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

Dr Tom Delbanco - The benefits of sharing medical details with a patient will outweigh the risks
Dr Tom Delbanco - The benefits of sharing medical details with a patient will outweigh the risks
Andrea Abellan 

After hearing the enthusiasm with which Tom Delbanco talks about his life in medicine, nobody would say he could have done anything else other than work in that field. Surprisingly, at college, he was studying to be a political scientist, before eventually changing his career plan. Dr. Delbanco has led three previous sessions at Salzburg Global Seminar. He says this is the perfect place for someone like him, with “the generalist disease,” as it always helps to have his curiosity piqued here. Toward a Shared Culture of Health: Enriching and Charting the Patient-Clinician Relationship is his fourth session and, in contrast to what happened on previous occasions, this time he hopes to act more as an observer rather than as a leader of the discussions.

OpenNotes is one of his most acknowledged achievements. He has led the organization together with Jan Walker since its creation in 2010. Dr. Delbanco recognizes the impact that his participation at the Salzburg Global Session, Through the Patient’s Eyes: Collaboration between Patients and Health Care Professionals, has had on him: serving as an inspiration to develop the digital platform. Discussions about the mythic nation of PeoplePower gave him the basics of what a patient-centered system should look like. He shared the outcomes of that meeting on a paper which has been circulated among the current group of participants at Schloss Leopoldskron. This paper is entitled Healthcare in a land called PeoplePower: nothing about me without me. Looking at the improvements in health technology 19 years later its seems that PeoplePower was more than a utopian proposal. 

The book Asylums: Essays on the Condition of the Social Situation of Mental Patients and Other Inmates, written by sociologist Erving Goffman, has also played a key role in the development of Dr. Delbanco’s ideas. The book describes mental hospitals, concentration camps, and prisons, as “total institutions,” places where two groups of people are forced to live together. One of the groups is in charge of taking care of the other that certainly does not want to be there. Unhappily, the two groups tend to form separate societies, with an invisible wall between them. In reading this book, Dr. Delbanco started to reflect on “the invisible walls that also divides patients and health care workers,” a phenomenon he has experienced from both angles.

Dr. Delbanco served as the founding Chief of the Division of General Medicine and Primary Care at Beth Israel Deaconess Medical Center in Boston for 30 years, and during this time he could see “how the medical staff interacted with each other while ignoring patients.” When he was a patient himself he could understand the situation better and realize the urgency of “breaking the walls down,” he says. 

Dr. Delbanco shows his positivity regarding the future of electronic medical records. But he recognizes a backlash towards them coming from some health professionals. “Doctors may say they hate them, but at the same time they panic if you ask what would happen if we would stop using them.” Dr. Delbanco trains his students on the use of digital platforms, even if for him the best teachers are still patients: “It’s equally important to have patients able to correct the notes a doctor has written about them.” He is an advocate of transparency, but he still recognizes the negative impact that sharing all the details with a patient can have. Overall, he thinks “the benefits will outweigh the risks.” 

When asked about where the US medical system is going now, with everyone now focused on the political situation in the country, Dr. Delbanco answers from a very medical perspective. “It’s very easy to make a diagnosis, but hard to come up with the treatment.’’ For him, the main concern is still how to subsidize the health system and assist the 20 million citizens who are still not covered. Overall, he expects that the government will have a difficult time undoing past achievements. 

Dr. Delbanco talks about himself as a person who finds it very difficult to slow down and as someone who likes “solving problems fixing things that do not work.” In fact, now that OpenNotes is working efficiently, with more than 12 million patients registered in its database, Dr. Delbanco has decided to get involved in a new project. OurNotes is his next plan, in partnership again with Jan Walker, who describes the project as “going from passive reading patients to active writing ones.” The idea is to have patients co-produce the records by writing their own medical history and stating their own priorities. 

Dr. Delbanco expects to leave Salzburg feeling surprised as has happened in every past occasion. He wants to go home thinking “Why hadn’t I thought about these ideas before?!” He also wants to keep this session alive after it ends on Wednesday. 

“I believe that new media and social media platforms are changing a lot and can help us with this purpose,” Dr. Delbanco concludes. 

Read more here in our session newsletter.

Download Issue 1 as a PDF

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: You can follow all the discussions on Twitter by following the hashtag #SGShealth

What full transparency means for patients and clinicians
What full transparency means for patients and clinicians
Oscar Tollast 

When contemplating new ideas of recording a patient’s journey through health and illness, one has to look at how each party involved could benefit from it. For example, an Internet-based patient record, as proposed in the Salzburg Global session Through the Patients’ Eyes: Collaboration between Patients and Health Care Professionals, could be easier to edit and track for a patient, and could save more time in the long-term for the clinician. While this may sound appealing, this answer leads us to ask more questions. 

What difference might full transparency make in different health systems around the world? Is the final blow to medical professionalism? Participants of Toward a Shared Culture of Health: Enriching and Charting the Patient-Clinician Relationship were asked for their thoughts on these questions on the second day of the five-day session.


OpenNotes, which is supporting Toward a Shared Culture of Health: Enriching and Charting the Patient-Clinician Relationship, is a U.S. organization which encourages health professionals to share the notes they write with the patients they care for. Before considering the pros and cons of transparency, they learned about the organization’s origins.

Speaking at Salzburg Global, Jan Walker, co-founder of OpenNotes, revealed the organization was established following a successful study. Despite doctors having initial concerns they would undertake an increased workload, the 12-month experiment which followed proved to be an overwhelming success.

After 12 months, doctors barely noticed the notes had become accessible. Those who had taken part completed a survey. Of those who responded 99 percent said they would like the experiment to continue. At the end of the study, not one doctor signed off. Patients felt they understood how to take better care of themselves. The study also found those people with the lowest literacy levels appreciated having accessible notes the most. 

The initial study took place in three institutions. All three voted to keep the OpenNotes system in place. 

Participants learned OpenNotes has grown exponentially. Its mission is to get adopted across the US and become the standard of care. The study, which concerned 20,000 patients, started in 2010. The paper was published in 2012, and OpenNotes’ patient database passed 12 million people a month ago. 

The question whether a patient could potentially erase or edit medical notes was described as a “central issue” which would be discussed during the week. 

Transparency: the final blow to medical professionalism 

Participants were later asked to consider in greater detail the pros and cons of full transparency in health care systems. 

To spark debate among the crowd, a participant representing each side of the argument took to the stage to offer talking points from their side’s perspective. 

The participant arguing for full transparency in health care said there were several ethical, logical and evidence-based arguments to show transparency is essential to professionalism in medicine. 

She argued to make a health care decision, a patient must be well-informed, and information which is deemed essential must be disclosed. 

The participant put forward the point that physicians must be honest with their patients to empower them to make decisions about their treatment. She added health care was most effective when patients were active and engaged. 

The participant arguing against full transparency in health care played the role of a doctor who said, “I have a body of knowledge [patients]don’t have.... I have to be efficient. I must not frighten them. I must not put them at risk.” 

The participant against full transparency also put forward the case that a transparent, open notes system could put patients at risk of having their data being hacked. 

After each participant had offered their opening arguments, both were given a chance to provide supplementary points. 

The participant arguing for full transparency said there were ways to implement transparency which would give clinicians more time. 

In response, the participant against full transparency said the arguments of investing now and receiving a pay-off later had all proven to be in vain. 

Participants were split into two groups and were asked to consider more arguments for either side. One-half of the room would argue for full transparency, the other half would argue against. 

There were contrasting views as to whether transparency could move health care workers toward professionalism. While someone arguing for full transparency suggested it could, another participant said professionalism was earned in a different manner. 

There was also a difference of opinion when it came to the matter of accountability. The participant playing the role of the doctor against full transparency said he would be protecting his patients more so than anyone else, as they wouldn’t be held accountable for the medical notes. 

This argument was countered with the claim that patients had to be accountable for their health, absolving them off that was not good for them or their clinician. 

Read more in our session newsletter.

Download Issue 1 as a PDF

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: You can follow all the discussions on Twitter by following the hashtag #SGShealth

Health care professionals return to the nation of PeoplePower
Health care professionals return to the nation of PeoplePower
Oscar Tollast 

Health professionals in Salzburg have been implored to create an "avalanche" of ideas linked to transparency and the future of medical records.

Clinicians, patients, health providers, and commentators are among those have gathered at Schloss Leopoldskron for the Salzburg Global Seminar session Toward a Shared Culture of Health: Enriching and Charting the Patient-Clinician.

The session, supported by OpenNotes, was kick-started on Friday afternoon with introductory speeches from the session's co-chairs Dr. Tom Delbanco and Professor Tobias Esch.

Dr. Delbanco, Koplow-Tullis Professor of General Medicine and Primary Care at Harvard Medical School, and co-founder of OpenNotes began by dedicating the session to Salzburg Global’s “fourth founder” Herb Gleason. Mr. Gleason was a major driving force behind a number of Salzburg Global's health care programs before he passed away in 2013.

Dr. Delbanco, a multiple-time Salzburg Global Fellow, then described what he hoped to achieve from the session. Likening it to an “avalanche,” he urged participants to come up with ideas for change to implement quickly.

His co-chair, Professor Esch, said he was keen during the session to focus on the patient and the relationships they have with the people who treat them. Having been involved in the topic for much of his life, Professor Esch said the session now provided a chance to sit down at the table and talk.

During the session, and among other topics, participants will consider what difference full transparency may make for patients and clinicians, with insights from the neuroscience of motivation and self-care, and patient-controlled health information.

The session aims to build on the work achieved at a Salzburg Global session held in 1998 called Through the Patient’s Eyes: Collaboration between Patients and Health Care Professionals

During this session, teams of health care professionals, patient advocates, and artists laid out the foundations for the country of “PeoplePower,” a country with a health system built “through the patients’ eyes.” In this scenario, patients and clinicians would both be encouraged to contribute actively to the patient record, demonstrating shared decision-making and governance. The session helped coin the patient empowerment phrase "Nothing about me without me."

Following the introductory remarks, Dr. Delbanco - chair of both that influential 1998 session and this 2017 follow-on - sat down with Salzburg Global Program Director John Lotherington to discuss PeoplePower’s history. He described people power as one of the least utilized resources, something which should be tapped into far more by health professionals.

Dr. Delbanco described the number of thoughts which came out of the 1998 session as “scary.” He said some of the electronic ideas suggested at the time were now coming “too fast.”

In addition, he claimed we still hadn’t reached a point where generic patients had a voice in the activities of health care institutions. Dr. Delbanco suggested shared decision-making, and patient power was a concept more talked about than something put into action.

Following this discussion, patients broke off into groups to discuss what they felt patients would want in a land called PeoplePower.

One table of Fellows highlighted a potential issue surrounding the assumption of having access as a patient. A participant argued a doctor should be inclined to ask their patient, “Have you accessed your notes? What did you think?" In response, Dr. Delbanco suggested patients were afraid of retribution if they challenged what their doctors told them.

Another table suggested rather than talking about the quality of health care, the conversation should be about the quality of health. Participants also considered how doctors and clinicians should respect cultural differences and account for them, with one suggestion being doctors should  “open their minds to the worlds patients bring into their practices.”

In addition to these talking points, participants considered what effect a direct line of contact between a doctor and a patient would have, and whether this would be taken advantage of. One table discussed a patient’s need to be heard, the need to communicate on an ongoing basis, and the concept of giving feedback.

Despite concerns being raised in some areas about this direct line of access, some participants did speak for it, suggesting such an act can demonstrate a mutual respect between the two parties. While more of a doctor’s time may be taken in the short-term, less time will be taken by the patient from the system in the future.

Participants will continue to discuss these ideas as the session progresses.

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: You can follow all the discussions on Twitter by following the hashtag #SGShealth

Health professionals consider new approaches to recording a patient’s journey
Health professionals consider new approaches to recording a patient’s journey
Oscar Tollast 

In today’s world, people have the ability to measure and track their health using a device on their wrist or a smartphone in their pocket. A smartphone can now store a person’s Medical ID, their medical records, their eating and sleeping habits, and remind someone when to go for a walk or have a drink of water. In a promotional video, one smartphone company claims that by better knowing your health, the better you know yourself. This is based on a patient’s relationship with their smartphone, but what about their relationship with their doctor? How can patient empowerment better enhance the patient-clinician relationship?

In 1998, a Salzburg Global session, Through the Patient's Eyes: Collaboration between Patients and Health Care Professionals, saw teams of health professionals, patient advocates, artists, and more lay the foundations for the country of “PeoplePower,” a nation whose health system was built “through the patients’ eyes.” At the heart of this concept was an Internet-based patient record, which “resides nowhere but is available everywhere.” Patients would have access to their medical record but would also be urged to edit, track and prioritize needs.

As acknowledged, there have been several new approaches to medical records since this meeting took place. In the US, secure electronic patient portals are accessible to millions of individuals. Organizations like OpenNotes, meanwhile, have inspired major health systems to invite patients to read and respond to notes written by their health providers. Similar practices are spreading across the world, and the technology continues to evolve. 

This March, a cross-sectoral mix of health professional, providers, policymakers, patients, commentators, and journalists are expected to convene at Schloss Leopoldskron for the Salzburg Global Seminar session Toward a Shared Culture of Health: Enriching and Charting the Patient-Clinician Relationship. Teams of four or five Fellows from diverse countries have been invited to take part in the five-day meeting.

The session, which is being supported by OpenNotes, and follows on from the ground-breaking 1998 session, will have a strong focus on aggregating experiences to create new approaches to developing and recording a patient’s journey. The session will be co-chaired by Tom Delbanco and Tobias Esch. Dr. Delbanco is Koplow-Tullis Professor of General Medicine and Primary Care at Harvard Medical School and was instrumental in the 1998 session, while Professor Esch is Professor of Integrative Primary Health Care at Witten/Herdecke University. 

During the session, participants from countries including Australia, Brazil, Sweden, Canada, the US, the UK will receive support from a panel of experts from a broad range of domains. They will analyze the challenges presented in PeoplePower. They will work in country teams, but plenaries, knowledge cafes and role playing exercises will enable participants from different countries to mix and learn from one another.

Salzburg Global Program Director John Lotherington said: "This session is set to be a milestone in Salzburg Global’s work on person and patient centered care, exploring how the sharing and co-creation of medical records between physician and patient can transform their relationship in further creative ways."

Among other questions, participants will be expected to ask themselves: 

  • If fully transparent communication becomes a foundation for the future patient-clinician relationship, how will medical practice evolve?
  • Can open medical records become central vehicles for engaging individuals actively in maintaining and restoring health, and in managing illness?
  • How might transparency and co-creation of medical records help people become better stewards of their own health outside of the clinical setting?
  • How might greater transparency promote community engagement in designing systems to deliver care both needed and wanted?

The session will aim to provide participants with new insights and tools to inform action plans in their own countries as medical records and self-care continue to evolve. They will be expected to disseminate what they’ve learned using social media and publications which are consumed by a broad range of health professionals, patients, and laypersons.

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: You can follow all the discussions on Twitter by following the hashtag #SGShealth

Rethinking care toward the end of life - Outcomes from a Salzburg Global Seminar
Rethinking care toward the end of life - Outcomes from a Salzburg Global Seminar
Julie Ling and Sheila Payne 

This article first appeared on the EAPC blog, which will continue to publish more posts on the Salzburg Question series.

Julie Ling, Chief Executive Officer of the European Association for Palliative Care, and Sheila Payne, Emeritus Professor, International Observatory on End of Life Care, Lancaster University, UK, were in Salzburg, Austria, to attend this global gathering. Here, they set the scene for a new series of posts that we shall be publishing throughout 2017 to encourage a global dialogue and shine a spotlight on the key topics affecting palliative care.

Sixty invited international delegates met in December 2016 to consider global opportunities and challenges in palliative care. They gathered at the Schloss Leopoldskron (some scenes from ‘The Sound of Music’ were filmed here) to discuss and debate seven key questions:

  1. How do we engage patients and families to ensure that end of life care honours what matters most to them, with respect for culture and for context at the level of the individual and the population?
  2. What are the relative contributions of health care and community-based social care in different contexts? How can they best be joined up to maintain function, independence, and agency for people for whom death is near?
  3. How can healthcare systems better support families,  caregivers and community members in caring for people of all ages for whom death is near?
  4. How are robust processes established and implemented for arriving at decisions when patients can no longer express their own preferences? What role does public engagement and government have in this?
  5. Which are the most promising evidence-based and cost-effective innovations in care towards the end of life? What yields the greatest value to patients, especially in low- resource settings?
  6. What can we learn from the systems failures in high-income countries with regard to supporting patients, families and caregivers with palliative care?
  7. How can palliative care best be undertaken in the context of societal deprivation or conflict?

Salzburg Global (SG) was founded in 1947 with the aim of encouraging intellectual dialogue in post-war Europe. SG aims to challenge leaders to help solve important global issues and since its establishment, SG has been a catalyst for global engagement on critical issues in education, health, environment, economics, governance, peace-building and more. SG achieves this by designing, facilitating and hosting international strategic programmes (seminars). Uniquely, Salzburg Global builds connections with and between people from a broad range of expertise, cultures and professional backgrounds. Over the duration of the seminars, government officials, institutions and individuals at all stages of their professional development and from all sectors are asked to rethink their relationships and identify shared interests, goals and outcomes.

A key outcome of the session was aimed to be the development of ‘A Salzburg Statement of key principles guiding care towards the end of life’. It was a testament to the freethinking and originality of the participants that for the first time in the history of SG, the outcome was not a statement, but instead, a set of nine questions. The questions are designed to highlight challenges facing the global community and will be linked to international ‘days’. Each of the nine questions will be explained more fully in EAPC blogs over the coming year.

There was snow and plenty of hard work, interspersed with some time to socialise and make the most of the beautiful location and, of course, there was schnitzel, Glühwein and a Christmas market.

Find out more....

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

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

Salzburg Questions Twitter series on health and palliative care begins
Salzburg Questions Twitter series on health and palliative care begins
Oscar Tollast 

People are invited to take part in a global conversation on the crucial issues affecting care towards the end of life. 

The #allmylifeQs hashtag will be in place throughout 2017, and people are invited to answer nine Salzburg Questions using this hashtag on Twitter.

Discussions around each question will be 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.

The launch date for this initiative is Monday (February 20), which coincides with the World Day of Social Justice.

Former Minister of Health in Rwanda, Agnes Binagwaho, will lead the first discussion on Twitter, asking: Why aren’t countries accountable to commitment on end of life (#EOL) care for vulnerable people?

Following this discussion, there will be eight more Salzburg Questions, which will be spread out throughout the year. 

Other Fellows due to lead discussions include Lynna Chandra, Suresh Kumar, Sheila Payne, Emmanuel Luyirika, Richard Harding, Bruce Chernof, Stephen Connor, and Irene Higginson.

Salzburg Global is encouraging its Fellows to take part by sharing blog posts around each question, and interacting on Twitter on the day and beforehand. 

Potential blog platforms include ehospice, EAPC blog, Palliverse, and IAHPC Newsletter

People who take part in the conversation are being encouraged to link relevant research to their tweets and blog posts. This research could include papers, studies, seminars or events. 

If you’d like to hold a debate, workshop or Q&A event about a question, we recommend filming it so that it can be viewed on a dedicated YouTube channel. The video should be sent to

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 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.

“What is the biggest mistake people should avoid making when building a palliative care system?”
“What is the biggest mistake people should avoid making when building a palliative care system?”
Yeji Park 

“When you decide who needs palliative care, it shouldn’t be based on prognosis. In the United States, it is required that two physicians certify that you are likely to die within six months if you want to receive palliative care. This is not a good policy, as we do not have an accurate way to measure when people will end their life. Patients have to give up all curative treatments in order to obtain palliative care as well, but this also is not a good policy. They should be able to make decisions about treatment independently of whether they receive palliative care.”
Stephen Connor
Executive Director, Worldwide Hospice Palliative Care Alliance, USA

“The mistake we will be committing unless we are aware of it, is to create walls, not bridges. In the Philippines, there is a trend where the specialists want palliative care to be recognized as a separate specialty and do not want to share skills or tasks with others. We need to be willing to share the knowledge and technology with more people, especially from the grassroots. Because, in the end, it’s not about competing against colleagues from other specialties or among ourselves, but all about making sure that everyone has access to good end of life care.”
Liza Manalo
Head, Section of Hospice and Palliative Care at the Medical City Hospital, Philippines

“In Germany, we have a slightly unusual structure where hospice care and palliative care unit are two different structures with different organizations. The palliative care unit is a part of a hospital where they provide more acute care, whereas hospice is a special care home where people can stay longer. These two work and function alongside each other, but they do not always cooperate closely, and sometimes they even work against each other. This is not helpful when you want to move a topic forward politically in the society. There has to be a joint force.”
Claudia Bausewein
Director, Department for Palliative Medicine at Munich University Hospital, Germany

“The biggest mistake that has been made, especially within Africa, is the inadequate funding of the entire health care system. Currently in Africa, 15% of the national budget goes to the health sector. In Uganda, it’s only 7%. This is not enough to cover every aspect of health care, especially the palliative care side. In addition, palliative specialists should be recognized and remunerated by the health service commission as such, so that they can fully concentrate on palliative care.”
Emmanuel Luyirika
Executive Director, African Palliative Care Association, Uganda

Have an opinion on any of our hot topics this week? Email Salzburg Global Seminar Editor Louise Hallman ( with either a short 50-100 word response or a 500-750 word article and we will consider it for publication in the report to be published in early 2017!

Download the full newsletter from Day 3 & 4

The Salzburg Global Seminar session Rethinking Care Toward the End of Life, part of the long-running series Health and Health Care Innovation, is being held in partnership with the Dartmouth Institute for Health Policy & Clinical Practice and the Mayo Clinic. Follow online on Twitter with the hashtag #SGShealth.

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