The uses of knowledge in global health

If the problem of society is mainly one of rapid adaptation to changes in the particular circumstances of time and place then the ultimate decisions must be left to the people who are familiar with these circumstances, who know directly of the relevant changes and of the resources immediately available to meet them. We cannot expect that this problem will be solved by first communicating all this knowledge to a central board which, after integrating all knowledge, issues its orders. We must solve the problem by some form of de-centralization But the 'people on the spot' cannot decide solely on the basis of their limited but intimate knowledge of the facts of their immediate surroundings. There still remains the problem of communicating to them such further information as they need to fit their decisions into the whole pattern of changes of the larger system. How much knowledge do they need to do so successfully? Which of the events which happen beyond the horizon of their immediate knowledge are of relevance to their immediate decision, and how much of them need they know? -F.