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

Fairness and the Right to Health
Fairness and the Right to Health
Salzburg Global Seminar Staff 
“Fairness to me is that everybody pays according to their means and everybody receives according to their needs. But I think we need to make a pre-recognition of need because we have to take into account whether their need was inflicted by the person, by their behavior, or not. And maybe we can create two different levels of equity: one is give to the poor people, and then think if...it was not their fault being ill then they need more help than those whose fault it was to be ill because of his behavior. So first, I do believe that we have to take into account income and secondly, maybe we can redefine according to behavioral health.” - Nelly Aguilera, Researcher, Inter- American Conference on Social Security, Mexico “The issue is: the right of someone’s to health access maybe someone else’s denial. So you could say ‘[there is] fairness, provided it’s transparent’ but that doesn’t help... I could say ‘Well, I only had $20 to spend and this is better value than that. I wish I had $40 to give it to you both, but I only have $20.’ So the question is that fairness is in the eye of the beholder to some extent because it depends on the individual who’s got the disease and has a different perspective about his right to health - that’s understandable but it doesn’t mean that you can meet that right, that fairness because the system doesn’t allow us so and we have to make deliberative choices... So how do we address that? We have to acknowledge that it exists! ... When does the right to offer an individual become a negative impactor on the right of another individual and how do you manage that?” - Lloyd Sansom, Special Advisor, National Medicines Policy Framework, Department of Health, Australia “Fairness doesn’t ask you to treat everyone, it doesn’t ask you to give everything to everyone. Fairness is not about unlimited generosity. Fairness is not about financial unsustainability. 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... Let’s have two societies, both equally rich or equally poor, and both of them face the same question - do we treat population A or population B? Both of them can come up with a different solution to that dilemma, and both solutions, although different in outcome, can be fair because the process...was. Fairness is not about the ultimate outcome - it is also about the process.” - Leonardo Cubillos, Senior Health Care Specialist, World Bank Institute, USA “Fairness in terms of right to health is about ensuring that all considerations are put in place. First and foremost to focus on those who cannot afford health care - that is the most vulnerable...the chronic poor, the active poor, as opposed to those who can actually pay for health care. The question of fairness comes about because resources are always scarce and therefore policy makers and persons who are involved in planning health programs have to make key decisions on where they are going to get the maximum gain, and the maximum gain should always be around enabling people who cannot afford healthcare to get it so that they can become part of the productive sector.” - Tina Ntulo, Director - New Initiatives, Basic Needs, Uganda
READ MORE...
Giving All That You Can For Everyone, Everytime
Giving All That You Can For Everyone, Everytime
Louise Hallman 
Two billion of the world’s population of approximately seven billion still live without access to medicine or basic medical services. According to the UN, the world’s governments will fail to meet the Millennium Development Goals on HIV/AIDS, maternal health, poverty reduction, gender equality and environmental sustainability. Proof, says Leonardo Cubillos, senior health specialist at The World Bank Institute (WBI), that we are failing as humankind. But this needn’t be the case. We are now richer than we have ever been, with an estimated $70tn global wealth. According to Cubillos’ figures, globally we spend $6.5tn on health care - but what are we getting out of this? How can we ensure everyone’s right to health is met? What do we mean by right to health? For five days at Schloss Leopoldskron, over 70 health care and human rights professionals from 22 countries will consider ‘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?’ at Salzburg Global Seminar, in the fifth in a series of health care seminars, and the first global symposium to be held on the right to health and health systems, held together with the WBI and The Dartmouth Center for Health Care Delivery Science. Fellows will discuss not only the right to health but also the intersection of the right to health and health care systems, explained co-chair Cubillos in his opening remarks. Also joining the opening remarks via videolink was Health Minister Agnes Binagwaho of Rwanda - a global success story in the provision of health care. Since the genocide in 1994, the death rate in the central African country has fallen by 75 percent, explained Binagwaho. As infectious diseases have been tackled, the focus has shifted to non-communicable diseases, but despite this new challenge, here also there has been success - women in Rwanda now receive universal access to the vaccine against cervical cancer, something Binagwaho herself said she couldn’t have imagined 10 years ago. “When you don’t provide healthcare to people who need it, it is against their human rights,” said Binagwaho, but that doesn’t mean that the right to health means providing everything to everyone - that’s rarely possible due to resource constraints. Instead, explained Binagwaho, ensuring everyone has the right to health is always providing what you can to everyone equally, regardless of class, race or gender. Besides their right to health, governments need to also give their people “right to information, right to decision making,” she added. Whilst the right to health is widely regarded as important by society, governments, human rights organizations and some national constitutions, it can mean very different things in different countries. As one Fellow put it: “In Nepal it might mean access to basic healthcare; in Chile it could be access to top cancer drugs.” “We’re here to re-think collectively,” urged Cubillos. The 75 Salzburg Global Fellows will strive answer two key questions: How can health systems contribute to realization of right to health? And how can right to health contribute to strengthening of health systems? “It works both ways,” Cubillos added. Health care must be available, accessible, acceptable (respecting cultural differences) and be of a high quality, said Cubillos. “By joining forces [human rights and health care] we will not only increase health outcomes and efficiency but also fairness of decisions and human dignity.”
READ MORE...
Tessa Richards: "Schools and health - could do better"
Tessa Richards: "Schools and health - could do better"
Tessa Richards 
The article was originally published online on June 13, 2012 as part of the British Medical Journal (BMJ)’s Group Blogs.
To what extent are we sabotaging the future health and wellbeing of our children through ignorance, neglect, and misguided policy? And what can we do to redress this? Discuss. Discuss? The education and public health experts participating in an international cross-sector meeting convened by the Salzburg Global Seminar in Klingenthal, near Strasbourg last week, scarcely drew breath. But there was a lot to talk about. Improving the life trajectories of children, particularly disadvantaged ones, through changes in policy and practice across the spectrum of child development and education is a challenging task. Topics discussed ranged from early detection and management of children with autism (US data suggests it effects 1 in 70 boys and Sweden is to start screening for it at the age of 2), to bullying in schools, social exclusion, teenage pregnancy, and sexual health, but the obesity epidemic dominated. Among the raft of policies being introduced the meeting was told about an initiative in Georgia in the US, which is seeking to engage, inform, and enlist the public’s help in tackling the problem. It’s been kick started by putting up posters of fat children with arresting captions. These include “Being fat takes the fun out of being a kid,” and “It’s hard to be little girl when you are not.” Key figures outside the health sector are also pushing for regulatory change, including the Mayor of New York, Michael Bloomberg, whose plans for a “soda” tax have been both welcomed and criticised. Not to be outdone, Boris Johnson, Mayor of London has just used his column in the Telegraph to herald new strategies to “release children from the captivity of fatness.” If only it were that easy. Jacky Chambers, a public health physician in Birmingham, said that over 70% of children in the UK are failing to meet national guidelines for recommended physical activity and it correlates strongly with socio economic status. By the age of 7 [as the Jesuits knew*] unhealthy behaviours are evident and the watershed for interventions to counter them is around 13 years. To hit home the point, she said that contrary to NICE guidelines, hundreds of obese teenagers with type 2 diabetes in her region were having gastric bands inserted; it was seen as the only way of dealing with their obesity. Sympathy for the excessive demands put on teachers’ time gave way to the consensus that they must explicitly acknowledge their responsibility for the physical and mental wellbeing of their pupils as well as their academic achievement. Teacher pupil relationships and school ethos may be as influential as parenting styles in the development of young children’s resilience and emotional quotient, it was argued. Light relief to high falutin discourse was enlivened with bursts of enthusiasm for quick fixes to promote healthy child development. Top of the list was the recommendation, a la Marie Antoinette, to “take them camping.” Another, pushed forcibly by Marianne Olsen, a Swedish health care manager, was for schools to mandate 1-2 hours of exercise a day, and provide healthy meals and education about nutrition. Evidence from “health promoting” schools programmes has shown that this not only pays health dividends, but also boosts educational attainment, she said. No further evidence was needed. But in the worst recession for decades with ministers focusing on knee jerk responses to poor academic standards while cutting back services, including the provision of youth schemes and extra-curricular activities, will anyone listen? One way of making them, suggested Wessel van Rensburg, a social media technology consultant, is to harness the power of the new media. Everyone from political activists to fashion houses recognise the power of the social media to propagate messages and create communities and networks whose collective view can spur public campaigns. Health professionals and educationalists need to think outside the usual boxes if they are to succeed in their quest to change the behaviour of young people and sway political mindsets. *“Give me a child until he is 7 and I will answer for the man” a maxim attributed to the Jesuits. The views expressed in this piece are the author's own and should not be attributed to Salzburg Global Seminar.
Tessa Richards is assistant editor at the British Medical Journal where she currently runs the Analysis and Comment section. Prior to joining the BMJ editorial staff she worked as a general physician at St. Thomas’s Hospital London, with a specialist interest in rheumatology. She is also a qualified general practioner. Her special interests include European health policy, global health, medical education, and patients’ concerns and perspectives. She writes regularly for the BMJ and for lay publications. Tessa is a Fellow of several Salzburg Global Seminar sessions regarding health and health care, including The Greatest Untapped Resource in Healthcare? Informing and Involving Patients in Decisions about Their Medical Care and Innovating for Value in Health Care Delivery: Better Cross-Border Learning, Smarter Adaptation and Adoption.
READ MORE...
“Hands-On Medical Education in Rwanda” - SGS Faculty, Dr. Agnes Binagwaho featured in New York Times
“Hands-On Medical Education in Rwanda” - SGS Faculty, Dr. Agnes Binagwaho featured in New York Times
Stephanie Novak, NY Times 
READ MORE...
Better Care for All, Every Time: A Call to Action
Click the links at the bottom of the page to download and support the statement
Better Care for All, Every Time: A Call to Action
Louise Hallman 
Low and middle income countries have major health challenges: many countries are not on track to attain their Millennium Development Goals (MDGs), non-communicable diseases are emerging as the primary cause of mortality for the future, and little progress has been made in addressing unsafe care that harms millions each year. Despite significant improvements life expectancy and in some aspects of health care in the last two decades, daunting challenges remain to be solved in these countries. The Salzburg Global Seminar “Making Health Care Better in Low and Middle Income Economies” brought together global health leaders and practitioners who believe that a change in the health care paradigm is needed to help countries to address the critical gap between knowledge of interventions that improve population health and the care actually provided to patients –Quality Improvement (QI) is one approach that can be applied to rapidly improve health system performance and outcomes. QI is a proven, data driven method that places the responsibility and knowledge for rapid change in the hands of every patient, provider, manager and leader. 58 health officials and representatives of leading health agencies from 33 countries, participants of the Salzburg Global Seminar, are now urging all health policy leaders, patients, communities, health care workers, non-governmental organizations (NGOs), development partners, and governments to endorse recommendations that could drive a new approach to solving health challenges in these countries. We call on:
  1. Governments to be accountable for the improvement of healthcare through legislation, policies and necessary resources
  2. Health policy leaders to adopt and promote quality improvement as a cornerstone of better health for all
  3. Communities to actively advocate for quality health care as part of their rights and responsibilities
  4. Development partners to invest in approaches that drive sustainable context-specific improvements in global health
  5. Non-governmental organizations and those providing technical assistance in global health to incorporate evidence-based improvement methods in their work
  6. Health care workers to continuously improve the delivery of expert and compassionate care to patients, their families and communities
  7. Patients to be empowered and at the forefront of promoting a shared vision for better health for all.
Sir Liam Donaldson, World Health Organization (WHO) Patient Safety Envoy, said: “The Salzburg Seminar brought powerful and original insights about how they might contribute to strengthening health care systems in middle and low income countries. The unique character of the Seminars and the free-thinking nature of the discussions have yielded ideas that are important and durable.” Sir Liam and Dr. Nils Daulaire, Director of the Office of Global Health Affairs, U.S. Department of Health and Human Services, will help lead a special session at the World Health Assembly in Geneva in May to present the joint statement to Ministers of Health and health leaders from over 140 countries. A small group of experts from USAID, Institute for Healthcare Improvement (IHI), University of North Carolina, the WHO Patient Safety Programme, HEALTHQUAL International, Heidelberg University, and SGS, led by Dr Rashad Massoud from University Research Corporation (URC), organized the seminar. The Bill and Melinda Gates Foundation, USAID, Salzburg Scholarships, URC, Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), WHO Patient Safety, IHI, Atlantic Philanthropies, Nippon Foundation, and the U.S. Centers for Disease Control and Prevention funded the meeting. Click here for the full text of the Salzburg Statement A PDF of the Salzburg Statement, for printing, and distribution, is available here and in French translation here.
READ MORE...
Session Summary - A Vision Worth Pursuing
View of the Untersberg mountain across from Schloss Leopoldskron, home of the Salzburg Global Seminar
Session Summary - A Vision Worth Pursuing
Louise Hallman 
The Session ‘Health and Healthcare Series IV: Making Health Care Better in Low and Middle Income Economies: What are the next steps and how do we get there?’ came to an end in Salzburg, Austria on Friday, April 27, with a lecture from session chairman Dr. M. Rashad F. Massoud. Dr. Massoud reiterated again that the week-long seminar had been the “beginning of a journey, not the end” and that the final day would prove the most important with the writing of the Salzburg Seminar. Summarizing the week’s discussions, Dr. Massoud highlighted the five key challenges that had emerged – inadequate human resources, community involvement, poor planning, the difference between patients’ preferences and their needs, and the differing perceptions of quality among providers, policymakers and the public – as well as reiterating concerns about the confusion that exists and the need for a common terminology in the area of quality improvement in healthcare. Dr. Massoud also emphasized the need for accurate and correct documentation to enable thorough knowledge and know-how sharing. “Knowledge sharing was a major theme and this is not only about what interventions are known to work, but about the know-how on how to implement these interventions in real life; that is a whole other area of knowledge, equally important, if not even more important than the content knowledge itself,” he said. Focussing on the latter half of the week, Dr. Massoud asserted the importance of addressing research and evaluation methods in quality improvement, stating that research is critical in supporting improvement techniques and that widely available, cost-effective, simplified data is vital for the future of quality improvement in lower and middle income countries and on a global scale. He went on to speak about the role of quality improvement as a means for strengthening healthcare systems, as well as the need for strong, visionary leadership. “Leadership is one of the most critical ingredients for success of this work – we know that – however leadership is very vaguely defined,” Dr Massoud explained. “One of the things that came up here was the need to implement work at all levels of the systems, involving leaders at the different levels, be them national, regional, provincial, district levels, community levels, all of whom need to get together to be able to do this. And nurturing leadership at all of the levels is a key component.” He particularly highlighted the need to target leaders who are tightly connected to their communities. Concluding, Dr. Massoud repeated the previous day’s “eight drivers” for sustaining execution – community and patient demand, health managers and providers and professional societies, data systems, capacitation of frontline health practitioners, managers and systems leaders in quality improvement methods, political “buy-in” of the quality improvement approach, support from external funders, external and internal quality improvement experts, the evidence base for using quality improvement methods – and their individual and combined importance in improving the quality of healthcare. Finally, Dr. Massoud presented his “learning agenda” for each of the identified interlinked constituencies;
  1. Communities and Patients: Understand their rights, and their role in driving the health improvement agenda.
  2. Technical Advisors: Promote quality improvement as a method for improving health outcomes as well as accurately collect, synthesize and disseminate the data needed to promote the learning agenda for quality improvement.
  3. The Leaders of the Health Systems: Be informed on how effective quality improvement efforts are in improving outcomes, what processes lead to those improvements and how much it cost, in order to promote the agenda for including quality improvement in national strategies.
  4. National and Global Academic Community: Promote quality improvement as a legitimate mechanism for improving health outcomes on a large scale. Impact data has the greatest influence, followed by cost effectiveness.
  5. Global health policy makers: Be informed on a simplified description of the quality improvement model, the key arguments in favor of its use (better outcomes, cost-effectiveness, improved return on investment), and improved efficiency of health systems.
Dr. Massoud finished by re-sharing the vision panelist Jim Heiby, Medical Officer and Contracting Officer's Technical Representative, USAID Health Care Improvement Project, Washington, DC, who had earlier in the week proposed the ‘Dream Quality Improvement Database’. “Where would we be if that were to exist? I think it’s a vision that’s worth pursuing,” added Dr. Massoud.
READ MORE...
Healthcare Session - Day 5: Preaching to the unconverted
Healthcare Session - Day 5: Preaching to the unconverted
Louise Hallman 
Senior IHI Fellow, Enrique Ruelas presented his ‘10 Commandments to deal with politicians’ during Pierre Barker’s ‘Sustaining Execution’ session. On the penultimate day of the Salzburg Global Seminar on ‘Making Health Care Better in Low and Middle Income Economies: What are the next steps and how do we get there?’, participants were given a new set of commandments to consider: ‘Ten Commandments for Dealing with Politicians’. Enrique Ruelas, Senior Fellow at the Institute for Healthcare Improvement, Mexico, shared his commandments with the group as part of the Thursday morning session on ‘Sustaining Execution’ covering introducing QI systems to countries unfamiliar with the methodology and designing sustainability into healthcare initiatives from the start. Mr. Ruelas’ commandments offered an insight into the psyche of politicians and included selling the concept of QI in healthcare to politicians, not arguing with them, and also aligning your position with existing initiatives. The full list can be seen overleaf. Reflecting on the morning’s session, Bruce Agins, chair of the previous day’s session on leadership said: “There clearly is no one way to communicate the benefits or importance of QI... One has to know and read your audience to adapt your message appropriately, i.e. scanning and reading the environment effectively to tailor and craft your message.” As with previous sessions, all key suggestions made by the group were collated by the session chair to be included in the final session to be held on Friday morning entitled ‘Next Steps’. Participants will not only reflect on the outcomes of the week-long Session but also produce a Salzburg Statement to be shared with key stakeholder groups.
Talking Point: What positive outcome will you take back to your colleagues from this session at Salzburg Global Seminar? “That the patient matters and quality improvement is all about the patient.”
Natalia Largaespada Beer, Maternal and Child Health Technical Advisor, Ministry of Health, Belize “Quality isn’t really my field...I was confused, and I guess I didn’t really grasp the importance of quality or the huge impact it has [until now].”
Michelle Vanzie, Director of Policy Analysis and Planning Unit, Ministry of Health, Belize “From this meeting I will have a lot of friends! [I will have] a lot of challenges. We have discussed a lot of issues on quality so when I go back, I think my vision will be different.”
Babacar Ndoye, Co-ordinator, National Program Against Nosocomial Infections, Ministry of Health, Senegal “This meeting has brought great light to ideas on what we can share with our country, not to show that QI is a program but a science. I think we can present, we can advocate to leadership that this is the QI methodology.”
Januario Reis, Clinical Site Monitoring Specialist, USAID, Mozambique “The one this is the validation of the enthusiasm around using quality improvement to enhance the healthcare of poor around the world and create a quality movement to really make great progress very quickly in healthcare.”
Sheila Leatherman, Research Professor, Gillings School of Public Health, UNC, USA
READ MORE...
Displaying results 169 to 175 out of 181

REPORTS