Turning the World Upside Down The search for global health in the 21st century

Turning the World Upside DownThe search for Global Health in the 21st Century

CPSO Annual Lecture, Royal Holloway4th November 2010

Nigel Crisp

Turning the World Upside Down The search for global health in the 21st 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 DownThe search for global health in the 21st 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 21st century

20th Century successes

The 20th Century paradigm•Greater professionalism•Scientific discovery•Commercial development•Growing funding

Turning the World Upside Down The search for global health in the 21st century

Health Wealth SocietyNew drugs Minimum wage HASAW

Surgery Liberalisation Education Clean air Consumerism Equalities Access Employment WelfareAnaesthetics Pensions Franchise Professions Industry

Labour/capital

Turning the World Upside Down The search for global health in the 21st century

21st 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 21st century

This model is now part of the problem

Turning the World Upside Down The search for global health in the 21st 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 21st century

Turning the World Upside Down The search for global health in the 21st 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 21st 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 21st century

Turning the World Upside Down The search for global health in the 21st 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

20

50 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

18Weighing 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 21st century

Turning the World Upside Down The search for global health in the 21st 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 21st 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 21st 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 21st 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 21st century

A movement of people and ideas

Turning the World Upside Down The search for global health in the 21st 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 21st 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 21st century