University medical education in the twenty first century: Challenges of social determinants of health and noncommunicable diseases

Abstract

Background: Research reports indicate that developing countries are experiencing an epidemiological transition consisting of communicable and non-communicable diseases (NCDs) driven by the Social Determinants of Health (SDHs) (1). NCDs cause 60% of deaths globally with 17% estimated increase yearly (1, 5) and are likely to be a major health problem in the twenty first century unless appropriate measures are adopted. The increasing problem of NCDs demands that Medical Education is challenged to better understand the role played by the SDHs if the vision of healthier nations is to be achieved. The SDHs implicated in the etiology of NCDs include unhealthy nutrition, low hygiene, smoking etc. The challenge begins with an analysis of how the Medical Education that is offered at the graduate level prepares graduates in understanding the role of SDH in NCDs.

Objectives: To determine the time that Graduate Medical Schools’ curricula provide for subjects related to the SDHs; analyse the curricula contents to establish how they relate to the SDHs; explore how the bio medical model may influence the graduates’ understanding of SDH role in health.

Methods: A review of graduate-level medical schools’ curricula in East and Central Africa was performed in November and December 2014.

Results: The findings indicate that the curricula contents and teaching is Bio-medical model driven minimizing SDH contents and understanding, and their link with NCDs. Out of the total training time of graduate physicians less than 10% is provided for SDHs related courses.

Conclusion: The curricula and training times provided are inadequate for graduates to fully understand SDHs and their role in NCDs. The Bio medical model addresses secondary causes of diseases-micro-organisms-and is inappropriate for the epidemiological transition evident in the twenty first century. A richer model is needed. This paper suggests an SDH and NCD driven curricula review.

Keywords: University Medical education, Social Determinants of Health, Non-Communicable Diseases, Professional formation