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01-03-2020 | Care | Review Article

Healthcare disparities in rheumatology: the role of education at a global level

Authors: Vaneet Kaur Sandhu, Mehrnaz Hojjati, Irene Blanco

Published in: Clinical Rheumatology | Issue 3/2020

Abstract

All fields of medicine are victim to health inequity worldwide, including rheumatology. While the health system is a key proponent to health access for all, other social determinants of health also impact world health. We describe herein the current state of global healthcare disparities in rheumatology and attempts at optimizing graduate medical education and resources for optimized healthcare, international research collaborations and a future of universal health equity. We performed a comprehensive search through Pubmed using the following keywords: healthcare disparities, medical education, access to care, community health.

Key Points

• Healthcare disparities are ubiquitous globally, including the field of rheumatology.

• The heterogeneity of global healthcare disparities emphasizes the importance of addressing unmet needs at a regional level.

• A standardized approach to incorporating healthcare disparities education in the medical field is lacking. Intervening at this level provides a foundation of increasing provider awareness of regional healthcare disparities so as to establish a framework of addressing such disparities in a culturally competent manner.

World Health Organization (1978) Declaration of Alma-Ata. International Conference on Primary Health Care, Alma-Ata, USSR. https://www.who.int/publications/almaata_declaration_en.pdf. Accessed 15 April 2019

WHO Glossary. https://www.who.int/hia/about/glos/en/index1.html. Accessed 18 April 2019

Braveman P, Egerter S, Williams DR (2011) The Social Determinants of Health: Coming of Age. Annu Rev Public Health 32:381–398PubMed

United Nations (2015) Resolution A/RES/70/1. Transforming our world: the 2030 agenda for sustainable development. Seventieth United Nations General Assembly, New York http://www.un.org/ga/search/view_doc.asp?symbol=A/RES/70/1&Lang=E. Accessed 15 April 2019

Dequeker J, Rasker JJ (2000) Rheumatology and the Bone and Joint Decade 2000-2010 ILAR UMER 2000 Project. Clin Rheumatol 19:79–81PubMed

US Department of Health and Human Services (2008) The Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2020. Phase I report: Recommendations for the framework and format of Healthy People 2020. Section IV. Advisory Committee findings and recommendations. http://www.healthypeople.gov/sites/default/files/PhaseI_0.pdf. Accessed 10 April 2019

Alamanos Y, Voulgari PV, Drosos AA (2006) Incidence and prevalence of rheumatoid arthritis, based on the 1987 American College of Rheumatology criteria: a systematic review. Semin Arthritis Rheum 36(3):182–188PubMed

Chopra A, Abdel-Nasser A (2008) Epidemiology of rheumatic musculoskeletal disorders in the developing world. Best Pract Res Clin Rheumatol 22(4):583–604PubMed

Cooper NJ (2000) Economic burden of rheumatoid arthritis: a systematic review. Rheumatology (Oxford) 39(1):28–33

10.

Osiri M, Maetzel A, Tugwell P (2007) The economic burden of rheumatoid arthritis in a developing nation: results from a one-year prospective cohort study in Thailand. J Rheumatol 34(1):57–63PubMed

11.

World Health Organization (2003) The burden of musculoskeletal conditions at the start of the new millennium. Report of a WHO Scientific Group. WHO Technical Report Series 919, World Health Organization, Geneva. http://whqlibdoc.who.int/trs/WHO_TRS_919.pdf. Accessed 17 April 2019

12.

Evans T, Brown H (2003) Road traffic crashes: operationalising equity in the context of health sector reform. Inj Control Saf Promot 10:11–12PubMed

13.

Guillemin F, Carruthers E, Li LC (2014) Determinants of MSK health and disability—social determinants of inequities in MSK health. Best Pract Res Clin Rheum 28:411–433

14.

Dolea C (2009) Increasing access to health workers in remote and rural areas through improved retention. Health Workforce Migration and Retention Unit. Department of Human Resources for Health. Cluster of Health System and Services. World Health Organization, Geneva. http://www.who.int/hrh/migration/background_paper.pdf. Accessed 11 April 2019

15.

GHO World Health Statistics data visualizations dashboard. SDG Target 3.c. | Health Workforce. http://apps.who.int/gho/data/node.sdg.3-c-map-1?lang=en. Accessed 17 April 2019

16.

Buchan J, Dhillon IS, Campbell J et al (2017) Health employment and economic growth: an evidence base. World Health Organization, Geneva

17.

Gibson T (2015) Rheumatology in India and Pakistan Today. Rheumatology 54(5):753–754PubMed

18.

Crisp N, Chen L (2014) Global supply of health professionals. N Engl J Med 370:950–957PubMed

19.

Misra DP, Agarwal V, Negi VS (2016) Rheumatology in India: A bird’s eye view on organization, epidemiology, training programs and publications. J Korean Med Sci 31(7):1013–1019PubMedPubMedCentral

20.

Li Z (2015) A new look at rheumatology in China—opportunities and challenges. Nat. Rev. Rheumatol. 11:313–317. https://doi.org/10.1038/nrrheum.2014.218 CrossRefPubMed

21.

Louthrenoo W (2015) An insight into rheumatology in Thailand. Nat Rev Rheumatol 11:55–61PubMed

22.

Yamamoto K, Song YW, Li Z (2018) Rheumatology in East Asia. Arthritis Res Ther 20:58PubMedPubMedCentral

23.

Kim H, Song Y (2016) The dynamic evolution of rheumatology in Korea. Nat Rev Rheumatol 12:183–189PubMed

24.

Pispati PK (2003) From the desk of the President of APLAR. J Indian Rheumatol Assoc 11:24

25.

Hofheinz E (2017) Inside Cambodia’s struggles with poverty, dearth of trained rheumatologists. The Rheumatologist. https://www.the-rheumatologist.org/article/inside-cambodias-struggles-poverty-dearth-trained-rheumatologists/. Accessed 22 April 2019

26.

Philippine Rheumatology Association Accredited Training Institutions. https://rheumatology.org.ph/about-us/training-institutions/. Accessed 15 May 2019

27.

Hoa T, Darmawan J, Chen S et al (2003) Prevalence of the rheumatic diseases in urban Vietnam: a WHO-ILAR COPCORD study. J Rheumatol 30(10):2252–2256

28.

Watad A, Al-Saleh J, Lidar M et al (2017) Rheumatology in the Middle East in 2017: clinical challenges and research. Arthritis Res Ther 19:149PubMedPubMedCentral

29.

Gheita TA, Eesa NN (2019) Rheumatology in Egypt: back to the future. Rheumatol Int 39(1):1–12PubMed

30.

Miller LJ, Lu Wei (2018) These are the economies with the most (and least) efficient health care. Bloomberg Business. https://www.bloomberg.com/news/articles/2018-09-19/u-s-near-bottom-of-health-index-hong-kong-and-singapore-at-top. Accessed 18 April 2019

31.

Davatchi F (2009) Rheumatology in Iran. Int J Rheum Dis 12(4):283–287PubMed

32.

Oyoo GO, Mody GM (2007) Report on the Fifth African League Against Rheumatism Congress in Nairobi, Kenya. Clin Rheumatol 26:1033–1035PubMed

33.

Erwin J, Woolf A, Oyoo O, Cederlund I, Mwaniki L, Etau P (2016) The UWEZO project—musculoskeletal health training in Kenya. Clin Rheumatol 35(2):433–440PubMed

34.

Mullan F, Frehywot S (2007) Non-physician clinicians in 47 sub-Saharan African countries. Lancet 370:2158–2163PubMed

35.

United Nations (2011) Prevention and control of non-communicable diseases: report of the Secretary General. United Nations, New York http://www.un.org/ga/search/view_doc.asp?symbol=A/66/83&referer=/english/&Lang=E. Accessed 5 April 2019

36.

Chipeta J, Njobvu P, McGill PE et al (2014) Progress made towards enhancement of rheumatology education and practice in Zambia: review of an ILAR-supported project. Clin Rheumatol 33:1367–1372PubMedPubMedCentral

37.

Oyoo GO, Espinoza LR (2006) The practice of rheumatology in Kenya: challenges and opportunities. ILAR visiting professorship program report. Clin Rheumatol 25:437–439PubMed

38.

Reveille JD, Munos R, Soriano E et al (2017) Review of current workforce for rheumatology in the countries of the Americas 2012-2015. JCR: J Clin Rheum 23(2):112

39.

Al Maini M, Adelowo F, Al Saleh J et al (2015) The global challenges and opportunities in the practice of rheumatology: white paper by the World Forum on Rheumatic and Musculoskeletal Diseases. Clin Rheumatol 34(5):819–829PubMed

40.

Ugarte-Gil MF, Silvestre AMR, Pons-Estel BA (2015) Access to an optimal treatment. Current situation. Clin Rheumatol 34(Suppl 1):S59–S66PubMed

41.

Rocha FAC (2017) Latin-American challenges and opportunities in rheumatology. Arthritis Res Ther 19:29PubMedPubMedCentral

42.

Pulver LJ, Haswell MR, Ring I et al (2010) Indigenous health—Australia, Canada, Aotearoa New Zealand and the United States—laying claim to a future that embraces health for us all. World Health Organization, Geneva

43.

Lennane GAQ, Rose BS, Isdale IC (1960) Gout in the Maori. Ann Rheum Dis 19:120PubMedPubMedCentral

44.

McQueen FMF (2017) Rheumatology around the world: perspectives from Australia and New Zealand. Arthritis Res Ther 19:24PubMedPubMedCentral

45.

Royal Australasian College of Physicians (2018) Physician Readiness for Expert Practice; Advanced Training in Rheumatology 2017–18 Program Requirements Handbook. Version 4. Updated 15 March 2018. https://www.racp.edu.au/docs/default-source/default-document-library/at-rheumatology-handbook-2017-18.pdf?sfvrsn=8. Accessed 30 April 2019

46.

Georgiev T, Stoilov R (2019) Bulgarian rheumatology: science and practice in a cost-constrained environment. Rheumatol Int 39(3):417–429PubMed

47.

European Board of Rheumatology (a section of UEMS) (2014) The European Rheumatology Curriculum Framework. https://www.uems.eu/__data/assets/pdf_file/0005/44438/UEMS-2014.21-European-Training-Requirements-Rheumatology-.pdf. Accessed 2 May 2019

48.

Sivera F, Ramiro S, Cikes N et al (2016) Rheumatology training experience across Europe: analysis of core competences. Arthritis Res Ther 18:213PubMedPubMedCentral

49.

Hewlett S, Clarke B, O’Brien A et al (2008) Rheumatology education for under-graduate nursing, physiotherapy and occupational therapy students in the UK: standards, challenges and solutions. Rheumatology 47(7):1025–1030PubMedPubMedCentral

50.

Woolf AD, Walsh NE, Akesson K (2004) Global core recommendations for a musculoskeletal undergraduate curriculum. Ann Rheum Dis 63:517–524PubMedPubMedCentral

51.

Sorensen J, Primdahl J, Horn HC et al (2015) Shared care or nurse consultations as an alternative to rheumatologist follow-up for rheumatoid arthritis outpatients with stable low disease-activity RA: cost-effectiveness based on a 2-year randomized trial. Scan J Rheumatol 44:13–21

52.

Cividino A, Bakowsky V, Barr S, Bessette L, Hazel E, Khalidi N, Pope J, Robinson D, Shojania K, Yacyshyn E, Lohfeld L, Crawshaw D (2016) How to attract trainees, a Pan-Canadian perspective: phase 1 of the “training the rheumatologists of tomorrow” project. J Rheumatol 43(4):788–798PubMed

53.

Loyola-Sanchez A, Hurd K, Barnabe C (2017) Healthcare utilization for arthritis by indigenous populations of Australia, Canada, New Zealand, and the United States: a systematic review. Semin Arth Rheum 46:665–674

54.

FitzGerald JD, Benford L, Battistone M et al (2013) Regional distribution of adult rheumatologists. Arthritis Rheum 65(12):3017–3025PubMed

55.

Hurd K, Barnabe C (2017) Mortality causes and outcomes in indigenous populations of Canada, the United States, and Australia with rheumatic disease: a systematic review. Semin Arthritis Rheum 47(4):586–592PubMed

56.

Accreditation Council for Graduate Medical Education. https://www.acgme.org/What-We-Do/Initiatives/Clinical-Learning-Environment-Review-CLER.%20Accessed%2004/30/19. Accessed 13 April 2019

57.

The Training Rheum. https://www.aapa.org/events/training-rheum. Accessed 15 May 2019

58.

World Health Organization, Division of Development of Human Resources for Health (1995) Defining and measuring the social accountability of medical schools. World Health Organization, Geneva http://whqlibdoc.who.int/hq/1995/WHO_HRH_95.7.pdf. Accessed 3 May 2019

59.

Larkins SL, Preston R, Matte MC, Lindemann IC, Samson R, Tandinco FD, Buso D, Ross SJ, Pálsdóttir B, Neusy AJ, on behalf of the Training for Healt (2013) Measuring social accountability in health professional education: development and international pilot testing of an evaluation framework, on behalf of the Training for Health Equity Network (THEnet). Med Teach 35:32–45PubMed

60.

Gorry C (2012) Cuba’s Latin American Medical School: can socially-accountable medical education make a difference? MEDICC Rev 14(3):5–11PubMed

61.

Browner B (1999) The bone and joint decade, 2000-2010. JBJS 81(7):903–904

62.

Copcord Information. http://copcord.org/information.asp. Accessed 17 April 2019

63.

Lau CS, Feng PH (2007) Rheumatology without borders. Nat Clin Pract Rheum 3(6):305

Title: Healthcare disparities in rheumatology: the role of education at a global level
Authors: Vaneet Kaur Sandhu
Mehrnaz Hojjati
Irene Blanco
Publication date: 01-03-2020
Publisher: Springer London
Keyword: Care
Published in: Clinical Rheumatology / Issue 3/2020
Print ISSN: 0770-3198
Electronic ISSN: 1434-9949
DOI: https://doi.org/10.1007/s10067-019-04777-x

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