Editorial Using the COVID-19 pandemic to BMJ Glob Health: first published as 10.1136/bmjgh-2021-005649 on 1 April 2021. Downloaded from reimagine global health teaching in high- income countries 1,2 3 4 5,6 Salla Atkins, Ananya Tina Banerjee, Kathleen Bachynski, Amrita Daftary , Gauri Desai,7 Aeyal Gross,8 Bethany Hedt- Gauthier,9 Emily Mendenhall,10 Benjamin Mason Meier,11,12 Stephanie A Nixon,13 Ann Nolan,14 Tia M Palermo,7 Alexandra Phelan,15 Oksana Pyzik,16 Pamela Roach,17 Thurka Sangaramoorthy,18 15 19 20 21 Claire J. Standley, Gavin Yamey , Seye Abimbola , Madhukar Pai To cite: Atkins S, Banerjee AT, INTRODUCTION educate students to address health disparities Bachynski K, et al. Using The COVID-19 pandemic has changed how wherever they occur, not just in LMICs. While the COVID-19 pandemic to reimagine global health we live, work and communicate. Global health the online format offers many challenges, teaching in high- income teaching is no exception. Across universities, we believe there are ways to increase student countries. BMJ Global Health professors like us have had to quickly rede- engagement and reduce fatigue (box 2). 2021;6:e005649. doi:10.1136/ sign our courses, and deliver them virtually, bmjgh-2021-005649 even as the pandemic continues to bring new challenges every day. Out of that struggle, USE COVID-19 AS A TEACHABLE MOMENT Received 8 March 2021 Even before the pandemic, students in HICs new learning opportunities have emerged. 2 Accepted 11 March 2021 This editorial, coauthored by 20 professors have shown great interest in global health. in seven high-income countries (HICs), aims However, over the last year, we see that student interest in global health has increased signif- to synthesise our learnings and insights from icantly. The pandemic is a powerful example over 25 courses we taught (or are currently to illustrate health interdependence, the teaching).1 We acknowledge upfront that our need for transnational efforts and global soli- insights might not transfer to global health darity,3 and the systemic barriers to achieving teaching in all contexts, especially in settings http://gh.bmj.com/ solidarity.4 It provides a superb example to where the digital divide is worsening educa- demonstrate how equity and human rights tional inequities. We hope to learn from are a core concern in global health. As the similar articles on how our colleagues in COVID-19 situation evolves, each class low/middle- income countries (LMICs) have provides an opportunity to break down in real adapted and innovated with their teaching time how inequities are magnified in times of on October 1, 2021 by guest. Protected copyright. during this crisis. crisis. Indeed, global health professors now Our collective experience suggests that have mountains of new material that can be despite the pandemic chaos and fatigue, global used to illustrate health inequities within health teaching can be improved (box 1) by and between nations, social determinants of using COVID-19 as a teachable moment to health, global health governance, vaccine focus on equity and human rights as a central nationalism, market failures, and the insep- theme, and by integrating anti-racism and arable link between politics, law, economics anti- oppression as core content and orienta- and pandemics. © Author(s) (or their tion in our curriculum. The online format The fact that a handful of HICs have employer(s)) 2021. Re- use allows instructors to centre voices from the monopolised a huge share of the COVID-19 permitted under CC BY-NC. No commercial re- use. See rights Global South, Indigenous scholars, and indi- vaccines is a stark indication of the persistent and permissions. Published by viduals with lived experience of oppression power asymmetry that permeates all aspects BMJ. and resilience. Remote teaching also helps us of global health,5 6 and how existing political For numbered affiliations see reach wider and diverse audiences, including and economic structures can be used to exac- end of article. groups that may not be enrolled in traditional erbate privilege further.7 Correspondence to degree programmes. Learning from COVID- Global health itself needs to be reimagined Dr Madhukar Pai; 19, which is widening disparities within and during this crisis, and global health education madhukar. pai@ mcgill. ca across countries, global health teaching must must use this crisis as a teachable moment for Atkins S, et al. BMJ Global Health 2021;6:e005649. doi:10.1136/bmjgh-2021-005649 1 BMJ Global Health future leaders to implement these changes. The pandem- BMJ Glob Health: first published as 10.1136/bmjgh-2021-005649 on 1 April 2021. Downloaded from Box 1 Adapting content and scope of global health ic’s wide- reaching impact has spurred commensurate teaching during the pandemic wide- reaching interest, including education. Today, we ► Use COVID-19 as a teachable moment, and use it to focus on equity have students from many disciplines showing an interest and human rights as a central theme in global health. in global health, attending our lectures. This can facilitate ► Cover the importance of understanding racism and white su- integration of a transdisciplinary lens into our teaching. premacy in global health, and include content on privilege, anti- Our teaching must frame global health inequities, prob- oppression, anti- racism and allyship. lems, and solutions within the broader context of global ► Include content on coloniality in global health and the persistent governance, economic, legal and political drivers of power asymmetries that affect every aspect of global health. inequality, and historical context (eg, colonialism, slavery, ► Decolonise pedagogy as a means of contributing to ongoing efforts imperialism, structural adjustment, capitalism). towards inclusivity in academia. Indeed, all of us have used COVID-19 examples and Centre the courses, where possible, on Black, Indigenous and peo- ► found our students to be very responsive to topical issues, ple of colour speakers, especially experts from the Global South, Indigenous scholars, and individuals working and living within their particularly as many of our students are joining virtually impacted communities. from all parts of the world and can draw direct compar- ► Teach students to see and address health inequities wherever they ison with each other’s lived experience of COVID-19. occur, not just in low- income countries. To that end, COVID-19 also provides an opportunity to ► Diversify the audience and allow more people to access course showcase the different ways in which HICs could learn content remotely, where universities permit this. from LMICs, and how LMICs and HICs can learn from their COVID-19 response to reimagine their health- care systems.8 9 It has been a humbling experience for countries like the USA and UK that often advised other governments on outbreak response to see large numbers Box 2 Tips and best practices for online teaching of COVID-19 cases and deaths. HICs can learn a lot from successful Asia- Pacific responses to COVID-19.10 ► Begin the class with a short check-in and ask students how they are are doing to show you care about them; talk to students about men- tal health, stress and burnout, and anticipate student and teacher INCLUDE ANTI-RACISM, EQUITY AND DIVERSITY AS CORE fatigue. CONTENT Relax attendance requirements (especially if students are in differ- ► The year 2020 was a year of racial reckoning, and we ent time zones); expect and accept attrition during the live sessions. know racism pervades all aspects of medicine and society. ► Cut back on assignments and examinations; reduce the volume of readings and use shorter rather than longer articles. Global health is neither global nor diverse, and racism ► Avoid long sessions (eg, 3 hours of class time) and incorporate more and white supremacy are major issues in global health breaks in all length classes. that continue to drive population and individual- level 6 11 12 ► Reduce didactic lectures, make them shorter, and use a combina- health inequities. Global health is delivered by http://gh.bmj.com/ tion of live and recorded lectures; use the flipped classroom mod- women and led by men, with HICs dominating every el with recorded lectures made available in advance, and use the aspect of global health.13 Research has shown a profound class time for student questions and discussions. need for ongoing anti- oppression and allyship training ► Alternate synchronous with asynchronous sessions (to address among future public health and global health students Zoom fatigue). and professionals.14 This need is urgent in the context of Use break- out groups and short student-led presentations to en- on October 1, 2021 by guest. Protected copyright. ► COVID-19, decolonisation efforts and Black Lives Matter. hance student interactions and participation. Some of our courses included content on privilege, anti- ► Use audience polls, interactive tools and social media. 15 ► Offer accessible office hours (flexible times for support) and engage oppression, anti- racism and allyship. Such sessions can teaching assistants to enhance student contact. be impactful and set the tone for the rest of the course. ► Assign multimodal content (eg, videos, films, podcasts, webinars, In fact, we would argue that all global health courses music, spoken word) as an alternative to required readings or books must include content on privilege, anti-oppression and (but ensure this time is counted towards the overall effort/time). allyship, informed by anti-colonial and critical race ► Be more lenient and kinder with grading; establish no detriment theory, as well as intersectionality. This is because our policy towards grading. global and public health education system reinforces the ► Forego rigid, examination- style assignments in favour of shorter, same inequities it was designed to overcome. Learning interactive assignments and open- book examinations; prefer es- about oppression that includes racism—specifically how says and short answers over fact-based, multiple choice questions.