International Health Collaboration Article for Fmlm

Opinion Article – Published 15th December 2016 International health collaboration - why the UK cannot afford to become isolationist as Brexit becomes a reality

By Felicity Knights and Daniel Knights

Clinical medicine is undeniably a team game. Multidisciplinary teams have long been recognised as central to excellent patient care. More recently, moves towards a ‘health in all policies’ approach has emphasised intersectoral collaboration to tackle underlying health determinants such as education, work, and housing.

But why should playing as a team be limited to the national level? Major health threats today, such as Ebola, access to medicines, and (ignore it at our peril) climate change transcend national borders and thus need global strategies and solutions – something which we saw up close when attending the 69th World Health Assembly (WHA69) earlier this year. As we look towards the implementation of the Brexit vote in 2017, and the UK threatens to pull up the drawbridge on the world, our health leaders need to keep engaging beyond our shores, now more than ever.

The World Health Assembly is arguably the highest decision making arena in global health, acting as an annual forum for debate, negotiation, and collaboration between almost two hundred country members. As British junior doctors, we had the opportunity to represent the World Medical Association (WMA) at the last WHA69 assembly. Our multinational team helped draft or deliver 14 statements and reported on various meetings. WHA69 had the most ambitious agenda ever, with over 75 key documents and 25 separate resolutions adopted, with subjects ranging from the global shortage of medicines and vaccines (WHA69.25) and the global strategy on human resources for health (WHA69.19), to the hot topic of Ebola and future responses to large-scale emergencies (A69/26). At home, the NHS is facing its own human resource crisis; dependent on immigration and our EU workforce, we are not immune to these far-reaching global health challenges.

Not only does the UK desperately need to be involved in global solutions, but it has the potential to lead in their creation. The UK delegation co-hosted WHA69’s side event on anti-microbial resistance, and authored the report on everyone’s lips – the O’Neill Review[1]. This is just one example of the opportunity, and arguably obligation, we have to use our expertise, resources, and leadership capabilities to work with international colleagues to tackle the challenges that threaten us all.

Engaging in international health networks also has the capacity to transform us as leaders. Nick Petrie of the Center for Creative Leadership coined the term ‘vertical leadership development’[2], with the aim of becoming an ‘interdependent collaborator’ – a long-term thinker who is able to hold multi-frame perspectives and contradictions, and see systems, patterns, and connections[3]. Perhaps it seems obvious that such an individual would collaborate internationally, but we also realised that international collaboration is exactly the sort of activity Petrie recommends for fledgling leaders like us to learn and grow.

Petrie describes vertical development as requiring three conditions simultaneously: - ‘Heat experiences’ to disrupt our normal ways of thinking, forcing a search for new and better ways to make sense of challenges - Colliding perspectives to challenge existing mental models - Elevated sense-making – structured reflection to integrate these perspectives and experiences into a more refined world view[4].

As young representatives stepping up to engage in such a high level meeting, a good dose of ‘heat’ was inevitable, with the delivery of interventions providing the proposed ‘high-profile project’ with ‘important people watching’. Petrie recommends peer-teaching to help perspectives collide, and training to develop a systems viewpoint[5]. These features were integrated into our delegation’s schedule through a two-day primarily peer-led workshop, sharing expertise and perspectives on the upcoming agenda. Lastly, we had the opportunity to reflect with and learn from fellow WMA representatives and seasoned experts in the issues we were working on, through both formal and informal meetings.

For us, it was attending WHA69, but there are so many international meetings and networks which combine these three elements. Travelling in itself often provides a ‘heat experience’, and working with global peers inevitably confronts us with different approaches. The threats of the future are increasingly international, and so are the solutions. This is intuitively understood by young leaders – look at how youth voted in the EU referendum, organisations such as the IFMSA (International Federation of Medical Students Associations) internationally, and Medsin in the UK, or the growth of global health courses across the UK. The more we look inward, the less strong we become. In the UK’s current state of turmoil, we need medical leaders who understand how global health issues affect their day-to-day practice, who celebrate diverse perspectives, and who stand up for our European and international NHS colleagues, alongside a zerotolerance approach to racism. We need leaders who collaborate internationally, and encourage others to do the same, incorporating a global perspective, and vertical leadership approach into their mentorship of newer leaders. We may be an island, but we cannot afford to cut ourselves off from the world. International collaboration is essential to tackle the health threats of this generation and many more to come.

With thanks to the World Medical Association.

[1] The Review on Antimicrobial Resistance Chaired by Jim O’Neill. Tackling drug-resistant infections globally: Final Report and Recommendations. May 19, 2016. Accessible from: http://amrreview.org/Publications [Accessed 28 July, 2016] [2] Petrie N. Vertical Leadership Development–Part 1 Developing Leaders for a Complex World. Centre for Creative Development. Available from: http://insights.ccl.org/wpcontent/uploads/2015/04/VerticalLeadersPart1.pdf [Accessed 28 July, 2016] [3] Ibid [4] Petrie N. The How-To of Vertical Leadership Development–Part 2 30 Experts, 3 Conditions, and 15 Approaches. Centre for Creative Development. Available from: http://insights.ccl.org/wpcontent/uploads/2015/04/verticalLeadersPart2.pdf [Accessed 28th July, 2016] [5] Ibid