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Developing a Digital Paper Trail for Better Health
Woman working on a tablet with one hand, and holding a stethoscope on the other hand.Photo: Pexels
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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Confronting Power and Privilege for Inclusive, Equitable and Healthy Communities
Image: Erin White/Unsplash
Confronting Power and Privilege for Inclusive, Equitable and Healthy Communities
By: Ascala Sisk and Salzburg Global Fellows 

Salzburg Global Fellows set out a call to interrogate power and analyze privilege to create and sustain healthy communities 

This article is part of the British Medical Journal's Building Healthy Communities collection.

According to the World Health Organization, inclusive, healthy and just communities are places that continually create and improve the physical and social environment to enable all people to be mutually supportive in all functions of life and to develop their maximum potential.[1] It is suggested that only 16% of health outcomes are determined by the quality and availability of health care; and the social and economic determinants of health, including where people live play a more significant role.[2]

This goes beyond the quality of physical structures in the urban environment or the space inside a home. It is about understanding neighbourhood conditions and the availability and quality of other determinants of health, such as employment, healthy food, childcare, schools, transport and recreation space. We know geographic disparities in health, which often fall along lines of ethnicity and socioeconomic status, are growing and can exist even between people living in adjacent neighbourhoods.[3] Health professionals and urban development practitioners therefore have an important role to play to ensure the practices and processes governing the design and development of our urban environment are inclusive and equitable for all and ultimately contribute to improved population health.

A Call to Action: Interrogate Power and Analyze Privilege to Create and Sustain Healthy Communities

The scale of current and potential inequalities in the urban environment demands a revolution of purpose and accountability. The challenges we face in building and sustaining healthy and equitable communities demand new forms of thinking, problem solving, governance, and decision making. Most importantly, it requires that we learn the skills of interrogating power and analysing privilege. 

Whether resources do, or do not, flow to communities is a direct product of both individual and institutional power. Power is defined as the ability to direct laws, policies, and investment that shape people’s lives. Privilege is the accumulation of benefits of special rights. Both power and privilege have been extracted and hoarded, consciously or not, by certain groups at the expense of others based on social categorisations including, but not limited to, class, ethnicity, religion, physical ability, and gender.[4,5,6]

We call on health professionals, planners, public servants, developers, financiers, and engineers – in fact, all practitioners working at the intersection of health and the built environment – to shift their normal course of business towards adopting practices that recognise privilege and cede power. This requires pushing against conscious and unconscious practices and the societal beliefs and norms that marginalise, exclude and perpetuate inequity. We charge this community of practitioners to dismantle the structures, systems and practices that reinforce inequity. Even with best intentions, data-driven interventions, and evidence-based improvements, we will inadvertently perpetuate inequities and widen disparities if we are not conscious of our own power and the power structures within which we work.

We know that power and privilege can be complex and sometimes overwhelming concepts, but we can and must engage with them. We have proposed steps below for health professionals, policy makers and urban development practitioners and other stakeholders to begin the journey. We make this call to action to fundamentally shift the way we plan, build, program, advocate, and legislate our communities to ensure the health and quality of life for all. While it may seem a daunting task to connect this aspirational call to on-the-ground practice, we urge that this not be a reason for inaction since “professional silence in the face of social injustice is wrong.”[7]

Steps for Examining Power and Privilege in Support of Healthy and Inclusive Communities

1. Create and/or seek out “Brave Spaces” to explore the role of power in your work

Confronting power and its role in our work begins by creating “Brave Spaces”. Brave spaces are intentional environments and settings that facilitate the courageous, uncomfortable, and honest exploration of social categorizations such as physical ability, race, ethnicity, class, and gender identity and the privilege or marginalisation that is extended to individuals based on these categorizations.[8

Brave spaces are created and maintained by a transparent commitment to practices that allow difference and celebrate new forms of action and strategy. You create brave spaces when you:

  • Speak your truth and listen deeply to the truth that others speak
  • Learn the truth about historical trauma and accept its impact on yourself and those you serve
  • Understand and honour your own experience and the experiences of others in equal measure
  • Bring your vulnerability to the table and create the space for others to be vulnerable
  • Invite yourself to make mistakes and be generous with the mistakes of others 
  • Acknowledge the limits of expertise – an expert frame can shut down learning 
  • Hold yourself and others accountable to practices that affirm diversity and inclusion

2. Understand the role that power plays in your current work

Within the brave space created above, consider as an urban developer, policy maker or health professional, a program, policy initiative, or other effort that you are working on to improve the physical, social and economic conditions of communities and ask the following:

  • What is the problem I’m trying to solve?
  • What decisions, policies, and practices have historically contributed to the problem? What is the root cause of the problem?
  • What is the formal and informal, the visible and invisible, decision-making or governance structure shaping the problem?
  • What would it look like if the problem is solved?
  • Who consistently benefits from the problem not being solved?
  • Who consistently suffers from the problem not being solved?
  • Are the people most affected by this problem represented in the decision-making process?
  • In seeking data, what sources of data are considered legitimate, and by whom? Are there credible sources that are being suppressed or dismissed because the power structure has deemed them unreliable?

3. Analyze and Challenge Privilege

Privilege is the accumulation of benefits of special rights, often over time, to a certain group. Think about your work and your role in your community of practice and ask:

  • What are the areas of life in which you hold privilege?
  • Despite your work to change outcomes, what remains the same?
  • Despite changes in the wider professional or sociopolitical context, what remains the same?
  • What are the cycles, actions, and processes we repeat regardless of the outcome?
  • Does a new protocol or procedure worsen or help existing disparities?

Privilege often shows itself when the status quo is challenged. When such a challenge is presented, and conflict ensues, ask yourself:

  • Who or what is blamed for the conflict in the narrative describing the challenge?
  • Who or what is sacrificed to resolve the conflict?
  • Are there any patterns that you can observe?
  • If the problem was “resolved”, did the group or process return to the norm or status quo? 
  • Who or what restores things to what they were before the conflict?

Download the Salzburg Statement on Confronting Power and Privilege for Inclusive, Equitable and Healthy Communities as a PDF

Authors

Ascala Sisk, Deputy Director, Center for Community Investment, Lincoln Institute of Land Policy; Odetta MacLeish-White, Managing Director, TransFormation Alliance; Vedette Gavin, Principle, Verge Impact Partners; Tamika Butler, Director, Equity and Inclusion and Director of CA Planning, Toole Design; Liz Ogbu, Founder + Principal, Studio O; Veronica O. Davis, P.E., Managing Partner, Nspiregreen LLC; Nupur Chaudhury, Program Officer, New York State Health Foundation, Urbanist in Residence, University of Orange; Sharon Roerty, Senior Program Officer, Robert Wood Johnson Foundation; Hanaa Hamdi, Director of Health Impact Investment Strategies and Partnerships, New Jersey Community Capital; Kelly Worden, Director, Health Research, U.S. Green Building Council; Noxolo Kabane, Deputy Director, Western Cape Department of Human Settlements; Shelly Poticha, Managing Director, Natural Resources Defense Council; and Hedzer Pathuis, Strategic Project Manager, City of Utrecht.

Acknowledgements

We would like to thank the all sixty-five fellows who participated in Salzburg Global Seminar program Building Healthy, Equitable Communities: The Role of Inclusive Urban Development and Investment, whose vast and varied experience helped to shape our call to action. We’d also like to thank Salzburg Global Seminar and the Robert Wood Johnson Foundation for creating the space to make connections and cultivate bold ideas.

References

  1. World Health Organization “Health Promotion Glossary” (2006) www.who.int/healthpromotion/about/HPR%20Gossary%201998.pdf
  2. Hood, C. M., K. P. Gennuso, G. R. Swain, and B. B. Catlin. 2016. County health rankings: Relationships between determinant factors and health outcomes. American Journal of Preventive Medicine 50(2):129-135.
  3. Woolf, Steven and Braveman, Paula. 2011. Where Health Disparities Begin: The Role of Social and Economic Determinants – and Why Current Policies May Make Matter Worse. Health Affairs, Vol. 30, No. 10: Agenda for Fighting Disparities, https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2011.0685
  4. Project Change’s “The Power of Words” Originally produced for Project Change Lessons Learned II, also included in A Community Builder’s Toolkit – both produced by Project Change and The Center for Assessment and Policy Development with some modification Racial Equity Tools.org. https://www.racialequitytools.org/glossary 
  5. McIntosh, Peggy. White Privilege: Unpacking the Invisible Knapsack. Wellesley Centers for Women, Seeking Educational Equity and Diversity. https://www.cuesta.edu/about/documents/vpaa-docs/1_Peggy_McIntosh_White_Privilege.pdf 
  6. Hobbs, Joseph. White Privilege in Health Care: Following Recognition with Action. Ann Fam Med. 2018 May; 16(3): 197-198. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5951245/ 
  7. Berwick, Donald M., MD, MPP. Moral Choices for Today’s Physicians, JAMA. 2017; 318(21):2081-2082. https://jamanetwork.com/journals/jama/issue/318/21 
  8. Arao, Brian, Clemens, Kristi. From Safe Spaces to Brave Spaces, a new way to frame dialogue and diversity and social justice. 2013, Stylus Publishing, LLC.  https://www.gvsu.edu/cms4/asset/843249C9-B1E5-BD47-A25EDBC68363B726/from-safe-spaces-to-brave-spaces.pdf 
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Bringing a First Nations Perspective to the Program
Louisa Whettam (right) presents a painting to Salzburg Global Seminar as a giftLouisa Whettam (right) presents a painting to Salzburg Global Seminar as a gift
Bringing a First Nations Perspective to the Program
By: Claire Kidwell 

Cultural practice advisor Louisa Whettam discusses nutrition in First Nations communities

“I think that this is the first step in moving forward for First Nations people at a global level,” said Louisa Whettam, a cultural practice advisor for Opportunity Child.

Whettam, a descendant from the Wiradjuri tribe in New South Wales, Australia, said she was honored to represent the First Nations Peoples of Australia at the Salzburg Global Seminar program, Halting the Childhood Obesity Epidemic: Identifying Decisive Interventions in Complex Systems.

She spoke with Salzburg Global just after sharing an emotional and personal anecdote with participants about the impact of colonization on the health of First Nations people, as well as land and food resources.

The colonization of Australia led to many conflicts, deaths, and settlers seizing the land of First Nations people. Whettam said, “[The colonizers] would just gather the people and put them in an area where they now had to live. But then [the First Nations people] also had to work the land for those who now occupied the land. So, that means vegetation was taken away. They had to clear their own vegetation, the food source that they were living off.”

Whettam said First Nations people employed by settlers would be paid with staples of food - often flour and sugar. “So, nutrition then became really terrible for First Nations people.”

The history of forced removals and loss of land and culture have all contributed to intergenerational trauma. The impact of the Stolen Generations, where Aboriginal Australian children were forcibly removed from their homes and put into institutions, has led to a “whole generation of lost adults who have never connected back to their family,” according to Whettam.

In 2017, the Australian Institute of Health and Welfare published a report called “A picture of overweight and obesity in Australia.” The report indicated Aboriginal and Torres Strait Islander children and adolescents were more likely to be overweight or obese than non-indigenous children and adolescents. 

The report said in 2012-13, 30 percent of Aboriginal and Torres Strait Islander children aged 2-14 were living with obesity or overweight, compared with 25 percent of their non-Indigenous counterparts.

In August 2019, ABC reported on the rising trend of children in Australia experiencing malnutrition. The Food Bank of Australia estimated one in five children had gone hungry in the past year. Whettam said the affordability of food was a factor, and people won’t buy food with nutritional value if it is too expensive. Meanwhile, takeaway food from fast-food restaurants and other processed food remains cheap.

In her work at Opportunity Child, Whettam helps ensure Australian children can succeed within their own communities.

The organization provides practical support to backbone teams and community structures; it uses its social innovation hub to help communities find solutions to complex issues; it advocates with “One Voice” to drive systems change.

Whettam said, “If you have children that have obesity or malnutrition, then that is a concern because they are not thriving within their own community.”

Whettam is a respected representative of the Warril Yari-Go Committee and is passionate about systemic change and how it impacts First Nations people. But she’s not sure if she has the answers yet on how to tackle childhood obesity among First Nations people, suggesting other factors have to be taken into account as well.

She said, “How do you fix that? Like, how do you look at the complexity of all the policies that have been made in the government that still continue to oppress a whole culture? How do you turn that around? I don’t know.”

Whettam hopes to find more answers and clarity in Salzburg, which she described as a “fantastic opportunity” to bring her perspective forward and learn from other experts around the world.

She said, “I think this is a great opportunity to make friends, where you can have friends from all around the world that can stand with you when you get back to your country [or] when I go back to my country and challenge and disrupt that system. I think that’s pretty awesome in moving forward.”

A Gift for Salzburg Global

At the end of the program, Whettam presented Salzburg Global a piece of Indigenous art she had created. The painting was a way for her to say “Thank you” for being able to attend and provide a perspective from the First Nations Peoples of Australia. Whettam said she wanted to depict the story of Salzburg Global, the past, present, and future.

In her own words, we asked Whettam to describe what different parts of the painting symbolized. She said, “Salzburg Global Seminar is the big middle piece, and the globe represents all the people coming together… The U-shaped people sitting around that circle represent the people from all different countries coming together and being a part of a [program].

“The footprints represent the journey going there, but also the journey going back… The red dots represent the topic, and they’re red because, as the world, we all need to be looking at this [topic] because it’s an epidemic. I also had the cross-hatching around the globe, representing the complex systems that we’re talking about.

“Then I had other dots representing the conversations that we’re all having together. There are ocean-like… coloured dots going out to the outer circles, and that’s the conversation carrying on outside of the [program]. We're taking back to our country all the warnings and all the knowledge from what's being given to us from other leaders around the world.

“Also, we're cross-pollinating the conversation; we're still having conversations with those who we met there, but they might know some key people who could help us create partnerships or collaborations. That's why you see all those dots crossing…

“You'll see white [dots] that are keeping the conversation in place so that it's not being swallowed up by other conversations. It's protecting that conversation so that you can bring it back and talk about the issue in your own country.

“Then the outer circles represent your country, and the handprint in the middle represents the children. And that's looking at the child in the future, but also the child now…  that's who it's impacting on - future children, children in the present and it has also impacted on past children… Around that hand, I have the red dots and yellow dots representing the hard conversations we're having within complex systems... And then you got cross-hatching around that as well that represents the government or complex systems that you have to deal with around that topic. The different colored outer dots that surround the painting depicts all peoples from around the world.”

Clare Shine, vice president and chief program officer at Salzburg Global, received the painting on the organization’s behalf. Shine said, “It’s fascinating to see how Louisa has used Indigenous Australian art forms to make sense of the complexity and trauma bound up with childhood obesity and depict the long-term impact we hope will radiate from this collaboration. I’m so moved by her generosity in creating this beautiful painting. We look forward to hanging it where as many people as possible can enjoy and learn from it.”

One month on, Whettam is still reflecting on the program she participated in and is still in touch with people she met. Despite feeling out of place at the beginning, the mix of the people in the room left her feeling uplifted.

She said, “I was really inspired by the influence that people had, which they sometimes don't realize that they had in terms of funding, policy, legislation, and decisions that are being made… I don't know if researchers realize this, but they have a massive influence in how that all gets processed. I didn't realize that myself, and I thought that policymakers had the biggest influence. But I now think that researchers have the biggest influence because funders won't give funding unless its evidence-based and the government won't act unless it's evidence-based and all that comes from researchers.

“For me, that is inspiring me to come back to study and become a researcher, especially as a First Nations person, and what influence I can do in the field that will make a better world for future generations of First Nations people in Australia. That has massively influenced me.

“I was also really inspired by the younger people over there. I was blown away by the passion they have. As an older person, the burden is really heavy, especially if you are a First Nations person, from whatever country you're from because of the impact that colonization has had on your people. There is a heavy burden that you carry; you want to see change happening, and you want to see the oppression stop.

“Seeing them and their passion made me realize that they're going to be rising up and they're going to be taking over where you leave off. It's not just about when you finish work, but it's about making sure you're mentoring them, and you're encouraging them and also that they are also encouraging you and mentoring you. It's not just about elders being right and having the power, but we're learning off one another.”


The Salzburg Global Seminar program, Halting the Childhood Obesity Epidemic: Identifying Decisive Interventions in Complex Systems, is part of our Health and Health Care Innovation multi-year series. This program is being held in partnership with the Robert Wood Johnson Foundation.

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