Turning the World Upside Down – global health, frugal innovation and the new age of well-being by Dr Hannah Brooks Specialty Registrar in General Practice, London Deanery and Dr Anas El Turabi, Specialty Registrar in General Practice, East of England Deanery

Judging from the turnout of the last Diagnosis salon, Global Health remains a popular topic for many doctors-in-training. Chaired by Pam Garside and held in conjunction with the Institute of Global Health Innovation at Imperial College, the salon boasted an all-star line up: Ara Darzi, former Parliamentary Under-Secretary of for Health; Richard Smith, former editor of the BMJ, now Director of United Health’s Global Chronic Disease Initiative; and in an unbilled cameo, Liam Donaldson, former Chief Medical Officer for England.

Ara Darzi’s talk focused on the convergence of health challenges between different health systems and the need to share successful innovations. Drawing on his experiences as a health minister and Director of Imperial’s Institute of Global Health Innovation, Lord Darzi made the case for revising traditional views of global health innovation.

Using examples like the Aravind Eye Care System in India, which is pioneering low cost, high quality ophthalmic care to some of India’s poorest populations, Lord Darzi highlighted the globally dispersed nature of innovation in health service delivery. In an argument reminiscent of the ‘reverse innovation’ advocated by GEs Jeff Immelt and ‘Jugaad innovation’ studied by Radjou, Prabhu and Ahuja, Lord Darzi challenged the audience to look beyond the traditional models of health system innovation, to discover new ways of adapting systems of care to meet healthcare and economic demands. (It was not clear whether Lord Darzi was ever aware of Pam Garside scribbling the words ‘Healthbox’ behind him in big letters).

‘Turning the World Upside Down’ was a theme that continued as Richard Smith challenged the salon to rethink what future priorities should be for global health. During a whirlwind tour of contemporary global health challenges, taking in the rising burden of chronic non-communicable disease, as well as a salutary introduction to the importance of Michael Marmot’s work on the social determinants of health, Dr Smith highlighted how changing patterns of global morbidity demanded a new approach to priority setting for global health.

The post-2015 development agenda will see the Millenium Development Goals superseded by the Sustainable Development Goals. With the SDGs still in development, Dr Smith argued that now is the time to be rethinking how we measure the success of global health endeavours. ‘Well-being’ he suggested might replace traditional measures of economic and health progress such as GDP or QALYs; an idea already being considered by the UK Government as part of its recent efforts to develop measures of national well-being.

With such high-profile and thought-provoking speakers, discussion was vibrant and wide-ranging. Amid nihilistic arguments of economic determinism in global health and less nihilistic arguments that all the world needs is more psychiatrists, Sir Liam Donaldson lent his considerable experience in global health, bringing a welcome clarity and insight to proceedings. What was more impressive however was how late into the evening discussions continued for many attendees. Proof again of both the draw of global health as a topic and the success of Diagnosis’ salon format.