Do you remember the Abbott and Costello skit, “Who’s On First?”

The two go back and forth in a complicated, confusing, and quite amusing conversation, using the same words but with a completely different understanding of what the other one is trying to say. Some elements of that skit were present at our convening in November, Achieving Lasting Impact at Scale, as we discussed just what “achieving impact at scale” actually means in relation to maternal, newborn, and child health. You can read an excellent report on the convening, which points out that both during the meeting, and more broadly in the world of global health, we often use the same words but mean different things.

The convening brought together global thinkers and doers from varied fields to start a conversation about global health challenges like neonatal and maternal mortality—issues that have defied solution for a long time. But by the end of the first day we realized that our varied backgrounds also gave diverse definitions to the core concepts of “scale,” “impact,” “spread,” and “innovation.”

Despite this diversity, we also represented a collective “we”—those who have a common interest in drastically reducing maternal, neonatal, and child mortality around the world.

Reducing maternal, newborn, and child deaths globally requires progress on many different fronts: developing new technologies, adapting existing tools to be more effective and user-friendly, designing delivery systems to make those technologies and tools more accessible, ensuring moms want and express sustained demand for those innovations, improving the ways we measure scale-up, and doing a better job at learning from failures and successes, among other things.

We deliberately left the definition of “scale” unrestrained as we began the conversation on this topic at the convening. The aim was to have us, as a group, reach a common language through a series of conversations.

Michael Little, convening facilitator extraordinaire and author of the synthesis report points out:

“There are dangers of over-definition…but there are dangers with under-definition, too, when people start to use the same words to mean very different things. Under-definition produces a false and temporary sense of concurrence that inevitably breaks down when the agreement is put to practice.”

As the conversations progressed, a common understanding of “scale” materialized. Scale can be small, like reaching every child in a school or village, and scale can also be large, as in reaching every child in every school or village in a given region, country, or continent.

The convening was a first step to start the conversation and to define what scale means to us as a global health community.

Defining a common language can aid scientific progress. And as we move forward in this global inquiry, our expectation is to add more voices to the conversation, including the perspectives of households and frontline health workers, and eventually contribute to a better understanding of how health impact at scale is actually attained.

So…are we on first? We hope so, with more clarity as we press on—with more voices and stories to help us save more lives!