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 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 08 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
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The Child in the City - Health, Parks, and Play
The Child in the City - Health, Parks, and Play
Oscar Tollast 
In some cases, a park is an often untapped treasure. It can be used for exercise, reflection, fun, and relaxation. Having an open space to go to in proximity of one’s home is essential for people’s welfare and quality of life. The world, however, is becoming increasingly urbanized, with almost 70 percent of the world’s population expected to live in urban centers by 2050. In these dense urban spaces, where will this treasure be found? A plan needs to be formulated to take this prediction into account. John Muir, one of the world’s most famous and influential naturalists, once said, “The power of imagination makes us infinite.” This notion becomes apt when we reimagine cities through the eyes of the child, an individual whose creativity knows no bounds. Wise investments and nature-based solutions could put human-centered design at the heart of urban transformation while providing a cost-effective way to improve public health. At Salzburg Global Seminar, experts and game-changers will convene at The Child in the City: Health, Parks, and Play to take this conversation forward. This program is the third session of the Parks for the Planet Forum, held in partnership with the International Union for Conservation of Nature (IUCN). The Huffington Foundation, the W.K. Kellogg Foundation, Parks Canada, and the Korea National Park service will provide further funding and programmatic support for the session. The Park for the Planets Forum, convened by Salzburg Global and embedded in the IUCN Global Protected Areas Programme, advances action, investment and leadership to implement the Promise of Sydney and the Sustainable Development Goals. The latest session held under this series will be marshaled by two co-chairs: David Anthony, Director of Policy and Analytics, UNICEF, and Kathy MacKinnon, Chair of IUCN/World Commission on Protected Areas. They will help lead around 50 experts from different generations and sectors, all of whom have perspectives related to the issue of children in cities and associated planning, policy, and investment decisions. Participants will take part in a highly interactive program combining theory, policy, and practice. There will be a combination of panel discussions and presentations, featuring leading experts and skilled practitioners. Those taking part will spend time in small thematic groups to identify the key challenges and create new agendas and policy recommendations.  There is a growing body of evidence that says a personal experience of nature in childhood is essential to generating a lifelong sense of connectivity and stewardship for the world’s environment. Participants will be asked to take an imaginative approach, looking through the eyes of young children, developing new collaborations that will benefit individuals, families, and long-term social, economic and environmental resilience.  Narrowed down further, this will include improving outcomes for early childhood development and education; individual and family health; community resilience and cohesion; and, environmental protection and conservation. Participants will explain what policies and frameworks need to be put in place to enable this to happen, and what else is required to advance an agenda for “the child in the city.” During the next few days, participants will consider:
  • How can parks and protected areas better meet the needs of, and be accessible for, all children – including the most vulnerable, marginalized and underserved – enabling and encouraging them to play, create and find joy in nature?
  • How can the benefits of public green spaces be maximized for the physical, mental and social health and well-being of children and, by extension, families, and community?
  • What are the implications for urban planning, design, and management if the needs of children are placed at the center, especially related to accessing and enjoying nature, improving health and development?
  • How can the long-term economic benefits of improved child health and development through access to nature be more clearly calculated and communicated to inform strategic investments
Participants will be tasked to push forward a new change agenda to promote access to nature, health, and development for children and communities in growing urban centers. They will also agree on strategic recommendations to share at the 15th World Congress on Public Health, taking place in April, and other leading international forums.
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 Menon-Johansson - "For me electronic records are like black boxes on airplanes, they allow you to manage information"
Dr Menon-Johansson - "For me electronic records are like black boxes on airplanes, they allow you to manage information"
Andrea Abellan 
Dr. Anatole Menon-Johansson’s testimony is clear proof of the successful integration of digital health tools in everyday clinical activities. Menon-Johansson’s professional experience is focused on sexual and reproductive health. He puts his energy in various activities; he is the clinical director for the charity Brook, the lead of the integrated service at Guy’s & St Thomas’ NHS Foundation Trust and the founder of two innovative social enterprises: SXT and SH:24. Menon-Johansson is a passionate advocate of the possibilities technology offers to assist patients. He decided to start using digital tools a long time ago, starting a decade ago with the use of text messaging results. Through this system he sees patients getting back more promptly to reduce the spread of infections. Text messaging is now a standard practice in sexual health care, but Menon-Johansson was one of its early adopters. The Sexual Health Clinic he leads in London became completely paper-free four yours ago. “We have all data saved in one single platform, which helps us to monitor our activities. For me electronic records are like black boxes on airplanes, they allow you to manage information properly,” he explains. Patients can make online appointments through booking service Zesty. Their time spent in the waiting room is reduced with the digital queues that a software named Qudini enables. Patients can get registered in the reception and then leave if they want to do anything else. A text message will let them know when their time arrives. In the meantime, they can keep their position in the line. “We have digital tools involved in the whole process, since a patient books the service and waits to be seen until they get their results back by an SMS,” the doctor states. The platform SXT.org.uk that Menon-Johansson designed, helps users to find the right service when they need to get tested for sexually transmitted infections, and if they need advice for abortion or sexual violence support. Another interesting adaption of the platform is the partner notification through which users can anonymously inform their sexual partners about a diagnosis. The sexual partners are advised on the best options to be tested. Another webiste he has helped to design, SH24.org.uk is focused on providing free testing for sexually transmitted infections (STIs). Its functionality is easy to navigate and oriented to preserve the confidentiality of users who receives the test and the results within 72 hours. Menon-Johansson presented his web-based emergency contraception calculator during the Salzburg Global session Toward a Shared Culture of Health: Enriching and Charting the Patient-Clinician Relationship. He says, “In the UK we have 186,000 abortions every year. We expect about 400,000 births, but we end up with 700,000. These numbers show the real disconnection between what women want and what actually happens to them.” Thus, Menon-Johansson explains, it is important to keep raising awareness of contraception methods. He supports the use of the Intrauterine Device (IUD) with copper as one of the methods offering better results. Menon-Johansson argues, “Research proves that it’s more reliable than any other emergency contraception method. I want to make sure that women understand that there are good alternative solutions they can benefit from.” The calculator service has a positive effect on the doctor-patient relationship too. It helps women analyze the data they have stored on their phones so they can have an idea of their risk of pregnancy and of the options they have. Menon-Johansson says, “I have real troubles when this information is not given to a woman before she meets the specialist because then she can feel under pressure to follow the doctor’s instructions and that goes against their autonomy.” The calculator was well received by the Fellows, who provided Menon-Johansson with useful advice. Most of the suggestions were oriented toward a better promotion of the platform. Participants proposed to include advertisements in social media channels, games or dating apps seeking to reach young women who might be those facing a bigger risk. Menon-Johansson explains that one of the biggest challenges he finds when developing health care technology is convincing a still very conservative audience. He says, “I have already proved that the system I’m using works, now I want to show its potential to amplify the quality of the health care system and to support clinicians in their work.” The calculator is currently only available in the UK, but Menon-Johansson expects this will change soon. In May, he is attending the Health 2.0 Europe conference which will take place in Barcelona and hopes this event will open the doors to the Spanish market. Menon-Johansson says he is leaving Salzburg Global feeling richer in knowledge and is looking forward to implementing many of the suggestions fellow participants have given to him. He says, “I have enjoyed the way the seminar has evolved from exposing problems to looking for solutions. It’s always important to reflect about how to implement good ideas that can make real things happen.”

The Salzburg Global program Toward a Shared Culture of Health: Enriching and Charting the Patient-Clinician Relationship is part of the multi-year series Health and Health Care Innovation in the 21st Century. The session is being supported by OpenNotes. More information on the session can be found here: www.salzburglobal.org/go/553. You can follow all the discussions on Twitter by following the hashtag #SGShealth


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