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PLOS BLOGS Speaking of Medicine and Health

A new paradigm for global health?

A couple of weeks ago I attended one of the lectures in the Edinburgh Enlightenment series. This lecture was given by Lord Nigel Crisp, who was previously Chief Executive of the UK’s National Health Service. His lecture was based on his book, Turning the World Upside Down: The Search for Global Health in the 21st Century.

As the leader of a developed world health service, his perspective is not what you might expect. The bottom line is that health systems in the West are no longer appropriate for 21st century health problems – meaning those that are primarily driven by diseases of lifestyle and environment, and which require a focus on prevention rather than cure. A radical rethinking of approaches to health care in the developed world is needed – and we could learn much from approaches in the developing world.

Other aspects of the book have an equally wide message: that Global Health really means global, not, as some would have it, to just mean diseases of the developing world. At its simplest that means that infectious diseases don’t respect national boundaries, but also that decisions made by health care systems in the UK, on staffing say, can profoundly affect health systems elsewhere if these decisions lead to a migration of health workers. In practice “we are in this together”.

His basic premise therefore is that health is a global public good, and we all have a stake in everyone’s health. He quotes the work of Gorik Ooms, who takes this idea further and who wrote in PLoS Medicine about whether a system of global health insurance should be developed.

If there was one thing missing from the book it was the role of health information – one that we at PLoS would argue is another global public good and which also requires a 21st century approach.  His quote on health could equally apply to health information: “We are not living in the past anymore; but we haven’t yet started to live in the future. “We are… stuck between paradigms”. Paradigm is an overused word, but in these two situations,  surely appropriate.


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