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Turning the World Upside Down


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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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