Confronting the challenges of today – and tomorrow

So were the questions posed to the 17 experts gathered in Salzburg, Austria for the inaugural meeting of Sciana, the Health Leaders Network. Two years in the making, Sciana is a groundbreaking international initiative, bringing together health care leaders from the UK, Germany, and Switzerland to address challenges and improve health and health care across Europe and beyond.  The initial cohort were welcomed to Schloss Leopoldskron, Salzburg by representatives from the three organizing partners, the Health Foundation (UK), Careum Stiftung (Switzerland) and the Robert Bosch Stiftung (Germany), as well as facilitator, Salzburg Global Seminar. Speakers on the opening day included Don Berwick, President Emeritus, Institute for Healthcare Improvement and Fiona Godlee, Editor-in-Chief at the BMJ via video-link, and Sir Harry Burns, Professor of Global Health, University of Strathclyde, and former Chief Medical Officer of Scotland, Ilona Kickbusch, Director of the Global Health Centre, Graduate Institute of International and Development Studies in Geneva, and Heyo Kroemer, Chair of the Managing Board of the University Medical Center Göttingen in Germany. Burns, Kickbusch and Kroemer have been selected as “Senior Ambassadors” of the Sciana Network and will continue to share their knowledge and expertise with the network throughout the four-day meeting. Major shifts in demographics, patient engagement, wider adoption of technology and big data, and continuing disparity in income inequality (see interview with Kickbusch) were all highlighted as key challenges facing the health care sector today and likely to increase over the next 20 years. Ageing populations mean not only are there fewer workers to pay taxes to support the welfare state and health care systems of the three participating countries, but also increasing number of users of these social and health systems. These older patients also often have more complex conditions and co-morbidities, with one speaker singling out dementia as one of the greatest challenges that the health care sector will face in the coming decades. The growing prevelence of self-care, especially assisted by mobile apps and information found online, was also highlighted as a growing trend. Many patients consider themselves experts in their conditions, which can put them at odds with their clinicians. We need a move from “eminence-based medicine to evidence-based medicine,” remarked one Sciana member. Patient empowerment and engagement in shared decision making requires that patients are well-informed. This means greater transparency and less complexity. Health illiteracy and misinformation is not confined to lower income communities, as demonstrated by measles outbreaks in affluent areas thanks to the growing “anti-vax” movement. How can we be sure that our patients are recieving the right information? The mindsets of clinicians need to be changes, along with the expectations and understanding of patients.  Technological advances, such as genome mapping, generate vast amounts of data, but how do we use and store this data best? Data protection laws may need to be reconsidered. One German participant asked if data protection had perhaps gone too far, with patients’ rights groups in the country complaining that “you are protecting us from ourselves” by hindering patients’ access to their own medical data. Much of this data, however, is owned by private IT firms and not the state – how can we ensure access to this data? “Medical records belong to the patient not the system. The system can borrow this information from the patient,” remarked one speaker.  Over the course of the next three days, this first cohort of Sciana members will confront these challenges, and more, as they share successes – and failures – in their own countries, consider the similiarities and differences of each country’s systems, and ultimately seek solutions. Read more in the daily newsletter (PDF)