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Be More Aware of the World's 'Bottom Billion'

Why don't we teach global health demographics along with such fundamentals as reading and writing well before young people enter college and medical school?

The global geography of death and disease

This op-ed was first published by UCLA Today Online.

By Claire Panosian

This spring, as in quarters past, I will teach global health and development to UCLA undergrads. It's hard work — but it's also a labor of love. After all, how many medical professors get to give the college course they would have most wanted to take, if only it had been offered way back when?

I start with big questions to which we actually have (reasonably) accurate answers. "How many people died in the world last year and what killed them?" is one of my opening gambits, followed by: "How many deaths were preventable? In whom? And why?"

No one posed these questions when I was in medical school. Does someone today? To be honest, I'm not sure. Given the fierce competition for curriculum and the focus on hard science, however, I wouldn't be surprised if more than a few med students still stumble over these global stats.

Which is not to point a finger, but to launch a thesis. With the information now available, and our 21st-century "small planet" mind-set, why shouldn't every well-informed American know something about the global geography of death and disease?

Or, to reframe the question, why don't we teach global health demographics along with such fundamentals as reading and writing well before young people enter college and medical school?

Is it because, as a British friend recently declared: "Americans are the most death-denying people on the face of the earth"? Although her statement has a ring of truth, I don't believe it affects what happens in American classrooms, as opposed, perhaps, to hospitals.

So here's a more plausible explanation. Until recently, easy global health teaching tools — for example, simple maps and tables, as opposed to technical reports and data sets — were hard to find. That's no longer true. International development students, please note: If you want a head start on our class, just look at the "Burden of Disease" cartograms recently added to the social, economic and health world maps at www.

Through my seminar, I've also learned the importance of putting a human face on the diseases we discuss, which is why I pull out all the stops when it comes to photos, videos and storytelling.

Finally, why should any of us who do not work in international development or medicine or public health care about the diseases of others far away? There are many answers to this question — too many, in fact, to cover here.

Rather than emphasizing the old, fear-based argument ("global bugs are gonna getcha"), teachers should start with fundamentals of global health that most people in the "bottom billion" still lack: water and sanitation, adequate nutrition, literacy and health information, safe childbirth, preventive vaccines, bed nets.

I'm all for distributing excellent drugs and building better hospitals in developing countries, but the first list equals the most basic building blocks of survival and hope. If nothing else, we should all know where these fundamentals still do not exist — and their toll on human lives.

Panosian, a clinical professor of medicine and infectious diseases, is co-founder of UCLA's Program in Global Health.

UCLA International Institute