------Speech in the First Global Symposium on Health Systems Research
First Global Symposium on Health Systems Research:
Science to Accelerate Universal Health Coverage
Montreux, Switzerland
November 16-19, 2010
Lincoln Chen
President, China Medical Board
Besides serene Lake Geneva and beneath the towering and majestic peaks of the Swiss alps (snow-capped with sunshine breaking through today but earlier all week snow falling on top and rain falling below), we 1,200 participants from more than 100 countries convened over four days in more than 100 sessions at the First Global Symposium on Health Systems Research: Science to accelerate Universal Health Coverage.
Literally, we arrived in Montreux from all around the world. Figuratively, the journey had many long and windy roads: Commission on Health Research for Development in Stockholm (1990), to Bangkok (2000), to Mexico City (2004), to Bamako (2008), and now to Montreux (2010). In between, we have had many forums, conferences, and workshops. There is the “classic” 2000 World Health Report on health systems to this year’s 2010 World Health Report on financing of health systems. For my task of summarizing structure, process, and people, three themes may capture the thrust of the Symposium -- solid foundation, timely opportunity, and plan of action.
Solid Foundation – All available evidence confirms that the near doubling of life expectancy worldwide in the 20th century is knowledge-based and socially-driven. By knowledge base, I refer to technologies (e.g. drugs vaccines, and diagnostics), people’s education, and information and evidence to guide HS. By socially-driven, I mean the contribution of HS as social institutions and also social determinants and social movements in health. HSR is at the heart of knowledge linkages to social action, and UHC is at the core of all HS goals. This linkage is captured well by Julio Frenk who spoke of the “power of ideas influencing the ideas of the power(ful).” Its centrality was expressed by Health Minister Penmak who described HSR as “indispensible,” especially for a poorer country like Laos that needs even more HSR for achieving good health with modest resources. HSR, he concluded, can “spearhead” advances in health.
Timely Opportunity – was underscored by NandiniOoman who blogged that HS is “sexy!” The field of global health has attracted a four-fold increase in new resources over the past two decades, reaching more than $20 billion annually. New policies to reform HS are accelerating in many countries – China, India, Brazil, South Africa, and many others – with researchers more often trying to catch up rather than shining the light on the path ahead. At the global level, HS is part of MDG-Plus since targeted programs depend upon HS for performance and sustainability. Saving the lives of mother and children is politically popular with statesman because it commands high moral ground of avoiding human suffering and death. There has been explosive growth of new knowledge on HS as reflected by several Symposium panels. Noteworthy is that there is recognition that national HS studies demonstrate huge differences in performance, opening up learning when n=200 experiences may be compared in South-South, North-South, and South-North dimensions. Montreux, to me, represents the transition of the Commission’s ENHR (essential national health research) to HSR (health systems research) as essential for health performance at the national but also local and global levels.
Social Action – To strengthen HSR and to advance UHC, social action is needed. Such will depend ultimately on social mobilization based on social solidarity propelled by a social movement. All social movements depend upon answers to three questions: What is the cause? Who are the actors? And what are the mechanisms for action?
The cause in this Symposium is clearly UHC which was described as inclusive, non-segregated, pro-poor and gender for equity. In Montreux, however, we went beyond UHC-1 to UHC-2 or UHC-squared. While UHC is a national construct, its values and ethos should extend beyond national boundaries to true universality including every human person in the world. As articulated by Julio Frenk, true UHC would witness 100% coverage of all people worldwide! The coverage of benefits need not be identical in every country, but there should be some core, basic, or essential package. UHC-2 should become an entitlement, a social right of global citizenship expressing our common humanity. The great historian, Arnold Toynbee, observed that the 20th century was the first time in human history that we dared to dream that progress could be shared with all people on planet earth. UHC-2 would be one 21st century realization of this unfinished 20th century dream!
The actors come from diverse constituencies -- scientists, policy-makers, leaders of government, UN and development agencies, NGOs, activists, and the private sector. Actors are both individuals but also as constituency groups, teams, partners, collaborators. In other words, like Lucy Gilson’s complexity theory of HSR, actors interact operating through dynamic relationships in the conduct of science and in the pursuit of social goals. For a social movement, the actors and constituencies must share similar core values, share a common commitment, and share a single social destination. UHC-2 is a worthy common social destination that can ignite passion among engaged actors and constituents.
Platform of Action -- Our cause on UHC-2 is just and our constituencies are energized, but what kind of mechanism can propel action? Based from this Symposium, the first modality will be spreading out – taking the Montreux train back home by 1,200 participants to more than 100 countries where we will carry the Montreux message to thousands of others. How each of us participants act differently changed by the Montreux experience constitutes the Symposium’s most important impact.
The organizers will be reaching out – to disseminate the Symposium through publications, website, podcast, and other communications media. Special focus will be the next generation of young leaders. As connectivity is key, social networking (like a HSR facebook) may be useful, not for romantic dating but for HSR dating, seed dating, speed dating, collaborative dating – bringing scientists from different disciplines and researchers and policy-makers together in the social movement.
Opening up is essential to grow a social movement with a big tent encompassing all interested individuals and institutions. Montreux set a good precedent as an open meeting with many participants responding to call for submissions from WHO. As a social movement, HSR-UHC is fundamentally a creative process, since “re-search” is a genuine search for truth, an endeavor unique to the human species and a social mission driving to achieve UHC-2.
One suggested model is the International AIDS Society at which the first conference of 300 participants expanded to 25,000 stakeholders who meet biennially. A proposed International Society on HS should grow from 1,200 to 100,000 members given what is at stake in a $5.5 trillion industry, about 10% of the global economy!
Organizing will be key to setting up an International Society that would be solidified by a Second Symposium. Many affiliated events over the next two years are already moving in this direction – annual Prince Mahidol conference in Thailand, the next International Health Economics Association meeting in Canada, the Metrics Conference hosted by The Lancet and the Institute for Health Metrics and Evaluation in 2011, the UN Summit on Non-Communicable Diseases in September 2011, and the People’s Health Movement meeting in Africa in 2012.
A Second Symposium in three years would seem like an appropriate timing, thus in 2013. The enthusiastic response of the audience to the offer by Peking University’s Meng Qingyue’s for China to host Symposium II, if requested, signaled popular support for this next logical step. The road from Montreux to Beijing, however, will require ongoing stewardship. I am pleased to report that this morning’s Steering Committee meeting agreed that the current leadership and operating structures be charged to create an International Society for Symposium II and that Symposium I Chair Tim Evans should carry forward his leadership to pass the baton to the next Chair at Symposium II.
On behalf of all of the participants, I would like to offer vote of thanks to the Symposium’s Steering Committee, Council of Deans, Scientific Advisory Committee, and the 23 sponsoring organizations. The Symposium secretariat operated by Shenglan Tang of TDR, Dale Huntington of HRP, and Abdul Ghaffar of the Alliance deserve our thanks. Special recognition is accorded to Kent Ranson who based out of TDR worked his heart out to make this Symposium a success. The outstanding leadership exercised by Tim Evans deserves much praise.
To all participants, travel well and safely -- beginning on the train from Montreux to Geneva which is the first leg of the journey from Montreux in 2010 to Beijing in 2013!
