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The boundaries are closer: international travel have reached the billion per year, international migration now stands at nearly 200 million annually, telecommunications join the heart of Africa and email today allows families maintain contacts throughout the world.
The progress in economic development, education, science and technology have the potential to improve health, but many of these advances are not available in large parts of the world. The World Health Organization recognizes that the disparity in the ability of people to be healthy is a global concern; disparities in health lead with them the threat of epidemics, growing impoverishment and political conflicts. As such, the inequalities in global health is a concern that affects all of us and our families and future generations.
The current global shortage of health workers trained contributes to disparities in santé2. The crisis is deepest in the poorest countries and particularly in Africa subsaharienne3.
The term "international" health describes the work related to health in an international setting (outside the country where a person lives and practice medicine) and the practices, policies and health systems in other countries. The term "global health" is more linked to health problems that transcend national borders, social class, race, ethnicity and culture, and that includes caring for some populations, such as immigrants and refugees, both local and étranger4. In this article, we explore the roles of family physicians and the opportunities available to them in world health, particularly in relation to primary care and family practice.
Primary Care and Health World
The Alma-Ata Declaration of 1978 emphasized the importance of primary care in the world entier5. The World Bank and World Health Organization explained that the most cost-effective health in low - and middle-income can be approached through the first ligne6 care.
The primary care are well placed to contribute to global health. Starfield has shown that countries that are more heavily focused on the primary care are more likely to have better health outcomes and lower costs in santé7 services.
Among the most important benefits of primary care is the potential to contribute to the economic development and well-being familial8. Poverty predispose patients to poor nutrition, overcrowding and poor housing conditions, and increases the burden of disease, such as malaria and tuberculosis, and blessures9-14. The financial burden of the disease can have devastating effects on households précaires15, as seen in countries heavily affected by HIV and sida14. The primary care can help to prevent and treat diseases, thus reducing morbidity and mortality at all socio-economic levels, which, in turn, can contribute to economic growth.
Doctors and family care frontline international
The primary care can promote in many ways health equity mondiale6. This notion is reflected in the principles of family practice, as defined by the College of Family Physicians of Canada16. The Canadian family physicians play a key role in the system of primary care and, as such, are ideal candidates to help achieve the goal of global health for all, locally and globally.
Globally, family physicians can help to strengthen health systems by contributing their clinical skills, their knowledge and dedication. A growing number of Canadian family physicians involved in global health. They provide care, teach, conduct research and are advocates of global health projects.
Contrary to popular belief that the people in developing countries suffer exclusively transmitted diseases, a growing share of the global burden of disease is attributable to chronic problems such as diabetes, hypertension, cancer, mental illness and the traumatismes15, 17. Family physicians are experts in understanding disease undifferentiated, social determinants of health and the first-line treatment of common problems. They have much to offer primary care in resource-poor settings.
In disasters, in crisis situations and in communities lacking resources, family physicians were able to demonstrate the breadth of their training and ability to work in environments healthcare diversifiés18. Despite the wealth of clinical assets found among family physicians, working abroad often requires some additional training. It is important that doctors are well prepared to ensure that the initiatives are profitable.
Most family doctors probably contribute to global health by seeing some patients, as recent immigrants, refugees, foreign students and international travelers. Most Canadian family physicians are more and more people of different cultural beliefs about the disease, different language or suffering from tropical diseases. More than 18% of Canadians were born abroad, a proportion that rises about 40% in Vancouver and Toronto19. In 2005, Canada has welcomed more than 262000 new arrivants20 aimed at incentive programs to settle in the cities and in remote rural areas. The global health concerns not only the people that take into consideration their skills in foreign countries, but also every Canadian family physicians.
Opportunities for family medicine and family doctors
The international health and global health could help revitalize family medicine, to attract new residents and to open new avenues for leadership and research. It is recognized that global health, once the bastion of pediatrics and medicine for infectious diseases, now build on the primary care-a natural habitat for family medicine.
The inclusion of international health programs in family medicine residency encourages more students to choose such programmes21. It has also been demonstrated that the training experience in international health translates into better grades to examens22. In addition, medical students who did an internship optional in low-income countries are more likely to choose rural practice and in a group to be more responsive to the needs and disparities communautaires21.
In addition to the practical reasons, we maintain that the incentive for greater involvement in global health has been part of our collective moral imperatives. As citizens, we have a shared responsibility to decry the deep inequalities, to question them and resolve them. As doctors, the privileged position that we are because of our education, our income and social recognition, not to mention the social contract that binds us to the people we serve, extends into a responsibility to speak and to act on behalf of those who are affected by the inequalities in health. We assert that caring for people in situations of extreme need is governed by both our humanity and our collective oath: "I m'interdirai being deliberately cause harm." Inaction is a source of harm.
It is obvious that the involvement would require additional investment. If we hope to see family medicine and family doctors as actors in the field of global health, we must find ways to increase exposure to global health in prédoctoraux and postdoctoral programs, provide ways to pay family doctors to work at home and abroad and help family physicians to develop the skills necessary to work at the international level. Some residency programs in Canada (University of British Columbia, Laval University and University of Toronto), for example, already offer advanced training in health internationale23. We must raise awareness of the resources available to students and family physicians in active practice to prepare them to work internationally.
Message to remember
The primary care are among the most effective and least expensive to achieve health equity at the global level. The International Health and Global Health has the potential to revitalize family medicine, to put our skills and our diverse abilities, and to help build a global community more healthy.
Family physicians have a role as leaders in primary care in Canada. There is a real need, and countless opportunities available to us to expand our role in the world. The experience we have to contribute as well as our moral obligation, our social responsibility and our professional ethics underpin the expansion of the principles of family medicine to include our commitment to the global community.
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