Five Reasons Global Health Matters—or Should Matter—to Cardiologists

March 28, 2017

Assistant professor of medicine and global health Gerald S. Bloomfield and 2015 Master of Science in Global Health alumna Melissa Burroughs Peña recently penned a commentary, “Five Reasons Why Global Health Matters to Cardiologists,” in the journal Cardiology Clinics. The piece appeared in a special issue of the journal with the theme “Global Cardiovascular Health,” which Bloomfield and Burroughs Peña co-edited.

They reflect on how our global environment bears on the cardiology profession, particularly for cardiologists in high-income countries. “Not only does global health impact our clinical practice and daily life,” they conclude, “but also globalization and interconnectedness will increasingly become the norm for how we train future generations.”

Here are a few highlights from the commentary:

1. Patients Travel

Bloomfield and Burroughs Peña argue that cardiologists in developed countries need the skills to offer health advice to the growing number of foreign-born patients. For example, familiarity with cardiovascular diseases (CVDs) endemic to other parts of the world—including infectious cardiac diseases such as tuberculous pericarditis—prepares cardiologists to identify rare conditions. “When was the last time you may have missed a case of Chagas disease, or endomyocardial fibrosis?” they ask. 

2. Cultural Sensitivity

All physicians, including cardiologists, should be sensitive to the fact that patients from other cultures may have different approaches to illness and health care, and that these views can affect their decision-making around health issues and adherence to medication. Cardiologists, Bloomfield and Burroughs Peña suggest, need to consider how a patient’s culture may affect his or her attitudes toward the health care system or the way his or her family makes health decisions and shares health information.  

3. Discovery Knows No Borders

“No country has a monopoly on talent,” Bloomfield and Burroughs Peña wrote. “Increasingly, collaboration with professionals from around the world informs how we derive evidence-based medicine.” In fact, they point out that many recent innovations in cardiovascular care—such as mobile health and fixed dose combination therapy—have roots in developing countries. They argue for a strong investment by high-income countries in global research training and capacity building.

4. Sutton’s Law

It’s said that when bank robber Willie Sutton was asked why he robbed banks, he would reply, “That’s where the money is.” Bloomfield and Burroughs Peña note that 80 percent of all deaths due to CVD occur in low- and middle-income countries, so interventions to combat these diseases would potentially have the greatest impact in these countries. They also suggest that the “untenable international disparities in the burden of CVD and access to appropriate therapies … should spur those in developed countries to act whenever possible.” 

5. The Future of Our Profession

Bloomfield and Burroughs Peña emphasize the critical importance of global health to trainees, arguing that “early clinical experiences in resource-limited settings usually derive a continuing return over one’s career.” They suggest that these experiences not only help cardiologists gain valuable clinical expertise, but also broaden their worldview and strengthen their character.

Read the commentary.

Bloomfield joined the Duke faculty in 2011 after completing the Global Health Pathway through the Duke Hubert-Yeargan Center for Global Health, based at the Duke Global Health Institute. He was instrumental in developing a sustainable, multi-faceted cardiovascular care program at Moi Teaching and Referral Hospital (MTRH) in Eldoret, Kenya, and he spends a significant amount of time working in Kenya.

Burroughs Peña, an assistant professor of medicine at University of California, San Francisco, since 2015, also completed a fellowship through the Duke Hubert-Yeargan Center for Global Health’s Pathway program.

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Gerald Bloomfield in the Field in Kenya
Gerald Bloomfield explains the results of an echocardiogram to a participant in a home-based study in Kenya that explored household air pollution and its effects on the heart.

Increasingly, collaboration with professionals from around the world informs how we derive evidence-based medicine.

Gerald Bloomfield and Melissa Burroughs Peña

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