Interview with Dorli Kahr-Gottlieb, EHFG Secretary General

Dorli Kahr-Gottlieb, EHFG Secretary General

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European Health Forum Gastein (EHFG) – an annual leading health policy event that is now taking place for the 17th time. That is probably a long history for a conference. So during those years what were the major achievements and changes in the EHFG, how was it earlier and how is it now?

The EHFG started as a pioneer project between the European Commission, specifically the Commissioner for Health, the Austrian Ministry and the founding president Prof. Günther Leiner. The original idea was to bring main and high-level European stakeholders from different sectors together in the beautiful Gastein valley. It started out with a couple of hundred attendees and slowly developed to its current size of about 600 participants. The basic idea is still there – it should bring different stakeholders together, offer them a platform for exchange and for networking. Additionally, we are now trying to focus more on the content and dissemination of our results to decisive European bodies and on allowing all sectors and regions to participate (e.g. the NGO sector – by offering a low NGO fee and by offering a free-of-fee workshop slot in the conference; the South Eastern European region by a collaborative workshop with the SEEHN network). As one major achievement I see the fact that the Health Commissioners have taken part in the Forum every year with one exception only, and that many Ministers of Health regularly attend.

What do you personally like the most about the EHFG?

I very much enjoy working with many different people from different cultural and professional backgrounds. I am also very proud of the Young Forum Gastein network which in my opinion has developed into a European showcase project in health.

This year the central discussion is about where we are and where we will we go. Could you pick out or highlight one issue that, in your opinion, will be a key (word) in the near future?

In our discussions with many speakers and participants and members of our board and advisory committee and of course due also to the Ebola crisis, health security has become a term of great relevance and one which will likely accompany us for a while. The Commissioner elect has declared health security to be one of his priorities during his term. And, viewed in a very broad sense by looking at the security of health systems as a whole, a sense of security for citizens due to social cohesion, prevention & promotion, etc. Besides the straight-forward interpretation of protection against infectious diseases, it will surely be on the agenda of next year’s EHFG.

The EHFG is now characterised by the four pillars – politics and administration, business and industry, science and academia and civil society. Which of those pillars should undertake the leading role in changing health policy, what do you think?

I strongly believe in what has been discussed for 15 years or so and still has not been fully implemented – health in all sectors/policies. Therefore, I do not think that any one of the pillars should or could steer health policies on their own but that they should jointly shape the agenda.

What is the EU to you?

Ideally, the EU to me is a place of solidarity and one of possibilities and equal chances, a place where we have the chance to travel freely, where we live in democratic and diverse societies, where we have the chance to choose our place of living and working freely and where we have a union of solidarity that allows for equality and fairness. Clearly, we are not there yet but I strongly believe in these core values and the future of Europe.

You are always surrounded be famous and important people. What could you say about them, how would you characterise them, are they different, do they have some similarities?

That is very difficult to answer, Andrius! One “famous person” is different from another; most are very approachable and are faced with the same everyday joys and obstacles that any of us are. In Austria we have a saying that in the end “everyone needs water for cooking!”

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Dorli, you are EHFG Secretary General, before you were also organising the European Public Health Conference and before that working at the Graz Medical University. It seems that you could also have many tips for Young Gasteiners. Could you share those with us please?

 

You mean how to get into these kinds of positions? I think most of you, Young Gasteiners, have what it takes – dedication for your work, an openness for other people and other ideas, a willingness to work hard, and then, of course, it also takes some luck and knowing the right people – which is also provided by the networking possibilities for Young Gasteiners.

What is the funniest thing that happened to you while working and organising the EHFG?

The funniest (and nicest!) thing for me is always to see high-brow policy makers and serious researchers, Young and Old Gasteiners meeting on the dance floor after dinner, having a great time, enjoying the music and dancing.

Thank You, Dorli, and let´s keep on dancing!

Interview conducted by Andrius Kavaliunas (Young Forum Gastein 2014 scholar)

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Interview with Ilona Kickbusch

Ilona Kickbusch, Director, Graduate Institute of International and Development Studies

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Reflecting on the theme of this year’s European Health Forum Gastein: Electing Health – The Europe we want! do you think there is a consensus between the member states on what kind of Europe we want, thinking of both the internal dynamics and the external positions?

Well we know that there is no agreement between the European Union’s member states on what kind of European Union they want, their expectations being quite different, however in principle that is not a problem because if we consider the EU a democratic enterprise than that is an issue of negotiation. At the same time it’s a political risk the EU has to take, considering its historical role and responsibility to strengthen some countries that otherwise would be left alone. Also it is to be noted that through the application process countries are pushed towards rule of law and other things. Yes, there are definitely differences, the differences come out more when there is conflict and less money and that is the case now. And you have a difference between what the governments in these countries think about the EU and what their people want from the EU. The issue of elections comes into place here – what kind of governments do the people of Europe elect and what kind of EU parliamentarians do they vote for?

You mentioned during one of the sessions about the brokering role of health officials, do you think the current education curricula especially with respect to public health professionals, offers the necessary tools for producing such professionals?

No, not at all. I think that public health training is totally outdated. We have different kinds of public health and of course we still need the traditional epidemiologists, the food safety people but we also need another specialisation, a totally new breed of health professionals who are able to negotiate, be strategic and can play that brokering role with the other sectors. It could also be very attractive for a new type of public health student to learn those kind of things. At least in my teaching, students who do public policy or international relations and development  – that’s the thing that really excites them about health – that link to political negotiations and maneouvering. I have often said what we really need in public health is more political science, more policy knowledge, more economic thinking and more law.

Do you think that with regard to the elaboration of the Sustainable Development Goals – SDGs, the political determinants of health have been taken into account enough for this framework?

It’s interesting, it depends on what you consider as a political determinant - this notion hasn’t totally been defined. I think on the one hand it is very interesting that there is consideration of governance and of inequality. Governance is not a technocratic enterprise, it’s something that in principle is very political. So in a way all the goals are influenced by political determinants. Of course you only get climate change if certain political decisions are taken and then you need the famous political will. You also have to be aware about the differences in ideology because the most critical thing in respect to the political determinants is that they reflect different political positions. The question of whether there is an opportunity for debating the different political differences of opinions should also be raised. If you were to look at the list in the study of The Lancet in respect to the political determinants and you look at issues like trade, financial investments and others – I think that these major global issues should have been considered more than they have been. They have been part of the discussions, are partly there in a soft language but are not there in a strong enough expression.

Still for the SDGs, due to their broadness they will engage a lot of countries, if we think of inequalities that exist between and within countries do you think this could also be a platform for setting sub-national goals?

Well I think definitely inequality is set in the global agenda and it starts to become a thing that you measure. Increasingly for many of the things that we measure we have learned that the aggregate is not sufficient, that you need to look very carefully and that is why a new geography of health has developed. Again that is a political process but if other than just looking at poverty, if the SDGs were really to look at inequalities than I think that kind of thinking would lead to a boost at all levels of governance and people will start asking more questions.

There has been a lot of discussion about solidarity. If we agree that mass communication is the source of construction of meaning in the public mind, how do you think the communication process around Ebola has been taking place, do you think this opportunity has been used to foster the much mentioned paradigm shift towards global solidarity?

I think we are very much at the beginning there because if you think back to HIV/AIDS it took in that case a couple of years to really understand the problem and realise that it is not a problem of some men in San Francisco, that HIV/AIDS is a disease of poverty not of sex. Initially there was the solidarity in the gay community but to have that larger solidarity which in a way now is expressed through the Global Fund, through Unitaid, UNAIDS – that was a process of over 10 years. Now there have been expressions of solidarity around Ebola in terms of people giving money and volunteering – for example in Germany the Ministry of Defense issued a call and 3000 volunteers responded. So solidarity expresses itself in different ways. You often find a lot of solidarity when there is a humanitarian crisis in a situation when the general view is that „People have been unjustly hit by fate”- like the tsunami cases and now even with Ebola. This kind of humanitarianism always falls into an emergency charity model and I think that these awful crises should get us to think more seriously about a different type of solidarity that is more stable. Probably the first step is some kind of international solidarity in maintaining what the Secretary General has called the White Coat Force – to have a steady stream of money that is actually there and can be used straight away – to find the mechanism for how these funds should be raised. We need to find new ways to finance collective global action and particularly to help the weakest. I am always worried when people think that if you talk about health security it’s only about building a wall between us – the rich and the others. Actually health security is about helping the most vulnerable, because you can only be secure if you address the weakest link – that means that you have to help failed states, build systems and take other such measures and realise that if you don’t help people there it will come here.

What themes would you like to see addressed at the EHFG during the next edition?

I would like the next EHFG to look back at the first year of the new European Commission, to be built a little bit like a kind of accountability-monitoring session, both with the Commissioner and others. The Commissioner Designate also said that he wants to see more health in all policies, he’s been told by Mr. Juncker that one key issue is health security so Gastein could develop into a kind of accountability session and watch closely various issues including for example negotiations around TTIP. Also I think that Gastein should try to get some senior health and other ministers from some of the central European countries like France, Germany, UK for at least some plenary discussions. I find that it’s very good that there is a commitment from the Eastern European countries which wasn’t there some years ago. This would also help Gastein communicate to these delegates what kind of European Health Union we want without these differences in health across Europe. Europe also cannot look only inward at this point in time, it has to look outside. Next year the SDGs will have probably been approved so we definitely have to look at that, so the presence of a senior person of the UN would be welcomed. So there needs to be this inward-outward dialogue and through that to become more relevant. Also the Forum needs to be inclusive and make sure the things that are discussed here are disseminated to a wider audience.

This interview was conducted by Ioana Ghiga  (Young Forum Gastein 2014 Scholar)

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Here I am! This is me!

EHFG_KathiMy name is Katharina Nemluwil and I will support the EHFG-Team as a student assistant while finishing my master’s degree at the University of Applied Sciences in Salzburg. I’m currently studying MultiMediaArt-Master focusing on Management and Producing. Due to my deep interest in health policy, it’s a great pleasure for me to improve my organisational and analytical skills in this field.
“Healthy citizens are the greatest asset any country can have.”
This quotation of Winston S. Churchill absolutely represents the importance of a fundamental health policy in each country. Therefore, I’m very honoured to be part of an organisation that offers a platform to discuss European and global health issues.

I’m looking forward to broadening my professional horizon in such a vivid and pleasant working atmosphere and cannot wait to be part of the following European Health Forums in Bad Hofgastein.

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Interview with Dr Nedret Emiroglu

EmirogluThis is a recorded interview with Dr. Nedret Emiroglu, Deputy Director, Division of Communicable Diseases, Health Security and the Environment, and the Special Representative of the Regional Director on MDGs and Governance, WHO Regional Office for Europe

 

 

Interview conducted by Guido Maringhini (Young Forum Gastein 2014 scholar)

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Interview with Dominique Polton, Director General, CNAMTS

Dominique Polton, Economist, Advisor to the Director-General of CNAMTS, France

After managing the Strategy, Research and Statistics Division of the French National Health Insurance Fund (CNAMTS) from 2005 to 2013, Dominique Polton is now Advisor to the DirecPolton_F3, W6tor-General of CNAMTS. Before joining the NHI, she was Director of the Institute for Research and Documentation in Health Economics (IRDES), an independent institute delivering applied health economics and health services research, and before that Head of the Health Economics Department at the Social Security Division of the French Ministry of Health. Polton is trained as an economist and graduated from the ‘École Nationale de la Statistique et de l’Administration Économique’. Her main publications concern comparative studies of health systems and their regulation policies. She is a member of the French High Council for the Future of Health Insurance.

1. Related to the conference forum on care coordination that we have participated in, what characterises, according to you, ‘strong and effective primary health care’?
For me, primary health care would in the first place be a first line of care and a first point of contact for patients. Also, primary health care would organise the journey of patients and guide them through the health care system for the rest of their care and the rest of their needs. Another dimension of primary health care is that it should be locally rooted in order to enhance prevention and promotion at the local level. Especially this last aspect seems to be missing in quite a lot of health systems.

2. Which barriers and facilitators for ensuring continuity of care do you see?
An important barrier is that we cannot integrate everything. Even in countries with very well organised and locally integrated health care teams with nurses, physicians, physiotherapists and others, there are still a lot of professionals working outside this system. We always deal with people working in different environments, which bring along difficult transitions, like for example the one from leaving the hospital to going back home, or the transition between social and health care services. All these issues cannot be solved only by integration. There is a need for mechanisms of coordination, especially for patients with multimorbidity, elderly people etc. Also, one size doesn’t fit all. Not everybody should be taken care of in an integrated way. A high proportion of patients have one disease or they have a chronic disease that they can manage by themselves. For people with more complicated needs though, the system should be able to coordinate the care, in order for the patients to have the services they need at their disposal.
All countries have their own solutions. Some countries, for example, have very strong primary health care, with e.g. teams of health professionals working together, which facilitates the first step, but it doesn’t exempt them to create links with other institutions of care as well. Each country has to deal with its own health care landscape. In France, for example, we have a rather traditional model with important individual-care provider relationships, and a strong emphasis on free choice of provider and the freedom to circulate in the system. Team work in primary care is not very developed and there are still a lot of solo practices, as is the case in other countries, especially those with social insurance systems.

Several initiatives have been taken in France to improve the coordination of care across sectors. For instance, hospital discharge planners employed by the health insurance fund can plan the care and support needed by patients when they come back home, arranging for follow-up appointments or tests, home help, etc. in order to ensure a smooth transition. The programme has been developed for maternity first, it is currently extended to orthopaedic surgery and an experiment is conducted for cardiac failure – in this area there is clear empirical evidence that the follow-up after an acute episode can prevent future decompensations and hospitalisations. Another pilot programme is targeted at frail elderly persons, with a combination of illnesses and complex needs. It emphasises two levels of coordination. The first level is the clinical coordination where a team of e.g. a GP, nurse and pharmacist, and sometimes the home service, work together to design a health care plan. They discuss the care objectives and what should be done by every care professional. The second level of coordination consists of a platform which can help the GPs or nurses. The GP may ask the platform for other services, like care managers, services available in the environment of the patient, geriatric expertise, etc. Finally, I don’t know if there are really right incentives to improve care coordination, I think it depends on what you want to achieve in a pragmatic way. In France, for example, the registration of the population with a GP allowed us to give the responsibility to the GP to take care not only of the patients coming to their practice, but also for the wider population who registered with them. Also, the registration allowed us to give feedback to the GPs on the quality of the care provided to the population they serve, and to introduce financial incentives linked with the quality of care.

3. In your opinion, in which way can the EU help countries in strengthening their primary health care?
I work more in a national system, I am not an expert in the EU, but I believe a lot in intelligent benchmarking. I think it is becoming more and more realised, but it needs to be reinforced even more. For instance, all EU countries have a lot of health data at their disposal, which we should share. I think there are many areas where we can still benefit much from benchmarking, like for questions about how patient journeys are organised in different countries, or how some countries manage to be more efficient than others. We should get more details in terms of what countries are doing and benefit from collective sharing. I believe the EU should promote that.

4. As an economist, what was (is) your main motivation to work in the health sector and how do you experience it?
During my training, I knew that I wanted to work in the public sector. I just happened to start in the health sector and I kept on specialising myself in this sector. For me, it is an extremely rich sector, because of the fundamental topic, it touches the health of the population which is crucial in itself. I love working with physicians and health care professionals, I think that our intelligence is really increasing when we work together across different backgrounds. For example, we had a big reform in our organisation some 10 years ago. Before that, we had physicians working on one side and administrative personnel on the other side. During the reform, it was decided to mix everybody’s expertise. Since then, it is amazing what we have been able to do. Finally, I think economists are valuable in the health area. We are not only thinking about the money, but also about values, and equity for example as cost-efficiency and value-efficiency. I think it is a wonderful domain to work in.

5. Is it your first time at the European Health Forum Gastein? What are your impressions and what do you perceive as its added value?
I understand that the Forum is a place where there is a lot of debate. This is very different from other conferences that I have attended, where it is more about presentations. The interactive form of the session on care coordination, for example by asking questions to the audience and inviting all attendees to vote, brought along interesting results and discussions. I think this is a very interesting way of organising conferences and brings along very lively discussions which it is worth travelling for so long to participate in.

Thank You for your time!

Interview by Lies Lammens & Magda Filonowicz (Young Forum Gastein 2014 scholars)

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