Stories from the Field: Just and Lasting Change

On May 28th, Prof. Carl Taylor was honored as the inaugural recipient of the Global Health Council LifetimePhoto by Medora Hebert, Global Health Council Achievement Award for his dedication to improving the health care of the world’s most marginalized people through innovative and sustainable community-based interventions. During his acceptance speech, Dr Taylor discussed the future of global health and that new directions will be required to meet the challenges as globalization takes over. He talked about the need to focus on “peoples self reliant social change” and that the greatest problem is going to be the issue of the “worlds total health ecology”. This is when the “3-way partnership” is important; where in addition to the top down officials and programs, and bottom-up self reliant communities, a new generation of health professionals must emerge that specialize in bringing the top and bottom together to find new patterns for collaboration. When this is accomplished, Dr Taylor believes that health for all will be possible and mutual empowerment will begin. (Photo by Medora Hebert, Global Health Council)

These concepts are based on decades of work and documented in the book he co-authored with his son, Daniel Taylor-Ide: Just and Lasting Change: When Communities Own Their Futures. The goal is to help communities become empowered – not just one individual but the community as a whole. If the community is dependent on outside aid to continue, then “sustainability is not sustainable”. Additionally, the way in which the donor community behaves can have negative consequences. Creating dependency to gain cooperation has been used in the past which only leads to more bureaucracy. The alternative approach is to conduct training activities to build capacity that preserves the community’s sense of ownership.

In their book, Just and Lasting Change, Carl and Daniel introduce the concept of SEED-SCALE: planting a seed and going to scale. SEED (Self-evaluation for effective decision-making) + SCALE (System for communities to adapt learning and expand) = SEED-SCALE. Scaling-up requires political leadership to work with the community. There are 3 dimensions of scale:

  1. Scale One: The seed process at a community level where you have working examples. The success of Scale One includes women’s empowerment.
  2. Scale Squared: The establishment of learning centers or clusters of successful communities that can influence an entire region. Potential growth depends upon the network of learning centers – or multiple growth points.
  3. Scale Cubed: Includes 1. Setting-up systems for partnership; 2. Top down support that makes the system sustainable.

This sounds complicated but Just and Lasting Change contains plenty of examples to show it works. The key ingredient to its success is the underlying belief that communities deserve respect, and when empowered, they can create a sustainable future for themselves.

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Carl Taylor, M.D., F.R.C.P., Dr.P.H. is a professor emeritus in the Department of International Health at Johns Hopkins Bloomberg School of Public Health, a Senior Health Advisor for Future Generations, and co-author of Just and Lasting Change: When Communities Own Their Futures. Dr Taylor served as UNICEF director for China from 1984 through 1987, and as a WHO consultant in preparing documents for Alma Ata, a World Conference in 1978 on Primary Health Care.

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