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

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 

Senior researcher with the Health Informatics Centre at the Karolinska Institutet discusses benefits of facilitating better communication between family carers and clinicians

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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Cecilia Rodriguez - Patients should be the head of their health care team, not the doctor
Cecilia Rodriguez - Patients should be the head of their health care team, not the doctor
Oscar Tollast and Nicole Bogart 
Cecilia Rodriguez, a social communicator with studies in public health, believes by improving the relationship between clinicians and patients, great improvements can be made in people's health. With that idea in mind, Rodriguez runs a patient-led organization in Chile for those with rheumatoid arthritis, a chronic condition she was diagnosed with six years ago. Rodriguez attended Salzburg Global Seminar's session Toward a Shared Culture of Health: Enriching and Charting the Patient-Clinician Relationship to share her insights on the importance of having a good relationship between patient and clinician. As a patient, Rodriguez says having a good relationship with the team of doctors, clinicians and medical practitioners who treat her condition has left a lasting impact on her health journey, describing a lack of patient-clinician relationship as a "world problem." But Rodriguez notes it is important clinicians take the time to understand their patients, their needs, and concerns to foster trust between doctors and patients. "My story and my beliefs, my values, [and] what I want from life, it is important for me that my clinicians know and if they don't care about that, it can become a trust issue," she says. "If I feel like he's not giving me the whole picture, that can also make a trust issue. [I need] everybody on the team to be clearer, to give me all of the information, and listen to what I think, I believe, and my needs." To help increase the level of trust in this relationship, Rodriguez argues patients should be the heard of their health care teams - not the doctor. "Once a doctor told me that I was a very collaborative patient and I was like, 'Sorry, doctor, but you are collaborating with me. It's my illness. I have lost so many things, when I got sick, at least let me keep my illness." Though Rodriguez notes patients should not assume to know more than their doctors, she believes it is important for patients to have a vision of where they'd like to be in the health care journey. Allowing patients to see notes and treatment options laid out by clinicians, through a platform like OpenNotes, allows people to make informed decisions about whether they would like to follow that treatment path. "Maybe someday I will say, 'You just tell me what to do.' Maybe that's my choice, and it's a good choice, but another day I want to make a decision, I want to think about it, and maybe I want to share it with my family or significant others and I want to get them involved, but all of those are decisions that, if I have the notes, I can make," she says. Rodriguez says her involvement in the Salzburg Global session has presented a unique networking opportunity, opening her eyes to similar work people from other countries are doing. In her home country of Chile, she says there needs to be a bigger focus on what patients can give. "We are still on a very paternalistic model. I'm glad more people from my country came, and we're making great teamwork, so we can make more for my country." She hopes to return to Chile and incorporate some of the knowledge she obtained during the session.
Cecilia Rodriguez 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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Maho Isono - Patients should make themselves the center of consultations
Maho Isono - Patients should make themselves the center of consultations
Oscar Tollast and Nicole Bogart 
Maho Isono teaches medical anthropology at the International University of Health and Welfare in Tokyo, Japan, and is currently conducting fieldwork regarding traditional Japanese Kampo medicine, specifically regarding the relationships between doctors and patients in this system. Isono attended Salzburg Global Seminar's session Toward a Shared Culture of Health: Enriching and Charting the Patient-Clinician Relationship and spoke about how the hierarchy of traditional Japanese medicine may impede patient-doctor relationships. "In Japan, doctors have [a] very strong power. It's very difficult for patients to deconstruct that hierarchy," Isono says, noting that carrying the title of Sensei is highly respected in Japanese society. "So, while you call someone Sensei, we tend to hold back, and we should be humble in front of that person. In that sense, it is kind of difficult for patients to articulate all kinds of theories and opinions to doctors." Through speaking with session participants at Salzburg Global, Isono says she is interested in exploring how these barriers between patients and clinicians could be broken down in traditional medicine, teaching patients to become more involved in their consultations. "I think we should tell patients how to put themselves in the center of their consultations and their right to be in that position," she says. Isono hoped to share research into the OpenNotes platform with peers and students upon her return to Japan, introducing the idea of enriching the patient-clinician relationship to Japanese doctors. "Because I'm a cultural anthropologist, I'd like to combine the anthropological perspectives into OpenNotes and make one class," she says. As a first time participant at Salzburg Global, Isono says she has been overwhelmed by the amount of information she has gathered from other participants, all from different backgrounds. "My experience in Salzburg is refreshing my experience in my life," she says.
Maho Isono was a participant of 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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Xanelé Purén - "We are underestimating the importance of being little"
Xanelé Purén - "We are underestimating the importance of being little"
Andrea Abellan and Nicole Bogart 
Xanelé Purén, co-founder of interactive design studio See Saw Do, believes children have a unique and important outlook on society and the cities we live in. This belief has a direct impact on her company's mission. Although the Cape Town, South Africa-based See Saw Do works with a variety of people, the spatial design studio mainly focuses on young children and designing public environments that enhance their sense of being a child. Purén attended Salzburg Global Seminar's session The Child in the City: Health, Parks and Play to share her view on place-making and how children's views can be incorporated into spatial design. "Place-making is a really holistic way of looking at a space," Purén says, noting the people who operate within it are also a part of that space. In many circumstances, children are a large part of public spaces within our cities. When working with schools, for example, she says it's important to work with teachers to create a better understanding of what a child is, what children need and how much power they have. See Saw Do was born out of Purén's fourth-year design project, while studying visual communication design at Stellenbosch University. Having always loved children, she spent time at a school in a nearby community to identify issues that could be addressed through design. Six years later, Purén says "we've grown our understanding of people, our understanding of children, and our understanding of place." Two years ago, See Saw Do began focusing on creative education, spending more time with children and exploring how simple tools can empower their sense of self. Purén says she's felt a great sense of joy watching children create and including them in the design process. But Cape Town faces a wide array of social problems, which presents unique challenges when trying to foster a child-friendly city, Purén says. She believes one of the biggest challenges residents face is understanding that children are active citizens. "We often hear that we have to train children to become contributors to society, so I think they're greatly underestimated as whole people. We are underestimating the importance of being little," she says. "I think if we can create a mindset in the minds of Cape Town citizens, that will already be a big step to empower children to be more integrated into society." Purén, who describes Cape Town as a dynamic and diverse city, says that on both a business and community level she sees more organizations focusing on children, providing a promising outlook for future generations. "I can envision Cape Town being a great city for children, hopefully, in the near future," she says, noting there is strength in diversity. Purén says her participation in Salzburg Global's session has allowed her to create connections with people from several different fields and areas of expertise, paving the way for future collaborations. She adds, "There is already some exciting stuff brewing between participants."
Xanelé Purén 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, 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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Salzburg Question - How have you prepared for your death?
Salzburg Question - How have you prepared for your death?
Oscar Tollast 

A global discussion on issues affecting care toward the end of life will focus on a new area by challenging people to think about how much they’ve prepared for their death.

As part of the Salzburg Questions series, people will be asked to provide their thoughts to this question using the #allmylifeQs hashtag on Twitter.

April’s question - How have you prepared for your death? - will launch on Friday, April 7, coinciding with World Health Day. Dr. Suresh Kumar (@DrSureshKumar), a palliative care physician and health activist, will lead the online discussion.

Since February 20, people from all across the planet have taken part in the conversation on Twitter, answering questions related to palliative care.

Each question is tied to an international day of observation and led by different individuals and institutions at the heart of the debate. These people were involved in a Salzburg Global session in December: Rethinking Care Toward the End of Life.

The first question, which launched in February, was asked by Salzburg Global Fellow and former Minister of Health in Rwanda Agnes Binagwaho. She asked, “Why aren’t countries accountable to commitment on end of life (#EOL) care for vulnerable people?”

The second question, which coincided with World Happiness Day last month, was asked by Lynna Chandra - an ex-investment banker who left for the not-for-profit world in 2006 to establish Rachel House. She posed the question, “Is dying well as important as living well?”

At the time of writing, the #allmylifeQs hashtag has generated more than 6.7 million impressions on Twitter. There have been more than 1,500 tweets posted and 300 participants across the world involved.

Salzburg Global is encouraging as many Fellows as possible to join in with this conversation on the day, beforehand, and afterward. 

People are also encouraged to write blogs, which could be hosted on ehospice; the European Association for Palliative Care (EAPC) blog; Palliverse; and the International Association for Hospice and Palliative Care (IAHPC) newsletter. Vlogs are also welcome and should be sent to katie.witcombe@kcl.ac.uk so they can be posted to a dedicated YouTube channel.

Please join in the conversation on Friday, which coincides with World Health Day, and remember to use the hashtag #allmylifeQs.

A Twitter list of Salzburg Global Health Fellows has been created. If you would like to be added to this list, please let us know by subscribing or contacting us on Twitter at @SalzburgGlobal.

List of dates, questions, and people leading discussions

20 February 2017 - World Day of Social Justice - Why aren't countries accountable to commitment on #EOL care for vulnerable people? - Agnes Binagwaho

20 March 2017 - World Happiness Day - Is dying well as important as living well? - Lynna Chandra

07 April 2017 - World Health Day - How have you prepared for your death? - Suresh Kumar

15 May 2017 - World Family Day - Will caring for your dying loved one bankrupt you emotionally and financially? - Sheila Payne

20 June 2017 - World Refugee Day - 145 countries signed bit.ly/2ah31bH why do refugees have limited access to quality health care and #EOL care? - Emmanuel Luyirika

17 July 2017 - World Population Day - How and what do you measure to ensure palliative & EOL care? - Richard Harding

28 September 2017 - International Right to Know Day - Doctors, Nurses, do you want to die the way your patients die? - Bruce Chernof

13 October 2017 - World Hospice and Palliative Care Day* - Do you know how to access #palliative care when you need it? - Stephen Connor

10 November 2017 - World Science Day for Peace and Development - What future research is needed to improve care for people with advanced illness & towards the end of life? - Irene Higginson

*This year's World Hospice and Palliative Care Day is taking place on Saturday, October 14. We will launch the question the day before to generate more discussion.

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Penny Low – “In this session, we have seen how many people are involved and concerned with creating better public spaces”
Penny Low – “In this session, we have seen how many people are involved and concerned with creating better public spaces”
Andrea Abellan 

Coming from Singapore, reported to be the greenest city in Asia, Penny Low speaks from experience when she talks about the characteristics an eco-friendly city should have. The former parliamentarian and founder of the of the Social Innovation Park (SIP),  attended Salzburg Global’s session The Child in the City: Health, Parks and Play, to share her views on sustainable urban development with a cross-sector mix of international fellows.

What are the key factors which have made Singapore an eco-friendly metropolis and one of the most livable cities in the world? Low has no doubt: people. For her, the limited number of natural resources in the country has traditionally promoted biggest levels of investment on what she likes to call “resources standing on two legs,” or in other words, human beings. Becoming independent only in 1965, the rapid growth Singapore has experienced has continued to receive international attention. According to Low, a dynamic, livable environment together with visionary leadership, have both managed to attract the international and national talent responsible for ensuring the country’s progressive development. “Singapore is built to be a peaceful, inspirational place where people want to live and stay,” Low says.

SIP, started by Low almost eleven years ago, seeks to boost the sustainable growth of the country by running multiple programs. This includes the Global Social Innovators Forum (GSIF) where social innovators and entrepreneurs share their ideas on sustainable social impact, and the SEED program – Social Entrepreneurship and Eco-park Development - a social innovator hub. The latter includes other projects such as the promotion of community farming spaces and the management of several restaurants employing marginalized communities. Each of these restaurants has a social mission, ranging from ‘Support Sustainable Living,’ and ‘Strengthen Communities’ to ‘Inspire Positive Change.’ In each of the restaurants it is possible to reserve drinks and meals for any person who might be in need of them. This green, social concept is attracting the attention of the media and Singaporeans.

One of Low’s most acknowledged works is her support in the expansion of Punggol city, a residential area located in the North-East of Singapore. Low explains how she planned to revitalize the area that was suffering from a deep crisis in the housing market. The “Punggol 21” plan was developed to build a better space that would make citizens feel engaged and comfortable. The project enhanced the creation of recreational facilities, public open spaces, and better transportation services. It also fostered the Punggol Waterway which provides waterfront spaces and extensive green areas.

Punggol is appealing to young families, which means a large number of facilities addressed to satisfy children’s demands have been built as well. Aside from numerous kindergartens, schools and childcare centers, Punggol also looks for open spaces which the elderly can enjoy too. As Low explains, the city aims to satisfy every generation, leading to an “intergenerational bonding” which allows every citizen to find their own space in the city to feel relaxed. Over the last few years, Punggol, considered the first eco-town in the tropics, has grown from 2,000 housing units to 65,000.

What makes Low feel more positive regarding the future is, again, her trust in people: “People are both the solutions providers and the challenges makers. In this session, we have seen how many people are involved and concerned with creating better public spaces. [That’s] what makes me feel very positive.” However, she is also aware of the obstacles that Singapore still has to cope.


Penny Low 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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