John BellDr John Bell
University of Alberta, June 9, 2003
Eminent Chancellor, Board Members, Mr President, Members of the Faculty and Graduating Students in Medicine and Dentistry, Nursing and Rehabilitation Medicine.
It is a great honour to come to this institution to be awarded an honorary degree and to participate in the awarding of degrees to all the talented students gathered here today. It is particularly special for me as I started my higher education at this University in 1971 in the hope of obtaining a higher degree, and I now feel that I have finally achieved that goal! This University has a special meaning to me as it will have to all of you who are graduating today. It trained me in my first four years of education and prepared me admirably for what was to follow at Oxford, but in addition, it educated almost all my family, both my parents, my two brothers and their children and countless other aunts, uncles, and cousins. Like many Alberta families, we have relied on this school to provide us with that most valuable of personal resources: a strong educational background.
This University has, despite its short history, a proud tradition of scholarships, particularly in the field of biomedical science. It has established world-renowned programs in biochemistry, diabetes, and virology, and I can say from personal experience that the quality of its medical education is competitive by any international standard. Sometimes a short history can prove to be extremely helpful, as you are not burdened with issues of the distant past. For example, one of my current jobs as Regius Professor of Medicine in Oxford is to act as Master of the Almshouses in Ewelme, a job given to the Regius by James I that makes me responsible for the "13 poor men and clergy" of a small village in Oxfordshire. Similarly, a recent governing body meeting of my college, Magdalen, spent most of the afternoon debating how best to safely display one of the few remaining remnants left by our Founder William of Waynflete in the 15th century. As it happened, this remaining relic is a pair of his socks, now after much deliberation, securely held in the College Library. It is no wonder that younger schools such as the U of A have a significant competitive advantage.
This is an important day for all of you who have come to receive your degrees. It represents a major milestone in your careers and you are to be congratulated for your efforts in achieving this result. I know only too well the time, effort, and dedication that is required to obtain such a high academic qualification. You have all toiled hard to earn your degrees. I am sure you would also all agree that there is another group in the audience who need congratulations today: that is the families of all of you who have succeeded in your academic ambitions. Your success today has grown out of years of support and dedication of your parents, spouses, and families who deserve at least some of the credit for your success.
I would like to spend the few minutes that I have today to remind you that you are entering into professions with substantial obligations to society and that an aspect of your role that is often forgotten is the international dimension of health care.
Perhaps more than any other profession, health care professionals have a role and responsibility that has many profound international implications and it is worth considering these on this, your graduation day.
Health care has few borders that have not been imposed by regulatory authorities. Unlike many other professions, mobility has been widely valued amongst doctors and nurses and only recently have constraints over registration — particularly in medicine — become a strong negative influence over those who wish to vary their experience. The great medical traditions of Canada, America, and the UK used to be closely tied by the steady flux of post-graduate trainees moving between centres of excellence. This flux has many benefits.
No country has an exclusive access to successful health care practices. Major therapeutic innovations have historically arisen from many unusual places: surgical devices from the old Soviet Union, heart transplantation from South Africa, and malaria medication such as artemesinin from Chinese herbalists. We should all welcome the opportunity to experience first hand how other countries practise in their professions. The nursing and rehabilitation traditions in different jurisdictions are also unique, each with their strengths and weaknesses. Similarly, we have much to learn from each other about health care delivery. I am aware of the anxiety Canadians have about their health care system and of the recent deliberations that have tried to find future for a publicly funded system. I sensed that these discussions were driven in part by an anxiety that an American-type health system might prevail with all its inequalities and inefficiencies. I wonder if the major conclusions would have been the same if more contributors had recently spent time in the British NHS, which provides a publicly funded system that is now beyond repair or the thriving mixed medical economies of French or German. There is no substitute for direct exposure to different systems when considering the options open to us. It leads me to acknowledge that there is probably no correct answer to many of these problems but to recognize that we could identify our strengths and weaknesses more efficiently if we each had wider experience outside our own systems.
Our mobility has now clearly been threatened by the level of regulation that now impedes movement of practitioners between countries. I hesitate to think what my predecessor William Osler would have done in today's regulatory environment as his career took him into three different jurisdictions: Canada, America, and Britain. He would have surely succumbed to a surfeit of accreditation exams! My strong advice to you all, despite this, is to seek out opportunities abroad and welcome exchange with other systems as there is much to be gained.
Another aspect of the international dimension we must recognize is the fact that biomedical research has now become truly global. Research in biomedicine has now reached the very large scale that physics did 30 years ago. No single country can mount the resources to tackle some of the major biomedical research projects that are now accessible.
The Human Genome Project proved that such international collaborations could work and now there are many more such opportunities. Canada has played only a minor role in such initiatives to date, despite having one of the great traditions in research in this area. My belief is that it must do more. An example recently is the Canadian/UK Structural Genomics Consortium based in Oxford and Toronto which will have access to more than $100 million to undertake recombinant protein expression and structural analysis of many proteins thought to be important in human disease. Similarly, the Biobank network of genetic epidemiology spans the UK, Mexico, and China and should be extended to Canada and Scandinavia. An international vision for this type of science will define success in this field going forward and those that do not look beyond their borders will find that their science lags behind and is marginalized.
Finally, a crucial aspect of an international perspective relates to our responsibilities socially within the global community. We have seen in recent weeks the importance of emerging infectious diseases, but more important than West Nile virus and SARS is the widening of health inequalities across the globe. This crisis in Africa is the most poignant example: a continent disabled by the major infectious diseases malaria, TB, and AIDS. It is now clear that such health care crises breed economic and political failure and it is our responsibility as health care providers to consider how we might contribute to resolving this human tragedy. AIDS, for example, will kill millions in Africa each year. Seroprevalence levels exceed 20 percent in many populations and it will decimate the young and economically productive. This is graphically illustrated by the position in Botswana where seroprevalence is almost 30 percent. If you are a fifteen-year-old child in Botswana today, you have a 90-percent chance of dying from AIDS. Where one young parent dies, the second will inevitably follow, leaving another crisis behind — hundreds of thousands of orphaned children with the evident burden on society for many years to come.
We all have a responsibility to help if we can and as health care professionals, there is much we can do. In Oxford, we have intentionally focused our research activities into global health sciences. A third of our research income (which is the largest in the UK) is spent on those problems that influence the developing world most. We have active programs developing a malaria vaccine and we have scientists based in five developing countries undertaking research work. We are currently initiating an MSc program in Global Health Sciences to attract and train the best young doctors and scientists in the major issues in global health to increase capacity in this under-serviced arena. We are active participants in the global search for an HIV vaccine, which would appear to be the only likely salvation for the continent.
As doctors, you carry enormous responsibilities for your patients here in Canada, but you also must remember that we all have special responsibilities for broader health issues in what is becoming an increasingly interactive global community and we have much to learn from interactions with others in clinical practice and in science. As you move onto your future careers I urge you to consider yourselves in the global perspective.
I am very envious of you all. You are starting a career at a time when health care could deliver dramatic improvements to every individual's quality of life. We must, however, ensure if we can to maintain an international dimension to all we do. Your careers and society will be richer because of it. Thank you for your time today and to the University and its Officers for granting this honorary degree.