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

"Ideas don’t happen because they’re good; they happen because people believe in them."
"Ideas don’t happen because they’re good; they happen because people believe in them."
Louise Hallman 
Rounding off an intensive five-day seminar on ‘Realizing the Right to Health’  at the Salzburg Global Seminar, World Bank president Jim Yong Kim publicly declared for the first time: “We fully embrace the rights-based approach to healthcare.” Speaking via live video-link, Kim’s declaration drew exaltation from Leonardo Cubillos, senior health specialist at the World Bank Institute. “Mission accomplished,” he tweeted. But while the long-time rights-based approach to health advocate has reason to celebrate, the seminar demonstrated through its lectures, group work and final presentations that there is much still to be accomplished in the realm of health and health care.  However, the seminar also demonstrated the dedication of the 75 Salzburg Global Fellows to this mission. As Cubillos quoted from the UN in his opening remarks, despite the $6.5tn spent on health care per year, a little over one quarter of the world’s population still live without access to medicine or basic medical care.  Many people are clearly not able to exercise their right to health. From November 9-14, Fellows and faculty from 22 countries across the world came together for a seminar examining ‘Realizing the Right to Health: How can a rights-based approach best contribute to the strengthening, sustainability and equity of access to medicines and health systems?’, hosted by Salzburg Global Seminar at its headquarters at Schloss Leopoldskron in Salzburg, Austria, and co-sponsored by session partners, the World Bank Institute (WBI) and the Dartmouth Center for Health Care Delivery Science (TDC). Over the five days, world-renowned faculty presented on a range of issues relating to the challenges and potential solutions in realizing the right to health to a room-full of eager Fellows. “When you don’t provide health care to people who need it, it is against their human rights,” Rwandan health minister Agnes Binagwaho stated bluntly on the first afternoon, via video-link from Kigali. The Right to Health = The Right to Health Care, Food, Shelter and Information
 Repeatedly over the course of the seminar, Fellows heard that realizing the right to health is not just about the right to health care, but the right to other aspects that improve health, such as basics like food and shelter, as well as the right to information that helps individuals makes better informed ideas about their own health and that of their wider communities. But, the right to health doesn’t necessarily mean the right to every single medicine available, Binagwaho clarified.  Resource constraints in many countries mean that delivery of expensive medicines and interventions is simply not possible. Rather, she said, realizing the right to health means ensuring the provision of all possible health care interventions to everyone who needs them in a given country, regardless of their class, race or gender. As one Fellow put it, in Nepal the right to health might mean the right to access the most basic health care, while in Chile it could be the right to access the top available cancer drugs. But what must be ensured in all cases is that people are not denied their right to equitable access to health care services, just because they are a disadvantaged person belonging to an undesirable section of society, as proven in the case in Kenya where HIV-positive women were forcibly sterilized without their consent. Resources are scarce in many countries, but they’re limited in all. No country has a bottomless pit of money for health care. Even in the richest countries, issues of fairness in the access to health care treatments arise; who more deserves an expensive course of cancer drugs – a 75-year-old who has paid into national health insurance for many years but has only a few more years to live, or a 25-year-old who hasn’t worked or paid taxes for as long but who will have a much longer life ahead of them (in which to be a greater contributor to society) should they be cured? Fairness in the Process, not the Decision
“Fairness doesn’t ask you to treat everyone, it doesn’t ask you to give everything to everyone,” explained Cubillos after his presentation. “Fairness is not about unlimited generosity. Fairness is not about financial insustainability. Fairness is not about charity. Fairness is about being responsible with your resources, in allocating them in such a manner that all parties agree—not on the decision, but on the process.” It is possible, Cubillos posited, to have two completely different outcomes which whilst opposite could both be deemed fair. “Fairness is not about the ultimate outcome – it is also about the process.” Patients across the world deserve “the care they need and no less, the care they want and no more,” said Albert Mulley, director of the TDC, in his talk to Fellows about the role of shared decision making in realizing the right to health.  Patients should have access to the health care they need, but shouldn’t be made to accept treatment they don’t want. “You have to recognize that different patients have different risk attitudes,” said Mulley. What works for one patient, won’t necessarily be what another wants owing to their own circumstances, and doctors should recognize the patient’s decision and personal expertise in their own condition and care. One way to ensure the process of a health care decision is fair and also enables the patient to make the most-informed decision they can about their own care is to make the treatment availability and decision-making process as transparent as possible. But even this is no panacea. “You can’t just dispense transparency – you must consider the reception of the information!” exclaimed Salzburg Global Seminar program director, John Lotherington. Better – not just more – Information
 By empowering patients with understandable information, rather than just simply abundant information, those patients in turn would be better able to make well-informed decisions not only about their own health care, but also that of their communities. The reverse of this, Lotherington pointed out, was visible in the MMR-Autism panic in the UK. A misleading and since disproven article relating the measles, mumps and rubella (MMR) vaccine to the increasing prevalence of the developmental disorder, autism, invoked panic in many parents who thus chose not immunize their children against three highly contagious diseases, potentially putting their children and the wider community at risk of infection. Empowering communities needn’t come only through informational leaflets and talks, Fellows were told during the week. In one of the more interactive sessions of the seminar, Fellows heard from Mary Flanagan of Dartmouth College’s Tiltfactor – a “interdisciplinary innovation team” that designs and studies “games for social impact”.
By developing games such as ‘ZombiePOX’ – a game that challenges players to stop the spread of zombies through their community – players of all ages can learn and understand concepts such as systems thinking, resource allocation, strategic vaccinations and herd immunity. Fellows themselves took part in a Tiltfactor designed game called ‘RePlay Health’, designed to help players understand the impact of different events and situations can have on health conditions, as a level playing field start to quickly reflect the unequal conditions many people face in the attempts to lead healthy lives. As informative as the lectures, discussions and games were, the Right to Health Fellows were brought to Schloss Leopoldskron not just to listen and play, but to plan and do.
 The hastily thought of initiatives from the end of their ‘RePlay Health’ game provided some with a starting point as the Fellows spent the last two days of the seminar developing and refining plans for initiatives they could launch in their home countries or regions. Building more than just Lego
 Working through a process called ‘rapid cycle prototyping’, the Fellows didn’t head straight to the seemingly ubiquitous flip charts, so favored throughout the week by seminar facilitators Reos; instead facilitators Joe McCarron and Zaid Hassan led the Fellows in building Lego models of their potential solutions.  But as McCarron pointed out, the Fellows were building much more than just Lego models. “When you have a short amount of time and a diverse group of people, working on a complex project, a methodology that uses your head and your hands is much more effective in creating the early seeds of ideas than having a bunch of people negotiate around a flip chart,” explained McCarron. “The intangible element of what we were doing today is how you build commitment and how you build emotional attachment to these ideas.” And these ideas will need commitment. Ranging from plans to improve governance in the health care system by involving the local communities in post-revolution Egypt; to a ‘Open Healthcare Info Bank’ – a platform for collecting, validating, processing and delivering health information, which would verify the amount, content and quality of the information, with the objective of enabling informed and knowledgeable decision-making in South Korea; plans to reorganize the procurement and distribution of medicines in the Brazilian state of Minas Gerais to ensure “the right medication, [get] to the right people at the right time”; and a cross-national group aimed at improving women’s health in Africa through greater social participation in health care delivery, the plans are nothing if not ambitious. These plans all aim to meet a so far unmet need – stopping corruption in Nepal, improving efficiency and coverage in Mexico, increasing affordability of medicines in East Africa, and so forth – but they have been developed with specific “next steps”, methodologies and well-placed team-leaders in mind. The teams of Fellows have made commitments to each other to carry their proposals forward, with many opting to use the newly launched Salzburg Global Fellowship Yammer Network – a social network platform exclusively for SGS Fellows – to help co-ordinate and implement their plans. The teams certainly haven’t been alone in putting together their plans. By repeatedly presenting their projects to their peers during the rapid cycle prototyping exercise and receiving feedback from the whole group each time, the Fellows’ projects have gone from being built by five people to 50 thanks to the constant input, explained McCarron.
 They’ve also received feedback from two world-renowned experts in health care delivery – Jim Yong Kim, president of the World Bank and former president of Dartmouth College, home of the Dartmouth College for Health Care Delivery Science, and Binagwaho, who joined the Fellows again at the end of the week to dispense her advice.  Kim praised the Fellows on their efforts, with Binagwaho offering to continue giving help and support online. Only time will tell which of these projects eventually come to fruition, but as Hassan said at the end of the week’s presentations: “Ideas don’t happen because they’re good; they happen because people believe in them.” Let’s hope their belief in their projects continues long after the Fellows pass back through the iron gates of Schloss Leopoldskron.
READ MORE...
"We fully embrace the rights-based approach to health care"
"We fully embrace the rights-based approach to health care"
Louise Hallman 

World Bank president Dr. Jim Yong Kim surprised, delighted and reassured Salzburg Global Seminar faculty and Fellows on Tuesday, November 13 when he expressed his support for the right to health. “We fully embrace the rights-based approach to healthcare,” Kim told the participants gathered from 22 countries across the globe during a video-conference link as part of the closing session of seminar ‘
Realizing the Right to Health’. This was the first time thenewly appointed World Bank president had publicly expressed his support for the approach, in his second appearance via video-link to a Salzburg Global Seminar session on health and health care. Introduced by Maria Luisa Escobar, manager of the Health Systems Practice at the World Bank Institute, a clearly enthused Kim was flanked by two of his World Bank vice presidents, Sanjay Pradhan and Tamar Manuelyan Atnic, whom Kim referred to as “master clinicians of development”. Following his opening remarks, in which he thanked the participants of the session for dedicating their time to debating the issue of the right to health, Kim gave feedback on Fellow-led initiatives aimed to improve the realization of the right to health in their home countries. The presentations included a team from Egypt, with their plans to improve governance in the health care system by involving the local communities in their post-revolution nation; South Korea, with their plan for a ‘Open Healthcare Info Bank’ – a platform for collecting, validating, processing and delivering health information, which would verified in its amount, content and quality, with the objective of enabling informed and knowledgeable decision making; and a cross-national group aimed at improving women’s health through greater social participation in health care delivery. Kim highlighted the importance of maternal health, which he said was a logistics and systems issue, as much as a medicinal issue. This was reiterated by vice president Atnic, who said mothers were an “enormous agent for growth and development”. Kim called the right to health a multi-faceted issue and urged health care practitioners and policy makers not to “just advocate for single disease programs.” “They are important,” the president said, “but we have to think [about] the entire system” and countries need to have “robust” programs to “give healthcare to everyone”. “There is no off-the-shelf system that will fix a particular country,” added Atnic, stating that countries needed to look at multiple models and case studies to find what would work best for them. Closing the session after Kim’s remarks, his former Dartmouth colleague and recently appointed director of the Dartmouth Center for Health Care Delivery Science, Albert Mulley quoted Margaret Mead – acclaimed American anthropologist and faculty of the first ever Salzburg Seminar in American Studies in 1947 – when he concluded the afternoon’s presentations, saying: “Some people doubt that a small group of committed people can change the world, when in fact nothing else ever does.” As the Fellows return to their home countries and work on the next steps of their ambitious initiatives, they would be wise to remember those words.
READ MORE...
Serious Gaming & Critical Play
Serious Gaming & Critical Play
Louise Hallman 
Can playing a game save the world? Perhaps, if Dartmouth College-based Tiltfactor has anything to do with it. Demonstrating their games for health and human rights, Tiltfactor director Mary Flanagan explained to Fellows how the "interdisciplinary innovation team" designs and studies "games for social impact" and how this approach can be a crucial driver of engagement in the path to the realization of the right to health. From ‘POX: Save the People’, a board game and iPad app, which challenges players to stop the spread of a deadly disease in their community, to card game ‘Buffalo’ designed gender stereotypes and bias, Tiltfactor develops games in its "lab" to change social behaviors. Well developed games can prompt changes in our own thinking and approaches to change and problems, and also help change group dynamics, Flanagan told Fellows, indicating that there is huge potential in the use of gaming in order to garner support and engage citizens with public policies, particularly within the sphere of right to health. Tiltfactor has games designed to target not only school children, but all stakeholders in health - from policy makers to doctors and patients. Ensuring the right to health needs engaged stakeholders and partners; this engagement can be fostered and strengthened through such gaming. Tiltfactor, Flanagan explained, not only design games, they also conduct thorough research into their game development and impact, sometimes with surprising results. In a revision of their POX game, zombies were added to the mix; Tiltfactor’s research found that players were more likely to understand systems thinking and resource allocation, as well as the importance of strategic vaccination of a population and herd immunity with the added element of zombies, rather than just considering a more realistic disease outbreak. Tiltfactor is now working on other public health games at the request of Rwandan Health Minister and Dartmouth honorary doctorate, Agnes Binagwaho, including a game for five-year-olds to encourage hand washing and thus prevent the spread of easily communicable diseases called ‘Wash It!’ and ‘Source’, a game focusing on the spread of cholera. After discussing the benefit of such games (and whether ethically they should carry a disclaimer/warning that they’re deliberately designed to alter behaviors and values), Fellows tried their hand at a game of role-play sport ‘Thrive!’, part of Tiltfactor’s RePlay Health project. Through the game, Fellows realized the impact that different events and situations can have on health conditions. As a level playing field started to quickly reflect unequal conditions, Fellows were able to participate in discussions about how to effectively implement programs and how to foster an enabling context for the effective realization of the right to health.
All of Tiltfactor’s games are available to buy and in some cases download from their website: www.tiltfactor.org/games
READ MORE...
Litigating the Right to Health
Litigating the Right to Health
Salzburg Global Seminar Staff 
Siri Gloppen, professor at University of Bergen, Norway, co-authored the book ‘Litigating Health Rights: Can Courts Bring More Justice to Health?’ in 2011. On Sunday, November 11, she shared her answer to that question with Fellows: yes. In many countries - not least in Latin American countries like Colombia, Costa Rica and Brazil, where hundreds of thousands of people go to court every year to claim access to health services - a large share of the cases are for  high-cost medication for serious conditions, often with marginal gain. However, in other countries, such as India and South Africa public interest litigation has ensured poor and vulnerable groups access to vital drugs – including antiretrovirals for HIV/AIDS – and to preconditions of health, such as food and water. Gloppen underscored that litigation can distort health care provision but in other cases , it can actually motivate the need for change by exposing weakness in the health care system. "Individual litigation is not a solution but it can serve a useful purpose when the health care system doesn’t work," said Gloppen. "People mistakenly assume that judges have the last word, but there’s rarely a last word," she explained. "There has to be dialogue."
READ MORE...
Unlocking Essential Medicines Lists
Unlocking Essential Medicines Lists
Felipe Estefan 
The realization of the right to health requires collaboration, across regions and across sectors, in which a wide set of actors engage to produce much-needed positive transformations. The need for collaborative, multi-stakeholder approaches is one of the key points that has emerged during the global symposium on  “Realizing the Right to Health”, hosted by the Salzburg Global Seminar, the Dartmouth Center for Health Care Science Deliver, and the World Bank Institute. In a conversation moderated by the World Bank Institute’s Leonardo Cubillos, panelists Lloyd Sansom, special advisor on the National Medicines Policy Framework at the Australian Department of Health, and Ellen Strahlman, senior vice president for GlaxoSmithKline, highlighted the importance and the willingness to engage in a collaborative approach to the realization of the right to health. We have to “unlock” the potential for us to be partners in order “to make sure that health care is delivered,” stated Strahlman. She explained the potential for civil society to work together with pharmaceutical companies in ensuring that citizens have access to medicines, and that the right to health is realized for all. Strahlman discussed the shared nature of the objectives of those working  in pharmaceutical companies, like GlaxoSmithKline, and of those working elsewhere trying to advance the right to health from different sectors. Ultimately, “the people who go to work in these [pharmaceutical] industries… their mental map is to deliver medicines,” she said. Furthermore, Strahlman explained why the timing is right for multi-stakeholder intervention. “There has never been a better time,” she told participants. The medicines are there, the technology is there, the communications tools are there, to ensure that the right to health can be realized. Sharing the experience from the Australian case, Lloyd Sansom also stressed the importance of a collaborative approach and suggested that the realization of the right to health “represents a new paradigm” and as such it requires for a wide range of actors, from all around the world to “do this as a collective.” One of the areas in which the realization of the right to health can lead to great progress is on the development of essential medicines lists in countries.  The issue of an essential medicines list is one directly linked to the impact that access to medicines has on the everday lives of citizens around the world. Sansom argues that the creation of such a list in a country must regard the social value of a particular medicine, by having citizens be active participants in an honest assesment of how having or not having access to a medicine in order to treat a particular condition may affect the way in which the patients, their families and their caretakers have to deal with such condition. More so, from a global perspective, this issue is one connected directly to development and to the notion of fairness. “Why is the accessibility, which includes availability and affordability so low in the developing world?...Why is accessibility so poor and affordability so variable, even within a country?” asked Sansom. Sansom encouraged participants to collaborate on how to “increase the cooperation and improve the efficiency” of health systems applying a rights-based approach.
 Collaboration around a common understanding of health from a rights-based perspective, can lead to important progress in the realization of the right to health and the strengthening of health systems around the world.
READ MORE...
PANTHER and the rights-based approach
PANTHER and the rights-based approach
Louise Hallman 
Panthers are usually found in the jungle or the zoo, but as Fellows of the Salzburg Global Seminar on ‘Realizing the Right to Health’ heard on Saturday morning, they also belong in the rights-based approach to health care delivery. Speaking in the opening session of the day, Margot Skarpeteig, senior advisor at the Norwegian Agency for Development Co-operation, Norad, explained the seven components to a rights-based approach to development, which can also be applied to health:
•Participation – ensuring patients have a role in their own health care;
•Accountability for both governments and doctors;
•Non-discrimination  – ensuring the delivery of health care to all, including the vulnerable;
•Transparency in the decision-making process;
•Human dignity – ensuring everyone is treated with respect of their cultural differences;
•Empowerment – ensuring patients are informed about their health care systems;
•Rule of law – ensuring all participants in the health care system deliver the right to health in accordance to legislation  A human rights approach to health care gives clear focus on the individual, not just the provision of medicine and hospitals, explained Skarpeteig. And a rights-based approach to health care also puts the focus on governments and their role. Are they actively working against people accessing their right to health, such as in the case of HIV-positive women in Kenya being forcibly sterilized? Are they just passive, such as failing to encourage girls’ education in Pakistan? Or do they simply not have enough resources? To ensure their citizens can exercise their right to health, governments are obliged to ensure that health services and medicines are available – exist in sufficient quantity; accessible – affordable and offered to everyone; acceptable – taking into account cultural preferences; and of good quality. Fulfil these criteria, and citizens will not only have their rights respected and protected, but fulfilled also.
READ MORE...
The care they need and no less, want and no more
The care they need and no less, want and no more
Louise Hallman 
Individuals often delegate decision making power to others – we trust mechanics to fix cars without needing all info, so why don’t we expect the same of our doctors? World Bank Institute senior health economist Roberto Iunes’s comment might have raised a wry laugh in Parker Hall with the participants of the session ‘Realizing the Right to Health’ at Salzburg Global Seminar, but it also raises a fair question for those not already familiar with the concept of shared decision making. After all, doctors are experts in medicine, no? "Shared decision making is not just informed consent," clarified fellow panelist Al Mulley, director of the Dartmouth Center for Health Care Delivery Science. Rather, shared decision making recognizes the patient’s own expertise – how they feel about their own treatment and condition. Just because a particular treatment, medicine or surgery works for one person does not mean that it will be the best course for all patients. Shared decision making also recognizes the patient’s possible alternative health futures. "You have to recognize that different patients have different risk attitudes," said Mulley. What works for one patient, won’t necessarily be what another wants owing to their own circumstances. This is particularly stark when dealing with critical patients; one may choose to exhaust all medical options, taking drugs with dire side effects in the hope they will prolong life. Others may simply choose to spend the time they have left with their families rather than a hospital. "A doctor’s job is only half done with the diagnosis," added Mulley. As he explained, the huge range of treatments available means that the doctor’s job is further complicated, in some cases essentially asking their patient ‘which side effect would you like to deal with?’ and ‘what trade-offs are you willing to make?’ But whilst many are starting to agree that shared decision making – giving the patient "the care they need and no less, the care they want and no more" – is important, doctors and patients must both recognize that a patient’s capacity to make an informed decision might been impaired, regardless of the amount of information available to them. Put simply, patients are by definition not in their best health. Shared decision making needs more than just a strong ethical relationship between a doctor and patient, it also requires a social contract between the government and the patient, added Iunes. Shared decision making brings transparency between the doctor and the patient, and the patient also needs transparency from government. In order to make a well informed decision, patients need reliable and accurate information. But simply providing the information and claiming transparency it is no panacea; the information must be easily understood and not misrepresented – which can often not be the case in the media. Highlighting the MMR-autism case in the UK (which saw the publication of a since-disproved study relating the MMR vaccination with a higher rate of autism and led to many parents choosing to boycott the vaccination), panellist interviewer SGS program director John Lotherington exclaimed: "You can’t just dispense transparency – you must consider reception of the information!" Doctors and governments have the responsibility to ensure patients are well informed. "It’s not just about doing things right, it’s about doing the right things," concluded Mulley, and ultimately trusting that the patient knows what’s right for them.
READ MORE...
Displaying results 162 to 168 out of 181

REPORTS