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

Joshua Bamberger – We All Deserve to Have a Decent, Safe Place to Live
Joshua Bamberger in the Meierhof courtyard during Building Healthy Communities: The Role of Hospitals
Joshua Bamberger – We All Deserve to Have a Decent, Safe Place to Live
Mirva Villa 

Joshua Bamberger has worked as a family physician for almost 30 years. While working in San Francisco, he has seen patients entering hospitals living in extreme levels of poverty. These patients are able to benefit from the hospital’s resources in the short term, but the difficult circumstances in which they live have often been far too powerful for his work to have a long-term impact.

“[It’s] as if I was treating people, and it was almost irrelevant to their wellbeing,” Bamberger says, speaking at the Salzburg Global Seminar session, Building Healthy Communities: The Role of Hospitals. “One thing that seems to help the people who I serve to feel better, live longer and have the quality of life that we all deserve is to have a decent, safe place to live.”

Bamberger has become a strong advocate of providing housing as the primary and most important aspect of improving people’s health. It has been his passion for the past 10 years.

“For people who don’t have a home it is the most important thing. Why? On the one hand, you can’t take your medications regularly unless you feel valuable. I can prescribe them to you, but if you don’t eat them, they don’t work. For many people who live on the streets, their sense of wellbeing, their sense of value is so low that the motivation to take the medication regularly is diminished.”

Having a place where you are safe and cared for helps increase a person’s sense of dignity and their willingness to take care of themselves, Bamberger argues. But it’s not just that: living on the streets is very disruptive to health.

Bamberger says, “Stress hormones that are constantly flowing through your body, they erode your ability to heal, to have a robust immune system, to battle cancer, to be able to function with a cardio-vascular disease. All the things that cause harm medically just don’t get better in an environment where your life is uncomfortable and stressful.”

Homelessness is a big issue in San Francisco area. According to the 2017 census provided by the Department of Homelessness and Supportive Housing in San Francisco, there were 7,499 individuals without homes, and little over half of them were living unsheltered, sleeping outdoors.

“It’s bad,” Bamberger says. “I’ve been doing this for 30 years and I’ve never seen it worse, it’s really disheartening.” He thinks the main driver for it is the ever-expanding U.S economy, which he suggests has created a lot of wealth but also pushed up the prices of commodities.

“If your finances are static at an incredibly low level and everything else is becoming more expensive, your buying power becomes less and less, particularly around housing. When I moved to San Francisco in 1989, the apartment I got was something like $400 a month on rent, and it was a nice apartment: one bedroom with a nice living room, it had a good view… You can’t get an apartment like that for less than $2,600-3,000 today,” says Bamberger.

The problem is obvious to him. Many people will never be able to afford to rent, let alone buy their own apartments. He says, “There’s no pathway to get off the streets unless the government pays for your housing.”

That’s why Bamberger hopes to see the health care sector embrace the issue of housing as something worth investing in. He hopes more people can see the benefit of reducing the expenditure on health care, and improving the quality of people’s lives by providing them with homes.

He can’t understand why people working in hospitals don’t feel like housing conditions of their patients are their responsibility. Bamberger feels there is a great disconnect between the “extraordinary investment financially and emotionally in health care, and the almost disregard of some of the basic conditions that make humans human.” 

Bamberger believes a hospital is responsible for assessing and improving the housing conditions of the people it treats. He recognizes hospitals want to be more responsive to community needs, but he suggests the threshold should be set higher to include the needs of individuals living on the streets. During this session, Bamberger’s questioned the practice of treating someone at hospital for a serious condition to only then send them back to living on the streets.

“I think most people here and elsewhere are able to somehow insulate themselves from the absurdity of making such a technologic investment, and then just having someone walk back to the sidewalk, sleep on the street… I can’t do that, so it’s a very uncomfortable place to be.”

Bamberger considers every workday a success. He’s already helped develop 2,000 housing units in San Francisco and is hoping to develop thousands more over the next five years with financial support from health care systems. Being able to move somebody indoors, hand them the key and welcome them to their new home is an unbelievable feeling, Bamberger says.

“They just totally glow, wondering how this happened to them. It’s sort of how I felt when I was offered to come here to Salzburg. Me? Coming to Salzburg, flying across the world? It’s an incredible excitement, and I can imagine that times a hundred when you move into a beautiful place to live after being on the streets for so many years. “


The session, Building Healthy Communities: The Role of Hospitals is part of Salzburg Global Seminar multi-year series Health and Health Care Innovation in the 21st Century. This year’s session is held in partnership with the Robert Wood Johnson Foundation. To keep up to date with the conversations taking place during the session, follow #SGShealth on Twitter and Instagram.

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Fellows Present Ideas on Enhancing Collaboration and Building Healthy Communities
Fellows Present Ideas on Enhancing Collaboration and Building Healthy Communities
Salzburg Global Seminar 

Participants of the Salzburg Global session, Building Healthy Communities: The Role of Hospitals, have been encouraged to keep the conversation flowing following the end of the five-day program.

This message came after participants presented their ideas on the final day of the program to enhance effective collaboration and information-sharing between hospitals, social services, and community organizations.

Their presentations explored several areas, building on the discussions and exercises that had taken place over the previous days.

The first group to present did so under the title of “Yearning for Change.” They advocated a framework for system change convening and assisting like-minded leaders in a community social movement to share experiences and test ideas while committing to a sustainable health system.

This would lead to a “Salzburg Community of Practice” – a group of peers from different countries who share a passion for sustainable system change who learn how to do it better through regular interaction on a voluntary basis. Everyone has access to information and each other. All peers share a view of what’s significant.

The group said they’d know if they were successful when an online library was established and actively used. Other markers include active participation by a minimum of five countries, and the sense participants find it useful.

The next presentation focused on creating a resource which would help result in healthy people, healthy communities, and a healthy planet – taking innovation to scale. This group produced a set of values they felt were paramount for successful innovation scale, which they referred to as the Four-Is Framework. Innovation, issue, and influence are the essential domains of interaction that are necessary. Impact, the fourth “I,” is only achieved when the other fields have had time to interface and intersect.

Underpinning this framework are guiding principles of equal partnership and representation, a focus on trusting, respectful relationships among all stakeholders, stakeholder/community engagement and co-creation, continuous involvement of end-users, investment of resources in enabling capacity for stakeholder engagement, and incremental progress.

The third working group showcased an action-oriented research agenda, designed to improve individual, community and planetary health simultaneously. The rationale behind it was that a more conscious research and action agenda on social determinants of health could maximize health system impacts and investments to achieve benefits at all three levels.

The group highlighted several domains where interventions could be identified. These areas included food insecurity, poor and unhealthy housing, energy poverty, transportation, waste management/recycling, air quality, education, violence prevention, and social isolation. An example of a research question could be: What are the most effective partnership models to achieve maximum results?

If health care professionals are to reach out to the community, they’ll need to understand the community first. This message came through during the next presentation. The working group behind the presentation focused on services to help clinicians to improve communication. Members advocated using local community resources and smart and existing technology to integrate, share and disseminate knowledge to improve community health.

The methods of achieving this include identifying community needs and health guardians in the community, using smart technology to develop connectivity and health education, and having a regular review of the whole process. The presentation concluded with the message: “Change will happen. It just needs passion, commitment, and desire.”

Throughout the session, participants considered the capacities of hospitals and the position they were in to support healthy communities. One working group decided to focus on ways to improve their capacities through a global toolkit. The final product would be a dynamic digital repository, which brings together individuals, frameworks, methodologies, tools, and cases to facilitate, strengthen and guide hospital collaboration, co-operation and co-design efforts with communities to improve the health of its citizens.

The group stated hospitals could and should work together with communities and evolve to improve the health and well-being of all citizens by addressing social determinants. While doing so, hospitals should continue delivering on their core mission, which is providing high-value care to its patients and families with “healthy staff.” Resources which could be made available in a global toolkit include partnership agreements, education and training materials, communication strategies, and co-design methodologies.

Members of the sixth working group began their talk by describing the existing system as unsustainable. The speaker said the system “doesn’t know what it doesn’t know.” The group proposed co-producing a learning front end to enable a health-creating system that is accountable to the community.

Members of this group suggested describing a theory of change based on people’s preferences and an understanding of needs and wants. The next steps would be to present a way to invite co-producers and then form or find communities of interest to refine and spread. One participant said what they were talking about was “transformational change” – starting with an individual and then extending to the system.

Taking the work forward

A seventh working group worked on an outline proposal for six peer-reviewed articles to be published by the British Medical Journal (BMJ), based on the themes that emerged during the session. The initial plan is to release these articles in 2018.

The articles would be presented on a BMJ Collection page alongside any BMJ Opinion pieces written by Salzburg Global Fellows. Participants heard a working group would meet regularly to ensure the project moves forward. Suggested article themes already include the role of hospitals, lowering the walls and breaking down barriers, and how data can act as a bridge.

Salzburg Global Program Director John Lotherington said Salzburg Global would do everything it can to support Fellows’ ideas, but he encouraged prime movers in each group to keep the conversation moving forward.

Several participants said they would support the idea of producing a Salzburg Statement. Lotherington indicated this was something which could be pursued but would have to stem from a smaller working group first before it could branch out to all participants.

Anne Weiss, managing director at the Robert Wood Johnson Foundation, said the program had provided her the opportunity to discuss a challenge experienced in more than one country and that the conversation had moved from hospitals to health eco-systems.

Susan Mende, a senior program officer at the Robert Wood Johnson Foundation, said participants had disproved the notion that something that happens in one part of the world can’t be applied to another. To conclude, Mende said participants had seen the "winds of change” at Salzburg Global, and a gale was beginning to build.


The session, Building Healthy Communities: The Role of Hospitals is part of Salzburg Global Seminar multi-year series Health and Health Care Innovation in the 21st Century. This year’s session is held in partnership with the Robert Wood Johnson Foundation. To keep up to date with the conversations taking place during the session, follow #SGShealth on Twitter and Instagram.

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Building Healthy Communities – Prioritizing Health Creation
Building Healthy Communities – Prioritizing Health Creation
Tomás De La Rosa 

The question of how health creation can remain a priority when institutions are geared to other primary goals is one that’s difficult to find just one answer for. Participants of the Salzburg Global session, Building Healthy Communities: The Roles of Hospital, considered the best strategies on Sunday morning as part of the session’s final plenary discussion.

In addition, participants also explored how to creatively manage the trade-offs for everyone, not just health care institutions. To help them, Gary Cohen, Gale Surgenor, Eddie Bartnik, and Paul Burstow spoke from their experience and provided case studies to reflect on.

Cohen discussed the broader mission hospitals have in supporting people in equitable and healthy societies through environmental sustainability. Calling hospitals “the cathedrals of our time,” he argued they need to reduce waste, use more sustainable energy sources, and eliminate toxic chemicals such as mercury.

He also explained how hospitals contribute to the health of individuals, communities, and the planet, finishing with the open-ended question, “Who else is to defend the human right to health than ourselves who are responsible for healing?”

Sharing the example of communities in South Auckland, New Zealand, where "only the hood can change the hood" is the rule, Surgenor explained how it’s essential to collaborate with communities to educate them about their own health. This type of co-design helps communities by having them teach institutions about human design.

Bartnik, a strategic advisor to the National Disability Insurance Agency, highlighted the importance of connecting with local communities through positive assumptions and asking the right questions to help communities find local solutions.

He also explained how strategic conversations are necessary for a fair and connected support system saying, “We must ensure it doesn’t take over and families or communities always have a say.”

Paul Burstow, former Minister of State for the UK Department of Health, used the example of elderly people in health care losing value and agency due to their status, as a reminder of how services must be humble as they only represent 10 percent of the concept of health. “What people fundamentally want is to live a good life, and not be surrounded by systems,” he said.

He then urged participants not to use co-production to perpetuate business arguing, “Products must enhance life, not burden people. Institutions should be fundamentally bottom-up; communities should instruct people at the top on what their needs are.”

Reflecting on the discussion, a participant talked about how each individual’s story is different, saying, “With decision-makers, it's about considering how to budget effectively to provide appropriate care, but with patients, it needs to be how to improve their lives and create a better experience.”


The session, Building Healthy Communities: The Role of Hospitals is part of Salzburg Global Seminar multi-year series Health and Health Care Innovation in the 21st Century. This year’s session is held in partnership with the Robert Wood Johnson Foundation. To keep up to date with the conversations taking place during the session, follow #SGShealth on Twitter and Instagram.

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Sowing the Seeds of a Global Conversation - The Salzburg Questions Series
Sowing the Seeds of a Global Conversation - The Salzburg Questions Series
Katie Witcombe 

This article first appeared on the EAPC Blog on Monday, December 11.

In response to Human Rights Day yesterday, 10th December, Katie Witcombe, Outreach Administrator for the Cicely Saunders Institute and one of the facilitators of the Salzburg Questions series, explains the importance of using digital campaigns to shine a spotlight on neglected issues and open up discussions to people all over the world.

When the seed of an idea for a multidimensional series of questions was planted at the Salzburg Global Seminar in 2016, its capacity for growth was unknown. At a meeting to consider global opportunities and challenges in palliative care, which was attended by international experts in the field and facilitated by Professor Irene Higginson of the Cicely Saunders Institute, it was decided that an interactive, digital debate would be the most inclusive way to initiate conversations about the major issues currently facing palliative care provision and how best these can be tackled.

A global conversation, including monthly Twitter ‘launches’ to coincide with international awareness days, corresponding blog posts, podcasts, videos and reports, was planned for the following 12 months with academic and clinical leads spearheading the campaign from around the world. Since its conception, the Salzburg Questions series has achieved a reach which has surpassed expectations; there has been an average of nearly 500 views for each blog post, the #allmylifeQs hashtag has received more than 10.4 million impressions on Twitter and been used in more than 3,500 tweets, and the online reach has extended to 182 countries. Monthly topics have included the inequality of palliative care provision in low- and middle-income countries, the emotional and financial impact of caring for a loved one at the end of life and the future research needed to improve care for vulnerable groups such as refugees, people with complex physical symptoms, and those living in poverty. The series has given project teams and researchers from world-leading institutions the opportunity to showcase their most recent research into global healthcare trends, place of death, how to support an ageing population and treatment for non-cancer conditions. These issues affect millions of people worldwide, and the application of this work into actual clinical practice has the potential to markedly improve the quality of life for patients and families approaching the end of life.

Ultimately, the Salzburg Questions series has highlighted the appetite that exists for discussions about the issues affecting palliative care, and the role that online platforms such as Twitter have to play in these global conversations. In this digital age, closed-room discussions are becoming a thing of the past and impact can be measured in re-tweets and shares. Twitter discourse is a democratisation of the decision-making processes which have governed research for so long; people from all demographics and backgrounds can now help to shape the direction of future work by signposting the areas which they feel need the most investment. In the aftermath of Human Rights Day this weekend, an increased awareness of vulnerable or neglected groups should be celebrated, as should the involvement of patients, carers and families in these discussions. The blog posts published monthly by the European Association for Palliative Care (EAPC) may have been produced by experts in fields as diverse as global health inequity, patient and carer psycho-social needs, advance care planning and epidemiology, but it is the responses from researchers, clinicians and members of the public which have enabled this series to gain momentum and relevance over time.

From tiny seeds, tall oaks can grow, and we hope that the roots that were laid over the course of the campaign will continue to flourish. The enthusiasm and engagement with which this series of questions has been met is a clear signifier of the conversations which people from all over the world are ready to have about the lasting need for high quality, effective and accessible palliative care.

Links and Resources

•    Catch up on the global Twitter discussions using the hashtag #allmylifeQs. The nine Salzburg Questions have been debated throughout 2017.
•    Read all nine posts published on the EAPC Blog in the Salzburg Questions series.
•    Find out more about the ongoing work of the Cicely Saunders Institute.
•    Find out more about the programmes and strategic aims of the Salzburg Global Seminar.
•    Follow Prof Irene Higginson @ij_higginson
•    Follow Cicely Saunders Institute @CSI_KCL

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Gael Surgenor - I am Driven to Make a Difference in People’s Lives and Make Things Better
Gael Surgenor - I am Driven to Make a Difference in People’s Lives and Make Things Better
Mirva Villa 

“I think the big challenge for us is the growing gap between people who are doing well, and people who are really disadvantaged: in employment, in incomes, in education and in health. There’s a big issue around child poverty in New Zealand. Recently we had a change of government and the prime minister took on child poverty as her responsibility, so that really shows how important it is to the new government,” Gael Surgenor says, speaking at the Salzburg Global session, Building Healthy Communities: The Role of Hospitals.

Surgenor is the director of community and social innovation at The Southern Initiative (TSI), a program which is part of the Auckland Council family. Its purpose is to amplify innovation in South Auckland.

The region has the biggest concentration of social and economic challenges in New Zealand, according to Surgenor. The population is young and  the level of unemployment is high, the incomes are low, and there are a lot of health issues.

“But it also means that South Auckland has a lot of opportunities,” Surgenor says, adding that it’s an area of economic growth. “It’s also a very creative community, it’s diverse, it’s young and there’s a whole lot of assets and strengths associated with that we we need to tap.”

TSI focuses on three main priorities. It grows the shared prosperity of people living in Auckland, it builds resilience in the community, and empowers families and children.

Employment and skills–improving initiatives have been put in place to help especially the young people to find jobs, and for local entrepreneurs to secure their place in the economy.

One of the initiatives to empower local youth was to invite them to have their say on local matters through an online platform. The young people can upload their own ideas, or respond to questions or calls and receive micropayments in return.

“Young people have fed back to us that it has created a safe space to share their ideas, to have a voice and help them to think. It’s not like Facebook where you like what someone has uploaded. In order to earn the micropayment, you have to think about the question and create a response.”

Young people have been asked to share their views on a variety of issues. Surgenor explains that South Auckland has a big problem with window washers - people who approach cars at traffic lights in anticipation of being paid for the service. A 16-year-old window washer was recently killed after being run over by a car, so getting young people to think about the dangers of it is important. Another call asking young people’s views on child poverty received around 200 responses.

Building resilience in South Auckland is focused on what new technologies enable, and what that’s going to mean to the future of work in the area.

“South Auckland has been a community that’s been very heavily impacted by the waves of social and economic change, so we want to make sure that the community is a bit more resilient to the change that’s coming,” says Surgenor. South Auckland has a very strong DIY-culture, she adds. New technologies have enabled people to innovate and create.

The third focus of TSI is on Whānau: families and children thriving. Health and social care services in New Zealand are delivered by the central government agencies, so the council aims to empower families through other means.

Surgenor has spent her whole career working in community development, social justice and human rights. From starting at a community law center, to working for Ministry of Social Development and now for the past five years at Auckland Council, she’s always been driven by one, simple thing: “making a difference in people’s lives, making things better”.

Seeing how the support and accompaniment of the council helps to drive positive change in the community is something Surgenor has found fulfilling.

“One really rewarding thing is working with a group of grassroots leaders, like the parent leaders from our cluster of six schools, and observing the confidence and the development of those leaders, and their empowerment and what they are making happen for themselves… and their community.”


The session, Building Healthy Communities: The Role of Hospitals is part of Salzburg Global Seminar multi-year series Health and Health Care Innovation in the 21st Century. This year’s session is held in partnership with the Robert Wood Johnson Foundation. To keep up to date with the conversations taking place during the session, follow #SGShealth on Twitter and Instagram.

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Building Healthy Communities - Aligning Incentives to Address Social Determinants of Health
Building Healthy Communities - Aligning Incentives to Address Social Determinants of Health
Salzburg Global Seminar 

In among the discussions at Building Healthy Communities: The Role of Hospitals, participants have been asked to consider how aligned financial incentives could better direct and support hospitals to address the social determinants of health.

On Friday afternoon, Jay Bhatt, Helen Buckingham, and Mike Nader took part in a panel discussion to explore the question in further detail. Each panelist chose to modify the question and tackle it from a different angle.

Nader, executive vice-president and chief operating officer at the University Health Network, in Canada, suggested people needed to look at how to align the “health ecosystem” to promote better health. He highlighted Canada as an amalgamation of many health systems where each province manages its own health delivery. These provinces are structured in different ways.

Many systems are volume-based, according to Nader. The more you do, the more money you get Nader said the concept of how we fund health should be flipped on its head.

In addition to this, Nader also said people needed to look at how to incentivize good transitions, care and support upstream and downstream of hospitals.

Buckingham, a senior fellow at the Nuffield Trust, in the United Kingdom, said she was interested in what stopped people from making the decisions they ought to take. She said what drives people to do the things they do is fulfilling their ambitions and potential. It is difficult to design a financial system which would make someone do something they wouldn’t do in any event.

Success relies on the data and the people who deliver it. Buckingham called for more people who have a greater understanding of what drives clinician behavior, patient behavior, and managerial behavior. Participants heard there were opportunities to develop local arrangements that prevent money from being a barrier, reduce gaps, and allow money to be the enabler of change rather than the driver.

Bhatt, the chief medical officer at the American Hospital Association, reframed the question. He asked: what are we for when accelerating health? The answers to this question can help guide the strategy. He said people knew investing in the social determinants of health could make a difference, but the evidence supporting this was still emerging.

The people who sit on the board of trustees often don’t understand the benefits of investing in community health and why it is the right thing to do, according to Bhatt. He suggested it was up to others to convince them.

In response to this discussion, one participant remarked that for a panel about financial incentives the conclusion seemed to be money isn’t everything. Another table discussed how changing payment models and incentives was perhaps necessary but not sufficient to change health systems.


The session, Building Healthy Communities: The Role of Hospitals is part of Salzburg Global Seminar multi-year series Health and Health Care Innovation in the 21st Century. This year’s session is held in partnership with the Robert Wood Johnson Foundation. To keep up to date with the conversations taking place during the session, follow #SGShealth on Twitter and Instagram.

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Building Healthy Communities - The Role of Metrics in Influencing Health Creation, Support and Care
Building Healthy Communities - The Role of Metrics in Influencing Health Creation, Support and Care
Salzburg Global Seminar 

On the third day of Building Healthy Communities: The Role of Hospitals, participants considered the use of metrics to drive the health care sector toward better alignment with other sectors and broader accountability to communities in support of population health.

Tracey Cooper, chief executive of Public Health Wales, began the discussion by informing participants about the Well-being of Future Generations Act, a piece of legislation passed in Wales in 2015. Its intention is to help improve the country’s economic, social, environmental and cultural well-being.

As one of several public bodies listed on the Act, Public Health Wales is expected to work toward achieving seven well-being goals. In the Act, a sustainable development principle exists which asks organizations to bear in mind the future when making decisions.

Cooper explained how she and others looked at the return of investment particular actions would lead to. When presenting this information to others, Cooper said the “reality landed.”

Anna Matheson, senior lecturer in public health at Massey University, said her interest was exploring health inequalities. She questioned whether long-term monitoring of aspects of community organizations was required. Matheson demonstrated the usefulness of case study methods for understanding social complexities.

She said it should be recognized that there are pre-existing relationships and activities going on within communities. The sensemaking process has been a useful way of taking data back to the community.

Patricia Frenz, director of the School of Public Health at the University of Chile, said metrics were about good data, valid indicators, and meaningful indexes. The starting point is people having a shared vision and an understanding of what dimensions need to be measured and interpreted.

In Chile, one of the concerns is the number of people who are invisible to the health system and don’t benefit from available services. Frenz said Chile had participation mechanisms in place to ensure the communities are identifying their needs and are involved in the health system.

Mahmood Adil, medical director at the NHS National Services Scotland, said every country has a different way of collecting and using data. The Scottish Index of Multiple Deprivation locates concentrations of deprived areas across Scotland and helps authorities collect data on the social determinants of health. Specialist intelligence teams are in place to help authorities interpret this data.

Adil said people needed to find ways to share knowledge on the challenges everyone faces. That said, he warned people should remember there is someone’s life behind data and the process needed to be humanized.


The session, Building Healthy Communities: The Role of Hospitals is part of Salzburg Global Seminar multi-year series Health and Health Care Innovation in the 21st Century. This year’s session is held in partnership with the Robert Wood Johnson Foundation. To keep up to date with the conversations taking place during the session, follow #SGShealth on Twitter and Instagram.

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