Published on Let's Talk Development

When the snow fell on health systems research: a symposium sketch

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Editor's warning: The author wrote this post after hitting his head and suffering some memory loss, and the World Bank cannot vouch for the accuracy of everything reported in it.

It was the perfect finale. In the vast high-tech auditorium of Beijing's International Convention Center, the audience jostled in the queue to pose questions to the final plenary panel of the Second Global Symposium on Health Systems Research

First came an elderly lady from the Indian subcontinent who asked why the panelists were so old. "How can we address the issues of tomorrow with the experts of yesterday? If we're going to be serious about universal health coverage, we need youth!" The crowd -- mostly young -- signaled their approval. A middle-aged gentleman from South Africa  tried to engage the panel on the damages inflicted on world nutrition by the global food corporations. Warming to his theme of corporate neocolonialism, land grabs, and genetically modified foods, he invoked the memory of Lenin. "That's Vladimir Lenin", he explained to the crowd, "not John Lennon." "Vladimir who? John who?" wondered the youthful crowd. The chair, the ever-youthful Lancet Editor-in-Chief Richard Horton, whose favored medium is Twitter, asked the gentleman to keep his comments tweet-length. A young woman from Britain's aid agency, DfID, eventually wrestled the mike from Lenin's apologist, and said what was on everyone's mind. "Richard, Dear Leader.", she urged, "Tell us your thoughts. It's you we want to hear!"

Richard, never one to duck a request to share his views, but ever the perfect gentleman, gave the deflated panelists time to get through their final remarks, and then strode athletically to the lectern. A flick of the forelock, a tap of the mike to make sure it was set to "extremely loud", and Richard was off. "Comrades, I offer you a vision!", he roared. "Only one thing matters. Universal Health Coverage. Nothing else. Our path up the mountain to UHC will be steep. But we must not shirk our duty to get the world there." "Yes!", thundered the crowd in response, "We must not shirk!" Richard, looking ever more like a prime minister in waiting, plunged onwards in what for him was fast becoming the speech of a lifetime and for us looked certain to be the speech of the conference. "And to those of you who say we should spend some time thinking what UHC is, how to measure it, and why to matters above all else, I refer you to an article in a distinguished journal." "Of course!", murmured  the crowd, "Our Dear Leader is going to refer us to an article in his own journal. He might even give us free access to it! "No!", Richard bellowed, "not The Lancet, for there is an even greater journal." A gasp from the crowd. An even greater journal than The Lancet? Surely not! "The article I refer you to was published in Nature.", Richard explained. "What the article shows conclusively, and once and for all" (The Lancet's Editor-in-Chief loves certainties; who doesn't?) "is that thinking is overrated. We make our best decisions when we don't think! Cast aside any nagging doubts about UHC! Cast aside thought itself! Just act!" To tumultuous applause, and with a discreet Asian-style bow, Richard returned to his place on the sofa to rejoin the now rather crestfallen and distinctly upstaged panelists.

The symposium organizers, surely the most responsive, efficient and imaginative that man- and woman-kind have ever seen, treated the fired-up crowd to yet more after the coffee break. First up were three members of UHC Youth, who exhorted us to join them on the steep ascent to UHC. Spinning giddily through a Prezi presentation (no boring Powerpoints for these youngsters) and worried we might not quite have grasped the challenge ahead of us, the trio flashed up images of a steep snow-covered mountain with a UHC flag planted firmly at its summit. And in case any of us was still tempted to think and not act, our brave young speakers showed us a gruesome picture of an auditorium full of sleeping people, victims apparently of some soporific evidence-based presentation.

The master of ceremonies, a little worried we might not be keeping up with the plot, wrapped us in the warm cocoon of a children's story. Who can resist the lure of a return to childhood where someone else did our thinking for us? Happily for this busy group of researcher-advocates, the moral of the story was tweet-length and in tune with the times: Act, and act now!

The man behind the Symposium didn't disappoint. Tim Evans, BRAC University's School of Public Health Dean, announced that the new society born at the Symposium will be known simply as Health Systems Global. "Membership applications from researchers are not discouraged", he added with a disarming grin, "but advocacy credentials will need to be verified."

As we filed out the auditorium, Health Systems Global volunteers handed out t-shirts:  "UHC we can!" on the front, and "We must not shirk!" on the back. Ever so politely they uninstalled Excel, Stata, and other unnecessarily quantitative software from our laptops. We headed for the exit just as Beijing's first snow of the season started to fall. Our steep journey toward the snow-covered UHC peak had begun. "UHC we can!" we cried.


Adam Wagstaff

Research Manager, Development Research Group, World Bank

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