Lawrence Gostin and colleagues offer a set of priorities for global health preparedness and response for future infectious disease threats.

Not all change is for the good; so before analysing how change can be promoted it is important to make clear that the changes I am concerned with are those based on sound evidence, whether in terms of patients' health status or satisfaction or in terms of organisational or economic benefits to the NHS. Nevertheless, studying processes can help in promoting good clinical care and in understanding and perhaps gaining more control over changes that are not good for patients or for the organisation as a whole.A second assumption is that if clinicians are given sound evidence that a practice is better they will adopt it or, conversely, stop a practice shown to be of little or no benefit or even to be harmful.

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Effective Care in Pregnancy and Childbirth (ECPC) is a comprehensive analysis of evidence. The findings are only now beginning to influence practice in the United Kingdom several years after its publication. This article assesses the extent to which policy makers and practitioners are prepared to use evidence and proposes ways to implement the ECPC findings. Such efforts would require leadership from the U.K. Department of Health and the commitment of the leaders of professional and consumer bodies to promote perhaps 10 or 12 key findings rather than try to push forward the whole program at once. A coordinated approach would then be needed to influence managers, professionals, and service users, first through informing them of the findings, and then by devising specific approaches, such as the use of opinion leaders, for each group. Finally, changes in practice should be monitored.