The Lancet commissions from all sources: public, private, development aid, and foundations. Third, stewardship mechanisms, including The Flexner report socially accountable accreditation, should be strengthened NURSING AN to assure best possible results for any given level of N THE UNITED STATES funding. Lastly, shared learning by supporting metrics, evaluation, and research should be strengthened to build up the knowledge base about which innovations work 量影露 under which circumstances Health professionals have made enormous contributions to health and development over the past century, but complacencywill only perpetuate theineffective application of 20th century educational strategies that are unfit to tackle 21st century challenges. Therefore, we call for a global social movement of all stakeholders--educators, Hgure Flexner, weidch-kose, and goldmark reports students and young health workers, professional bodies, complementing the importance of social determinants universities, non-governmental organisations, inter- and social movements in health. In these endeavours national agencies, donors, and foundations--that can professionals play the crucial mediating role of applying propel action on this vision and these recommendations knowledge to improve health. Much evidence suggests to promote a new century of transformative professional that coverage and numbers of health professionals have a education. The result will be more equitable and better direct effect on health outcomes. Health professionals performing health systems than at present, with are the service providers who link people to technology onsequent benefits for patients and populations information, and knowledge. They are also caregivers everywhere in our interdepend communicators and educators, team members, managers ders, and policy makers. -1z As knowledge brokers Section 1: problem statement health workers are the human faces of the health system Background and rationale Arguably, dramatic reforms in the education of health professionals helped to catalyse health gains in the past Health is all about people. Beyond the glittering surface century. After the discovery of the germ theory in Europe, of modern technology, the core space of every health the beginning of the 20th century witnessed widespread system is occupied by the unique encounter between one reforms in professional education around the world. In set of people who need services and another who have the USA early in the 20th century, such reports as by been entrusted to deliver them. This trust is earned Flexner. 3 Welch- Rose 4 and Goldmarks transformed through a special blend of technical competence and postsecondary education of physicians, public health service orientation, steered by ethical commitment and workers, and nurses, respectively(figure 1). These efforts social accountability, which forms the essence of to imbed a scientific foundation into the education of professional work, Developing such a blend requires a health professionals extended into other health fields. 6 lengthy period of education and a substantial investment However, in the first decade of the 21st century, glaring by both student and society. Through a chain of events gaps and striking inequities in health persist both fowing from effective learning to high-quality services to between and within countries. -m A large proportion of improved health, professional education at its best makes the 7 billion people who inhabit out planet are trapped in an essential contribution to the wellbeing of individuals, health conditions of a century earlier. Many face conflict families, and communities and violence. Health gains have been reversed by the Yet, the context, content, and conditions of the social collapse of average life expectancy in some countries effort to educate competent, caring, and committed health which in sub-Saharan Africa is attributable to the professionals are rapidly changing across time and space. HIV/AIDS pandemic. uz Poor people in developing The startling doubling of life expectancy during the 20th countries continue to have common infections entury was attributable to improvements in living malnutrition, and maternity-related health risks, which standards and to advances in knowledge. Abundant have long been controlled in more affluent populations evidence suggests that good health is at least partly For those left behind, the spectacular advances in health knowledge not only produces new technologies but also ensure the equitable sharing of health progress. sure to knowledge based and socially driven. 23 Scientific worldwide are an indictment of our collective failure to empowers citizens to adopt healthy lifestyles, improve At the same time, health security is being challenged care-seeking behaviour, and become proactive citizens by new infectious, environmental, and behavioural who are conscious of their rights. Additionally, knowledge threats superimposed upon rapid demographic and anslated into evidence can guide practice and policy. epidem-iological transitions. -7 Health systems are Health systems are socially driven differentiated struggling to keep up and are becoming more complex institutions with the primary intent to improve health, and costly, placing additional demands on health workers. ww.thelancet.comThe Lancet Commissions www.thelancet.com 7 from all sources: public, private, development aid, and foundations. Third, stewardship mechanisms, including socially accountable accreditation, should be strengthened to assure best possible results for any given level of funding. Lastly, shared learning by supporting metrics, evaluation, and research should be strengthened to build up the knowledge base about which innovations work under which circumstances. Health professionals have made enormous contributions to health and development over the past century, but complacency will only perpetuate the ineffective application of 20th century educational strategies that are unfit to tackle 21st century challenges. Therefore, we call for a global social movement of all stakeholders—educators, students and young health workers, professional bodies, universities, non-governmental organisations, inter￾national agencies, donors, and foundations—that can propel action on this vision and these recommendations to promote a new century of transformative professional education. The result will be more equitable and better performing health systems than at present, with consequent benefits for patients and populations everywhere in our interdependent world. Section 1: problem statement Background and rationale Complex challenges Health is all about people. Beyond the glittering surface of modern technology, the core space of every health system is occupied by the unique encounter between one set of people who need services and another who have been entrusted to deliver them. This trust is earned through a special blend of technical competence and service orientation, steered by ethical commitment and social accountability, which forms the essence of professional work. Developing such a blend requires a lengthy period of education and a substantial investment by both student and society. Through a chain of events flowing from effective learning to high-quality services to improved health, professional education at its best makes an essential contribution to the wellbeing of individuals, families, and communities. Yet, the context, content, and conditions of the social effort to educate competent, caring, and committed health professionals are rapidly changing across time and space. The startling doubling of life expectancy during the 20th century was attributable to improvements in living standards and to advances in knowledge.1 Abundant evidence suggests that good health is at least partly knowledge based and socially driven.2,3 Scientific knowledge not only produces new technologies but also empowers citizens to adopt healthy lifestyles, improve care-seeking behaviour, and become proactive citizens who are conscious of their rights. Additionally, knowledge translated into evidence can guide practice and policy. Health systems are socially driven differentiated institutions with the primary intent to improve health, complementing the importance of social determinants and social movements in health. In these endeavours, professionals play the crucial mediating role of applying knowledge to improve health. Much evidence suggests that coverage and numbers of health professionals have a direct effect on health outcomes.4 Health professionals are the service providers who link people to technology, information, and knowledge. They are also caregivers, communicators and educators, team members, managers, leaders, and policy makers.5–12 As knowledge brokers, health workers are the human faces of the health system. Arguably, dramatic reforms in the education of health professionals helped to catalyse health gains in the past century. After the discovery of the germ theory in Europe, the beginning of the 20th century witnessed widespread reforms in professional education around the world. In the USA early in the 20th century, such reports as by Flexner,13 Welch-Rose,14 and Goldmark15 transformed postsecondary education of physicians, public health workers, and nurses, respectively (figure 1). These efforts to imbed a scientific foundation into the education of health professionals extended into other health fields.16 However, in the first decade of the 21st century, glaring gaps and striking inequities in health persist both between and within countries.17–20 A large proportion of the 7 billion people who inhabit out planet are trapped in health conditions of a century earlier. Many face conflict and violence. Health gains have been reversed by the collapse of average life expectancy in some countries, which in sub-Saharan Africa is attributable to the HIV/AIDS pandemic.21,22 Poor people in developing countries continue to have common infections, malnutrition, and maternity-related health risks, which have long been controlled in more affluent populations.23 For those left behind, the spectacular advances in health worldwide are an indictment of our collective failure to ensure the equitable sharing of health progress.24 At the same time, health security is being challenged by new infectious, environmental, and behavioural threats superimposed upon rapid demographic and epidem-iological transitions.25–27 Health systems are struggling to keep up and are becoming more complex and costly, placing additional demands on health workers. Figure 1: Flexner, Welch-Rose, and Goldmark reports