National Academies Press: OpenBook
« Previous: II: The Documents Considered: Reflections and Implications
Suggested Citation:"A Final Note." Institute of Medicine. 1996. Global Health in Transition: A Synthesis: Perspectives from International Organizations. Washington, DC: The National Academies Press. doi: 10.17226/5513.
×

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

Suggested Citation:"A Final Note." Institute of Medicine. 1996. Global Health in Transition: A Synthesis: Perspectives from International Organizations. Washington, DC: The National Academies Press. doi: 10.17226/5513.
×

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.

Suggested Citation:"A Final Note." Institute of Medicine. 1996. Global Health in Transition: A Synthesis: Perspectives from International Organizations. Washington, DC: The National Academies Press. doi: 10.17226/5513.
×
Page 83
Suggested Citation:"A Final Note." Institute of Medicine. 1996. Global Health in Transition: A Synthesis: Perspectives from International Organizations. Washington, DC: The National Academies Press. doi: 10.17226/5513.
×
Page 84
Global Health in Transition: A Synthesis: Perspectives from International Organizations Get This Book
×
Buy Paperback | $49.00 Buy Ebook | $39.99
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF

For many reasons, this decade is a time of rethinking many things. There is the impending turn of the millenium, an event packed with meaning. There is recent political history, which has changed the global structure of power in ways few could foresee, and there is an economic fluidity worldwide that makes every day unpredictable and the future uncertain. There are movements of people and surges of violence that seem unparalleled, and well may be. We are awash in change, and people everywhere are trying to understand that and read its implications. It is a time that provokes soul-searching: backward, into the lessons and achievements of the past, and forward, into ways for the future to be better.

The fields of health and social development are no exception. More specifically, events and conditions in the health sector point to the need to rethink some large issues. Nations everywhere are grappling with the economic and ethical dilemmas of achieving and maintaining healthy populations, since these are both cause and consequence of true development. Increasingly, the thinking is global, because there are comparisons to be learned from, connections that have implications, obligations to fulfill, and costs that are somehow shared.

As part of this dynamic, there has been an explosion of analytic documents, published since the start of this decade, that deal mainly, though not exclusively, with health in developing countries. The purpose of Global Health in Transition is to distill the essential elements from those efforts, discuss the major ideas they share and the thoughts they prompt, ask what those might mean for a next agenda in global health, and comment on the shifting context in which our current concepts of the ideal will proveor not provetheir adequacy for the future.

  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    Switch between the Original Pages, where you can read the report as it appeared in print, and Text Pages for the web version, where you can highlight and search the text.

    « Back Next »
  6. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  7. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  8. ×

    View our suggested citation for this chapter.

    « Back Next »
  9. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!