Book Review

Global Health Leadership and Management

N Engl J Med 2005; 353:2825-2826December 29, 2005

Article

Global Health Leadership and Management
Edited by William H. Foege, Nils Daulaire, Robert E. Black, and Clarence E. Pearson. 241 pp. San Francisco, Jossey-Bass, 2005. $47. ISBN: 0-7879-7153-7

It is a welcome breath of fresh air to read William H. Foege's preface to Global Health Leadership and Management. He zeroes in on the looming crisis in global public health with a tiger's instinct for the jugular vein.

Bridging the huge gap between the knowledge of medical science and the delivery of public health is the focus of this book. From the standpoint of global public health, medical science that goes undelivered is the same as no medical science at all. To Foege, the effective and sustainable delivery of medical science is critical to achieving better world health. He believes that the key is creative and effective leadership and management.

Foege declares that

science is not enough, good intentions do not change the health picture, and resources are easily wasted. We need the same constant attention that is absolutely expected in the business community, with a focus on developing objectives, working out strategies for reaching those objectives, organizing all components of a program to pursue the strategy, pushing for continuous quality improvement, and developing the ability to measure both process and outcome goals for constant midcourse corrections.

He goes on to state that “global health waits expectantly for management to match its science” (and, I might add, for more leaders and commentators who can match Foege's insight and vision). With that, the powerfully written preface ends.

What follows, in a well-organized fashion, is a collection of 17 essays of varying quality, each 6 to 18 pages in length, written by some of the most prominent figures in international public health. A few of the contributors merely restate the problem or recite the obvious and do not build particularly well on Foege's excellent foundation — perhaps understandably, because this book charts truly new territory. It must have been difficult to organize such an army of prominent explorers and to keep them marching in the same direction. Editing the book must have been a considerable challenge. Overall, however, it has come out well. The occasional and probably unavoidable unevenness does not really matter, because many contributors have delivered pure diamonds. These essays alone are well worth the price of the book and the time it takes to read it.

Harlan Cleveland's essay regarding the broad effects that the global information revolution may be having on global public health is particularly thoughtful, as well as thought-provoking. Nils Daulaire presents a powerful analysis of the striking similarities between the characteristics of successful leaders at the local level in global health and those of managers at the level of individual business enterprises. Susan Dentzer details the important lessons to be taken from Brazil's approach to HIV and AIDS. Jo Ivey Boufford effectively addresses the critical problem of how to find, train, retain, and motivate the extraordinary people who will be the agents and leaders of change. She examines this problem from the standpoint of what has worked well in the business world.

When I began reading the short contribution from Jeffrey D. Sachs, I was prepared to be disappointed with a brief summary of what he has often expressed before — how could he present anything really new in only six pages? I was wrong. The last half of his essay should be published in the opinion and editorial pages of major newspapers everywhere. It is a precise, four-step blueprint for poor countries to obtain more financing for health services from donors. It is also a practical and politically savvy prescription that incorporates the best of business planning and management.

This collection does not (and as structured, obviously could not) address in depth many of the obstacles of structure, politics, and values that confront global public health. But it does offer important new ideas and ways of thinking that will be essential to incorporate if substantial progress is to be made. In that respect, it is a must-read for anyone who has a stake in global public health, which means everyone.

A particular challenge is that many of the changes that are needed could be perceived to threaten the niches of global health professionals. The changes will need to be spearheaded by “transformational leaders” in the field, as Cleveland refers to them. As he says, “It takes an unusual measure of both self-confidence and tact for [such leaders] . . . to muscle into the policy domains of more conventional colleagues.” I hope these leaders will be successful. It will be ironic if the final analysis shows that, as Pogo said, “We have met the enemy and he is us.”

Kenneth E. MacWilliams, M.B.A.
Woodrow Wilson Associates, New York, NY 10022
macwilliams@post.harvard.edu