Dr Sue Goldstein visits Salzburg Global Seminar "Hooked on Health Care: Designing strategies for Better Health"

As a follow on of a meeting that was held in London about measuring Social and Behaviour Change I was invited to a “Salzburg Global Seminar” entitled “Hooked on Health Care: Designing strategies for Better Health.

It was funded by the Robert Wood Johnson Foundation and the Salzburg Global Seminar itself. It is unclear how the participants were selected – there were people from many different health services, from funding agencies, from numerous countries, from business and even an architect interested in creating healthy spaces.

The workshop was held in an old castle (Schloss) – a beautiful old building that originally built by a Bishop and then owned by a Jewish art collector before being taken over by the Nazis.

After the end of the war the house went back to the family who decided to use it for global understanding and dialogue.

The programme

The programme started at 4pm on the Saturday and the introductions, overview of what the next days would entail and words from funders etc. were held. We went on to 7pm and then were given a tour of the Schloss. I thought it rather clever to start in the late afternoon as it meant that one could really get down to work the next day.

The following days were a mixture of panel discussions and then engagement with the audience (us). The discussions were about why there is not more focus on health and only on health care. (i.e. why not health promotion).

What was really interesting was the reporting and documentation of the process. There was a woman there who (also a guest) wrote on huge pieces of paper as people talked but it wasn’t only writing she summarised, drew pictures etc. really clever and a brilliant summary. It might be a really useful technique for very visual people i.e those who don’t like reading.

Another interesting aspect was that every day the staff produced a newsletter about what happened the previous day. Very impressive it was always ready the next day.

There was a lot of tweeting.

A third method of interest was the knowledge café- this was in the evening event and despite my scepticism it really worked well. There were 6 tables set out with 6 hosts to lead a discussion about a particular issue. The discussions were limited to about 30 mins. The “audience” or participants were able to attend 3 of the stations and engage with experts about their subjects.

On day 3 we wrote cards on what was important to us and these were collated and developed into a number of working groups who had to then present to the larger group on day 5 (peer review).

These working groups had a set programme to follow.

The one I attended was about global health equity. In my group were a number of really interesting people including Juan Garay (a Spaniard who previously worked in Africa, then was head of EU health for a while, now works in Mexico); and David Chiriboga an Ecuadorian who was at one time minister of health there). They developed a method of measuring health equity which includes sustainability (i.e. carbon footprint). The book is launching in April. It was really fascinating and I would like to promote the concept and ideas in future.

On day 3 we took the afternoon off and walked into the town of Salzburg – and attended a short concert in Mozart’s birthplace on his own piano.


The food was excellent! The accommodation was fine – a bit overheated. It was really cold there with snow storms and the lake in the grounds of the castle froze while we were there (in the background of the picture below.

I was really privileged to be able to attend this event and found it really stimulating and interesting.

I am attaching the Programme and in appendix 1 there is a description of the different groups.


After five days of intensive debate and collaborative discussion around conceptualizing health outside of health care, how to move on from being hooked on health care, and the role of civil society, public authorities and health justice in health improvement, the Salzburg Global Seminar session Hooked on Health Care: Designing Strategies for Better Health concluded with Fellows in groups presenting their projects that hope to put their words into action.

The 61 Fellows, who represented 17 different countries, consisted of people from many different fields including nutrition, traditional medicine, maternal health, health care improvement and architectural design. They all came with the purpose of finding ways to turn the focus of health improvement away from health care and instead focusing on promoting healthy lives and healthy communities.

The first group proposed that an “Amnesty International for Health” was needed to help achieve health equity for all. The group remarked that current rise in health care is unsustainable and we needed to foster a community interest from civil society, social movements and aid from the business sector. The group hopes to raise awareness for these issues in a co-written editorial they aim to be published in medical journals and the mainstream press.

The second group addressed the use of social movements as leverage to promote health movements. They looked at other progressive social movements and hoped to use what they had learnt to network and spread health movements. “We can start now, so why wait? Let’s take all the knowledge we have and use it with help from our sponsors,” said a representative from the group.

The third group proposed the development of a Community Health Laboratory to find and improve research into other determinants of health by engaging with the community and community leaders. They proposed this approach as they claimed this was “the only way we can make definitive changes.” They also wanted to focus on progress rather than targets as funding was considered to be far too dependent on meeting targets.

A fourth group focused on investment strategies and how to better use all available capital to achieve sustainable population health goals. “We can’t focus and rely on philanthropy,” said one Fellow while discussing the barriers that are currently hindering investment. They suggested that previous experiments have been expensive and with limited scope; single goal, single idea, single backer. The idea proposed by the group involved issuing bond style investment opportunities in the hope of securitizing public health and commoditizing the outcomes needed to improve health.

Another group offered local strategies for engaging business in health initiatives for their local communities. The group rationalized the importance of engaging the business sector due to it being a key stakeholder in health and its importance for the sustainability of the health sector. Their proposals involved making sure effectiveness was contextualized to the local community, creating long-term working relationships and defining problems both facing the health sector and health issues within the business sectors. One Fellow will be testing the methodology from this group in Baltimore, MD, USA in the coming weeks.

A sixth group focused on a sustainable health equitycompass (SHE). They proposed using a new simple integrated benchmark based on low GDP but high life expectancy to address health equity. Their aim is to validate and apply accessible tools that measure the magnitude and trends of health inequity at international, national and local levels to help inform decision making. One Fellow summed up the ideology of the project by stating: “With this process we have to dig, to find the root cause of the root causes.” The Fellows intend to launch a website once they return to their home countries.

The seventh and final group focused on politics and how to speak “health” to power. In homage to their location at SchlossLeopoldskron and its ties to the Sound of Music, the group asked: "how do you solve a problem like health?" In response, they created a website called The Salzburg Method that offers a clear twelve-point plan, aimed at both those inside and outside governments at all levels who "want to move health up the agenda inside existing structures."

While many in the room were looking forward to moving their projects forward in their home contexts as they prepared to leave Salzburg, anyone who felt like the challenge was too big to tackle was inspired in the closing remarks by an African proverb: “If you think you're too small to make a difference, lock yourself in a room with a mosquito.”

Daily Summary

Hooked on Health Care - Day 4: Global case studies and the power of data

Fourth day of discussions center around diverse case studies and the role of Big Data.

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