Lord Crisp KCB


Turning the world upside down - the search for global health in the 21st century

Reviews and commentaries from around the world – from nurses, doctors and national leaders alike – stress the importance of sharing ideas between rich and poor countries in a new and respectful culture and relationship

Thank You Mr. Nigel Crisp for a very inspirational book. I am a registered nurse from Kenya (not part of the brain drain) … really focusing on things of priority like the patients and not the professionals. Thank you, Lianne Wachira

In today’s joined up world we are all connected and the health of one person or nation affects us all. In this important and timely book Nigel Crisp describes how we can all learn from each other, rich and poor, and work together to improve health. Archbishop Desmond Tutu

We are at the threshold of a new era in global health, marked by unprecedented challenges and novel opportunities. Nigel Crisp’s book offers an essential guide to understand the dynamic nature of this new era and to successfully open up innovative avenues for progress. His original insights provide a fresh perspective on one of the crucial topics of our times. Julio Frenk; Dean of the Faculty, Harvard School of Public Health

A revolutionary book packed with important ideas. The book is radical and readable and packed with ideas, and I find that I keep returning to it. Richard Smith, former editor of the BMJ

‘Delivering sustainable health care in under resourced communities can be challenging and frustrating for those of us who work in the privileged sophisticated health care systems in the West. However, local solutions are needed for local problems. Nigel Crisp bursts the bubble of Western arrogance with a clear and measured response as to who knows best in health service design and delivery in Africa. This outstanding text is very challenging and should be mandatory reading for all those committed to trying to make a difference in global health care.’ Tony Falconer, President of the Royal College of Obstetricians and Gynaecologists

Turning the World Upside Down is a wonderful book with fresh insights over the transformation of global health that brings all societies, rich and poor together, into an interdependent health world where opportunities for learning and solutions, both local and global, can be greatly enhanced by adopting a "global outlook. A decade before its time, Nigel Crisp's book describes our emerging health world for the remainder of this 21st century. Lincoln Chen, President China Medical Board

Thanks for your book, what insights! Thanks for the boldness to say what you said, I have never heard it said that way. I agree so much with the debt that needs to be settled in some way and Britain does have a wealth of knowledge to SHARE. Maria Akrofi He is challenging health professionals about the part they can play and questioning the arrogance of some western aid schemes imposed on developing countries. “Just stop telling people what to do and start listening to them”. Nellie Bristol, the Lancet

This is a very important topic, particularly at a time of global recession. Nobody could be better qualified to compare what is happening in health in the rich and the poor world and to bring fresh and provocative insight to the subject. The Honourable Mary Robinson, Former President of Ireland and UN High Commissioner for Human Rights

The poorer world has something of real value to teach the richer world - in health and elsewhere - and Nigel Crisp is supremely well qualified to interpret it for us. Julia Neuberger, Baroness Rabbi Neuberger DBE

Very well written, "Turning the world upside down - the search for global health in the 21st century" is truly a remarkable book. Very timely, with great insights and practical examples on global public health, it spreads a powerful and urgent message: richer countries can learn from poor ones. This is one of the best books I ever read - highly recommended for policy makers, innovation thinkers and practitioners in any field, not just on health. In short, if you believe globalization must be collaboration, not standardization, this is your book. Diogo Vasconcellos, Distinguished Fellow, Cisco Systems International and Chair of Business Panel on EU Innovation Policy, author of the report "Reinventing Europe Through Innovation".


The most striking thing about health in the 21st Century is the way that the whole world is now so interconnected and so interdependent. This interdependence is changing the way we see health, creating a new global perspective and will affect the way we need to act.

Turning the world upside down is a search to understand what is happening and what it means for us all. It is based on my own journey from running the largest health system in the world to working in some of the poorest countries and draws on my own experiences to explore new ideas and innovations from around the world.

It has 3 unique features. It:
  • Describes what rich countries can learn from poorer ones, as well as the other way round
  • Deals with health in rich and poor countries in the same way, not treating them as totally different, and suggests that instead of talking about international development we should talk about co-development
  • Sets out a new vision for global health, based on our interdependence, our desire for independence and our rights and accountabilities as citizens of the world.

There is an unfair import export business in people and ideas that flourishes between rich and poor countries. Rich countries import trained health workers and export their ideas and ideology about health to poorer ones, whether or not they are appropriate or useful. What, I ask, if we were to turn the world upside own - so the import export business was reversed and poorer countries exported their ideas and experience whilst richer ones exported their health workers?

Health leaders in poorer countries, without the resources or the baggage of rich countries, have learned to innovate, to build on the strengths of the population and their communities and develop new approaches which are relevant for the rich and the poor alike.

At the same time richer countries and their health workers could help poorer countries to train, in their own country, the workers they need for the future. They would help pay a debt for all the workers who have migrated and learn for themselves the new ways of working they will need in the 21st Century.

We could stop talking about international development – as something the rich world does to the poor – and start talking about co-development, our shared learning and shared future.

There is already a movement of people and ideas travelling in this direction. Young people get this intuitively. Many thousands of young professionals want a different professional education for themselves - in global health. Together with the leaders from the poorer countries and the innovators around the world, they are creating a new global vision for health.

Turning the world upside down is a search for understanding that helps us to see how Western Scientific Medicine, which has served us so well in the 20th Century, needs to adapt and evolve to cope with the demands of the 21st Century. It sets out a new vision and concludes by describing the actions we need to take to accelerate the change.

I mention many people in the book and in each case tried to obtain their permission prior to publication. I tried but failed in the case of Dr Mauvareen Beverley, to whom I make two short references, and only managed to speak with her after publication. I apologise to her for this discourtesy.

To purchase

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