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New Administration – New Commitment to Global Health?
Man displaying "Biden President 2020" banner behind his backPhoto by Gayatri Malhotra on Unsplash
New Administration – New Commitment to Global Health?
By: Andrea Feigl, Thomas Roades, and Erin Gregor 

As President Biden recommits to the WHO and the international community, Salzburg Global Fellow Andrea Feigl, Thomas Roades, and Erin Gregor - all of the Health Finance Institute - argue the incoming administration should invest more in the global fight for better health

While the new US administration is much-anticipated for many reasons, those of us in global health are eagerly waiting to see whether the new US will not merely rejoin the global community but ring in a new era of global health leadership.

In that vein, and as advocates for greater spending on the highest-burden diseases, we also have some ideas and hopes. What might the world expect from a renewed global outlook from the US administration? What should the world expect?

First, President Biden has already promised to "rejoin the WHO and restore [America's] leadership on the world stage." WHO's Director-General, Tedros Adhanom Ghebreyesus, congratulated President Biden and welcomed the opportunity to "reimagine leadership…to end the pandemic and address the fundamental inequalities that lie at the root of so many of the world's problems". Reestablishing US-WHO relations is a critical first step since the outgoing administration had frozen funding and began to "scale down its engagement with the WHO."

Second, joining the global effort towards an equitable vaccination strategy and eradicating COVID-19 at home and abroad will certainly be very high on the agenda.

However, one persistently neglected disease group – that of chronic diseases – ought to be a priority as part of any forward-looking global health strategy. COVID-19 --  all too painfully --- highlights that countries with the highest chronic disease burdens stand to suffer the most from infectious disease outbreaks, both in terms of health and economic impact. What's more, NCDs are the leading cause of death worldwide and account for over 70% of all global deaths each year. Efforts to combat these chronic diseases are chronically underfunded; just two percent of development assistance funding for health goes to NCDs. Therefore, as the incoming administration renews the US' commitment to the WHO and the global community at large, it should consider renewing and improving the country's commitment to fighting noncommunicable diseases (NCDs) as well.

The representation of chronic diseases on the US' global health agenda would be forward-looking and represent a clear break with past trends: historically, much more of the US' substantial contributions to global health were earmarked for communicable diseases, like HIV, tuberculosis, and malaria. In fact, in the Kaiser Family Foundation's detailed breakdown of the US government's funding for global health in 2020, NCDs don't even merit their own line item – presumably, they're buried within the one percent of funding classified as "other."

US Government funding for the WHO is similarly skewed towards communicable diseases and the additional priorities of polio eradication and combating hepatitis. Again, NCDs are relegated to just 0.5% of US funding to the WHO, a mere $3 million.  

The US is uniquely positioned to turn this tide and shift attention and funding in proportion to the disease burden. As the WHO's top funder, the creator of the ambitious PEPFAR plan, and a core contributor to the Global Fund, the US has traditionally spearheaded trends on the global health agenda. Focusing on and committing to NCD programming and funding would help the US re-emerge as a global health leader once more.

Still, given the past two decades' focus on infectious diseases – is there reason to believe that 2021 will be the year of a broadening global health agenda? Indeed, the officials who President Biden chose for his transition team bode well for a renewed effort in combating NCDs, especially in low- and middle-income countries.

Leading the transition team for international development were Linda Etim, formerly of the US Agency for International Development (USAID), and Elizabeth Littlefield, former head of what is now the US International Development Finance Corporation (USIDFC). Etim worked on development assistance funding to Africa during her tenure at USAID. As head of USIDFC (at the time known as OPIC), Littlefield worked to catalyze private investment from the US into LMICs to spur development. Before the Senate in 2013, she explained the importance of this work for "improv[ing] low-income families' access to energy, clean water, health services, and schooling." Both Etim's and Littlefield's track records suggest they will be well-suited to kickstarting efforts to re-engage the country in global health and development efforts.

The administration's most recent nomination in this field has been former UN Ambassador Samantha Power, who was nominated to be USAID Administrator on January 13. President Biden simultaneously announced that he would be elevating the position of USAID Administrator to a member of the National Security Council, in keeping with Power's experience in security work (including her time serving on the Council under President Obama). Power also has some experience working in global health, however, particularly during the Ebola epidemic – she convened the first-ever meeting of the UN Security Council focused on public health in response to that outbreak. We hope she will treat the slower moving but the far more deadly NCDs epidemic with similar urgency.

In 2021, President Biden also has the opportunity to appoint fresh talent to the WHO's Executive Board – another chance for the administration to signal its commitment to addressing NCDs. Under the Obama administration, Nils Daulaire filled the US seat on the Board. Daulaire has spoken to the urgent issue posed by NCDs several times, but as NCDs grow ever more deadly, rhetoric is no longer enough. The next administration's nominee to this position should be someone similarly aware of NCDs' urgent threat and someone who is ready to back those words with a financial commitment.

The new administration will require support from the legislative branch as well, as Congress has the power to set levels of funding for global health programs. The House and Senate Appropriations Committees, specifically, are closely involved in this process. The current Chairwoman of the House Appropriations, Rep. Rosa DeLauro (D-CT), has historically advocated for treating global health as a higher priority. And following the Georgia runoff elections, in which two Democratic wins flipped the balance of power in the Senate, Sen. Patrick Leahy (D-VT) is expected to take over as Chair of the Senate Appropriations Committee from current Chairman Sen. Richard Selby (R-AL). Sen. Leahy spoke out against the Trump administration's withdrawal from WHO and even introduced a bill to block the move – perhaps an encouraging signal for his attitudes on the importance of US leadership in global health.

Though increased funding to begin to close the NCD financing gap would be a great start, turning the tide on this issue will take more than just a cash infusion. Any action the incoming administration takes should be sustainable and high-impact – the burden of chronic diseases is large and will not disappear overnight. The US has an opportunity to lead, but real change will require real cooperation. If the administration aims to address this issue, they should be thinking about the levers of international governance and multilateral organizations that can generate concrete action, like the UN Multi-Partner Trust Fund Office, or expanding the mandate of the Global Financing Facility to include chronic conditions, for example.

Given the raging pandemic and the global interconnectedness of each nation's response, as well as the associated health and downstream economic effects, the incoming administration will place significant focus on global health. However, we hope and advocate that the focus on tackling the infectious pandemic does not come at the detriment of addressing what's killing and affecting most people: chronic diseases, such as mental health, diabetes, cancer, lung disease, and heart disease - the 'other' global pandemic that has been too out of sight for too long.

This article was written by Salzburg Global Fellow Andrea Feigl, Thomas Roades, and Erin Gregor - all of whom work for the Health Finance Institute. The article and comments represent the views of the authors and not necessarily those belonging to Salzburg Global Seminar.

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Improving Access to Dementia Care Resources in Rural Communities
Mary Pat Sullivan at Salzburg Global Seminar in 2017 (Photo: Katrin Kerschbaumer)
Improving Access to Dementia Care Resources in Rural Communities
By: Mira Merchant 

Salzburg Global Fellow Mary Pat Sullivan discusses her research and improving dementia care in remote and rural Canadian communities

Within the Canadian health care system, the gap in resource allocation between urban and rural communities is often far too wide. While urban areas see more significant investment in health care programs, initiatives and research, in many cases, rural communities have only basic health care infrastructure.

Salzburg Global Fellow Mary Pat Sullivan aims to close this gap, particularly for dementia care. A professor and researcher at Nipissing University, Sullivan's research examines dementia care resources available in remote and rural Canadian communities, as well as how best to provide resources needed to improve the quality of life for individuals with dementia and their families.

As Sullivan says, "In smaller communities, we simply don't have the specialists to help diagnose an individual… so people are having to leave their smaller communities and go to large urban centers to get a diagnosis... But when the individuals return home to their smaller communities, they're often just kind of left on their own to get on with it."

In December 2017, Sullivan attended the Salzburg Global program, Changing Minds: Innovations in Dementia Care and Dementia-Friendly Communities, which was held in partnership with the Dartmouth Institute for Health Policy and Clinical Practice, and the Mayo Clinic. Also attending the program were Fellows Sebastian Crutch of University College London (UCL), Stéphanie LeClair of Alzheimer Society Sudbury-Manitoulin North Bay & Districts and Paul Camic of Canterbury Christchurch University.

Following the program, the four Fellows received a grant of more than $6,000,000 funded by the Economic and Social Research Council and the National Institute for Health Research, enabling their institutions to jointly explore new forms of dementia support.

It has been almost three years that the group has been collaborating. Sullivan describes the relationships as "very, very positive," citing the group's many common interests and concerns in terms of how to address dementia care.

The COVID-19 pandemic has meant that the group's meetings, data collection and participant interviews must all take place entirely online, but this has not hindered progress. Sullivan says, "We're continuing to work together. We're continuing to progress our work and our ideas. So I can imagine the relationships continuing for some time."

Virtual health care is not a new concept for people in remote and rural communities. Often located hours from the nearest metropolitan areas, and without proper specialists in local hospitals, patients rely on virtual resources. As Sullivan says, "Sometimes they're feeling disconnected with our traditional services or just don't know where to turn. And so even pre-COVID, some people are very resourceful and have connected virtually, even before this study."

Sullivan describes the research resulting from the grant as an extension of work that has been done at UCL.

"The work [at UCL] specialize[s] on people with rarer forms of dementia, and often those are in individuals who are under the age of 65. So the work is an evolution of specifically focusing on how to best support people who aren't in the older age groups and looking at what their support needs are from really the beginning… in terms of people trying to get a diagnosis … and then from there on, how to support them and their families, because often someone with younger-onset [dementia] might still have… young children at home, often a care partner.

“And often what we're seeing is their parents, older parents … who are also stepping in to support them, but need support themselves as well. So that's essentially what the project is about: how to support people with rare or young-onset dementia."

Through her research, Sullivan hopes to raise greater awareness for the fact that that no two people with dementia have identical experiences, and those who are diagnosed with dementia earlier in life have unique needs, characteristics and challenges. She also hopes to ensure that services are equally accessible to younger dementia patients.

"These are … younger people with younger families, and the services [should be] equally responsive to supporting them with their needs… And [there is] great work we're doing with older people. And so if we could just replicate some of that success with younger people, then we're heading in the right direction."

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Developing a Digital Paper Trail for Better Health
Louise Schaper holding a microphone and smiling, while giving a talk.Photo: Louise Schaper
Developing a Digital Paper Trail for Better Health
By: Mira Merchant 

Salzburg Global Fellow Louise Schaper discusses the "global problem" of paper-based health care systems and the need to move toward digital health care

The field of digital health falls at the intersection of technological advancement and health care delivery. According to the World Health Organization, digital health provides opportunities to accelerate progress in achieving the health-related Sustainable Development Goals, particularly Goal 3, Good Health and Well-Being.

Whereas traditional health care systems have run mostly on paper for data and information collection, digital health care systems, as the name suggests, aim to digitize data collection, improving the process for health care seekers and providers alike.

Salzburg Global Fellow Louise Schaper has worked in the field of digital health for the past two decades. She has spent the latter decade as the chief executive officer of the Australasian Institute of Digital Health (AIDH). Schaper says the Institute "provide[s] a much-needed space for the entire digital health community of Australia to come together and collaborate on projects to advance the cause of digital health in Australia."

The Institute works toward the creation of a connected health system and digitally competent health workforce. Schaper says, "It's a global problem that health care in 2020 in many places across the world still runs on paper."

Founded in February 2020, the Institute is the result of the merger of the Health Informatics Society of Australia and the Australasian College of Health Informatics. The two organizations had been working closely for years, and shared many common goals and objectives.

The Institute operates on an individual and organizational membership model, and hosts accessible programs and services on digital health and related topics. Seeking to “develop collaborative partnerships, elevate the voice of consumers and build an empowered health workforce delivering care in a digital world,” the Institute promotes the exchange of ideas and information from Fellows and members.

Despite being less than a year old, the Institute already boasts a community of over 36,000, over 1700 members, over 100 industry partners, and over 3000 events attendees, with a vision to expand further.

Practically speaking, digital health care systems are much more efficient than their paper-driven counterparts, where practitioners often only collect information for a singular purpose or visit. Schaper notes information doesn't "flow easily" throughout the health care system, often requiring each member of a person's care team to collect the same data. But despite the efficiency, digital health care systems are not the norm, primarily because of the tremendous costs associated with implementing such a system.

"In developed countries like Australia… huge amounts of money are required. So if you want to take your hospital that pretty much runs on paper, and put a full[y] electronic system in, you need hundreds of millions of dollars… That's why we don't have these systems as widespread as we'd like because it's usually expensive."

Implementing digital health care systems is already a difficult task in the developed world. In developing countries, it might seem near impossible, owing to the lack of technological infrastructure. However, Schaper says this isn't the case.

"Developing countries, in a lot of aspects, do better than us in the Western world…  If you've got [lots] of money, then you think…to solve this problem that's in front of me, I need to throw money at it, I need to hire people, I need to buy software… And when you don't have money, you have to be creative and innovative and resourceful, and resilient. All of those things which I don't think are lauded enough… So there are lots of examples in developing countries that they do better [because] spending hundreds of millions of dollars on an IT system is… just not even worth considering. So there's a lot of open access software [which is] very, very low cost and that you can put in place."

Schaper believes integrating digital health into university curricula is an effective way to ensure future health care practitioners are exposed to this subject before they even begin their careers. Traditional curriculum in Australia, she says, does not always include modules on digital health. When it does, the modules are often elective. This arrangement means scores of new health care practitioners who join the workforce every year are unfamiliar with the subject and not always likely to pursue it further. Schaper stresses health care practitioners should not think of digital health only as a technology issue. "It's really about improved patient care and quality of outcomes," she says.

The COVID-19 pandemic has reaffirmed to Schaper the importance of having a digital health care system and a digitally competent health workforce. Looking ahead, she hopes digital health can become commonplace so health care workers can better use the information to provide high-quality patient care, and not just focus on digitizing it.

"The fact [is] that we don't have good systems in place… the way that we build organizations, build protocols, build collaborations across countries, they're not there. So this information isn't where it needs to be so that we can act on it quickly. … I would hope that [AIDH] can contribute to that journey."

Schaper recognizes the importance of having diverse perspectives to be able to solve a problem, something she was lucky to find during her time in Salzburg. A Fellow of Session 553: Toward a Shared Culture of Health: Enriching and Charting the Patient-Clinician Relationship, Schaper says, "The only way we can solve problems is by bringing people together from diverse perspectives, who have diverse journeys, who have diverse knowledge and experience to bring to the table, and by drawing from that diversity and having that diversity as a strength to collaborate on solving problems."

Schaper has many goals for AIDH over the next decade. One, in particular, is her hope the Institute has to rename itself. She says, "I'd love in 10 years if we have to rename ourselves… because digital health doesn't exist. I would love to see [if digital] health care can become just health care and remove the "digital" … it seems ridiculous to refer to it as such because that's just how we do health care now."

 

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New Timeliness Metrics Seek to Improve Pandemic Preparedness
Image: Martin Sanchez/Unsplash
New Timeliness Metrics Seek to Improve Pandemic Preparedness
By: Salzburg Global Seminar 

Fellows devise first-ever “One Health” timeliness metrics to track improvements in disease surveillance

As the novel coronavirus continues to grip the world, it is clear that few countries were prepared for this pandemic. However, a pioneering group of Salzburg Global Fellows, funded by US-based non-profit Ending Pandemics, aims to improve global preparedness for both COVID-19 and future epidemics. Together, they have designed a new system to assess how quickly countries can find outbreaks and stop them before they become deadly global pandemics.

The new timeliness metrics for One Health surveillance were developed at Salzburg Global Seminar’s program on Finding Outbreaks Faster in late 2019, building on earlier work to develop timeliness metrics for the public health sector in 2018. The programs developed “Outbreak Milestones” to enable tracking of timeliness metrics for disease surveillance and response across human and animal outbreaks. 

The Outbreak Milestones for public health were the product of years of pilot testing by Ending Pandemics with country partners and expert consultation with diverse stakeholders. They were further refined by Salzburg Global Fellows in November 2018 and incorporated into key WHO country guidance in early 2019. 

These new Outbreak Milestones go one step further, recognizing critical interconnections between human, animal, and environmental health to have broad applicability to a range of disease outbreaks. It is understood that the SARS-CoV-2 virus first developed in animals before transferring to humans. In recent years other zoonoses – pathogens carried by animals that infect humans – also led to SARS, MERS and Ebola. This interconnectedness prompted Ending Pandemics to lead development of timeliness metrics for “One Health”, recognizing that an integrated, multi-sector approach to disease surveillance is essential.  

Get Prepared

In February as the world was just starting to recognize the possible scale of the current pandemic, Mark Smolinski, president of Ending Pandemics, called SARS-CoV-2 a “wake-up call,” adding “Outbreaks such as this that spread from animals to humans will continue to occur. My motto is, ‘Don’t be scared, get prepared.’”

Developed collaboratively by Ending Pandemics and 35 Salzburg Global Fellows from across the world recognized as international experts in public health, epidemiology, veterinary medicine, and ecology, the One Health Timeliness Metrics are designed around “milestones”: the dates when an outbreak is predicted, detected, verified and responded to, when the authorities are notified, and when a multisectoral investigation is launched, lab tests conducted, control measures implemented and the public informed.

“We recognize that this release coincides with a critical point in the progression of COVID-19,” said Adam Crawley, Program Officer for Ending Pandemics, as the One Health Timeliness Metrics were released in May 2020. 

“Some countries are beginning to pivot from initial response activities and strict social distancing measures to building preparedness capabilities needed for continued early detection and containment. Early detection, timely testing, and rapid response are necessities for combatting this pandemic, and the Outbreak Milestones and Timeliness Metrics provide countries with a framework to monitor their ongoing performance.”

Political Will

Lack of preparedness has been a common failing in many – though not all - countries’ efforts to contain the spread of the novel coronavirus pandemic, as has the lack of consistent responses to sound scientific advice. 

“We are proud of our Fellows for developing what could prove to be a valuable tool in tackling the next phases of the current pandemic and to halt future outbreaks at a much earlier stage, wherever these begin” said Salzburg Global Vice President and Chief Program Officer, Clare Shine. “But such tools can only achieve their full potential if there is risk literacy and political will at national and international levels, aligned with best available scientific guidance.

“Founded in the wake of World War II, Salzburg Global has challenged current and future leaders to shape a better world for over 70 years. As the world enters a new era of great upheaval, we call on political leaders to support and work with scientific advisors using these cutting-edge innovations to prevent and mitigate future risks and to help communities and economies build back better.”

The One Health Timeliness Metrics are available for download here:

Download One Health Timeliness Metrics as a PDF

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Building Healthy Communities: What Is Yours To Do? 
Teddy bear in the window of a neighborhood in COVID-19 lockdown. Photo: Nicolas Gonzalez/UnsplashPhoto: Nicolas Gonzalez/Unsplash
Building Healthy Communities: What Is Yours To Do? 
By: Nupur Chaudhury 

Public health urbanist Nupur Chaudhury says that the time for building healthier communities is not after the pandemic but now

As a public health urbanist, I look at connections, cities and communities through a grassroots lens. I sit a mile away from the epicenter of the Coronavirus pandemic here in the United States and I’ve been examining the fracture of life that’s currently unfolding. I have been a part of numerous conversations focused on the fact that life will never be the same when we emerge from this pandemic. Although many conversations focus on the “after” on the “when all of this is done,” I would urge us to think about building healthy communities now. 

My colleague Lourdes Rodriguez, at the Cities Research Group (a project of the University of Orange), developed the concept of Collective Recovery, a theory that focuses on the idea that in moments like this we cannot focus on heroes and victims, but rather that we must focus on the collective: that we are all in pain, that we all hurt, and most importantly, we are all the makers and authors of what our collective recovery can be. She developed this concept in the aftermath of the 9/11 attacks in New York City, where the tendency was to focus on the geographic footprint of the attacks (a one-mile radius around the twin towers), and the workers, businesses and first responders, rather than realize that the entire region was hurting. 

I have found Rodriguez’s framing of the four tasks of Collective Recovery - Remember, Respect, Learn, and Connect - to be grounding at this time. The central question in all of this is when thinking about recovery is “what is yours to do?”

We have seen examples of all four tasks play out over the lifespan of this forced and managed retreat: We have seen seamstresses create an assembly line, churning out masks by the thousands. We have seen neighborhoods place teddy bears in their windows for children to see on their daily walks. We have experienced the connection of friends near and far in the form of food deliveries and care packages. And we have collectively banged on pots and pans every night at 7pm in honor of our essential workers. These are not government sanctioned activities, nor are these leaders professional health workers or urban planners. These are the community builders we need now. 

These tasks are all of ours to do. And there is still more to do! This recovery is ours to imagine, and ours to create. And it is this recovery, together, that will build healthy communities for the future. 

Nupur Chaudhury, MUP, MPH is the Urbanist-in-Residence, Cities Research Group at University of Orange, Orange, NJ, USA. She is a Fellow of Salzburg Global Seminar having participated in the program, Building Healthy, Equitable Communities: The Role of Inclusive Urban Development and Investment in October 2018. She is a co-author of the Salzburg Statement on Confronting Power and Privilege for Inclusive, Equitable and Healthy Communities

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How Can Urban Planning Contribute to Building Health Equity?
How Can Urban Planning Contribute to Building Health Equity?
By: Sharon Roherty 

Chair of the Salzburg Global program on Building Healthy, Equitable Communities: The Role of Inclusive Urban Development and Investment, Sharon Roerty writes for The BMJ on what can be done to make cities a more healthy place to live

This article is part of The BMJ's Building Healthy Communities collection.

Place is among the many social factors—including income, education, food security and early childcare and development—that contribute to health, both individually and collectively. Study after study have shown that how long and how well you can expect to live have much to do with where you reside.[1]

55% of the world’s population lives in urban areas; by 2050, that figure is expected to reach 68%.[2] Urban features such as housing density[3], public transport[4], sanitation[5] and green space[6] all have significant impacts on health.

Yet, in so many places all over the world, urban development and investment do not support opportunities for everyone to achieve optimal health—the definition of health equity. Instead, development and investment decisions have created deep-rooted barriers to good health. Faced with challenges like concentrated and entrenched poverty, substandard housing, pollution, poor public transportation and neglected and unsafe parks and streets, too many people start behind and stay behind. 

In October 2018, at the Salzburg Global Seminar program on Building Healthy Equitable Communities supported by the Robert Wood Johnson Foundation, there was consensus that investors, planners, engineers and developers can and must hold themselves accountable for increasing opportunities for everyone to be healthier, especially people living in places where obstacles to a long, healthy life are greatest. Building on that discussion, a series of articles coming from that meeting explore a number of questions, including the following:

  • How can investments in urban revitalization and infrastructure advance health, equity and the public good?
  • What are the key policy strategies and practices that address the roots of inequality and support healthier and more inclusive housing, transportation, utilities and open space systems? 
  • How can cities foster a shared sense of community to build infrastructure that serves the public interest? 
  • How can citizen science and data be used to promote equitable development and community-driven solutions?

Part of the problem has been the failure to integrate health into urban planning and decision-making. Around the world, examples abound of more integrated and more conscious approaches to urban development and improvement. Being intentional about whom such improvements will benefit will result in opportunities for better health and well-being for everyone.

Bogatá, Columbia, pioneered the use of ciclovías, the regular closing of main streets to automobiles for runners, bicyclists, skaters and most importantly every kind of people, to use freely. This practice has expanded to cities around the world. Meanwhile, major cities in Spain have declared a war on cars—banning or limiting their use on designated streets. A new study estimates that Barcelona’s plan to limit cars and capture nearly 70 percent of street space for bikes and pedestrians could save 667 lives per year.[7]  

Housing is another area of intense interest. In Nairobi, Kenya, where slums occupy about 2 percent of the land but house half the city’s population, the Muungano alliance has organised residents to save collectively, meet regularly and demand and help fund community improvements, including sanitation, water, housing and electricity. And in Delhi, India, a company called Micro Home Solutions takes an interdisciplinary design approach—drawing on the insights of sociologists, urban planners, architects, policymakers, and engineers—to create sound and sustainable housing for low-income dwellers.

As these and many other examples show, we can make the world’s cities healthier and more equitable by designing and building communities with the explicit goals of inclusion, health and opportunity for all. This will require leveraging the potential of the built environment to both prevent disease and promote health equity. The other articles in this collection provide details on how leaders working across sectors can achieve this.

Sharon Roerty, a senior program officer who joined the Robert Wood Johnson Foundation in 2011, is an urban alchemist who has spent a lot of time at the intersection of health and transportation. She served as the Chair of the Salzburg Global Seminar program on Building Healthy, Equitable Communities: The Role of Inclusive Urban Development and Investment in October 2018. The program was held in partnership with the Robert Wood Johnson Foundation.

References

  1. Marmot M. “Social determinants of health inequalities.” The Lancet, March 19, 2005, 365 (9464) 1099-1104.
  2. United Nations Department of Economic and Social Affairs. “68% of the world population projected to live in urban areas by 2050, says UN.” May 16, 2018. Available at: https://www.un.org/development/desa/en/news/population/2018-revision-of-world-urbanization-prospects.html 
  3. Braveman P, Dekker M, Egerter S, Sadegh-Nobari T and Pollack C. “An examination of the many ways in which housing can influence health and strategies to improve health through emphasis on healthier homes.” The Robert Wood Johnson Foundation, May 1, 2011. Available at: https://www.rwjf.org/en/library/research/2011/05/housing-and-health.html 
  4. Frank LD, Andresen MA and Schmid TL. “Obesity relationships with community design, physical activity, and time spent in cars.” American Journal of Preventive Medicine, 27 (2) Aug. 2004: 87-96.
  5. WHO Commission on Social Determinants of Health. “Globalization, water and health.” Globalization and Health Knowledge Network, May 2007. Available at: https://www.who.int/social_determinants/resources/gkn_wilson.pdf?ua=1 
  6. Braubach M, Egoroy A, Pierpaolo M, Wolf T, Ward Thompson C and Martuzzi M. “Effects of urban green space on environmental health, equity and resilience.” Theory and Practice of Urban Sustainability Transitions. Springer, September 2017. Available at: https://link.springer.com/chapter/10.1007/978-3-319-56091-5_11 
  7. Bliss L. “The Life-Saving Benefits of Barcelona’s Car-Free Superblocks.” City Lab, September 9, 2019. Available at: https://www.citylab.com/transportation/2019/09/barcelona-superblock-car-free-streets-cities-urban-design/597484/ 
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Building Healthier Communities
Building Healthier Communities
By: Salzburg Global Fellows 

Fellows of Salzburg Global programs on healthier and more equitable communities pen blog series for The BMJ

In 2017 and 2018, Salzburg Global Seminar in partnership with Robert Wood Johnson Foundation convened a series of three programs exploring the conditions which can create and protect health and wellbeing beyond a traditional focus on health care. The three sessions covered hospitals, urban planning, and childhood obesity.

In the intervening months, several Salzburg Global Fellows of those programs have come together to write a series of articles for The BMJ, all of which are available for free. The articles in this collection reflect the wide ranging discussions by program participants from around the world, identifying challenges and opportunities for building healthier communities.

John Lotherington, Salzburg Global Program Director said: "We’re delighted to see this collection of articles arising from our sessions in collaboration with the Robert Wood Johnson Foundation on Building Healthy Communities: the Role of Hospitals and Building Healthy, Equitable Communities: The Role of Inclusive Urban Development and Investment*. They are great contributions to our joint goal of how better to build a culture of health, bringing together stakeholders from diverse sectors and from every continent.

"We should pay tribute to all the authors, who carried the energy and ideas forward from the session, and despite onerous 'day jobs' continued these collaborations to produce such fascinating articles which, through BMJ Online, will influence thinking around the world."

The Role of Hospitals

GDP and the economics of despair
We should switch to a measure that promotes health, not consumption, says Harry Burns

Hospitals could be anchors for an economy focused on wellbeing
Paul Simpson asks how can healthcare systems help build healthy societies beyond providing high quality medical care

Can New Zealand’s wellbeing budget help address social inequalities?
Plans for a wellbeing budget have been met with both scepticism and hope, reports Anna Matheson

Lowering hospital walls to achieve health equity
Hospitals have a pivotal role in reducing health inequities for indigenous people and other marginalised groups, argue Anna Matheson and colleagues

How healthcare can help heal communities and the planet
The gains from healthcare are often undermined by the sector’s contributions to social inequity and environmental damage, but it doesn’t have to be that way argue Damon Francis and colleagues

Inclusive Urban Development and Investment

Strengthening the links between planning and health in England
Gemma McKinnon and colleagues argue that multidisciplinary action in planning and health will contribute to more equitable communities and improved health and wellbeing

How can urban planning contribute to building health equity?
Sharon Roerty tells us more about what can be done to make cities a more healthy place to live.

Confronting power and privilege for inclusive, equitable, and healthy communities
Ascala Sisk and colleagues set out a call to interrogate power and analyse privilege to create and sustain healthy communities.

Connected green spaces in cities pay real dividends
Nick Chapman writes about the benefits of urban green spaces.

*A third set of articles connected with the RWJF-funded program on Healthy Children, Healthy Weight is forthcoming. 

This collection is a series of articles based on discussions from Salzburg Global Seminar programs on building healthy communities. Open access fees were funded by the Robert Wood Johnson Foundation. The BMJ peer reviewed, edited, and made the decision to publish the article with no involvement from the foundation.

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