Sustainable Health Systems means Democratizing Health

1. Sustainable Health Systems means Democratizing Health Ilona Kickbusch Careum Foundation, Zürich, Switzerland Brussels PiSCE conference 17.3.2017 Kickbusch Brussels 2017

2. We are at a turning point in health policy: the nature of 21st century health, changes in society and technology call for a radical change of mindset and a reorganization of how we govern health in the 21st century. This changes the role of the health sector, of the health professionals, of patients and of citizens – and of other sectors and societal actors including the private sector. We need intelligent systems for health with a focus on equity and participatory governance. The Turning point Kickbusch Brussels 2017

3. Health - what "Health is a precondition, outcome, and indicator of a sustainable society, and should be adopted as a universal value and shared social goal and political objective for all" (Oslo Lancet Report 2014) Kickbusch Brussels 2017

4. Health - where • Health is created at the local level in the settings of everyday life, in the neighbourhoods and communities where people of all ages live, love, work, shop and play. Kickbusch Brussels 2017

5. Sustainability -the goal: • Creating health in thecontext of everydaylife • A systembuilt for activecitizens and criticalconsumers • Supportingthemost vulnerable • A patientcentered health caresystem – chronicdisease • A systembuilt for active and empoweredpatients, theirfamilies and carers • Supportingthemost vulnerable Kickbusch Brussels 2017

6. Sustainable (health care) systems • Means designing systems with inherent “resilience” by taking advantage of fundamental properties such as diversity, efficiency, adaptability, and cohesion. Kickbusch Brussels 2017

7. Whole systems approach Kickbusch Brussels 2017

8. Sustainabilityonlypossiblethrough a patientcenteredsystem • The old way of governing health—sectoral, hierarchical, focused on cure, based on a medical paradigm—is no longer sufficient to address the new challenges, and has also reached its limits with regard to the organisation of the health care sector itself. • expansion of self governance for health: health literacy, empowerment, self management and monitoring, self reliance – powered by IT revolution Kickbusch Brussels 2017

9. Sustainability implies a power shift • Chronic disease + technology + patients will change the face of the health care system: co production • NCDs + citizens action will change the face of health promotion and prevention: co benefits for health VALUES System design SYSTEMS LITERACY Kickbusch Brussels 2017

10. At the centre: Patients – citizens • What we want as individual patients and how we articulate these needs can be distinguished from our collective aspirations as citizens or members of the public (Coulter 2005). • As citizens we may be concerned about abstract notions of what constitutes a ‘good’ service, for example: affordability; efficiency and value for money; universality, equity and fairness; safety and quality; health protection and disease prevention. • As patients, we do not lose our citizen concerns at the door of the GP surgery or the hospital, but we naturally prioritize our own interactions with the system, especially with the health professionals who deliver our care. Individual engagement includes concepts such as personalization and choice, • Collective engagement is concerned with strengthening the public voice, by encouraging democratic accountability and ensuring that the health system is responsive to people’s needs and preferences. (Coulter 2011) • HEALTH CITIZENSHIP – HEALTH LITERACY Kickbusch Brussels 2017

11. Rethink the system: learn from the IT Revolution • The user should not be learning the language of the device – the device must learn the language of the user. • Der Spiegel Nr.41/10.10.11 S 75 Kickbusch Brussels 2017

12. Sustainabilitymeansco-production of health HEALTH CITIZENSHIP Kickbusch Brussels 2017

13. Chronicdiseaseredefinesthemedicalhome +the expert • The health system supports the patient and her carers – starts with where people live, love, work and play ---- • Health promotion, prevention, integrated care, ambient assisted living, PCMH patient centered medical home are conceived as a system not as silos • The interface with other systems – social care – is a quality standard Kickbusch Brussels 2017

14. Diversity of care Kickbusch Brussels 2017

15. Co production: hassynergisticoutcomes • Increasedsatisficationwithservices • Promotessocialparticipation • Strengthenspoliticalengagement • Reducescoststhroughactiveparticipation • Improvesquality and outcomesthroughparticipation BUT:Participationrequiresstructures and competence (health literacy) Social inequalityreducesparticipationas well as health Kickbusch Brussels 2017

16. What must the health care system learn? • Provide opportunities for personal growth and development to people, so that they are treated as assets, not burdens on an overstretched system. • Invest in strategies that develop the emotional intelligence and capacity of local communities. • Use peer support networks instead of just professionals as the best means of transferring knowledge and capabilities. (NEF) Kickbusch Brussels 2017

17. Example: Ontario’sChronicDiseasePrevention and Management Framework • Health Care Organizations that make systematic efforts to improve prevention and management of chronic disease; • Delivery System Design that is focused on prevention and that improves access, continuity of care and flow through the system; • Provider Decision Supports that integrate evidence-based guidelines into daily practice; • Information Systems that enhance information for providers so they can provide quality care, that support individuals in managing their diseases, and that integrate services across the system; Kickbusch Brussels 2017

18. Example: Ontario’sChronicDiseasePrevention and Management Framework • Personal Skills and Self-Management Supports that empower individuals to build skills for healthy living and coping with disease; • Healthy Public Policies that improve individual and population health and address inequities; • Supportive Environments that remove barriers to healthy living and promote safe, enjoyable living and working conditions; • Community Action that encourages communities to increase control over issues affecting the health of their residents. Kickbusch Brussels 2017

19. Evidence • Kaiser Permanente USA adopted a series of systematicmeasures to addresschronicdisease, puttingpatients in thecenters and ensuringintegratedcare • Over a tenyearperioditachieved: • A heartdiseasemortality rate thatis 30% lowerthan in otherplans; • A 15% decrease in deathratesfromcongestiveheartfailurefrom 1996-2001; • A smoking rate of 12% among plan membersfrom northern Californiacompared to 18% for thestateas a whole (Kaiser Permanente). Kickbusch Brussels 2017

20. Health CO benefits • Active Urban transport: • Active travel, such as cycling and walking, and lower-emission motor vehicles could lead to substantial reductions in greenhouse gas emissions and the burden of chronic diseases. • In London, the strategies could reduce the disease burden from heart disease and stroke by 10-20%, breast cancer by 12-13%, dementia by 8% and depression by 5%. Kickbusch Brussels 2017

21. Sustainability – planetary health • The health of people can no longer be seen separate from the health of the planet and wealth measured along with parameters of growth will no longer ensure health. Kickbusch Brussels 2017

22. Final thoughts • Governance for health is not only about “governing better for results” in terms of outcome but also in normative terms of values and process. A health system is also a social system. • This implies the foundation in a human rights based approach including a commitment to health equity and the democratization of health. Kickbusch Brussels 2017

23. Sustainable development goals Kickbusch Brussels 2017