By Virginia Rowthorn, JD

I am the co-director of an interprofessional global health education center on a graduate school campus that is comprised of schools of medicine, nursing, law, pharmacy, nursing, social work, and dentistry.  Our center – through grant programs and logistical services – supports global health experiential learning and research projects.  A colleague and I were sitting at a global health conference 18 months ago and musing about the different sessions when one of us casually commented, “there’s a lot of talk about global/local this year.”  In fact the words global/local, glo/lo, and the questionable shortcut glocal were suddenly everywhere.  As a lawyer who works in global health, words and definitions matter to me and I wondered out loud, “what exactly do people mean when they say global/local?”

Grammatically and conceptually, global/local is difficult.  Is it a noun (an idea or theory we teach), is it an adjective (a way to describe a program that does something specific), or is it a concept (a framework upon which to build a course or curriculum)?  More importantly, if we agree on what global/local is, how do universities do it?  Should it be part of the global health curriculum or the community public health curriculum or both?  In subsequent conversations and research, I have come to believe that global/local does mean something and should mean something to global health educators, but the path forward is difficult because there is little agreement on terms and practices.  Our throwaway conversation has since led to a national roundtable, a white paper, and a thriving initiative at our home institution of University of Maryland Baltimore on the topic of global/local.  We’re the ones doing a lot of talking about global/local now and we have apparently tapped into an emerging way of thinking and teaching that many in the global health, study abroad and service learning fields are already embracing using different terms.

What we have discovered through our global/local initiative is a trend in global health education to recognize the local (U.S. domestic) component of global health. Although educators are using the term global/local in different ways, many have created innovative programs that are helping students make the link between what they observe internationally and what exists in their own communities.  Global/local programs seek to break down or link two fields that have historically been siloed from each other  ̶  global health and community public health  ̶  and the university institutions, faculty, scholarship, funding and jobs that flow from these separate pathways.  We found global/local programs emerging from individual graduate schools, interprofessional global health centers, undergraduate institutions, and non-profit organizations.  However, because these global/local programs have never been linked under a single rubric, their successes and challenges are not shared and no best practices have emerged to help others create their own global/local programming.

Global health has always focused on the health of communities, but almost exclusively on communities outside the Global North and outside our students’ home environments.  The current divide that we see between global and community (US) public health is related to historical forces that encouraged the transfer of skills and services from countries with more resources to countries with fewer resources.  However, global health educators and others are coming to recognize that virtually all of the skills that characterize good practice in an international low-resourced setting are appropriate when working with vulnerable populations domestically and vice versa.  In other words, the idea that one set of skills is needed for global health work (i.e. non-domestic work) and another for local work (i.e. domestic work) is mostly inaccurate and squanders opportunities for shared research and solutions.  This divide also plays out in the employment market and limits the opportunity for professionals trained in one area to work and share knowledge in another area.

The interest in global/local is also fueled by a desire to remove artificial divides between domestic and international needs and solutions.  Those who support an increased focus on global/local believe that training students to understand the universality of health concerns and the need for culturally appropriate solutions will foster greater humility, greater empathy, and greater ties between health care professionals and patients/communities.  An additional reason for the growth of interest in global/local is greater university focus on community engagement and the health needs of vulnerable communities in their own backyard, particularly in the case of urban campuses.  Finally, the interest in global/local also relates to a growing interest in bi-directional learning, reverse innovation and the value of adapting low cost/high impact innovations developed outside the Global North for use domestically.

When I first started thinking about global/local, I did what we urge our students not to do – conduct my research using Google.  I cataloged the ways in which global/local and glocal are used by organizations, universities, scholars, and anyone else.  My initial conclusion was that the terms are used widely and without a common definition or common goal.  I then studied the scholarly literature of multiple fields and found that there is a rich discussion of global/local in the sociology literature (most commonly in discussions of globalization) as well as an established use of the term glocal in business literature to describe adapting international product lines to meet the needs and demands of local consumers.  McDonalds is a leader in glocal business practices and the McDonald’s bulgogi burger sold in Korea is a self-explanatory expression of a glocal business decision.  However, in the global health and public health literature – both scholarly and programmatic – there is no accepted definition of global/local or glocal, not even proposed definitions.

Based on my research, I found that most global/local programs incorporate themes of social justice and focus on meeting the needs of vulnerable communities both local and international.  Beyond this, I compiled the various definitions and usages of global/local and was able to distill seven ways in which it is used:

• Sometimes global/local is used to refer to shared themes that are present across the globe with different local manifestations (e.g. gender violence – a universal occurrence with shared themes as well as different local manifestations).
• Sometimes global/local refers to an educational method that teaches the personal and interpersonal skills (aka “soft skills”) that are relevant for community organizing and social justice work at both the domestic and international level. These programs often focus on cultural competence skills.
• Global/local is sometimes used to refer to programs that are designed to teach technical/professional skills (aka “hard skills”) from different perspectives in different settings. Many clinical health programs adopt this approach.
• Global/local is also used in conjunction with the concept of reverse innovation, or adapting demonstrated strategies utilized in one context to another context, usually from a low income to high income setting.
• Global/local is sometimes used in reference to bi-national research consortiums in which the same work is conducted in different settings as part of a international collaborative project.

On March 25, 2015, the center which I co-direct  ̶  the University of Maryland Baltimore (UMB) Center for Global Education Initiatives (CGEI)  ̶  held a national workshop titled “Global/Local: What does it mean for global health educators and how do we do it?” Working with my co-director, Dr. Jody Olsen, and Director of UMB’s Center for Community-Based Engagement and Learning, Dr. Jane Lipscomb, we held the workshop the day before the annual Consortium of Universities for Global Health conference (it was co-sponsored by the USAID Global Health Fellows Program II).

The workshop brought together global health educators to study how universities, community partners, and NGOs are defining the concept global/local and glocal and how they are operationalizing it.  120 people attended the workshop which, as far as we know, was the first time global health educators had gathered to discuss this particular topic.  Interestingly (and nicely), among the nation’s top global health directors and administrators, there was no disagreement about the value of incorporating global/local themes in the global health curriculum nor any serious disagreement on the broad themes of what global/local means. In addition to agreeing that global/local themes should be part of global health curricula, workshop participants also agreed that lack of a common language in this area, as well as institutional silos, will make it difficult to move forward rapidly.

An interesting discussion question addressed at the workshop was: “[i]s there anything to be gained from an international education experience that can’t be captured in a well-designed domestic education experience?”  This question is important because most global health programs exclusively offer students the chance to study and practice internationally.  Students clamor for these experiences and possibly focus on global health studies specifically because these international experiences are available.  However, if global health programs only offer international experiences, the global/local divide is emphasized and institutionalized.  Workshop participants noted the value of a disruptive immersion experience that trains students to manage complicated logistical issues, handle the complexity of unfamiliar situations with unfamiliar people, and to work outside their comfort zone.  However, recent scholarship, such as Putting the Local in Global Education: Models for Transformative Learning Through Domestic Off-Campus Programs, emphasizes that domestic immersion experiences that happen in a structured way, with the opportunity to prepare and reflect, can expand the students’ concept of culture, help develop empathy, foster interprofessional learning, and create global citizens just as international experiences can.  Most meeting participants agreed that a global health educational paradigm that teaches the common humanity and needs of communities near and far provides a correct and balanced approach where specific location preferences for study are not required.

As organizers, we felt a strong mandate to pursue this topic and work toward a series of best practices and model programs to help guide universities in developing their own global/local programs.  In early 2016, CGEI will host a working meeting to begin to move forward in this area using the preliminary conclusions as a springboard.

The agenda and all the March 2015 pre-CUGH workshop presentations are online.

Virginia Rowthorn, JD, is Co-Director of the University of Maryland, Baltimore Center for Global Education Initiatives and Managing Director of the Law & Health Care Program at University of Maryland Carey School of Law. Ms. Rowthorn’s work focuses on interprofessional global health education and she has written several articles and co-hosted national roundtables on this topic. Ms. Rowthorn has also developed experiential learning programs in Malawi and the Delta region of Mississippi.