The world has faced a number of major health challenges over the past few decades. These include the resurgence of a number of infectious diseases, the HIV epidemic, periodic pollution disasters, the rising burden of chronic illness and the SARS outbreak. There is a growing realisation that the world’s population is interconnected and an associated concern about the possibility of global pandemics. Health has been rising up the political agenda in rich and poor countries. Governments and charitable foundations are increasingly willing to support initiatives for addressing health-related needs. The political concern about global health is creating major opportunities for improving the lives of poor people. It is also creating risks that poorly designed interventions will fail to achieve their objective or even have damaging consequences.

This paper argues that we are approaching a major turning point in the organisation of national and global health systems. Its aim is to stimulate debate about how to support systems that take into account the complex interactions between ecology, technology and social organisation within which health problems arise and are addressed. Its primary concern is how best to ensure that the health systems that emerge from this period of change address the needs of the poor.

A summary briefing of this paper is also available.