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

Maho Isono - Patients should make themselves the center of consultations
Maho Isono - Patients should make themselves the center of consultations
Oscar Tollast and Nicole Bogart 
Maho Isono teaches medical anthropology at the International University of Health and Welfare in Tokyo, Japan, and is currently conducting fieldwork regarding traditional Japanese Kampo medicine, specifically regarding the relationships between doctors and patients in this system. Isono attended Salzburg Global Seminar's session Toward a Shared Culture of Health: Enriching and Charting the Patient-Clinician Relationship and spoke about how the hierarchy of traditional Japanese medicine may impede patient-doctor relationships. "In Japan, doctors have [a] very strong power. It's very difficult for patients to deconstruct that hierarchy," Isono says, noting that carrying the title of Sensei is highly respected in Japanese society. "So, while you call someone Sensei, we tend to hold back, and we should be humble in front of that person. In that sense, it is kind of difficult for patients to articulate all kinds of theories and opinions to doctors." Through speaking with session participants at Salzburg Global, Isono says she is interested in exploring how these barriers between patients and clinicians could be broken down in traditional medicine, teaching patients to become more involved in their consultations. "I think we should tell patients how to put themselves in the center of their consultations and their right to be in that position," she says. Isono hoped to share research into the OpenNotes platform with peers and students upon her return to Japan, introducing the idea of enriching the patient-clinician relationship to Japanese doctors. "Because I'm a cultural anthropologist, I'd like to combine the anthropological perspectives into OpenNotes and make one class," she says. As a first time participant at Salzburg Global, Isono says she has been overwhelmed by the amount of information she has gathered from other participants, all from different backgrounds. "My experience in Salzburg is refreshing my experience in my life," she says.
Maho Isono was a participant of the Salzburg Global program Toward a Shared Culture of Health: Enriching and Charting the Patient-Clinician Relationship. This program is part of the multi-year series Health and Health Care Innovation in the 21st Century. The session was supported by OpenNotes. More information on the session can be found here: www.salzburglobal.org/go/553.
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Xanelé Purén - "We are underestimating the importance of being little"
Xanelé Purén - "We are underestimating the importance of being little"
Andrea Abellan and Nicole Bogart 
Xanelé Purén, co-founder of interactive design studio See Saw Do, believes children have a unique and important outlook on society and the cities we live in. This belief has a direct impact on her company's mission. Although the Cape Town, South Africa-based See Saw Do works with a variety of people, the spatial design studio mainly focuses on young children and designing public environments that enhance their sense of being a child. Purén attended Salzburg Global Seminar's session The Child in the City: Health, Parks and Play to share her view on place-making and how children's views can be incorporated into spatial design. "Place-making is a really holistic way of looking at a space," Purén says, noting the people who operate within it are also a part of that space. In many circumstances, children are a large part of public spaces within our cities. When working with schools, for example, she says it's important to work with teachers to create a better understanding of what a child is, what children need and how much power they have. See Saw Do was born out of Purén's fourth-year design project, while studying visual communication design at Stellenbosch University. Having always loved children, she spent time at a school in a nearby community to identify issues that could be addressed through design. Six years later, Purén says "we've grown our understanding of people, our understanding of children, and our understanding of place." Two years ago, See Saw Do began focusing on creative education, spending more time with children and exploring how simple tools can empower their sense of self. Purén says she's felt a great sense of joy watching children create and including them in the design process. But Cape Town faces a wide array of social problems, which presents unique challenges when trying to foster a child-friendly city, Purén says. She believes one of the biggest challenges residents face is understanding that children are active citizens. "We often hear that we have to train children to become contributors to society, so I think they're greatly underestimated as whole people. We are underestimating the importance of being little," she says. "I think if we can create a mindset in the minds of Cape Town citizens, that will already be a big step to empower children to be more integrated into society." Purén, who describes Cape Town as a dynamic and diverse city, says that on both a business and community level she sees more organizations focusing on children, providing a promising outlook for future generations. "I can envision Cape Town being a great city for children, hopefully, in the near future," she says, noting there is strength in diversity. Purén says her participation in Salzburg Global's session has allowed her to create connections with people from several different fields and areas of expertise, paving the way for future collaborations. She adds, "There is already some exciting stuff brewing between participants."
Xanelé Purén was a participant in the Salzburg Global program The Child in the City: Health, Parks and Play, which is part of the multi-year Parks for the Planet Forum, a series held in partnership with the IUCN. The session was supported by the Huffington Foundation, Parks Canada, Korea National Park and the W.K. Kellogg Foundation. More information on the session can be found here: www.salzburgglobal.org/go/574
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Salzburg Question - How have you prepared for your death?
Salzburg Question - How have you prepared for your death?
Oscar Tollast 

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

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

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

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

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

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

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

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

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

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

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

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

List of dates, questions, and people leading discussions

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


Penny Low was a participant in the Salzburg Global program The Child in the City: Health, Parks and Play, which is part of the multi-year Parks for the Planet Forum, a series held in partnership with the IUCN. The session was supported by the Huffington Foundation, Parks Canada and Korea National Park and the W.K. Kellogg Foundation. More information on the session can be found here: www.salzburgglobal.org/go/574

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Harlan Krumholz - “We are ready to see a renaissance in innovation but we are just in the beginning of it”
Harlan Krumholz - “We are ready to see a renaissance in innovation but we are just in the beginning of it”
Andrea Abellan 
Harlan Krumholz has devoted his career to the purpose of “making healthcare systems more responsive to patients and to generate knowledge that will help them to make better-informed choices.” Aside from his role as the Harold H. Hines, Jr. Professor of Medicine at Yale University, Dr. Krumholz has a vast experience as a researcher. He is also the director of the Yale-New Haven Hospital Center for Outcomes Research and Evaluation and is co-director of the Robert Wood Johnson Foundation Clinical Scholars Program at Yale. Dr. Krumholz came to Salzburg Global’s session Toward a Shared Culture of Health: Enriching and Charting the Patient-Clinician Relationship to share his views on the benefits and disadvantages of health technology. Dr. Krumholz has put a lot of effort into investigating how the use of technology can enhance patients’ experiences. He acknowledges the better capacities digital tools can offer to gather information, the support they provide for decision-making processes plus the additional opportunities to accelerate research and personalization options. Despite his trust in technology as a resource able to empower patients and put them in control of their health care, he is aware of the risks its use might have. These risks include the hazard of making health systems less human and the potential for unintended consequences such as the overlooking of valuable information.  The cardiologist, however, is expecting digital healthcare to keep evolving while the negative effects are addressed. “We are ready to see a renaissance in innovation, but we are just in the beginning of it.”, Dr. Krumholz says.  The app Dr. Krumholz and their team are launching, which is called Hugo, might be one of those tools contributing to the upheaval of health care technology. Hugo is a free app intended to help patients pull their personal data. Dr. Krumholz goal is to have patients’ records stored on one single platform.

Dr. Krumholz is frustrated with many health care institutions which remain afraid to share data with patients and fail to make the procedure as easy as it could be. Hugo wants to help to make the switch by simplifying the process. Hugo is always updating information on patients’ behalf and organizing the collected data for them. Dr. Krumholz likes to define the platform as a “tool to empower people and to embrace opportunities to use data in ways that were not an option before.”

Hugo’s users have full control of their records and the power to decide what they want to do with them. For instance, they could choose to share them with the medical community and participate in research studies. Dr. Krumholz finds, in this option, the opportunity to assist with the cultural change that needs to take place in the field of medical research. Dr. Krumholz supports the concept of transforming the relationship between researchers and patients into a partnership. He believes patients deserve to be in a position “where they actually own their data and are the ones allowing researchers to use it.” Likewise, Dr. Krumholz argues patients should be informed of research findings, which could motivate their involvement in future studies. “This would be a way to respect and honor patients’ participation,” he states. Dr. Krumholz hopes the concept of having patients in control of their medical records will be embraced over the globe. He advocates finding the tools, such as Hugo, which can make it easier to keep track of relevant information. He also stands for the benefits of bringing together communities of people facing the same challenges so they can share advice which can be verified through their records.  Dr. Krumholz insists on saying there is no time to waste when talking about diseases and promotes the need to accelerate the generation of research. He declares, “Data collection is not the solution to everything; [it] is more about what we build on top of that.”

Dr. Krumholz says his participation in Salzburg Global’s session was a very interesting opportunity to share ideas with people from different countries, backgrounds, and thoughts.  He adds, “I have been amazed to realize that in every country we are facing very similar issues.  It’s time for us to do things differently and find new solutions.”
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 was supported by OpenNotes. More information on the session can be found here: www.salzburglobal.org/go/553.
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Salzburg Global Vice President Clare Shine speaks at World Congress on Public Health
Salzburg Global Vice President Clare Shine speaks at World Congress on Public Health
Oscar Tollast 

Salzburg Global Vice President Clare Shine traveled to Melbourne, Australia this month to chair the World Leaders Dialogue on “Nature is good medicine” at the 15th World Congress on Public Health.

Keynote speakers at the Congress were Dr. Maria Neira, Director of Public Health and Environment at the World Health Organization, and IUCN President Zhang Xinsheng. The panel featured Cristina Romanelli, Secretariat for the Convention on Biological Diversity; Daniel Buss from Pan American Health Organization; Matthew Jackson, CEO of Parks Victoria; and Kevin Lafferty from the Forestry Commission Scotland. Jerril Rechter, CEO of VicHealth, introduced the debate that was formally closed by Paul Smith, Deputy Secretary, Victoria State Government.

The World Congress on Public Health is held every two to four years by the World Federation of Public Health Associations, attracting around 4,000 delegates. This international forum for exchange of knowledge and experience focuses on critical challenges such as non-communicable diseases, mental health, the built environment, health equity and vulnerable groups, climate change impacts and optimizing health across the Sustainable Development Goals.

Clare Shine used the platform to share recommendations by participants from three Salzburg Global sessions: Early Childhood Development and Education (2015); Nature, Health and a New Urban Generation (2015); and The Child in the City: Health, Parks and Play (2017).

In Melbourne, World Leaders Dialogue panelists discussed how the positive impacts of biodiversity and ecosystem services for human health and wellbeing could be better understood and measured to drive policy and practice and avoid future health costs. They identified ways for leading institutions and change makers to champion new strategies and alliances linking health and environment in a rapidly urbanizing world.

At Salzburg Global’s recent session on The Child in the City: Health, Parks and Play, participants considered key questions to advance high-level debate in Melbourne. They were guided by two co-chairs: David Anthony, UNICEF Director of Policy and Analytics, and Kathy MacKinnon, Chair, IUCN World Commission on Protected Areas

The Salzburg group used the lens of young children to explore the pivotal role of safe outdoor play and accessible green spaces for children’s physical, mental and social development and broader family and community cohesion. Participants stressed this was a fundamental equity issue and identified practical ways for the health, environment and urban planning sectors to better integrate health across local and national policies and investments. They highlighted co-benefits and cost savings that could be generated by landscape connectivity and nature-based solutions to promote healthy urban ecosystems.

On the final day in Salzburg, participants shared principles and ideas which will feature in the vision of an upcoming Salzburg Statement. They recognized that country settings and opportunities vary widely but called for nature to be brought into cities and everyday spaces so that children could discover and freely interact with nature on a regular basis. The “city should grow with the child,” as one participant summed up, creating new partnerships and investments to enhance nature.

The Child in the City: Health, Parks and Play was the third program of the Parks for the Planet Forum, a ten-year partnership with IUCN for transformative leadership and action to implement The Promise of Sydney and the Sustainable Development Goals.


The Salzburg Global program The Child in the City: Health, Parks and Play is part of the multi-year Parks for the Planet Forum, supported by partners including IUCN and the Huffington Foundation. The session was supported by Parks Canada and Korea National Park Service and 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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David Anthony – “Play should not be a luxury for children but an integral part of their development and growth”
David Anthony – “Play should not be a luxury for children but an integral part of their development and growth”
Andrea Abellan 
With half of the world population living in cities, there is an urgent need to reflect on the impact of urban growth and the consequences it might have, namely, a lack of basic services, inequality and widening gaps between the poor and the rich. David Anthony, Chief of Sustainability and Policy Action at UNICEF, wants to view these challenges as opportunities to create better-planned cities which have children at the core of their systems. During The Child in the City: Health, Parks and Play, Anthony sat down with Salzburg Global's Andrea Abellan to discuss his views.

 AA: One of the values contemplated in the Convention on the Rights of the Child (CRC), a legal framework for UNICEF’s work, recognizes the right of children “to rest and leisure, to engage in play and recreational activities appropriate to the age of the child and to participate freely in cultural life and the arts.” How does UNICEF work toward the protection of this right?DA: UNICEF has understood how children’s demands have evolved over the years. When we started to work we were focused on offering legal support to children and protecting them against sexual abuses and physical exploitation. However, children’s rights to express themselves, associate, have leisure, and participate in cultural interactions have always been part of the convention. 

In UNICEF we acknowledge that play should not be a luxury for children but an integral part of their development and growth. We are very conscious of the need to promote this right, and we work to create safe and clean environments for children to learn, grow and play that are absolutely vital. We run projects such as the Child Friendly Cities Initiative (CFC) that seeks to provide guidelines and support to transform cities into spaces able to match children’s needs.

 AA. How does UNICEF integrate both developed and developing countries in its campaigns?

 DA: We run programs in 140 countries at all income levels, and we partner with different social agents, from local NGOs to private companies or academic people. I would say that one of the biggest challenges is to plan initiatives that are cost-effective, that allow us to do as best as we can at reasonable costs. We look for projects that can be maintained over time because same solutions might not be practical in different countries. For instance, it is fundamental to have green spaces in urban settlements, but it is equally relevant to consider how these spaces are going to be preserved otherwise they will disappear very quickly. It is not the same to build a park in a tropical environment with highly irregular levels of rainfall than in a Northern Hemisphere climate space. 

We also pay attention to the notion of inequality within the metropolises. Parks are usually located in the centers of the cities. That means that most vulnerable communities, which tend to live in cities’ outskirts, do not have easy access to them. We should put fragile communities on the top of our priorities, so we can effectively look for the best strategies to successfully integrate them. 

 AA: During this session, The Child in the City: Health, Parks and Play, the topic of climate change and how it specifically influences children has arisen several times. What is your perspective on this subject?

 DA: There are approximately 2.2 billion children in the word; two billion of them are affected by the impact of climate change. We are talking about a whole generation of children that grow up suffering the consequences of climate change such as floods and droughts. There are other related issues to consider as well, meaning water scarcity and respiratory infections caused by air pollution. If we continue building unplanned cities and polluting the planet at this rate, we will have more children at risk than ever before.   

At the same, cities themselves have always come up with solutions. Electricity, water supply systems, trade, and community participation are just some of the resources that were developed within the cities. There are many cities starting to be built from scratch in Africa and Asia; I see strong opportunities to influence how they are designed and start making them child-friendly from the beginning. 

 AA: The hardships of prioritizing green areas among other basic needs such as food security or health-related issues have also been discussed during this session. What do you think about it? 

DA: Because health, nutrition and education are such important topics it does not mean that we always have to prioritize them over other subjects. One of the factors fostering problems such as crime or radicalization is the inability to find activities for young people. One of the most cost effective solutions would be to promote leisure amongst young people so they can learn how to use their time wisely.

It is not a matter of health versus leisure; it’s more a question of how to be able to work on every aspect of a healthy development. In my opinion, we should invest in making people more conscious of the benefits of play. In this way, they will create leisure spaces themselves or demand them to the authorities. And when the request exists, the supply aspect tends to be more flexible.
David Anthony was a participant in the Salzburg Global program The Child in the City: Health, Parks and Play, which is part of the multi-year Parks for the Planet Forum, a series held in partnership with the IUCN. The session was supported by the Huffington Foundation, Parks Canada and Korea National Park and the W.K. Kellogg Foundation. More information on the session can be found here: www.salzburgglobal.org/go/574
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