Examining the Bigger Picture of Health and Health Care

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May 02, 2019
by Martin Silva Rey
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Examining the Bigger Picture of Health and Health Care

Leading expert advisor in well-being, sustainability, and public health Fiona Adshead reflects on her career and how to reduce health inequalities Copyright Salzburg Global Seminar / Katrin Kerschbaumer

“That’s what I learned from… being a doctor in clinical practice is actually people’s health was much more influenced by things that were outside my control,” explains Fiona Adshead, leading expert advisor in well-being, sustainability, and public health. Her rich background comprises senior positions in major organizations including the World Health Organization (WHO) and the global NCD Alliance

She decided to become a doctor, but during her time of working with patients, she started to wonder how the health care system could be changed.

“[My future path was shaped by my experiences as a doctor] and sort of feeling powerless that a lot of the things that were dictating people’s experience was the rules that got them into a particular kind of treatment, or decisions that people made which may or may not be fair, or the fact that maybe their housing or not having a job was actually equally important to when they had a cancer medicine.”

She started working on public health at the local level. Almost by chance, after an unexpected phone call, she found herself working in the UK Government, responsible for health improvement and health inequalities. She then work for the WHO.

To convey initiatives from different sectors, Adshead is chairing the latest Salzburg Global Seminar program, Bridging Worlds: How Can We Use Business and Economic Development Strategies to Support Better Health? She emphasizes, conversely, how health can support business, praising the Nordic health care models.

“You’re beginning to think about how do you design outcomes for people’s health and to other policies… So often it’s about health as a means to other ends, and for people, it’s about enabling me to have the life I want to live, spending time with my family, work, [and] do all the things I value”

One of those ends can be economic profit.

“All the evidence shows now that putting both people and the planet into your thinking as a business strategically is good for business. So, if you look at companies that have invested in wellbeing of their people, and then you look at their share performance… they consistently outperform companies that don’t invest in well-being. So, it’s good for business… You might hope that businesses would do that because of the values that they had, but actually, even if they don’t share the values around health, it’s actually good for business… They’ve got to respond to their shareholders.

“One thing we haven’t talked about that is interesting is that investors are beginning to think more about social and environmental issues in terms of where they think capital should be invested, where pension funds should be invested. So, obviously that started in things like carbon-intensive industries around climate change, but it’s also true around whether companies should hold shares in tobacco companies. You know, that’s a kind of tried-and-tested measure.”

When asked about the conditions for the success of health policies, she suggests adaption is vital, since “societies can change, and health can change. And as societies change, health changes and vice versa.”

A strategic systems thinker, she stresses the importance of a cross government analysis of policies, like the one New Zealand has implemented, to avoid “inherent contradictions” between bureaucracies. “When I worked in the health ministry, there was a newspaper headline that my minister had which was ‘What’s it to be, Minister? Healthy diets or sustainable fishing stock?’ Because we were promoting people eating oily fish as part of a healthy diet, but at the same time, the agriculture ministry was promoting sustainable fishing.”

The gap of health inequalities is Fiona Adshead’s highest concern. “I think the challenge is what do we do about it, and how do you change it, and how can you do that in a targeted way that will make a difference.”

Adshead is someone who wants to make a difference. 

“Fundamentally, I’m interested in people, what makes them tick, and also how you really improve their everyday experience. Because I think, what we haven’t talked about is health happens every day. It doesn’t happen in the doctor’s surgery.”


The Salzburg Global Seminar program, Bridging Worlds: How Can We Use Business and Economic Development Strategies to Support Better Health?, is part of the Health and Health Care Innovation multi-year series. More information on this multi-year series is available here.