Six big ideas for health

One of the participants of the Salzburg Global Seminar Session: Hooked on Healthcare - Designing Better Strategies for Improving Health summed up the five days with a quote from a 19th century architect and urban planner ‘Make no little plans for they have no magic to stir men's blood’. Certainly the action and commitment that emerged could not be accused of being ‘small plans’ and let’s hope, given women have such a critical role to play in shaping health, they will stir everyone’s blood!

Our final two days were spent in groups, developing and testing strategies that participants want to progress on return to their workplaces.

The report out of these six groups provided some valuable insights and practical suggestions.

1. Engaging citizens in this agenda

We need to think through how we can better engage individuals in the factors that influence their health. This is not to go down the route of suggesting that health is solely the product of our own choices. The decisions that those in public authority and in business make set the environment which shapes our health status. But as individuals, we can influence these decisions as voters, consumers, employees and shareholders if we understand the problem.

We need to make the impact on health of decisions around factors such as housing, transport, education visible in terms of the avoidable harm (or the potential benefit) that may accrue. How can we equip citizens to be just as (or perhaps more?) prepared to lobby their politicians over the levels of nitrous oxides on their local streets, or the lack of street level activity in their housing estates, as the closure of an A&E?

2. Supporting community based co-design to define and solve ‘problems’

A recurring theme of the session was the importance of starting with the problems as defined by communities themselves, rather than the problem as perceived by the authorities. The world is littered with nationally conceived ideas that, while they may make sense of paper, when implemented locally simply do not get traction.

‘Five a day’ is a great concept and has no doubt worked for some people, but what does it mean if you live in a food desert? Improving access to health services for depression and anxiety is necessary but if for instance, the root cause of people’s anxiety is lack of housing security; a pill or talking therapies isn’t going to solve it.

Developing and applying better strategies for engaging with people in their local context and understanding what they aspire to as a healthy life and the changes that can support this, are the only ways we will get sustained improvements.

3. Aligning wider policies with improving health

Which policy decisions have the greatest impact on health? There is now emerging consensus that the decisions that influence job supply, housing quality, or our ability to lead active lives are going to have more impact on our health than whether we fund a new treatment or build a new hospital.

At policy level, health is largely still seen as the remit of health care chiefs. We need better strategies for engaging the broadest set of decision makers in the consideration of health impact.  One group came up with 12 practical steps to do this which we are looking forward to putting into action.

4. Engaging local business and employers

The value of health in a local population to business and employers is one opportunity we tend to overlook. Which is better for the economy:

A downward spiral where commercial interests override the health of the consumer and employer; where the effects of ill health caused by non-communicable diseases, industrial injury and stress affect an individual’s ability to contribute to family, community and work?

Or a virtuous circle where responsible businesses and employers provide the conditions and products that enhance employees’ and consumers’ health and in return reap all the benefits that this ensues?

The consensus of the group was that there was much more that could be done to align commercial and employer interests with the wider societal value of a healthy population.

5. Mobilising wider resources and supporting longer term investment

A separate group looked at how it might be possible to bring together stakeholders to make the longer term investment in strategies to improve health and wellbeing.

Addressing the ‘wrong pocket’ problem (where those that need to make the investment to improve things are often not those who benefit from the savings that accrue), this group looked at the potential of ‘health bonds’. 

Different from current revenue spending and social investment, the concept of the health bond would encourage all stakeholders to put a monetary value of the benefit to them of a specific dimension of better health. Then, pooling this value into the health bonds, it would create a funding stream for upfront investment in start-up ideas. With all the investors being part of the governance arrangements, they would have direct influence in decisions about which initiatives to support. And with the right choices, would see their initial investment returned through the subsequent savings arising from avoiding the costs of ill health.

6. Developing a global health equity compass

Finally, and perhaps for me the most provocative thought from the five days, was the view that we need to start viewing health as a finite asset.

In a world facing resources constraints (financial and human), with consensus on the need to reduce our consumption of natural resources, Juan Garay and David Chiriboga eloquently made the case for a global health equity compass.

In brief, this analysis identifies those countries that are achieving sustainable levels of health status as defined by securing above average life expectancy, below average GDP (a proxy measure for resource use) and meeting the climate change standards as a measure of sustainability. At present there are 14 countries that meet these criteria. They can point the way to the achievable and sustainable levels of health outcomes that all countries can and should aspire. Their work which will shortly be launched on the eqimov.org website will challenge us all to think differently about health.

Final thoughts

I couldn’t have hoped for a more stimulating, action-focused five days and to quote Margaret Mead (a founder member of the Salzburg Global Seminar) ‘Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has’.

Jo is Director of Strategy at the Health Foundation, www.twitter.com/JoBibbyTHF