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Nils Daulaire, M.D., M.P.H.
President & CEO
Global Health Council
Opening Welcome: 32nd Annual Conference: Health Systems: Putting Pieces Together
How do any of us know whether what we do is useful? In today's world, some would say: Let the markets decide.
With over 1,600 global health professionals already registered for this conference, and more coming through our doors every minute, I would say the markets for action and progress in global health are speaking loud and clear.
Welcome to the Global Health Council's 32nd annual conference: Health Systems: Putting Pieces Together. Over the next three days, together, we will try to do exactly that. And we don't even have to meet in a tent.
Change can be a bracing experience, and, as you can see, over the past year your Global Health Council has survived the transition to full financial independence quite well indeed. Our commitment to reproductive health, to children's health, to women's health, to controlling HIV/AIDS and other infectious diseases, remains the bedrock of our work. We intend to use that independence to help move the global health agenda forward in accordance with our longstanding traditions of inclusiveness and open debate, and our commitment to speaking out on behalf of those lacking the power to move markets, the women, children and men living in poverty and ill-health in the poorest corners of the world.
That's what we are all here for.
Speaking on their behalf calls - among other things - for erasing the insidious barrier of invisibility; after all, how can people care about what they don't even know exists? So this morning, we're delighted to give you a very special sneak preview of a PBS documentary series that was first conceived five years ago at the Global Health Council’s 2000 annual conference, and in which we at the Global Health Council have been involved from its earliest stages.
Called Rx for Survival: A Global Health Challenge, this six-hour three-part series will air nationally on PBS over the first three nights of November. Later, it will be broadcast in many countries around the world. Filmed in twenty nations on five continents, the series is co-produced by an award-winning team from the WGBH/NOVA Science Unit and Vulcan Productions.
The scenes you are about to see are meant to introduce the subject of global health to a general lay audience, and to connect with the broadest audience possible to help them understand that global health matters to everyone; that success can be achieved; and that individuals and good leadership can make the difference in saving people's lives - right now.
Think how far we've come. Something of this scope and calibre would have been unimaginable a decade ago.
If people care, politicians will care too. So perhaps the time is right, finally, to move global health to center stage. We're doing all we can to make the most of this opportunity, and we welcome all of you to get involved.
Of course, a documentary by itself doesn't accomplish anything, any more than a new vaccine by itself does. All of us recognize that without the systems to turn good intentions and great ideas into meaningful, lasting action, our best efforts are like dust before the wind.
Systems. What do we mean when we use that word in the global health context?
A regular set of rules, rigidly applied? A fixed prescription, one size fits all? Of course not.
We have seen too many times the consequences of such approaches, failing to take into consideration the human and cultural dimensions of health and illness, and the many competing claims on time and attention of those whose job it is to deliver the goods. The landscape of global health is littered with failed efforts that began with lofty premises but did not understand the realities needed to make things work.
No, when it comes to global health, systems are like living organisms. Complex, interconnected, and, if they are to survive, adaptive. Also: turbulent and chaotic, and ultimately neither predictable nor strictly controllable.
A lot of work has been done over the past years to better understand complex, adaptive systems. The science underlying this has become known as Chaos Theory.
We're only just starting to make the mental leap. The established disciplines of linear cause and effect - which serve as the basis for epidemiology - reflect a mechanical vision of a clockwork universe which perfectly models the Newtonian machinery of the Industrial Revolution. Well, we’re in the Information Revolution today, and in this universe, we cannot assume that, given enough information about inputs and adequate control over "extraneous" factors, outputs can be calculated and predicted with certainty.
The universe we live in, and our experience in global health, is quite different. The science of chaology - the study of chaos - grew out of observations in diverse fields of scientific study, such as meteorology and fluid dynamics, which reflected a universe unthinkable by Sir Isaac Newton, but one that fits with what we now know about quantum physics and the study of complex interactive systems.
In this universe, simple linear cause and effect is replaced by a far more intricate set of interactions of infinite variety in which there can never be certainty about a particular outcome. It is also a universe in which small inputs can be progressively amplified by these interactions until they have enormous results - the famous Butterfly Effect.
You all know the story.
The butterfly does not cause the hurricane, in the Newtonian sense. Many things do. But in the chain of events which lead to the formation of the hurricane, if that butterfly does not flap its wings at the time, in the place and with the force it does, this particular hurricane will not be born. The butterfly creates a tipping point.
Chaos theory shows that these kinds of interactions are not the exception, they are the rule in complex systems in which numerous forces interact continuously. While a probability distribution can be generated for the outcomes of some of these interactions, a single individual outcome cannot be firmly predicted, and a particular outcome may have an enormous influence on the direction of the overall system.
The forces that will influence - and be influenced by - global health are intrinsically chaotic. Those so-called "extraneous factors" are ever-present and fundamental. They are deeply interactive. They take place at the interface of several highly complex systems: the biosphere, human society, the process of innovation and scientific discovery, health systems.
This troublesome reality actually gives me great hope. Because if global health truly were a linear process, the odds against us might be too great.
But the outcomes of complex interactive systems rely more on the principles that define the dynamic interaction of their subsystems, and that direct their flow, than they do on the size of specific inputs. And that's what the issues at the heart of this year's global health conference are really all about. Human resources. Supply and logistics. Information. Financing. New discoveries. Policies. Management. Political commitment. All interlinking subsystems, affecting one another and the ultimate outcome that is our common cause: human health.
It is not just pieces we are putting together this week, it is processes.
Let me postulate for you a set of boundary conditions, of rules of engagement, consistent with the realities of complex interactive systems that can illuminate how we should approach health systems in our deliberations over the next several days.
- Systems that welcome pluralism, collaboration, flexibility and experimentation will prevail over systems that are rigid, hierarchical and based on command and control.
- Systems that are transparent, share their failures as well as their successes, and seek to continuously learn from them and adapt will prevail over systems that are secretive, in which information flow is tightly restricted, and in which failure can never be admitted.
- Systems built in partnership between local communities, knowledgeable intermediaries, and those with access to resources will prevail over systems created top-down by development "experts" and external funders.
- Systems built on a recognition of the interdependence between the rich and the poor within a society, and between rich and poor societies themselves, will prevail over systems that provide their goods predicated on which class you had the fortune or misfortune to be born into.
- Systems built on the empowerment, dignity and the human rights of those they are intended to serve will prevail over systems based on charity, paternalism and political dictates.
As I said, health systems are similar to living organisms. The better ones evolve, and those built on processes that can best adapt to challenging environments are most likely to survive and thrive. Evolution works for health systems; but for health systems, there truly is a case to be made for intelligent design.
That's one of the reasons we are here this week, to share our intelligence, to make unexpected and unpredicatable connections - both with ideas and with each other - and to see if we can come up with ways to accelerate change for the better.
There is another basic reality of complex interactive systems involving human decisions: within them, ideas and innovations spread through social contacts and networks far more effectively than through instructions, manuals and policy directives. Good businesses have learned this, and have thrived.
That's what makes gatherings such as this so important for the future of global health. You are the future. Here from over seventy countries. Seasoned health professionals, students, researchers, managers. Front-line workers and policymakers. Secular and faith-based. Leaders of thought and of action.
There are those who believe that meetings like this are a waste of time and resources, that less time should be spent in uncontrolled conferences, that all we need is to do as we are instructed, and that getting together to challenge each other to do better just leads to trouble. They are the designers of systems that, because of their single-mindedness and linearity, may look strong for a short moment, but nature and experience teach us that their approach is destined to falter and to fall by the wayside. All we need to do is maintain our principles, our understanding of the real world, our willingness to hear and debate contrasting views, our readiness to collaborate, and our commitment to follow the facts to their logical conclusions, and we will see - inexorably - that it is indeed our work that defines the future.
And remember: in a polarized, black and white world, it is tempting to think in terms of enemies. But the vision of multi-hued complexity that we here share does not allow for such oversimplification. Like a stream flowing over rocks, we will find ways to address the challenges they raise to our assumptions, incorporate the good in their ideas, and move forward.
So here is my challenge to you over the next three days: Welcome the unexpected. Challenge yourselves by attending sessions that are outside your own comfort zone and find what remarkable things you can learn and connections you can make when you interact with systems and issues you are less familiar with. Speak up in our panel discussions and debates, and bring your own experiences to bear on the questions they are addressing. Find new partners to collaborate with in the year ahead. Share your passion for social justice, and celebrate with your colleagues the seemingly small successes that may be the next beat of the famous butterfly wing.
These things can't be done in articles, or even on-line. They require us to be together.
Interacting.
Sharing.
Learning.
Growing.
This is what the Global Health Council is, and this is why we have gathered for each of the last 32 years.
Welcome.
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