Turning the World Upside Down The search for global health in the 21 st century Turning the World Upside Down The search for Global Health in the 21st Century CPSO Annual Lecture, Royal Holloway 4 th November 2010 Nigel Crisp

Turning the World Upside Down The search for global health in the 21 st century The Search for Global Health Interdependence The unfair health trade Turning the World Upside Down Co-development Transition between paradigms

Turning the World Upside Down The search for global health in the 21 st century The unfair health trade Health workers Health systems Pandemics Resources Trade, Aid and FDI

Turning it Upside Down Training and education Learning and understanding Rights Equity Transparency Turning the World Upside Down The search for global health in the 21 st century

20 th Century successes The 20 th Century paradigm Greater professionalism Scientific discovery Commercial development Growing funding Turning the World Upside Down The search for global health in the 21 st century

Health Wealth Society New drugs Minimum wage HASAW Surgery Liberalisation Education Clean air Consumerism Equalities Access Employment Welfare Anaesthetics Pensions Franchise Professions Industry Labour/capital Turning the World Upside Down The search for global health in the 21 st century

21 st Century disruptions Life has changed Diseases and conditions Patients and the public Science and technology Health becomes global Turning the World Upside Down The search for global health in the 21 st century

This model is now part of the problem Turning the World Upside Down The search for global health in the 21 st century

New ideas from elsewhere Pioneers Other industries Poorer countries Young people Disability and rights groups Turning the World Upside Down The search for global health in the 21 st century

Turning the World Upside Down The search for global health in the 21 st century Health in poorer countries Poverty, social issues and internal and external power relationships Shortages of resources and health workers Non-communicable as well as communicable diseases

The distribution of HIV/AIDS Refreshment and personal development Greater cultural awareness Learning specific skills and practices Challenging our long-held ideas Shaping the future together Turning the World Upside Down The search for global health in the 21 st century

Non- communicable disease Independence – bringing together patients, health and social workers Rebalancing of health systems between care, population health and costs Quality improvement and performance Health worker training and re-design Interdependence and co-development Turning the World Upside Down The search for global health in the 21 st century

Turning the World Upside Down The search for global health in the 21 st century Innovation HIV/AIDS Specific conditions Policy initiatives Product development Telemedicine Identified by GE, McKinseys

14 Innovation in health care delivery is taking place around the world SOURCE: McKinsey analysis PDA: Social marketing (humorous) for reproductive health 5 Integrated care solution global locations: social marketing for killer diseases 17 Co-operative medical system 22 Veteran’s Health Administration 21 Mini clinics in retail stores 16 Remote triage/referral 1 Remote chronic disease care 15 Low-cost eye-care solution 11 High-volume, low- cost heart surgery hospital 14 Midwife led, low- cost maternal care 2 6 Mauritania complete low-cost obstetric care Valencia: Integrated HC 8 Integrated primary care units 18 Weighing children to predict and prevent diseases 9 Real-time weighing and diagnosis 19 Low-cost eye-care solution 3 Training for reproductive health clinics 10 Social marketing program of PSI 4 Franchise network of stores for deadly diseases 7 Innovative emergency response model 13 Remote advice and mobile care solution 12 Turning the World Upside Down The search for global health in the 21 st century

Turning the World Upside Down The search for global health in the 21 st century An emerging tradition Community, family and women Health, education and work Social enterprises Public health and clinical medicine Train for the job not the profession

Independence Seeing world in terms of peoples’ lives not our services “Getting our lives back” Living a life we have reason to value Turning the World Upside Down The search for global health in the 21 st century

Co-development Top down development - western experts The invention of international development Understanding Global Health Turning the World Upside Down The search for global health in the 21 st century

Benefits of co-development for poorer countries Country led and owned Culturally sensitive and respectful Able to draw on all traditions Avoids the faults and weaknesses of richer countries Recognises the shifting balance of power Turning the World Upside Down The search for global health in the 21 st century

Benefits of co-development for richer countries Refreshment and personal development Greater cultural awareness Learning specific skills and practices Challenging our long-held ideas Shaping the future together Turning the World Upside Down The search for global health in the 21 st century

A movement of people and ideas Turning the World Upside Down The search for global health in the 21 st century

A new paradigm Professionalism, scientific discovery, commercial development and funding added to by Interdependence, independence and rights Turning the World Upside Down The search for global health in the 21 st century

Accelerating the change Make it visible and coherent Health worker education and training Experience and exchange Turning the World Upside Down The search for global health in the 21 st century