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

Dima Boulad - “It is necessary for our society to have open spaces where individuals can interact”
Dima Boulad - “It is necessary for our society to have open spaces where individuals can interact”
Andrea Abellan 
During the Salzburg Global Session, The Child in the City: Health, Parks and Play, participants have learned how valuable the role of open space can be in post-conflict countries. Dima Boulad, co-founder of the Beirut Green Project, is one of the reasons behind that. The Beirut Green Project is a social initiative, born with the aim to assemble the concerns of citizens seeking to develop a more liveable city. With 0.8m2 of green space per person, Beirut remains below the Wealth Health Organisation’s standards which recommend every citizen should have at least nine square meters of green space. Boulad says, “Some citizens do not recognize the access to public spaces as a right they can claim, and this is what we aim to change.” To counter this, the Beirut Green Project has run awareness campaigns and organized many social events. The consequences years of war have had on Lebanon remain visible. In some areas, the country lacks basic facilities such as electricity or access to water. Outages of these services remain frequent. Complicated circumstances such as those above make it harder to place the development of green spaces as a priority in the minds of politicians. The goal of non-profit organizations such as the Beirut Green Project is to make clear that in spite of the urgency of meeting basic needs, citizens should not have to waive other civil rights such as the opportunity to enjoy public spaces. Boulad highlights the significance public spaces have in post-conflict areas. Boulad says, “In Lebanon, we grow up in a culture of fear. It is necessary for our society to have open spaces where individuals can interact with others. Accessible public areas might help to change our habits, break the bubbles where we live and therefore, improve our relationships.” Boulad says the work of advocates such as herself is not easy in Lebanon. She says, “It is very hard to have the attention of the government and to manage to get things done. Taking part in a Seminar like this can facilitate our jobs as it allows to create alliances with other countries from which we can learn and get aid.”

The Salzburg Global program The Child in the City: Health, Parks and Play is part of the multi-year Parks for the Planet Forum, a series held in partnership with the IUCN and Huffington Foundation. The session is being supported by Parks Canada and Korea National Park. It is being sponsored by the W.K. Kellogg Foundation. More information on the session can be found here: www.salzburgglobal.org/go/574 - You can follow all the discussions on Twitter by following the hashtag #SGSparks

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Incremental change to transformation
Incremental change to transformation
Oscar Tollast 
Ideas and words can change the world, but without the right execution, the majority of people will fail to benefit. With that in mind, participants at Salzburg Global’s session The Child in the City: Health, Parks and Play have received insight into how they can leap from incremental change to transformation.

To help them, participants have heard several case studies taking place in different areas around the world.

Reimagining the Civic Commons is a U.S. initiative supporting placed-based efforts to catalyze lasting change through the creative use of civic assets. It has involved engagement at all levels and has encouraged prototyping. Storytelling is important to its core. Participating cities such as Chicago and Detroit can learn from one another.

How Housing Matters is an online resource which depicts how quality and affordable housing can benefit everyone. It collected the research, refined the message and told the story. It built a bigger boat to bring more people on board.

In 1965, the idea of a Garden City was put forward in Singapore - not a concrete jungle but a place where people wanted to live. People now talk about the “city in the garden.” The first transformation involved reframing the issue. The second concerned housing. The third change involved connected parks. After being expelled from Malaysia in 1965, Singapore survived by transforming itself. To survive, participants heard you need the best resources and best investment.

There is a campaign in the U.K. to make London the first National Park City. The campaign draws on principles visible in national parks but ties them to an urban environment. The campaign has used maps, data, and voices from those in London. It has gained traction through local councilors and is reaching the decision-makers. In two years, it could be a reality.

The Urban Land Institute’s primary audience is the private sector. Materials, messages, and activities are geared toward them. The private sector can fund parks and enhancements and become a powerful ally. Projects like Complete Streets and Vision Zero are based on a core set of shared values, which rely on a coalition of partners. Both started small and scaled upwards. They share the responsibility for action between professionals and individuals.

A speaker said to create a transformation, a list of ingredients is required. This includes setting a goal, having a unique insight, having a value proposition, a theory of change, partners, customization, maintenance, and the ability to learn.

Participants were told to have a bold vision, a coalition of partners, a story to tell, and leverage the evidence.
The Salzburg Global program The Child in the City: Health, Parks and Play is part of the multi-year Parks for the Planet Forum, a series held in partnership with the IUCN and Huffington Foundation. The session is being supported by Parks Canada and Korea National Park. It is being sponsored by the W.K. Kellogg Foundation. More information on the session can be found here: www.salzburgglobal.org/go/574 - You can follow all the discussions on Twitter by following the hashtag #SGSparks
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Ideas on how green spaces and parks can become more accessible
Ideas on how green spaces and parks can become more accessible
Oscar Tollast 

There are several ways as to how parks and protected areas can better meet the needs of children. However, to begin with, there is perhaps a greater need to identify how these areas can become more accessible, and what changes are required to ensure children can spend more time in nature.

Participants at The Child in the City: Health, Parks and Play have been asked to consider what individuals and organizations can do to develop more child-friendly parks and protected areas. They have also asked themselves what the children involved actually wanted.

Regarding the latter, the ideas which came forward varied in detail, from short responses such as fun, freedom, and risk taking, to detailed responses outlining concepts such as “The Right to Play.” In the eyes of participants, they believed children wanted safe public spaces which were decriminalized and provided opportunities to express their interests and desires.

Some participants suggested through their ideas that greater focus should be paid to children’s creativity. One participant said children’s play should be observed to capture what they want, while another participant said they should see children as active agents who can bring about change themselves.

Adults were viewed as an obstacle by one participant, who called for them to behave more like children to allow fun and learning to continue.

To ensure these changes are possible, participants considered what steps could be made. Their ideas covered areas from accessibility and education.

Children could become more familiar with nature and green spaces by including them in their day-to-day lives more often. They could spend their lunch break on green schoolyards, bring nature into classrooms with plants, and finish at an earlier time in the afternoon to allow more time to be outside. Nature can play a stronger part in the school experience, right from Kindergarten. These ideas require the support of parents, schools, and city officials.

Outside of school, there could be intergenerational design sessions involving parents and children, allowing people of all ages to have community ownership of a public space. Children and adults can be encouraged to become “citizen scientists,” monitoring the nature that exists around them.

Another actionable step is to maximize the use of existing assets in the city, such as temporarily using land which remains unused for creative and fun purposes.

Individuals and organizations need to work together to ensure children feel safe in these open spaces. This could be achieved by asking children what frightens them and valuing their opinions. Parents’ and guardians’ fears should also be noted and listened to.

These ideas and others will continue to be worked on as participants look for equitable, practicable, and cost-effective solutions which involve children.

Read more here in our session newsletter.

Download Issue 1 as a PDF


The Salzburg Global program The Child in the City: Health, Parks and Play is part of the multi-year Parks for the Planet Forum, a series held in partnership with the IUCN and Huffington Foundation. The session is being supported by Parks Canada and Korea National Park. It is being sponsored by the W.K. Kellogg Foundation. More information on the session can be found here: www.salzburgglobal.org/go/574 - You can follow all the discussions on Twitter by following the hashtag #SGSparks

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Martin Spray - "I am totally convinced about the need to invest in the education of younger generations"
Martin Spray - "I am totally convinced about the need to invest in the education of younger generations"
Andrea Abellan 

The Wildfowl & Wetlands Trust (WWT) stands for the protection of wetlands and nature areas with a growing focus on urban environments. Its chief executive, Martin Spray, runs the rule over nine wetland parks which cover some of the UK’s most diverse wilderness. He sat down with Salzburg Global’s Andrea Abellán while attending The Child in the City: Health, Parks, and Play, and discussed how he hopes to connect peopleto nature.

Martin Spray took over the work of the Wildfowl & Wetland Trust’s founder, Sir Peter Scott, in 1991. He pushed forward Scott’s “visionary ideas” to make them a reality. The painting, representing the founder’s “last great vision,” currently resides in Mr. Spray’s office and continues to inspire his work within the organization.

Before passing away, Scott illustrated his plans to build a wetland park in the heart of London. With more than 250,000 visitors a year, the London Wetland Centre has since become a reality. The Centre attracts visitors from all over the world, and imitations of its design are visible in countries such as China and Dubai.

Spray considers increasing the organization’s reach and influence his biggest success. He says, “I am especially proud of having helped to take the ideas of an incredible founder to a 21st-century context.” Mr. Spray highlights the role played by the big, diverse team working to make the WWT projects function. Professionals from a wide range of sectors – from researchers to marketing specialists – have joined forces to make natural areas attractive for civil society.

London’s Wetland Centre has a playground and educational materials where children can learn about more than 200 bird species visiting the site. It also has a cafe, a shop, and comfortable seating areas with panoramic views. Everything is planned to make a visitor’s experience enjoyable. Spray explains, “It’s all addressed to connect people to nature.”

Apart from work in its wetlands centre, the WWT takes an active role in training projects, restoring wetlands, and water management-related initiatives. These efforts include working with sustainable drainage systems and natural water-treatment systems. It also runs the “Inspiring Generations” project, which enables around 60,000 students – most of whom from deprived areas – to visit Wetland Centres each year.

The program, funded by the bank, HSBC, educates both teachers and children by enhancing their environmental awareness. Spray confesses the project is something very close to his heart. He says, “I am totally convinced about the need to invest in the education of younger generations. They are who are going to take decisions in the future and who will takethe world forward. This [idea] is the main focus of the Inspiring Generations program and also the main reason why I’m in this seminar.”

Spray became interested in nature at a very young age. Supporting his passion, his parents quickly became used to seeing him running after lizards, butterflies, and any other animal which crossed his path. After spending almost the first half of his career in the government sector, where he learned “a lot about management skills,” Spray spent several years working as a volunteer for the World Wildlife Fund (WWF).

From this volunteer work, he was offered a full-time position, which opened the doors to a career in the environmental sector. In 2013, his work regarding nature conservation was recognized by Queen Elizabeth II, who awarded Spray a C.B.E, “Commander of the Most Excellent Order of the British Empire.”

In 2015, Mr. Spray took part in the inaugural session of the Parks for the Planet Forum, titled Nature, Health, and New Urban Generation. Spray says this program has had a lasting impact on his thinking. He says, “Meeting other Fellows made me realize that there were people all over the world facing similar issues and using the same language to talk about them.”

This session became a source of inspiration that led to a switch in his organization from a pure conservation perspective to a more people-centered one.He hopes this year’s session will help him go back home with renewed energy once again.

Spray defines himself as a positive thinker and believes citizens can be persuaded to develop more conscious and sustainable attitudes. He believes the focus should be on finding the best ways to inspire them. He has observed a growth in environmental awareness among people over the last decades, but he recognizes the “battle has not been won yet.”

Spray says there is a lot of work to do to create healthier environments and provide better access to public spaces. While Scott’s “last great vision” may have been achieved, Spray’s work has only just begun.

Read more here in our session newsletter.

Download Issue 1 as a PDF


The Salzburg Global program The Child in the City: Health, Parks and Play is part of the multi-year Parks for the Planet Forum, a series held in partnership with the IUCN and Huffington Foundation. The session is being supported by Parks Canada and Korea National Park. It is being sponsored by the W.K. Kellogg Foundation. More information on the session can be found here: www.salzburgglobal.org/go/574 - You can follow all the discussions on Twitter by following the hashtag #SGSparks

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Different ways children can benefit from nature
Different ways children can benefit from nature
Oscar Tollast 
Around 50 experts from different generations and sectors convened at Salzburg Global Seminar to set a new agenda to promote access to nature for children and communities in growing urban centers. Participants are meeting at Schloss Leopoldskron for the third Planet for the Parks Forum – The Child in the City: Health, Parks, and Play. They will aim to propose strategic recommendations to be shared at the 15th World Congress on Public Health to be held next month in Australia. Huge numbers of people have moved to urban areas around the world. Enough decades have gone by that people are beginning to sense they are missing something. Experts are looking at the positive experiences of nature and how that helps physical health. Research undertaken suggests that the more access children have to nature, the better for their health and wellbeing. Speaking to participants, Richard Louv, author, and co-founder of the Children & Nature Network claimed children who play in natural play spaces tend to be more creative.  The tide is beginning to turn. Louv said, “There’s far more interest in thinking about cities as places that connect people to nature.” He referred to research that indicated children in the US who spent a third of their day outdoors performed better regarding academic improvement than pupils in other schools who did not.  Louv said the barriers preventing children from going outdoors were “intense.” Electronics are a barrier, he claimed, but more attention needs to be paid to other obstacles, such as fear of strangers. With so much tech entering children’s lives, we need to balance that with nature.  Louv suggested the ideal student is the student who has both skills learned from the natural world and the virtual world. Environments are at risk of narrowing children’s senses, making them feel less alive. Louv said, “We need to begin seeing this as a human right. Any less than that, it will not be taken seriously.” However, as long as environmental education is only spoken about by environmental educators, children lose out. Louv said, “We need a bigger boat.” This conversation requires a bigger constituency.  When wider audiences start talk about a nature-rich future, people can begin to envisage what that might look like. Louv said there needed to be a social movement for balance, bringing conservatives and liberals together. The work without that larger social force “will be impossible,” he warned. Read more here in our session newsletter. Download Issue 1 as a PDF
The Salzburg Global program The Child in the City: Health, Parks and Play is part of the multi-year Parks for the Planet Forum, a series held in partnership with the IUCN and Huffington Foundation. The session is being supported by Parks Canada and Korea National Park. It is being sponsored by the W.K. Kellogg Foundation. More information on the session can be found here: www.salzburgglobal.org/go/574 - You can follow all the discussions on Twitter by following the hashtag #SGSparks
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Dr Jonathan Koffman - What makes a patient happy?
Dr Jonathan Koffman - What makes a patient happy?
Jonathan Koffman 

This article first appeared on the EAPC blog, which will continue to publish more posts on the Salzburg Question series. It coincided with the launch of the second Salzburg Question: Is dying well as important as living well?

In response to the Salzburg Questions, a new series encouraging a global discussion about the key issues affecting palliative care, Dr. Jonathan Koffman of the Cicely Saunders Institute, King’s College London, UK, explores the importance of addressing happiness at the end of life. It’s a timely post given that today, March 20, is the International Day of Happiness.

When did you last ask a patient, “What makes you happy?”

At first glance happiness seems to be a little bit like love; if you have to ask whether you are in it or not, you probably aren’t. So what is happiness? The subjective, fuzzy, vague feeling of this concept has been neglected in psychology until relatively recently. Is it possible that psychologists weren’t particularly interested in the scholarly research of happiness? I’m not convinced. Achieving quality of life is considered to be one of the main goals of palliative and end-of-life care. A widely presumed component of quality of life is happiness, a concept considered to be so important to human existence that the World Health Organization now recognizes it as an integral component of health.

Given the importance of happiness in quality of life it is perhaps surprising how little research has examined its meanings among people living with advanced disease. Moreover, no research has attempted to understand the meaning of happiness among people living with advanced disease from diverse communities. Addressing this concern is important because increasing globalization has brought with it an unprecedented number of people who have migrated to developed countries.

We recently conducted a study to explore and compare, for the first time, the centrality and interpretations of happiness across two cultural groups. We interviewed 26 Black Caribbean and 19 White British cancer patients living with and, dying from, advanced cancer in London. Beyond providing detailed accounts of how they comprehended their cancer and symptoms, we also asked participants to tell us very simply, in their own words, what made them happy. This is a question that rarely appears in the clinical assessment of patients.

Nearly all participants volunteered views on happiness, which were related to four main themes:

Empty lives, a theme associated with lives devoid of contentment.

Happiness and the physical form, such as the effect of distressing symptoms on wellbeing.

Love and affection, which concerned relationships with family and friends

Realising personal meaning in life, which related to God, prayer and the sacred world.

The findings provide a very evocative account of the presence of happiness even in the darkest moment of advanced disease. For example, we observed that black Caribbean participants often comprehended the inexplicability of their cancer through the lens of their strong religious beliefs, which enabled them to make the successful transition to a state of acceptance and happiness.

We recommend that health and social care professionals be aware that happiness is an important, complex and multidimensional human experience, which at times is also culturally shaped. They must therefore be sensitive and willing to ask the questions that, on the face of it, seem indulgent when compared to the task of treating physical symptoms. This will enable them to better understand their concerns and then to devise therapeutic responses that maximize moments of happiness and subsequent quality of life.

For more information about the study conducted into happiness amongst different cultural groups at the end of life, the full paper can be viewed here.

Follow the EAPC Blog for more posts in the Salzburg Questions series.

Follow the global dialogue on Twitter. Using the hashtag #allmylifeQs the nine Salzburg Questions will be debated throughout 2017.

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Second Salzburg Question on palliative care asks whether "dying well" is important as "living well"
Second Salzburg Question on palliative care asks whether "dying well" is important as "living well"
Oscar Tollast 

A global conversation on crucial issues affecting care towards the end of life will take a different direction with a new Salzburg Question.

Since February 20, people all over the world have been using the #allmylifeQs hashtag on Twitter to answer a Salzburg Question related to palliative care.

This question was the first of nine to be asked in 2017, each pegged to an international day of observation. March's question - “Is dying well as important as living well?” - comes as people around the world observe World Happiness Day.

Discussions around each question are being led by different individuals and institutions at the heart of the debate and who were involved in a Salzburg Global session in December: Rethinking Care Toward the End of Life.

Salzburg Global Fellow and former Minister of Health in Rwanda Agnes Binagwaho led the first campaign, asking, “Why aren’t countries accountable to commitment on end of life (#EOL) care for vulnerable people?"

At the time of writing, this question and hashtag have generated more than six million impressions on Twitter. There have been more than 1,200 tweets and 237 participants involved. 

The next question will be launched on March 20 by Lynna Chandra (@lynnachandra) - an ex-investment banker who left for the not-for-profit world in 2006 to establish Rachel House. This organization is the first pediatric palliative care service in Indonesia for children from marginalized communities living with cancer and HIV. 

Chandra will pose the question, “Is dying well as important as living well?” with respondents encouraged to answer on Twitter using the same hashtag, #allmylifeQs. 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 Monday, which coincides with World Happiness 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 w 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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