Clocks, watches, mountains, and trains. Clean Swiss efficiency. So, I was fascinated to learn about Swiss primary care when speaking at a recent conference in Lausanne; mostly single handed, still predominantly male, and with limited use of electronic records. Joining me from the UK was Stephen Campbell from Manchester, one of the architects of the quality and outcomes framework, and together we described both the theory and reality; from an overall perspective to day to day practice. Accepting that there are imperfections, it was a privilege to acknowledge the achievements of UK primary care. Concepts of quality and performance, which we now take for granted in the UK, were new and a little threatening for our audience. As in many countries, GPs are concerned about government motivation and worried about control. more…

US healthcare costs are unsustainable and a large amount of money is being wasted on unnecessary treatment.  There was general agreement about these statements among the audience, speakers and panelists at the recent Avoiding Avoidable Care conference, held in Boston. The summit was organized by the Lown Cardiovascular Research Foundation, the New America Foundation, and co-hosted by the Institute of Medicine. more…

On Friday 4 May 2012 “Strengthening the Global R&D System: Innovation for Health Needs in Developing Countries” took place in Geneva.

The keynote address, ”Investing in Global Public Goods” was given by Joseph E Stiglitz, recipient of the Nobel Memorial Prize in Economic Sciences (2001) and professor at Columbia University. more…

In an attention-grabbing presentation, Paul Walker, of the US affiliate Green Cross International, engrossed delegates at the World Congress of Public Health in Addis Ababa with his skillful exposition of the burden on humanity represented by warfare and the preparations for it. Tying the issues neatly into the concerns of Africa, he noted that the global annual expenditure on military activities of all sorts was in the order of $1.5 trillion and that was twice the GDP of the entire continent. The annual expenditure in relation to nuclear war preparation is, by itself, $100bn. He named the guilty parties; those countries that were not yet signed up to the Test Ban Treaty, the Non Proliferation Treaty, the Chemical Weapons Convention, and the Biological Weapons Convention. more…

This week I attended and participated in a panel discussion at the Council for Health Research and Development (COHRED)’s 14th Global Forum for Health Research in Cape Town, South Africa. Last year the Global Forum merged with COHRED, and this year’s forum has had a distinctly different focus from the thirteen previous meetings. Whereas in the past focus was on how to get aid efficiently from richer countries to poorer ones, this year’s forum focused on how to stimulate research and development for health in low and middle income countries (LMICs). As I walked into the conference venue I was greeted by a banner that read “Change, not just exchange.” This represents a rather radical shift in thinking, away from the delivery of aid in a vertical giver-receiver fashion and towards considering how to strengthen health systems and creating capacity for research, development, and innovation within poorer countries themselves. more…

The Flying Doctors Service of East Africa sounds like an echo from a romantic, and bygone age. But its formation in 1957 was the first step in the creation of a major African health development organisation that has been given the World Federation of Public Health Associations’ Institutional Award at the 13th World Congress of Public Health in Addis Ababa. The African Medical and Research Foundation (AMREF) has a great story to tell; of how it works in the remotest communities in Africa and works alongside those communities to build the knowledge and skills to transform their own health, how it provides training every year to more than 10,000 health professionals, and how it set up the international campaign “Stand Up for African Mothers” with its demand that no woman should die giving life. Oh, and it still provides a flying doctor and emergency evacuation service over much of Eastern and Central Africa. more…

“Doctors are not interested in health” is one of my many wild generalisations. My evidence is my experience, a 40 year collection of anecdotes, and the observation that a thousand page medical textbook usually comprises five desultory pages on health and 995 pages detailing disease. Now I have further evidence.

I’ve just attended the World Cardiology Congress in Dubai, an event with more than 10 000 attendees and an A4 programme that is 370 pages long. Not used to such extravagant events, I imagined every session packed with enthusiasts. more…

In a quiet house in Soho, where Charles Dickens reputedly wrote “A Tale of Two Cities,” C3 Collaborating for Health hosted a breakfast meeting last week on the importance of nutrition in athletics; a hot topic with the London 2012 games fast approaching. Breakfast reflected the theme, with not a bacon rasher or greasy pastry in sight, and Roger Clemens, president of the Institute of Food Technologists, and a former athlete himself, gave his views on how athletes could best prepare themselves. His answer? Optimum nutrition and optimum exercise provide optimum performance.

But what is optimum nutrition for any one athlete? Do athletes know what they are consuming, and how it is affecting them? What to eat? When to eat it? How much should they eat? What’s the right way to get to the weight they need to be? What supplements will boost their performance, and which will disqualify them? more…

Eighty thousand spectators hold their breath as they watch the penalty. Hushed anticipation. Fearful will he hold his nerve, handle the pressure, cope with the stress. But, is it that important? Nobody dies. Not like the decisions you make every day. For a surgeon or anaesthetist, fatal outcomes can be immediate. For others their mistakes may take a little longer. Life and death decisions, long term disability, or discomfort. But, let’s be realistic. Patient safety and sport—hardly comparable. more…

We live in our own little boxes. Maureen Bisognano from the Institute of Healthcare Improvement , in her keynote address, told us we need to get out of our own little boxes if we are to improve healthcare. Quality improvement means breaking out of silos. She told us we needed to focus more on our patients asking not “What is the matter” but, “What matters to you.” She urged us to look at the organisation of healthcare citing the benefits from multidisciplinary rounds and the importance of teamwork in reducing mortality in intensive care. Everyone’s voice is important and it is essential that everyone, clinicians and nurses work together, a point echoed later in the day by Hugh Rogers from the NHS Institute for Innovation and Improvement, who described the difficulties of reconciling different tribes in the operating theatre: anaesthetists, theatre nurses, and surgeons. Maureen also encouraged us to look to the community—we currently focus most of our resources on the 3% at the top of the healthcare pyramid and only 3% of resources on the bottom 50%. Can we challenge the community to look at their own healthcare? She told a story: more…