Voluntourism followup

Hi everyone,

Thanks for the great discussion at the last QSM session! I hope everyone was challenged on the issues around medical volunteerism and voluntourism.

As promised, here's a great article that encompasses many of the issues we discussed:

GLOBAL HEALTH ETHICS FOR STUDENTS
ANDREW D. PINTO AND ROSS E.G. UPSHUR

http://www.ncbi.nlm.nih.gov/pubmed/19302567

Abstract
As a result of increased interest in global health, more and more medical students and trainees from the ‘developed world’ are working and studying in the ‘developing world’. However, while opportunities to do this important work increase, there has been insufficient development of ethical guidelines for students. It is often assumed that ethics training in developed world situations is applicable to health experiences globally. However, fundamental differences in both clinical and research settings necessitate an alternative paradigm of analysis. This article is intended for teachers who are responsible for preparing students prior to such experiences. A review of major ethical issues is presented, how they pertain to students, and a framework is outlined to help guide students in their work.

Voluntourism

International health experiences, and more broadly, any type of overseas volunteerism in the the developing world has become increasingly popular. Amoungst medical students in the US, 5.8% completed such an experience in 1978. In 2003 it jumped to more than 1 in 5; 22.4%.

However, in the midst of this growth many tough questions around the ethics and implications of these experience for host communities have been short changed. For example, what are our own intentions when undertaking these experiences? What are the consequences for the local community, good and bad? What are the overarching goals of these experiences?


If you have 5 minutes:

To Hell with Good Intentions - Ivan Illich

Written in 1968, but still relevant today, Illich turns the idea of ‘mission-vacations’ on its head, arguing that these projects are irredeemably mired in hypocrisy. Using his experience with 'voluntourists' in Latin America, he argues:

- Good intentions are meaningless when the result is a ‘do-gooder’ army that offends many Mexicans.

- Volunteers are ultimately selling an American value system and ‘seducing’ the ‘underdeveloped’ with the benefits of their way of life. This value system is a product of American consumerism with little in common with the local community.

- Ultimately, volunteers have no ability for a meaningful dialogue with those they are ‘helping’. Their only meaningful exchanges can be with Latin American versions of themselves, the educated and middle class elite.

Finally Illich urges the volunteers to stay at home and work for change in their own communities, where their work can be understood and have meaningful consequences.

If you have 10 minutes:

Read the full article. Much more powerful then our bullet points and worth the time:
http://www.swaraj.org/illich_hell.htm

For a medical perspective, read this short piece from the BMJ: Medical tourism can do harm
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1117889/

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If you have 5 minutes:

Watch this 4 minute video from Free the Children. If extolls the virtues of the type of experience Illich rails against.

http://www.youtube.com/v/0J9ZqW5KyDE?autoplay=1


As physicians where does this leave us? There are clear inequities in health and health care in Canada and overseas. Do we have a role in addressing them? If so, how do we do so responsibly and respect the principle of 'do no 'harm?' If not, what is our role in dealing with health disparities?

After our discussion, we'll post an article that addresses these issues in it's own way.

Fast food, fat profits: Obesity in America (& Canada?)

As a follow-up to our discussion, here's another take on industry influence on the way we eat. Josh Rushing of Al-Jazeera explores the world of cheap food for those living at the margins. What opportunities do people have to eat healthy? Who is responsible for food deserts and processed food in schools? Rushing finds food revolutions taking place and speaks with the people that are fighting back.

Canada's Food Guide

Before 2007, the last major revision to Canada's Food Guide was in 1992 - a full 15 years before. Despite the gap, it is not an insignificant government document destined for a dusty book shelf. It has far reaching implications, with schools, hospitals, retirement homes and other institutional settings directly deriving their menus from the it. However, it's methodology and final recommendations have come under heavy criticism for being a product of "big food" and "a recipe for dramatic increases in premature death resulting from chronic diet-related disease."

Given this, how valid is the 2007 version of the Canada Food Guide and what is its utility in practice?


If you have 5 minutes:

Critics have pointed to a number of changes calling into question the guide:

1. Health Canada's Food Guide Advisory Committee included representatives from organization with a vested interest changing the food guide. 25% of parties in the review were from the food industry and included the BC Dairy Council, the Vegetable Oil Industry of Canada, Food and the Food Consumer Products Manufacturers of Canada (representing Cadbury, Pepsi-Cola, Conagra).

2. The food guide is "obesogenic." The fewest calories anyone following the new guide would consume daily is 1700 (females aged 19–50), assuming they only drank water, didn't use salad dressing or have dessert. A middle-aged, sedentary woman of average height would burn about 1500-1900 calories per day.

3. Curious changes have been made to serving sizes. For example, lower consumption of fruits and vegetables (for most categories, a daily intake of 5–8 servings, as opposed to the 5–10 recommended in the 1992 edition) has been recommended, as has more consumption of meat (an intake of 4 servings for men, instead of the 2–3 urged in 1992). The Food Guide also includes a My Food Guide section allowing customization of serving guidelines, that based only on age and gender without taking into account acitivty level, height and other factors, is infact misleading.

4. In June 2010, the 2010 Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans was released. When compared to the 2007 Canadian Food Guide, significant differences are present calling into question the use of evidence based recommendations. For example, the US guidelines suggest increasing the intake of seafood and fat-free/low-fat milk products and consume moderate amounts of lean meats, poultry, and eggs, whole milk, pudding and chocolate milk The Canadian Food Guide does not recommend an increase in the amount of seafood and puts no limits or cautions on meat consumption. It lists in their online guidance.

If you have 15 minutes:

Article in CMAJ

Dr Yoni Freedhoff, a family doctor practicing bariatric medicine has been the guide's most vocal critic and outlines his concerns in the press and in his blog:
Canada's Food Guide to Unhealthy Eating
Big Food Has a Seat
2010 American Dietary Guidelines vs. 2007 Canada's Food Guide
The Bad Joke that is "My Food Guide"

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The following is Health Canada's explanation of their process and methodology in developing the Canada Food Guide.

If you have 5 minutes:

Health Canada and the Food Guide

In 2004 HC undertook a significant revision of the food guide in a effort to respond to changes in Canadian food habits and to address concerns with the last iteration of the food guide in 1992. This led to a revised food guide in 2006. Criticisms of the old food guide included vague terms such as ‘moderation’, poor representation of ethnic and multicultural foods and a sense that the guide itself had become visually outdated.

In terms of its evidence base HC used a computer modeling processes to determine what food intake patterns ought to be among Canadians of various age and gender groups. Food composites (a measure of various nutrient values) were generated and compared against daily recommended intakes (DRIs) of various nutrients. After a number of attempts, HC arrived at a simulated diet for Canadians in terms of nutrient quantity.

In the second step, HC used surveys that showed what real foods were being eaten by Canadians as a way to test their models and to arrive at how much of actual food should be eaten by people to achieve an appropriately nutritious diet. Essentially, the first step of the process arrived at a diet based on abstract nutrient counts, whereas the second step converted these into actual foods that people might consume. Eventually, by cycling between these two steps, the Food Guide as it stands was developed.

HC describes the strengths of the food guide as ‘flexibility, simplicity, visual appeal, widespread awareness and its consistency with current science’. HC promotes the Food Guide as non prescriptive, reflecting food that is both available in the market and food that is widely consumed already by Canadians.

If you have 15 minutes:

Read the full methods on the Health Canada website

Food for Thought

When we are asked to advise patients on obesity, eating to manage chronic disease and eating at various stages of growth and development, we often cite the Food Guide as a tool that is available to help make healthy food choices.Indeed, allied health professionals may also use the Food Guide to help patients in their healthy lifestyle efforts.However, it is clear that these recommendations are not without a number of challenges and indeed, are not universally accepted.

The question is: should we be recommending the food guide as a tool for patients? If so, which patients are likely to benefit from it? For those patients who are unlikely to benefit, what alternatives do we have to offer them, and are we prepared to spend scant available resources to provide appropriate education?

Redefining Health

Three stories of the social determinants of health and a social medicine approach. Produced by the Community Health Promotion Network Atlantic, based in St. John's, Newfoundland.

http://www.changingourpictureofhealth.ca/
http://www.chpna.ca

Redefine. Rebuild. Reconnect: Changing our picture of health from Population Health Working Group on Vimeo.

The Right to Health

Munk Does Healthcare

Hi everyone! Thanks for great turnout at our first Queen's Social Medicine meeting on Essential Medicine. Hopefully the next topic will invite just as much lively discussion.

In 2004, Canadians voted Tommy Douglas, father of medicare, as our 'Greatest Canadian.' Beating out the likes of Wayne Gretzky and Pierre Trudeau, this was not only a testament to the stature of Douglas, but also showed the value we place on our health system and has surrounded the debate on how to move reform forward.

Many reformers have looked outside our own borders to draw lessons for change at home. Our closest neighbour has garnered much of that attention and was the focus of the 5th bi-annual Munk Debate (June 2010).

Debating the resolution "Be it resolved I would rather get sick in the United States than in Canada" were physician leaders from both countries. On the PRO side was Bill Frist (former US Senate leader and surgeon) and David Gratzer (Canadian psychiatrist with a cross-border practice). On the CON position was Howard Dean (former Governor of Vermont, US presdentital candidate and family physician) and Bob Bell (CEO of UHN and surgeon).

If you have 15 minutes:

Check out this excellent summary from Steve Paikan of TVO's public affairs program 'The Agenda.'

If you have 60 minutes or more:

CBC Idea's has a 53 minute abridged version of the debate available here. If you're a fan of podcasts, it's also available through iTunes.

If you'd like to see the entire debate uncut and in video, you can watch it from the Munk Debates website.

Make sure to use the following log-in information:
Username: queenssocialmedicine@gmail.com
Password: Virchow123

Keep this in mind as you wait for the video to load.

If your curious about the choice of password, this should help.