Members of the inaugural meeting of the Sciana network have spent days contemplating the challenges facing the health and health care systems of today, and of the future. But when theorising solutions to these challenges, Sir Harry Burns, professor of global public health at the University of Strathclyde, Scotland, stresses the importance of not falling victim to the belief that one grand scheme is the solution.“The way in which to change a complex system isn’t through a grand plan – it’s through people examining problems, coming up with solutions, testing those solutions, and spreading learning,” Burns says.Burns’ focus is on how societies can create overall “wellness” for its citizens, where health is a state of physical, mental and social wellbeing, not just the absence of illness. But this approach, he explains, is one based on a series of complex systems coming together. “It would be a mistake to think that the health care system on its own can tackle the determinants of health,” he says. “First of all, the health care system tends to focus on illness, whereas wellness goes hand-in-hand with treating illness in terms of creating a society where wellbeing is the aim.” He continues: “A society with lots of wellbeing isn’t just a society where health is good, it’s a society where education attainment is good, where people are engaged, where there is a high level of social cohesion,” noting there is scientific evidence indicating this process begins with children and young people. “Children who experience difficult in early life through parental absence, through mental illness of parents, through poverty, will often find it harder to learn, to behave correctly in stressful situations,” he says. “As a result they’re more likely to fail. So giving support to families who find themselves in difficult circumstances is the basis of a wellbeing society. But it doesn’t stop, it continues through life.”After spending just three days with members of Sciana, the health leaders network, Burns, whose involvement will continue with the network in the coming months as a senior ambassador, says he has gained a greater insight into the way different health care systems are financed, and how that financing determines their functionality and ability to change. “What I’ve heard in some systems is finance doesn’t seem to be a huge problem, therefore what’s the incentive for change? Whereas in the UK system our government has decided there is a limited amount of money for health care, [so] we are forced to discover new, more efficient ways of delivering care, which is why we focus on wellbeing as a way of reducing the need for care.”