Health » Overview

Salzburg Global Seminar has long been a leading forum for the exchange of ideas on issues in health and health care affecting countries throughout the world. At these meetings agendas have been re-set affecting policy and practice in crucial areas, such as patient safety and the engagement of patients in medical decision making. In 2010, Salzburg Global Seminar launched a multi-year series of seminars to crystallize new approaches to global health and health care in the face of emerging challenges affecting us now and set to continue on through the coming generation.


Interviews and coverage from our Health programs

Ina Kopp – “We need to start caring for our societies at an early stage”
Ina Kopp – “We need to start caring for our societies at an early stage”
Nicole Bogart 
The German, Swiss and British health care systems are very different, each tackling distinct difficulties regarding reform, funding, and political trials. But despite these differences, they still face many of the same broad challenges; from ageing populations and depleted workforces, to the ever-increasing costs of health care. Ina Kopp, Director of the German Association of the Scientific Medical Societies’ Institute for Medical Knowledge-Management, believes these three nations also share difficulties regarding social care and the promotion of wellbeing in societies.

“We need to go for prevention – we need to start caring for our societies at an early stage,” says Kopp.

Sciana members echoed this concern, one describing the German system as a “sick care” system instead of a health care system, noting most fail to see a doctor until they are already ill. But this promotion of wellbeing is a societal responsibility, one that must begin outside of the health care system, in schools and workplaces to encourage healthy living, says Kopp.

“Prevention must take place where the people are. Where the people work and where the people live,” she notes. “What might be different in Germany is that we have 80 million people to care for, and last year we had one million refugees we [now] need to integrate, not only in the health care system, but really in our society.”

Yet it is these shared challenges Kopp believes will empower Sciana, the health leaders network, to become a platform to facilitate ideas, allowing members to share unique outlooks on problem solving.

“We can share some experience from pilot projects,” she says. “I’ve heard so many other approaches to the same problem that I really expect we can learn from each other.”

Kopp describes the inaugural Sciana meeting as an exciting opportunity to network with health care professionals from other countries, noting discussion between members blossomed within minutes of arriving in Salzburg.

“I do hope the next days will really bring us some opportunities to not only develop new ideas, but also write them down and work on some recommendations," she says.
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Lynn Ross - When did you first fall in love with nature?
Lynn Ross - When did you first fall in love with nature?
Lynn Ross 
This post was first published on Lynn Ross' LinkedIn profile. Ross attended Session 574 - The Child in the City: Health, Parks and Play, which is part of the multi-year Parks for the Planet Forum. I first fell in love with nature as a child playing for hours on end in the backyard of my family home where the grass, trees and flowers were animated participants in all my magical backyard adventures. Even as a dedicated city dweller my love affair with nature has continued into adulthood, so I was honored to become a fellow of the Salzburg Global Seminar last month during Session 574, “The Child in the City: Health, Parks, and Play.

This session, hosted over 4 days at the amazing Schloss Leopoldskron in Salzburg, Austria, included advocates, researchers and practitioners representing 20 countries. Each participant brought a unique perspective and a wealth of experience. Here are just a few of the interesting initiatives I learned about:
  •     Urban95 is a global initiative of the Bernard van de Leer Foundation that asks what city leaders, designers, and planners what they would do differently if they viewed the city an elevation of 95 cm – the average height of a healthy 3-year-old.
  •     The Laboratorio para la Ciudad in Mexico City is using research to explore play and developing tools for engaging children in government through their Playful City initiative.
  •     Park Rx America is handing out “park prescriptions” to reduce chronic illness by mapping parks and providing info on making the most of the park (including transit tips to get there).
  •     City Health, an initiative of the de Beaumont Foundation, has rated 40 cities on nine evidence-supported policy areas that support community health and well-being.
  •     Natural Neighbors is an international effort designed to promote expanded alliances with museums, schools and universities and parks and conservation areas by linking exhibits, outreach materials and activities across organizations.
During the session, I also had the pleasure of leading a discussion on moving from incremental change to transformation. Through case studies from the United Kingdom, the United States and Singapore, the panel shared the following key takeaways which apply not only to kids and nature, but to any community building effort:
  •     Have a big, inclusive vision that people can see themselves in.
  •     Clearly articulate the value proposition and theory of change early in the process.
  •     Build meaningful, inclusive partnerships and are those partners with the tools they need support the work and outreach.
  •     Prioritize crafting and customizing messages for diverse audiences.
  •     Build a culture of learning and plan for evaluation into the effort from the start.
There were many more efforts, takeaways and resources shared throughout the session and I encourage you to check out the “Resources” section of the session page.

On the final day of the session, we started the process of transforming our collective learning into a set of principles that can be shared broadly. A smaller group of participants is continuing that work post-session. In addition, each participant shared personal commitments to continue the work of the session in their daily practice. It’s no surprise that my experience in Salzburg is already influencing my work on the Reimagining the Civic Commons initiative, but what has been a surprise is how much the experience has me thinking about the role of nature, parks and play as part of housing affordability and equitable community development.

So, I’ll leave you where I started but with an addition: when did you first fall in love with nature? And what can you do in your practice to ensure that all children will someday get to answer that same question?
Lynn Ross was a participant in the Salzburg Global program The Child in the City: Health, Parks and Play, which is part of the multi-year Parks for the Planet Forum, a series held in partnership with the IUCN. The session was supported by the Huffington Foundation, Parks Canada and Korea National Park and the W.K. Kellogg Foundation. More information on the session can be found here: www.salzburgglobal.org/go/574
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Dr Suresh Kumar - Have you prepared for your death?
Dr Suresh Kumar - Have you prepared for your death?
Suresh Kumar 
This article first appeared on the EAPC blog, which will continue to publish more posts on the Salzburg Question series. It refers to the third Salzburg Question: How have you prepared for your death? Dr Suresh Kumar, Director of the WHO Collaborating Center for Community Participation in Palliative Care and Long Term Care & Technical Advisor, Institute of Palliative Medicine, Calicut, Kerala, India, explores the third question in the Salzburg Questions series, that encourages a global discussion about the key issues affecting palliative care. Most people are taken aback by a question about their own death, because death is something that happens to other people!

So, reactions to the question ‘Have you prepared for your death?’ posted on social media recently were not totally unexpected. This question was posted on Facebook and Twitter with a hashtag #allmylifeQs by more than 250 people on 7 April as a Salzburg Question. Salzburg Questions are a series of questions to bring attention to issues related to end of life, death and dying. More than 750 people participated in the online discussions that followed the ‘preparations for death’ question. Responses varied, from a calm, calculated yes to a big no in surprise and horror. A few people said they had already thought about this. Most haven’t.

Many people have already pointed out that there is a huge difference between the philosophical statement: ‘We all will die one day’ and the awareness of: “I am not going to die in a few months’ time”. Though we all know that we have to die one day, most of us have never reflected on what it would be like to die. And society does not generally encourage such thoughts. Thoughts and words about death are usually considered ‘dark’ and something to be avoided.

Why should one think of death much before it comes, when one is busy with life? For one thing, Death is an unpredictable guest. Many of us working in the area of end-of-life care realize that deliberate avoidance of death as a topic of discussion from the social and medical deliberations has resulted in society becoming more and more ‘death denying’ with a lot of negative implications. Though it is very important, it is extremely difficult (and very often insensitive) to take up the topic of preparing for death when someone is on his/her deathbed. Even when possible, it is often too late to address many of the issues raised. The best time to start discussing preparations for death is when we are sure that we are not going to die immediately! Such discussions can help in reflecting on one’s own philosophy of life, in identifying unfinished priorities in life, and in looking at how one wants to face the inevitable final event in life. It is particularly important to make choices since the available technology can prolong the dying process for days or even months.

Our experience has been that informal discussions about death and dying will go a long way in helping people to identify and address key issues in their life and death. Because you cannot die well unless you live well!

Have you prepared for your death?
Tweet your answer to #allmylifeQs 
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Ilona Kickbusch – “A small group really can make a difference”
Ilona Kickbusch – “A small group really can make a difference”
Nicole Bogart 
When confronting the key issues facing health and health care over the next 20 years, Ilona Kickbusch believes demography cannot be discussed without addressing inequality. As significant portions of the population in the UK, Germany, and Switzerland grow older, Kickbusch says addressing the inequalities of aging is vital. “All of our societies are faced with major demographic change; ageing is one of them, migration is another. But the fact is, usually when we talk about the ageing of society, we don’t look at some deeper social factors that are actually a dimension of that demographic development,” Kickbusch, Director of the Global Health Centre at the Graduate Institute of International and Development Studies in Geneva, and a member of the Board of Trustees of Sciana network partner the Careum Foundation says. “Ageing [is] something that is very unequal in our societies. A significant number of people do not have the same amount of healthy life expectancy, so people on the lower social stature will tend to have up to 7 to 10 years less of healthy life expectancy, meaning that they have more chronic disease and disabilities.” The Sciana network is an international collaboration between the Health FoundationCareum Stiftung and the Robert Bosch Stiftung, facilitated by Salzburg Global Seminar and hosted at Hotel Schloss Leopoldskron. The health leaders network will bring together leaders in health and health care policy over the next two years to find solutions to shared challenges being faced in health care across Europe. Kickbusch explains that while all people are indeed getting older, we are not all living to the same age and with the same level of health thanks to socioeconomic disparities. This challenge of ageing inequity will certainly continue over the next 20 years – making initiatives like the Sciana network invaluable in developing positive change. Reflecting on the international aspect of the collaboration within the Sciana network, Kickbusch, whose key interests have long revolved around health policies and global health, notes: “The interesting thing is that, in the end, very similar issues emerge… I think there is a great opportunity that a group like this can come up with at least a unique framing of some of these issues, or a priority-setting that can be very important and taken forward by the next group. That’s my own experience working in this field for a long time – that a small group really can make a difference.” Although Sciana is in its infancy, Kickbusch says bringing together three European organisations to discuss shared problems in health care, along with a cohort of bright minds, is a very significant step.
“If a certain kind of idea, or manifesto emerges from here, it can really have an impact on discussion in Europe, and maybe even around the world,” she says.
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Sciana – New European health leaders network launched
Sciana – New European health leaders network launched
Sciana Network 
The Sciana network, a groundbreaking international initiative that brings together health care leaders from the UK, Germany, and Switzerland, will hold its inaugural meeting in Salzburg this week (April 26 to 29). The health leaders network is an international collaboration between the Health Foundation, Careum Stiftung and the Robert Bosch Stiftung, facilitated by Salzburg Global Seminar and hosted at Hotel Schloss Leopoldskron. Sciana will bring together leaders in health and health care policy over the next two years to find solutions to shared challenges being faced in health care across Europe.

Against a backdrop of financial strain, demographic change, chronic diseases, and migration, the network will provide members with time and space to share insights gained from their own experiences and debate new and innovative approaches to health care and health policy, with the potential to make real and lasting change to future health care delivery.

Seventeen members including health policymakers, practitioners, academics, and public sector leaders will make up the first meeting – with each organization contributing up to six members. Salzburg Global Seminar will coordinate and deliver the programs, supporting members in the running of activities, including leading workshops, and showcasing and developing policy proposals.

Salzburg Global has long been a leading forum for the exchange of ideas on issues in health and health care, running dedicated health and health care policy sessions since the 1970s. The multi-year series Health and Health Care Innovation was launched in 2010 to crystallize new approaches to global health and health care in the face of emerging challenges.

“Salzburg Global Seminar has been bringing together outstanding health and healthcare leaders since 1978. We were delighted when the founding partners invited us to facilitate this groundbreaking network, which will foster crucial cross-border collaboration and innovation,” says Salzburg Global Program Director John Lotherington. Jennifer Dixon, chief executive of the UK’s Health Foundation and a Fellow of Salzburg Global Seminar, having participated in Health and Health Care Innovation sessions Reforming Health Care: Maintaining Social Solidarity and Quality in the Face of Economic, Health and Social Challenges and The Greatest Untapped Resource in Healthcare? Informing and Involving Patients in Decisions about Their Medical Care, says: “We are excited to be supporting this unique and innovative network of health care leaders. During a time when our relationship with Europe is going through unprecedented transformation, we are delighted to be contributing to a health project that will build even stronger links with our European peers. Sciana is built around our common challenges that we face as European neighbors. It is an opportunity to foster and focus this talent and energy, for the benefit of our respective health care systems.”

“Careum aims to offer committed and interested health experts in positions of influence the opportunity to discuss important questions with their colleagues in an inspiring setting,” Hans Gut, president of the Swiss-based Careum Stiftung explains. “Members are expected to share their experiences and learn from one another. The international alumni network should help the Sciana members to keep in touch outside of the seminars.”

Bernadette Klapper, head department of health, Robert Bosch Stiftung in Germany, adds: “The Robert Bosch Stiftung is dedicated to finding sustainable solutions for future societies. For us, Sciana is more than three foundations working together and building an international network. It’s about bringing the right health care experts together, to find the solutions to tomorrow’s health challenges, today.”

A dedicated online platform has been launched for the Sciana networking including a website (www.sciananetwork.org), a Facebook page (www.facebook.com/ScianaNetwork), and a Twitter page (www.twitter.com/ScianaNetwork), where you will find news about this groundbreaking collaboration.
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Maria Hägglund – “With better tools, better processes, and better ways of letting family carers in, we would have much better and more efficient care”
Maria Hägglund – “With better tools, better processes, and better ways of letting family carers in, we would have much better and more efficient care”
Andrea Abellan and Nicole Bogart 


Family caregivers are an integral part of health care systems around the world. While they often take on the role of being a home nurse, these family carers often take on the role of health care coordinator, balancing appointment schedules, medications, and communication between clinicians and specialists. Maria Hägglund, a senior researcher at the Health Informatics Centre at the Karolinska Institutet in Stockholm, recently attended Salzburg Global Seminar’s session Toward a Shared Culture of Health: Enriching and Charting the Patient-Clinician Relationship. During this session, she discussed her research into patient access to electronic health records and shared a personal story about the impact technology can have on family carers.

“From my experience, health care is quite fragmented – you don’t know the different persons involved in your family member’s care, you might not know their names, you might not have their contact details,” Hagglund says. “Having access to that type of information is essential when you’re trying to coordinate things.”

Hägglund currently runs a study called PACESS, evaluating the introduction of patients’ online access to their electronic health records in Sweden and has been involved in national eHealth projects for years. However, the researcher says she personally experienced the importance of access to technology when her father became ill with cancer.

After running into instances where her father’s health care teams failed to communicate, she took on the role of an information carrier, coordinating communication between clinicians on some occasions.

“I think most family members are actually happy to do this job. It’s tiring, it’s exhausting, but you feel like you’re actually helping. And in a situation where you are otherwise quite helpless, it’s actually a good feeling,” she says.

Hägglund believes providing access to information will help repair relations between family carers and clinicians; a relationship often strained by the stress of caring for a loved one.

“By not being allowed, or given the right tools to participate and to help, that willingness to help is turned into a frustration and an anger,” she says. “I think that is why many family members are perceived as difficult. I think with better tools, better processes, and better ways of letting family carers in, we would have a much better and more efficient care.”

Hägglund believes technology will play an increasingly important role in health care moving forward, especially for carers seeking support systems. While caring for her father, Hägglund turned to online groups not only for emotional support but also for additional information about clinical trials and medications.

“When my father was offered to join a clinical trial, of course, I could read all the materials about the trial, but I could also go onto this forum and ask, ‘Has anyone heard about this new medication? Maybe somebody is already on it; what are your experiences?’ And I quickly got a lot of excellent feedback,” she says. “Of course patients have a much greater interest – it’s a matter of life and death if you are a patient or family carer, so the willingness to share and help each other is also very great.”

Despite being an advocate for the importance of data sharing in health care, Hägglund says clinicians must remember patients own their data, and shouldn't be looked at as merely a data source; an issue she says happens quite frequently in clinical research.

Hägglund says she is grateful to have gained an international perspective on eHealth and patient-clinician relationships as a participant at Salzburg Global. “To see that the problems and challenges we are experience are experienced all over the world,” she says. “We are all sort of in the same house – the same Schloss – working towards mutual goals.”
Maria Hägglund attended the Salzburg Global program Toward a Shared Culture of Health: Enriching and Charting the Patient-Clinician Relationship. This program is part of the multi-year series Health and Health Care Innovation in the 21st Century. The session was supported by OpenNotes. More information on the session can be found here: www.salzburglobal.org/go/553.
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Sara Riggare - “Even without being actively supported by health care, patients can do a lot for themselves”
Sara Riggare - “Even without being actively supported by health care, patients can do a lot for themselves”
Oscar Tollast 
From time to time, extraordinary people walk through the grounds of Schloss Leopoldskron. Sara Riggare, an engineer and health informatics researcher, is one of those people, acting as a source of inspiration each time she’s attended Salzburg Global Seminar. Riggare, who’s currently pursuing her doctorate at Karolinska Institutet in Stockholm, Sweden, is challenging the traditional role of patients in managing their health through technological innovation and data collection.

Riggare, diagnosed with early onset Parkinson’s disease, practices self-tracking to help manage her medications, and other aspects. She returned to Salzburg Global in March to attend Toward a Shared Culture of Health: Enriching and Charting the Patient-Clinician Relationship. Once again, Riggare was able to provide a unique perspective as a patient and researcher to a mix of health professionals. She said, “This session is about empowering patients in their collaborations with their physicians, and that’s basically what I do, both in my life and in my work, [and] in my research. So, it was irresistible to me.”

During the session, Riggare gave her fellow participants a presentation on her experiences managing her Parkinson’s disease, which she’s lived with for more than 30 years. She explained how she used her data and observations to understand her disease better and communicate what she learned with health care professionals. Riggare says her presentations “show the power of data and how even without being actively supported by health care, patients can do a lot for themselves.”

Riggare highlighted the “many interesting discussions” which took place during her latest session and the benefit of having more patients in these conversations. She said, “There’s power in numbers and to hear the stories of other patients over lunch, over coffee, and at the sessions makes me understand even more about what we need to do to see this through and make the world see a new kind of health care system.” A new form of health care system will involve different approaches to recording patients’ journeys. Riggare helped inspire one of these new methods, which was presented to her and others on the final day of Toward a Shared Culture of Health: Enriching and Charting the Patient-Clinician Relationship. A group focusing on person-centered health care came up with the concept Self-Actualized Realization and Autonomy, also known as SARA. In this model, a user is a person, not a patient, who collects their data and uses it as a citizen scientist.

Riggare first attended Salzburg Global in 2015 for Session 548 The Promise of Data: Will this Bring a Revolution in Health Care? Following this, she returned to Sweden with a refreshed perspective. Riggare created an app and took on new research projects. She said, “This place is just amazing. It brings together great minds, great thinkers [and] great people with amazing experiences and stories to share - from all over the globe to a place that’s probably more like paradise than anything else on earth.”
Sara Riggare attended the Salzburg Global program Toward a Shared Culture of Health: Enriching and Charting the Patient-Clinician Relationship. This program is part of the multi-year series Health and Health Care Innovation in the 21st Century. The session was supported by OpenNotes. More information on the session can be found here: www.salzburglobal.org/go/553.
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