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Turning the World Upside Down

Turning the World Upside Down is a search to understand what is happening and what it means for us all. It is based on Nigel Crisp's own journey from running the largest health system in the world to working in some of the poorest countries, and draws upon his own experiences to explore new ideas and innovations around the world. The book has three unique features: Describes what rich countries can learn from poorer ones, as well as the other way round Deals with health in rich and poor countries in the same way, not treating them as totally different, and suggests that instead of talking about international development we should talk about co-development Sets out a new vision for global health, and our rights and accountabilities as citizens of the world There is an unfair import export business in people and ideas that flourishes between rich and poor countries. Rich countries import trained health workers and export their ideas and ideology about health in poorer ones, whether or not they are appropriate or useful. What, Nigel Crisp asks, if we were to turn the world upside down - so the import export business was reversed and poorer countries exported their ideas and experience whilst richer ones exported their health workers? Health leaders in poorer countries, without the resources or the baggage of rich countries, have learned to innovate, to build on the strengths of the population and their communities and develop new approaches that are relevant for the rich and poor alike. At the same time, richer countries and their health workers could help poorer countries to train, in their own country, the workers they need for the future. They would help pay a debt for all the workers who have migrated and learn themselves the new ways of working, which they will need in the 21st Century. We could stop talking about international development - as something the rich world does to the poor - and start talking about co-development, our shared learning and shared future. There is already a movement of people and ideas travelling in this direction. Young people get this intuitively. Many thousands of young professionals want a different professional education for themselves - in global health. Together with the leaders from poorer countries and the innovators around the world, they are creating a new global vision for health. Turning the World Upside Down is a search for understanding that helps us to see how Western Scientific Medicine, which has served us so well in the 20th Century, needs to adapt and evolve to cope with the demands of the 21st Century. It sets our a new vision and concludes by describing the actions we need to take to accelerate the change.
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Table of Contents

Health and poverty Health and wealth Unfair trade (1): exporting health workers Unfair trade (2): importing ideas and ideology Learning from low- and middle-income countries Practical knowledge for the twenty-first century Practical knowledge for the twenty-first century The paradigm shift to global health

About the Author

Lord Nigel Crisp has unique experience of health in both rich and poor countries. He ran the UK's National Health Service for more than 5 years and was, exceptionally, head of the Department of Health at the same time. The NHS is the world's biggest health system and the 4th biggest organisation in the world with 1.3 million staff and AGBP90 billion annual turnover. He has subsequently worked extensively in poor countries as an advisor to Tony Blair and consultant to the World Health Organisation and the Gates Foundation. He is currently supporting Sarah Brown with the Maternal Mortality Campaign and has founded the Zambia UK Health Workforce Alliance to promote mutual learning and development. He has published two very influential reports - Global Health Partnerships in 2007 and Scaling up, Saving Lives in 2008 as well as several chapters and articles in journals such as The BMJ and The Lancet and is in demand globally as a thinker and speaker on global health. Nigel Crisp is an independent Peer in the House of Lords, Chair of Sightsavers International, a Professor at the London School of Hygiene and Tropical Medicine, a Senior Fellow of the Institute for Healthcare Improvement in Cambridge, Massachusetts and an Honorary Fellow of St John's College, Cambridge and of the Royal College of Physicians. More information is available at


Thank you, Mr Nigel Crisp, for a very inspirational book. I am a registered nurse from Kenya (not part of the brain drain) ... really focusing on things of priority like the patients and not the professionals. Thank you. Lianne Wachira In today's joined up world we are all connected and the health of one person or nation affects us all. In this important and timely book Nigel Crisp describes how we can all learn from each other, rich and poor, and work together to improve health. Archbishop Desmond Tutu We are at the threshold of a new era in global health, marked by unprecedented challenges and novel opportunities. Nigel Crisp's book offers an essential guide to understanding the dynamic nature of this new era and to successfully open up innovative avenues for progress. His original insights provide a fresh perspective on one of the crucial topics of our times. Julio Frenk, Dean of the Faculty, Harvard School of Public Health A revolutionary book packed with important ideas. The book is radical and readable and packed with ideas, and I find that I keep returning to it. Richard Smith, former editor of the BMJ Delivering sustainable health care in under-resourced communities can be challenging and frustrating for those of us who work in privileged, sophisticated health care systems in the West. However, local solutions are needed for local problems. Nigel Crisp bursts the bubble of Western arrogance with a clear and measured response as to who knows best in health service design and delivery in Africa. This outstanding text is very challenging and should be mandatory reading for all those committed to trying to make a difference in global health care. Tony Falconer, President of the Royal College of Obstetricians and Gynaecologists Thanks for your book, what insights! Thanks for the boldness to say what you said, I have never heard it said that way. I agree so much with the debt that needs to be settled in some way and Britain does have a wealth of knowledge to share. Maria Akrofi He is challenging health professionals about the part they can play and questioning the arrogance of some western aid schemes imposed on developing countries. "Just stop telling people what to do and start listening to them". Nellie Bristol, The Lancet This is a very important topic, particularly at a time of global recession. Nobody could be better qualified to compare what is happening in health in the rich and the poor world and to bring fresh and provocative insight to the subject. The Honourable Mary Robinson, Former President of Ireland and UN High Commissioner for Human Rights The poorer world has something of real value to teach the richer world - in health and elsewhere - and Nigel Crisp is supremely well qualified to interpret it for us. Julia Neuberger, Baroness Rabbi Neuberger DBE 5 Stars: A revolutionary book packed with important ideas The book is radical and readable and packed with ideas, and I find that I keep returning to it. Amazon customer review, Mar 2010 This is enlightening stuff, not only for healthcare managers and those considering working in developing countries, but for anyone interested in how political, commercial and cultural factors affect the world's health. Interesting anecdotes and a wealth of facts and figures highlight shocking discrepancies in national health systems. An objective and unbiased overview is informed by experience of running the world's biggest health service and by working in poor countries as an adviser to the Prime Minister, and consultant to the World Health Organization and the Gates Foundation. The Pharmaceutical Journal Health Service Journal Review - 25 March 2010 British Medical Journal Review - 16 February 2010 Times Review - 6 January 2010 Podcast - Tom Daschle and Nigel Crisp discuss Global Health Care - 21 January 2010 Latest Reviews Very well written, "Turning the World Upside Down" is truly a remarkable book. Very timely, with great insights and practical examples on global public health, it spreads a powerful and urgent message: richer countries can learn from poor ones. This is one of the best books I have ever read - highly recommended for policy makers, innovation thinkers and practitioners in any field, not just on health. In short, if you believe globalization must be collaboration, not standardization, this is your book. Diogo Vasconcellos, Distinguished Fellow, Cisco Systems International and Chair of Business Panel on EU Innovation Policy Here we have a former top civil servant arguing that we simply have to do things differently. The Lancet, Dec 2010 Packed with facts about the health status of the world ... Crisp knows the issues facing healthcare in the richest and poorest countries. He does what the title promises: he rejects the constraints inherent in traditional methods of delivering healthcare and turns the donor-recipient relationship upside down. He offers suggestions as to how all countries in the 21st century can work together, learning from each other as we address global need in healthcare, and the social, political and economic inequalities that accompany it. Chris Lavy, review in Christian Medical Fellowship; 49: 2010

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