Turning the World Upside Down Again
Global health in a time of pandemics, climate change and political turmoil
Lord Crisp has produced a fascinating examination of how the developed world can learn from the innovation and insights of poor and disempowered communities both globally – and domestically
This book is chiefly about people coping with poverty and how they can lead the world by their example. If this seems a contradiction, it is also about rich people doing without unnecessary technology and learning more from the poor.
It is a thesis argued by the smaller, more radical, aid agencies for years – led by Ernst Friedrich Schumacher, Ivan Illich and many others. But their voices have not been heard enough and it takes someone of the stature of Nigel Crisp, once
NHS chief executive, to drum it home. With admirers like Mary Robinson and Archbishop Tutu, and because of his unique experience of world health, he had a fair wind for his original book.
A decade on, this updated version is likely to attract even more attention because it takes account of the Covid pandemic and new development initiatives, including the Sustainable Development Goals, against a highly unstable economic and political background. Most people in difficult times look for new solutions and there are plenty to be found here.
Sustainable development is the new catch phrase used by the United Nations, meaning working towards integrated solutions which will last. In an
agricultural context this could mean a hand pump for a well, farmers growing a second cash crop like onions alongside sorghum, or small businesses using alternative energy.
But in the wider health context, SDGs could have a number of meanings. It could mean more investment in local services and clinics. It could mean rural health workers or traditional birth attendants supporting pregnant girls and mothers. It could be a greater use of alternative medicines and nutrition. And it must mean a range of activities to improve the environment,
“Most people in difficult times look for new solutions and there are plenty to be found here”
agriculture and health education, so as to improve the value of community health.
Nigel Crisp says all these things are essential, and some of them have been pushed by the UN for years. For example, the Alma-Ata Declaration of 1978 committed governments to primary health care and community health – and yet in the 1990s half of Zambia’s health budget was still being spent in one Lusaka hospital.
Some of the larger health campaigns run by UN agencies used to bypass local government services and even substitute themselves for government, pleading excessive bureaucracy. This is still happening. The recent pandemic shows how difficult it can be to deliver vaccines in remote areas unless the communities come forward and take the initiative themselves.
Crisp is rightly impressed by some of the NGOs who have achieved high levels of sustainable development such as Bangladesh Rural Advancement Committee (BRAC), which now claims to reach 126 million people all over the country. There are many smaller highly effective organisations dedicated to specific needs, such as Sightsavers and WaterAid.
There is a fascinating chapter about the migration of health workers and the need for ethical policies for international recruitment. As NHS chief, Lord Crisp saw a rapid increase in staffing in the UK in 2000 to 2005. Since then he has helped the WHO to design a code of practice to ensure that poorer countries are better able to manage migration. Developed countries, he believes, have a special responsibility because so many staff receive their training abroad.