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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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Building Healthy Communities - The Smart Utilization of Technology
Building Healthy Communities - The Smart Utilization of Technology
Tomás De La Rosa 

Participants started the third day of Building Healthy Communities: The Role of Hospitals by discussing how new technologies, or novel applications of older ones, can assist in transforming health services, as well as how these technologies can create a more open, connected and collaborative institutional culture of hospitals.

The session was led by Graham Adams, Toyin Ajayi, Selina Brudnicki, and Lynna Chandra. Each discussed ways in which technology can transform health.

Brudnicki said involving patients was key to developing effective tools to maintain patient data. To support this, she explained how the University Health Network, in Toronto, had managed to identify gaps in primary care by having patients look at their own medical information and point out inaccuracies.

Gauging on technology’s role, Ajayi, chief health officer of Cityblock Health, said when considering what she is trying to build, she asks herself whether technology can help at all. And although she does believe it can, now is not the time. “We have tools that are in place to record data and produce bills, but we need to produce full information of patients as people,” she said.

To produce said information, she said building care teams that are in place to create relationships with patients is necessary, saying, “We cannot think of technology as a replacement of humans in care, it should be an augmentation for people.”

“Why don’t we look at technologies that will bring down the hospital walls, rather than creating more barriers in the system?” said Chandra, co-founder of Absolute Impact Partners, highlighting how the system has lost people’s trust and technology should be used to rebuild it.

Adams, CEO of the South Carolina Office of Rural Health, told participants that when people talk about population health and the life of a community, we need to ask how to make sure we have a vehicle that allows everyone at a local level to have access to their information.

Participants heard and discussed the lack of linguistic fluency between clinicians, health systems, and technology developers. Ajayi argued that a solution would be common competency between clinicians and technologists.

Participants continued to discuss the relationship between health and technology among themselves. One participant said that A.I. and visual algorithms can help identify visible threats, but ultimately decisions should be made by someone who understands the patient and their context.


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 - Steps Hospitals Can Make to Act on Social Determinants of Health
Building Healthy Communities - Steps Hospitals Can Make to Act on Social Determinants of Health
Salzburg Global Seminar 

To address the social determinants of health, hospitals may have to consider realigning their missions, practices and institutional networks.

Pablo Bravo, Marianne Olsson, Juan Pablo Uribe, and Alison Verhoeven considered the best ways for hospitals to do this during the second panel discussion on the second day of Building Healthy Communities: The Role of Hospitals.

Uribe, director general of Fundación Santa Fe de Bogotá, asked how health care professionals within hospitals could learn from one another and ensure knowledge was maximized. He called for a better performing system, one where each part is doing the right thing at the right time.

Missions are important for institutions. If another mission is put forward, that is something for another organization to pursue, according to Uribe. He said he and his colleagues strived to provide the best possible care that Bogotá requires, and they wanted to be connected and coordinated upstream and downstream.

Verhoeven, chief executive of Australian Healthcare and Hospitals Association, suggested Australia had a high-performing health system, but challenges remained in terms of how rural and remote areas accessed health, and how the indigenous population experienced health.  

Participants heard there were opportunities to have structures for consumers to co-design services that meet the needs of communities genuinely and authentically. Verhoeven said data could be linked to inform how to better design services.

One way in which hospitals can realign their practices to address the social determinants of health is through advocacy. Bravo, vice president of community health at Dignity Health, revealed his employer’s advocacy efforts ranged from health care related issues to issues such as access to clean water and affordable housing.

Participants also heard how vacant land had been made available by Dignity Health for farming activities. Meanwhile, facilities no longer useful have been transferred to developers to create low-income housing.
Bravo said this was only possible through working with partners. Dignity Health is focused on providing care to its patients and doesn’t have the capacity or expertise to expand into areas like the construction of housing.

Olsson, an independent consultant, discussed how she helped launch a new hospital in the poorest area of a city in Sweden. Its purpose was to reach a part of the population not served by others.

The key to success is combining data and dialogue. It’s important not to get stuck on fixed concepts when changing health care systems. Olsson said health care was in a better position than others to be the driver of a movement for a healthier community and act as the inspiration for other authorities to follow.


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 - Working Together for Better Health
Building Healthy Communities - Working Together for Better Health
Salzburg Global Seminar 

Many hands make light work, as the saying goes. The more people who help with a project, the more comfortable the task becomes. Participants started the second day of Building Healthy Communities: The Role of Hospitals by considering how other sectors could more effectively and proactively collaborate with hospitals in support of better health.

They were assisted in their thinking by Sir Harry Burns, Rev. John Edgar, Rebecca Davis and Mark Rukavina. All four took part in a panel discussion.

Burns, a professor of global public health at the University of Strathclyde, said it was important to involve as many sectors as possible when finding solutions. There is never going to be one answer. In a society which is governed by rules of efficiency, organizations may act as if they exist to do things to people. Burns argued organizations should be doing things with people and asking what they need.

Rather than strictly focusing on their needs, Edgar said his organization, Community Development for All People (CD4AP), worked with people and communities based on their assets, hopes, and relationships. Edgar, CD4AP’s executive director, said after listening to people’s hopes and the changes they wanted to see, they saw notorious developments when it came to housing-based health.

Davis told participants how she had worked with hospitals to understand their recruitment and employment practices. She suggested leaders who wanted to develop a more diverse workforce must ensure there is better cultural understanding in hospital wards. To reach valid conclusions, it’s important to not only look at research but also combine it with local experience and the realities of the communities that are being served.

Participants heard the introduction of the Affordable Care Act, in the United States, in 2010, meant non-profit hospitals had to undertake community health needs assessments every three years. This provided an avenue to understanding the assets and issues communities had.

Rukavina, the business development manager with the Center for Consumer Engagement in Health Innovation, said hospitals had an opportunity to engage with vulnerable, low-income and under-favored communities and change the perception of the health system.

In response to this discussion, participants considered the existing structures in society that make it difficult for people to address issues and the need to break down walls.


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.

READ MORE...
Toyin Ajayi - Health Care Interventions Don’t Always Lead to Better Health for Communities
Toyin Ajayi - Health Care Interventions Don’t Always Lead to Better Health for Communities
Mirva Villa 

Toyin Ajayi likes people. That is what led her to become a doctor and develop new models of care. She believes health care systems are in need of a new perspective when delivering health. Speaking on the second day of the Salzburg Global session, Building Healthy Communities: The Role of Hospitals, Ajayi says, “I think we are all much more complex as organisms existing within an ecosystem than we are if we focus on just the biology within us.”

In addition to her role as a family physician, Ajayi is the co-founder and chief health officer of Cityblock Health, a recently launched New York-based health and social services company with the goal of offering better integrated health and social services for people with low income and complex care needs. The connection – or even contradiction – between health and health care is at the basis of Cityblock Health’s work. What is this contradiction about, exactly?

“It is a fact of most of our health care systems that we become quite good at doing things to people, and for people: prescribing things to people, doing procedures, and offering interventions that in themselves are health care, but don’t always in aggregate lead to better health,” Ajayi replies, while sitting in Max Reinhardt’s study.

To back up this point, Ajayi gives an example: a person sleeping outside on the streets who develops an obstructive lung disease from smoking and being exposed to lots of other environmental factors. When they access the health care system, Ajayi suggests the focus typically will be on managing their respiratory problems through “aggressive interventions.”

She adds, “We will give them medications, we might put a breathing tube down their throat to breath for them, we might prescribe them additional tests, additional therapies… Those things, in absence of addressing their need for housing, don’t actually make that person healthier in the long term,” says Ajayi. According to her, health care systems have been narrow-minded in their approach. They don’t address the totality of reasons why people have become unhealthy, Ajayi argues. The health sector needs to make a conscious effort to shift their thinking on seeing people holistically.

“Being able to make that transition from more health care to better health requires us to think about things that we’ve never really thought about in health care;” Ajayi says. “Things like transportation, education, access to healthy food, access to housing, social support and community, and love and engagement and trust and empathy – these are all very unfamiliar parts of our armamentarium as health care professionals, but are integral if we actually want to improve the health of communities and populations.”

Ajayi became passionate about the subject while completing her residency training at Boston Medical Center. Some of the patients came to her with problems that far exceeded her ability to treat them.

“I recognized very quickly that if I didn’t understand their ability to take those medicines, their ability to understand the instructions I was giving them, if we didn’t have a trusted relationship, if they didn’t have a fridge to store the medicines, food to eat with their medications, social support and family support to encourage them and keep them engaged, then I could write as many prescriptions as I wanted and it wouldn’t actually improve anyone’s health or well-being.

“I got very interested in thinking how we build models of care to enable doctors like me, frankly, and other professionals who are very passionate about helping people to make better choices for themselves, and live the lives they want to live, to actually gain the skills and experience and the tools to do that and be part of that for them.”

Cityblock Health’s journey has only just started, and the team is working hard to make sure their services and tools will respond to the needs of their future patients.

Commenting on what keeps her moving forward, Ajayi says, “I just fundamentally can’t accept that in 2017, in a country that has such a wealth of resources, some people continue to suffer, continue to face worse outcomes and restricted opportunities based on where they were born and the resources that are available to them. I just cannot accept that we can’t do better than that, and I’m motivated by the idea that we must.”


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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