the next six months, the framework was revised and used to guide the identification of enabling global health competencies (behaviours, skills and attitudes) for Canadian Family Medicine training. Results: The main outcome was an evidence-informed interactive framework http://globalhealth. ennovativesolution.com/ to provide a shared foundation to guide the design, delivery and evaluation of global health education programs for Ontario's family medicine residency programs. The curriculum framework blended a definition and mission for global health training, core values and principles, global health competencies aligning with the Canadian Medical Education Directives for Specialists (CanMEDS) competencies, and key learning approaches. The framework guided the development of subsequent enabling competencies. Conclusions: The shared curriculum framework can support the design, delivery and evaluation of global health curriculum in Canada and around the world, lay the foundation for research and development, provide consistency across programmes, and support the creation of learning and evaluation tools to align with the framework. The process used to develop this framework can be applied to other aspects of residency curriculum development.
International Journal of Peace and Development Studies, Feb 1, 2013
Health and peace are complex ideologies that share several fundamental elements. In this paper, w... more Health and peace are complex ideologies that share several fundamental elements. In this paper, we begin by defining health and peace to better understand and appreciate their elements and how they can be promoted. Building on this, the paper tackles the determinants of peace and health at various levels: at the individual, community, and societal level by identifying barriers to health and peace promotion. Using this background, mutual determinants of peace and health are analyzed, with the goal of developing an integrated model that covers both facets of well being.
... Under-standing nonviolence, violence and conflict analyses, reconciliation and conflict resolut... more ... Under-standing nonviolence, violence and conflict analyses, reconciliation and conflict resolution/ transformation ... From anthropology case studies, key informants, partici-pant observation and focus group ... how resilience may be fostered rather than merely treating trauma in a ...
Canadian journal of public health = Revue canadienne de santé publique
The College of Family Physicians of Ontario recently released a comprehensive report on pesticide... more The College of Family Physicians of Ontario recently released a comprehensive report on pesticide exposure and health risk, concluding that various pesticides had adverse health effects. The pesticide industry says that pesticides are "safe" when used as directed because they are studied and approved by governmental agencies. Yet many municipalities, including Canada's three largest, and the province of Quebec have enacted bans on cosmetic use of pesticides, largely in response to health concerns. Reviewing the report, the status of regulation of pesticides and the limitations of studies and of regulation in Canada, it appears that on the basis of evidence available to date, public health officials should support a ban on cosmetic use of pesticides.
Http Dx Doi Org 10 1080 13623690701417311, Jun 21, 2007
This article initially examines the moral dilemmas of war from personal and family experience, fr... more This article initially examines the moral dilemmas of war from personal and family experience, from the perspective of a family doctor trained to preserve life and a member of the peace movement. It then explores Just War from religious viewpoints and the challenges to pacifism from those living in war zones, and from human rights and human security perspectives. It concludes that the Responsibility to Protect reflects sound medical principles balancing the need to make war an extreme last resort with the responsibility of the international community to assist those unable to defend themselves.
Http Dx Doi Org 10 1080 13623690208409646, Oct 22, 2007
Figures for deaths from private use of small arms, particularly in children and young people, are... more Figures for deaths from private use of small arms, particularly in children and young people, are summarized and responses to the discussion of these figures in a recent editorial in the British Medical Journal are considered. It is contended that the figures highlight a major public health problem, particularly in the United States. Further, this article emphasizes that the politicization of the debate by the US gun lobby should not be allowed to obscure the conflict-related consequences of small arms in the developing world.
This Chapter explores applications of decision-making primarily in health care but also examples ... more This Chapter explores applications of decision-making primarily in health care but also examples dealing with environmental challenges and international affairs. It gives recent evidence of failures in each of these sectors and attempts to explain how such errors recur. It then describes some medical approaches to decision-making, evidencebased medicine, guidelines, epidemiology, risk assessment, prevention and screening and how they might apply beyond the world of medicine, even to international affairs. Guidelines and decision-making in medical practice are frequently premised on fundamental logical fallacies and questionable assumptions. These include faulty end points, surrogate indicators and a failure to understand the difference between causation and association. Such mistakes, also occur in international affairs, and seem to be related to narrowly reductionist, 'scientistic' or 'Realist' approaches, which ignore biases and distortions to objective decision-making. Reasons for acceptance of such failures include perceived self-interest and various cognitive distortions promoted in each sector by corporate use of media, think tanks, key opinion leaders, consumer or citizen groups, all which appeal to fears and uncertainties. Recommendations are made for changes to achieve more robust decision-making in each of medicine, environment and international affairs.
Recent threats to the state sovereignty system may be symptomatic of an underlying malaise in Wor... more Recent threats to the state sovereignty system may be symptomatic of an underlying malaise in World Order with the current dominant 'Realist' model failing to live up to its promise. A new model based on principles from the realm of medicine is proposed. Beginning from a sound ethical base, this would redefine the primary role of government as being that of health promoters. In the domain of international affairs it would see governments approaching problems through the public health lens of Primary, Secondary and Tertiary prevention. When considering the need for an intervention, that would violate the autonomy of a 'patient' state which failed to look after the health of its citizens, the guiding principles of Responsibility to Protect seem to reflect sound medical practice and ethics. The example of US difficulties in Iraq is used to illustrate how this health model might have helped with diagnosis, assessing prognosis and determining a more effective treatment plan.
Health pro fes sion als, through their knowl edge of med i cal eth ics, pub lic health mod els, a... more Health pro fes sion als, through their knowl edge of med i cal eth ics, pub lic health mod els, and di rect ad vo cacy may suggest treat ment of the vex ing new prob lems of the 21st cen tury. The evolv ing con cept of Peace through Health en cap sulates such ac tiv i ties, and Cro atian Med i cal Jour nal's ac tiv i ties in the 1991-1995 war in Croatia is one ex am ple of such work. The Re spon si bil ity to Pro tect re port, on the duty of the in ter na tional com mu nity to pre vent geno cide and eth nic cleans ing, shows the con gru ence of med i cal ideas with the do main of in ter na tional af fairs. Col lat eral Dam age, a re port on po ten tial health con se quences of war on Iraq, is a re cent ex am ple of the in creas ing in volve ment of phy si cians in the di rect con duct of world af fairs. Pre ven tion and heal ing on a global scale re quire clear eth i cal prin ci ples for ac tion, just as they do in the per sonal prac tice of med i cine.
Peace through Health is a field of study of how health workers and methods can contribute to peac... more Peace through Health is a field of study of how health workers and methods can contribute to peace. The topic has been developed as an academic discipline and is now taught in universities in several countries. Examples of successful interventions may include humanitarian ceasefires in El Salvador, the formation of International Physicians for the Prevention of Nuclear War, the Landmines convention and the development of the Red Cross. Yet health work can also lead to harm in terms of Peace. A "Conflict analysis tool" can help reduce the chances of negative outcomes. This session is meant to explore such methods, including examples of health work which did not consider conflict analysis, which actually led to worsening of conflict.
International medical electives (IMEs) have demonstrated positive impacts on students' educat... more International medical electives (IMEs) have demonstrated positive impacts on students' education and career development, but there are growing concern about the potentially negative impact of students from higher income countries in healthcare settings in low-income countries. Within Canada, particularly at Western University, students have led development of standardized predeparture training and its evaluation. With the aid of partners from Canada and outside we have conducted a literature review and led a scan of electives offered through 14 Canadian medical schools to document all aspects of these electives and to assess the student and host experience. Preliminary results indicate much variation in the nature and scope of the placements, the pre-departure training offered, and the extent of program evaluation at the schools. We need to assess both pre-departure preparation and global health courses for effectiveness, and develop standardized procedures to prepare students f...
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