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

Preface

There are two simple ideas at the very heart of this book - that rich countries can learn a great deal about health and health services from poorer ones and that combining the learning from rich and poor countries can give us new insight into how to improve health.

Having run the world's biggest health service, England's NHS, for more than 5 years, I was asked by Prime Minister Blair to look at how we could use all the accumulated experience and expertise about health which we had in the UK to improve health in developing countries. As I travelled the world at his request, meeting people and visiting services, I began to see that there were indeed many ways in which we could help, that many British health workers and organisations wanted to help and, indeed, many were already doing so.

I also began to realise, however, that creative, passionate local people in countries that didn't have our resources, were innovating, finding solutions and working out how to use the materials at hand to provide the best deal they could for their patients. Unconstrained by our history, conventions and institutions, they were training people differently, creating new types of organisations, involving families and communities, and concentrating much more on promoting health and independence rather than on just tackling disease.

There is no comparison, of course, between the problems to be found in the poorest parts of the world and those in rich countries like the UK. Ill health, poverty, life expectancy and disability are all so much worse in the poorer countries. People die and are damaged by some of the simplest and most treatable or preventable diseases and situations. It is plain to see that science, technology, medicine, professionalism, knowledge and systems, combined with more resources and health workers are desperately needed. It is also plain and obvious, however, that health systems in rich countries are in trouble. Whilst poorer countries need more of what we in richer countries have - our science and expertise - perhaps we also need more of what they have learned.

This very simple idea has led me to recognise that talking about developing and developed countries and about international development can be very misleading. We all have something to learn and all have something to teach. We are in this together and we will develop together. I have used instead the expressions richer and poorer countries and, in doing so, recognised that there is a spectrum. There are very rich and very poor and many in between, all of them with their own particular circumstances and features - however it is the richer that have most of the power and who determine the way the world's institutions and relationships work, and the poorer who have to live within a world shaped by others.

I have used many examples and illustrations from my own experience and observations - drawing on my time in the NHS and my experiences working on global programmes to train more health workers in poorer countries. I have also used examples from my role as Chair of Sightsavers International, which works with local partners in 33 countries to prevent blindness, treat eye disease and help blind and partially sighted people live as independent lives as possible.

I am grateful to the many people who have allowed me to tell a part of their story and to them and the many others from whom I have learned. I have used their examples to bring the book to life and ground it in reality.

Turning the World Upside Down is in many ways a description of what is happening now and of the things which innovative health workers, leaders and politicians are doing today. It describes people learning how to work more effectively and how to have a greater impact and is written in conscious admiration of the many millions of health workers worldwide who work with such compassion, determination and imagination. They, not I, are the people who are creating the new vision for health that I describe in this book.

I am deeply grateful to many people who have taught me about their countries and continents including Francis Omaswa, Bience Gawanas, Fazle Hassan Abed and Srinath Reddy as well as to Don Berwick, Maureen Bisognano and colleagues from the Institute for Healthcare Improvement for their inspiration and insight; Mary Robinson, Peggy Clark and colleagues from Realizing Rights for helping me understand human rights and health; Michael Birt and colleagues at the Pacific Health Summit for introducing me to new ideas; Margaret Chan, Tim Evans and colleagues at the World Health Organization; Joy Phumaphi, Julian Schweitzer and colleagues from the World Bank; and Ernest Massiah, Peggy Vidot and colleagues from the Commonwealth Secretariat, for their continuing support and guidance.

I have been privileged to work with many people in The Global Health Workforce Alliance and the Gates Foundation and to have been accompanied on my earlier travels by Imogen Sharp and Amy Kesterton. Throughout, I have also been very fortunate to have been able to call on help from so many people in the UK's Department for International Development and Foreign Office; both of whom have proved to be unparalleled sources of insight and understanding. It has been a pleasure to see how highly they are regarded in the countries where they work. The UK is a global leader in international development. I am also very fortunate to have been able to call on help from the Department of Health and benefit from the expertise of many of its staff.

I am also indebted to the people who read and improved parts of this book who include, as well as some of the above, John Bacon, Kate Barnard, Vivian Bazalgette, Ali Enayati, Ruth English, Phil Freeman, David Jenkins, Anna Maslin, Joe McCannon, Debbie Mellor, Eldryd Parry, David Percy and Paddy Salmon.

Susana Edjang has done an outstanding job as my researcher, providing me with the evidence, analysis and references I needed and offering me her own insight. The book is much the richer for her contribution.

Finally and above all, I am grateful to Siân, Madeleine and Alastair for their advice on science and anthropology and their - almost - unqualified understanding and support over the last year.