A Final Note
CONVERGENCE ON UNCERTAINTY: THE PARADOX OF THE NEXT AGENDA
The documents reviewed and the ideas presented in this report signal a world of great and accelerating change whose effects pervade the fields of health and social development. History does not tell us what is coming next, but one thing is sure: Our time is one of profound uncertainty, ambiguity, diversity, disorientation, and varying degrees of disaffection. It can be argued that the world has been ever thus, but we are still driven to ask about the kind of changes we face and how those might affect global health, since any new global health agendaa Next Agendamust build from such understandings.
The paradoxone we tentatively view with hopeis that, amidst volatility and frustration, and partly because of them, consensus has evolved nonetheless and in some generally common directions: toward fuller comprehension of the hard demands of development, the potential of more effective methods for coping with its obstacles, and more awareness about the larger global context in which development must be addressed. There are also glimpses of a new language around these issues, one that substitutes cooperation for assistance; global for international; and terms more balanced, fine-grained, and reflective of contemporary reality than “Third World” and “developing countries.”
There is a tradition in the health sector for some reports to make a difference. The 1910 Flexner Report revolutionized the education of
health professionals; the Alma-Ata Declaration revolutionized thinking about health care delivery worldwide. The 10 documents reviewed here can also make a difference. Their content, together with the areas of inquiry, zones of convergence, reflections on change, and the implications that we found in them, offer a plausible and flexible framework for a Next Agenda that can encompass
The emerging problems that directly threaten human health, ranging from infectious diseases, to the triad of poverty-population-environment, to the unfolding mysteries of the human genome;
The global uncertainties that threaten human well-being less directly, though no less surely; the irrelevance of yesterday's solutions to today's problems; and the social and political instabilities impinging on opportunities for constructive action; and
A new and evolving organizational, financial, and policy “architecture” for dealing with global perspectives; with fresh forms for collaborative sharing of ideas, resources, and programs; with common as well as discordant values; and with the need for sustained and open dialogue about development and what it means.
Every Synthesis document refers to the necessity for collective action. Unfortunately, the current vocabularyterms like “collaboration,” “coordination,” “cooperation,” and “partnerships”have become so hackneyed by overuse and underimplementation that they seem unreal or empty, or are seen as all too real and menacing to national, sectoral, or institutional autonomy. Yet, the Synthesis documents also counsel us that, given the complexity of the problems, the certainty of uncertainty, the urgency for allocating all manner of resources more wisely, and the rapidity of movements of people and information, separation from collective action makes scant sense. Indeed, it is difficult to imagine significant advances from those documents without a truly interactive global community honestly, modestly, and realistically engaged in the further elaboration and pursuit of the Next Agenda in Global Health.