In this century, medical schools will be gauged by their capacity to anticipate the kind of doctors required by evolving health systems. They will need to consider the challenges these health systems face as they grapple with critical health concerns in society. In this context, two things immediately become apparent: one, the roots of ill health lie in poverty, discrimination, lack of education, maldistribution and misuse of often scarce resources; and two, in any given country, those who identify health issues, act on health determinants, decide on the use of resources, deliver health services, or train health manpower are usually different groups that may not share the same value system and priorities. Thus, fragmentation is a serious threat to the efficiency and effectiveness of health systems everywhere.

These observations set the table for some tough questions: What readjustments do health systems need to make? What roles should doctors play? Which responsibilities should medical schools shoulder to contribute to the development of healthier societies? I like to think that being aware of these overarching issues is a first step towards social accountability.