Advocacy and the physician in training moving forward from March Meeting 2013?

The theme of the IFMSA General Assembly in March 2013, “Advocacy and the Physician in training,” acknowledged that advocacy and medicine are inseparably intertwined. Discussions at international conferences such as the “World Health Summit” and reports by eminent organisations such as the Royal College of Physicians UK have also highlighted the ever evolving awareness of the need for physicians to be equipped with advocacy skills. Yet standard medical school education in no way prepares future physicians for this role.

Physicians as advocates is not a new concept. Historically, physicians were known to be those that advocated on behalf of their patients, their communities and stood up for those without a voice. In a climate where social determinants of health are increasingly considered, the advocating physician is required to engage politically, to debate policy and to battle for funding. Currently, to ensure that you are prepared for this role requires extra-curricular involvement and significant time investment. To teach such skills in medical school isn’t to say that all physicians would go on to use them, but it would be the first step to creating a generation of empowered advocates.

To begin considering how advocacy could be incorporated into medical curricula the recent emergence of global health education onto medical curricula could provide a basis. Linking the teaching of advocacy to global health education may promote a culture of linking problem identification to action. In that sense, incorporating advocacy skills into medical education could provide a new culture of thought in which the skills for tackling issues which arise within medical training are provided.

Physicians in training advocate for access to education in Quebec (2012)
Physicians in training advocate for access to education in Quebec (2012)

Within the International Federation of Medical Students Associations (IFMSA) and many of its member organisations, advocacy training and global health education workshops are commonplace and ever-growing. Feedback is consistently positive, and an increasing base of evidence demonstrates the success of these workshops in empowering participants. This year, the Think Global initiative within the IFMSA will aim to continue and broaden the provision of global health education and advocacy skills in order to produce a generation of medical students equipped to change the world!

Current projects include the development of a standardised Global Health Advocacy Training which will be piloted locally in Quebec and at a meeting of the IFMSA in Tunisia. The Think Global project is also in the process of collating resources for this training; all contributions would be welcome at

In the near future we hope to develop this training, disseminating plans and empowering more global health advocates worldwide.

Anya Gopfert & Claudel P-Desrosiers
Think Global Coordinators 2013-2014

PreRM: Global Health Equity and Health Systems in America and the Caribbean

“Action on social determinants of health and health equity means putting social justice at the heart of social action…You are the future and the future in your hands is one that has the potential to improve lives for everybody” Professor Sir Michael Marmot, chairman of the WHO Commission on Social Determinants of Health.

preRM Global Health Equity and Health Systems: National Hospital "San Rafael", El Salvador.

A few weeks ago marked the last day of the 2013 pre-Regional Meeting of the Americas IFMSA region on “Global Health Equity and Health Systems”; and we can only say that everything went beyond our personal expectations.

preRM: Global Health Equity and Health Systems

On the menu of the workshop, we had trainings, dynamics, interactive lectures, videos, group presentations and small working groups on social determinants of health systems, health systems from America, advocacy, global health challenges and new approaches. We also had the opportunity to visit the National Public Hospital “San Rafael” in Santa Tecla, El Salvador. Health systems as identified by the WHO Commission on Social Determinants of Health are one of the crucial determinants of health within countries. The visit to Hospital “San Rafael” was an eye-opening experience, most of us were shocked and impressed at once: shocked because it was far from the reality we are used to; and impressed because Salvadorian health professionals were doing so much with so little. Just as one example, the lack of material is a constant burden on the health professionals, especially interns, as they must, in their daily practice, ventilate manually their patients because they don’t have enough machines to do it.
The reality is straightforward. The world as we know it has never possessed such a sophisticated arsenal of interventions and technologies for curing disease and prolonging life. Yet the gaps in health outcomes continue to widen. Much of the ill health, disease, premature death, and suffering we see on such a large scale are needless, as effective and affordable interventions are available for prevention and treatment. The power of existing interventions is not matched by the power of health systems to deliver them to those in greatest need, in a comprehensive way, and on an adequate scale. Making even harder the achievement of national and international goals without greater and more effective investment in health systems and services.
Even though there is no single set of best practices that can be put forward as a model for improved performance, as health systems are highly context-specific. There are certain shared characteristics in health systems that function well. On day #2 of the workshop we studied the WHO Framework for action on Health Systems, followed by a Comparative Health Systems session. From north to south, Quebec, Mexico, El Salvador, Costa Rica, Colombia, Peru, Argentina and Chile even an adopted latino: Sweden. This might be one of our favorite activities of this preRM, as we saw young medical students sharing their passion and knowledge on their respective national health system. And as the purpose of the Framework for Action a common understanding of what a health system is, what are the fundamental “building blocks” of health systems and what constitutes health systems strengthening were promoted.
preRM: GHE and HS
This interactive session helped us sharpen our vision on our healthcare systems, and we developed a critical eye on what is done already and what could be done better. One striking example of what we were lucky enough to learn about was the Costa Rican health care system which since its creation in the late 1940s, Costa Rica’s Social Security System, known as the Caja, has become the country’s most-respected public institution, providing universal health-care coverage and some of the best health-care services in Latin America. What’s more the World Health Organization frequently place Costa Rica in the top country rankings in the world for long life expectancy. Add that Costa Rica tops the 2012 Happy Planet index and has embraced sustainability in its national policies: it produces 99% of its energy from renewable sources, has reversed deforestation in the country, and has committed to becoming carbon neutral by 2021.preRM: GHE and HSpreRM: GHE and HS


Over the course of those days, we shared knowledge, we shared inspiration, and we shared hope. Slowly, step by step, with trainings on advocacy and public speaking skills along the way, we were able to individually and with a collective approach turn our “wish list” of ideas and concerns about how we might do things differently, and better, on our wards, and in our hospitals and communities into potentially generalized realities whilst creating positive health and social change. A few more sessions on what can medical students do and how can we tackle the global health challenges of today were also on the menu to tool participants up with concrete ideas on what can be done locally, nationally and internationally and turn them into global health equity advocates.
preRM: GHE and HS
We must say: Our stay in sunny Salvador was close to perfect. We met amazing and extremely generous people, who made us feel so welcome in this beautiful country of Central America. We feel extremely blessed for had been able to share those extraordinary preRM days with a group of dynamic, energetic and enthusiastic people convinced that we can close the gap in our generation, young physicians committed to work for “a world where social justice is taken seriously”. It is definitely more than encouraging to put IFMSA mission “to offer future physicians a comprehensive introduction to global health issues” in action. It is indeed through IFMSA meetings and other opportunities that medical students develop cultural understanding, and positively influence the transnational inequalities that shape the health of our planet.
preRM: GHE and HS

Altagracia Mares de Leon, IFMSA Global Health Equity Initiative Coordinator
Claudel P-Desrosiers, President of IFMSA-Quebec

Coordinators of the Global Health Equity PreRegional Meeting of the Americas 2013

[Day 1] Welcome to the PAHO/WHO Regional Meeting!

IFMSA, being active on the international scene as usual, has an exceptional delegation to the 28th Pan American Sanitary Conference (also the 64th World Health Organization Regional Meeting). Altagracia Mares de Leon (IFMSA-Mexico), Daniel Tobon Gracia (ASCEMCOL-Colombia), Sachalee Campbell (JAMSA-Jamaica), Reshma Ramachandran (AMSA-USA) and I are representing the IFMSA delegation at the PAHO Meeting in the hopes to represent and voice out IFMSA’s views on the WHO Reform, Child health, NCD strategy and the Consultative Expert Working Group on Research and Development: Financing and Coordination.      Image

Any WHO meeting has some sort of thrill to it. The first day, and even the first speeches, usually determines the direction that the conference will take. From Dr. Mirta Roses (Director of PAHO) to Dr. Margaret Chan (WHO Director General), the focus was not only on social determinants of health and the past progress of the region in terms of health outcomes but also about the post-2015 health agenda and how Universal Health Coverage needs to be at the forefront of global negotiations. PAHO is a very active Regional Office and it is very well respected by its respective member states. Looking at PAHO’s track record, we can observe that major trends emanating from World Health Assembly resolutions actually come from previous PAHO activities: NCD prevention campaigns, vaccination week, etc.

The question that remains is how to move past the Millennium Development Goals? Are Sustainable Development Goals the answer? Official UN processes are already in place for such goals to be formed, but do they really represent the importance of health? Through discussion with Dr. Margaret Chan today, we learnt that if health has a chance in being included within the seven Sustainable Development Goals, it needs to be a goal which encompasses many avenues and doesn’t exclude specific diseases.

According to Dr Margaret Chan, the answer is simple: Universal Health Coverage. It is broad enough so countries can specify their needs and what needs to be covered but, at the same time, it doesn’t exclude any particular disease group such as infectious diseases or NCDs. We all have come to realize that the best indicator for sustainable development is health. Growing economies are only prosperous if there is a significant trickle down effect which entails an improvement in the health of the general population. Hence, this is why health has become a major issue in the Rio+20 discussion this past June. We can no longer deny the multi-sectorial effect of health and the multifactorial factors on health.

Take NCDs for example: healthy lifestyles are promoted, laudable goal, but it is fairly unrealistic to the majority of the population at-risk of NCDs. NCDs are prevalent in populations that do not have a choice but to make the wrong choice. Most of the time it’s not a case of health education, it’s a case of unavailability of making healthy choices. Low-income parents can only feed their children the cheapest way possible; what if the cheapest way is having breakfast at a fast food chain? Can you blame the individual for feeding their children while managing to pay rent? What if their two years old child gets sick, how would they be able to pay for patented drugs?

Such broad questions demand an answer. At PAHO, Member States are determined to give a direction to such solutions, realistic or not. Only time will tell if we are on the right track.

Stay tuned for the updates of the PAHO meeting!


Alexandre Lefebvre

IFMSA Treasurer 2011-2012,

On behalf of the IFMSA PAHO Delegation