There is an inarguable need to move improvement in health care to a new level to attain and exceed the Millennium Development Goals. The challenges can be overcome through concerted action of key stakeholders and the application of scientifically grounded management methods to enable the reliable implementation of high-impact interventions for every patient every time needed.

Robert Kagan's Of Paradise and Power is the latest attempt, following Francis Fukuyama's The End of History and Samuel Huntington's The Clash of Civilizations, to provide us with “The Answer,” an analysis of the way the world works to take away some of the pain of the uncertainties which have dogged us since the end of the Cold War. The pattern has been the same: first an article in a journal, striking a chord with a wider than usual readership and then the press in general, aided by an arresting sound-bite –(the titles in the case of Fukuyama and Huntington, the tag from the first page of Kagan's Policy Review article: “the Americans are from Mars and Europeans are from Venus.”). It is through such caricature, given just enough resonance to contemporary anxieties and provoking just enough outrage, that a viewpoint can gain currency among the journalists and policy wonks who set the parameters of the policy debate surrounding governments and legislators. To reinforce academic respectability, the articles were then expanded into books, to reveal, or create, the philosophical and historical underpinnings of the original argument. The timing of these publications creating a stir is everything: those moments when the worrying complexity of international relations cry out for the simplicity which a caricature can offer, when there is a demand to make the hard-to-calibrate risks in world affairs comprehensible through their replacement by goals achieved or threats cut and dried.

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