Making progress in global health: the need for new paradigms

This article takes the state of health in the world today as the starting point for a backward look at the trajectory that has led to our current position and speculation about prospects for improved global health in the future. Our model of social development and its dominant value system, which has promoted scientific progress but has also brought about great social, economic and health instability, is interrogated. This leads to questions such as what it means to be healthy and what the practice of medicine is about. Three potential scenarios for global health in the future are outlined. It is suggested that deep introspection about our current value system is required to achieve a paradigm shift that could reverse current trends and lead both to improvements in health globally and to less human insecurity. The authors conclude that while we have the material resources to achieve ambitious goals we may lack the moral and political will to do so. An expanded discourse on ethics and human rights-as well as on the limits of what is politically possible- may provide the impetus to drive change towards an improved global economic system and better health globally.