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

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

2. 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 21st century

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

4. 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

5. 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

6. 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 21st century

7. 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

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

9. 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

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

11. 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

12. 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

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

14. 3 2 14 15 8 High-volume, low-cost heart surgery hospital Low-cost eye-care solution Midwife led, low-cost maternal care Remote chronic disease care Valencia: Integrated HC 6 9 10 13 21 20 Mauritania complete low-cost obstetric care Weighing children to predict and prevent diseases Training for reproductive health clinics Innovative emergency response model 16 Veteran’s Health Administration Integrated care solution Mini clinics in retail stores 12 Remote advice and mobile care solution 1 Remote triage/referral 19 5 PDA: Social marketing (humorous) for reproductive health Real-time weighing and diagnosis 22 Co-operative medical system 4 11 Social marketing program of PSI Low-cost eye-care solution 18 17 Integrated primary care units 7 50 global locations: social marketing for killer diseases Franchise network of stores for deadly diseases Innovation in health care delivery is taking place around the world Turning the World Upside Down The search for global health in the 21st century 14 SOURCE: McKinsey analysis

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

16. 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

17. 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

18. 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

19. 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

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

21. 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

22. 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