From the editor
The holidays are over (well, for most of us)! In the April Newsletter editorial, we acknowledged the debt we owed to Sean Conlan who had just resigned as Director and Trustee, and we were faced with the task of finding someone to take his place. We’re delighted to confirm that Dr Sara Burke, Associate Professor in Health Policy, Centre for Health Policy & Management, Trinity College Dublin has stepped into the role. We very much look forward to sharing her expertise to further the aims and vision of EHFF. Her bio can be found here: https://www.tcd.ie/medicine/staff/burkes17/
In this edition as previously promised, we offer four thought pieces from members of the EHFF Advisory group, based on activity they shared with us at the EHFF AGM and strategy meeting six months ago. We’re very excited about what these folk are doing, as it demonstrates that we have EHFF members who are ‘walking the talk’ in the arena of health system transformation. Its also timely to share this, as in about a month’s time we’ll all be meeting, for the first time since the pandemic, face to face. We’ll be in London for the second of the 2022 EHFF strategy meetings as advised in our July mid-summer newsflash.
Professor Michael Bewick, as his bio on the website describes, was Deputy Medical Director of the UK’s NHS England management structure and now is an independent consultant. His piece describes the work he’s been doing with one of the more innovative UK Medical Schools to promote learning in digital skills, an essential part of the toolkit for health professionals today.
Professor Daniel Steenstra had trained as a medical Doctor, then moved sideways to become a design engineer in the automotive industry and when we first met him was Royal Society of Engineering Professor of Medical Innovation at Cranfield University. Now freelance, Daniel sketches out his role at OnKai, a US start-up dedicated to improving access to healthcare through use of AI.
Another Advisory group member is Kristine Sørensen, PhD, who is the Founder of the Global Health Literacy Academy and President, International Health Literacy Association. Kristine, as well as a world leader in the field of Health Literacy is a champion for the European Health Union and in her piece explains the rationale behind this important initiative.
Lastly, Matthijs Zwier, based in Utrecht, the Netherlands, is a health entrepreneur, long-time associate Director of EHFF and describes the important work he’s been doing with local community services in facilitating cohesion and community empowerment in the Utrecht Health Pact project.
This is quite a sizeable Newsletter but hopefully will offer a long read that provides plenty of food for thought.
David Somekh EHFF Director
Mike Bewick. Digital Health: a pragmatic course to support practical solutions in health and social care.
Since 2018 I have been involved with one of the new medical schools in the UK, The University of Central Lancashire, who’s focused on local and international recruitment. Setting up a satellite campus in a remote deprived area on the coast of the Lake District required a different approach to medical education. The small local District General Hospital did not have the resources for the formal teaching programme of existing schools. As a result, the university, along with the local health economy, recognised the need for digital solutions to improve access to education and health care. The initial approach was to set up a Faculty of Remote and Rural Medicine.
As part of this development, I was asked to develop a postgraduate course in digital health, looking at the broadest aspects of how new technologies, data management and personalised care could impact on improved access and the quality of care. The course was developed in 2019, but because of the coronavirus pandemic was rapidly revised to include the significant learning during the various lockdowns with the consequential restrictions in accessing traditional forms of healthcare.
This has been an exciting and challenging project. While the course is aimed at a master’s level, students can opt for diploma or certificate level of attainment. One of the strengths has been to access ‘real world evidence’ from subject matter experts which has given both the necessary core knowledge and a challenge to traditional medical models of healthcare. The modules aim to cover practical aspects in the workplace including robotics, ‘big data’ applied to population health, AI/machine learning, Tele Health, wearables/self-care, smart pharma, implantable technologies, and augmented reality.
A theme throughout has been to set a challenge on the ethical dilemmas that present and to avoid the inevitable expansion of the inequalities gap without due regard to implementation and how this risk can be mitigated. We have had great contributions from service users, not always flattering, about how the NHS and wider care systems are utilising technologies. We have also had excellent examples of where new technologies have improved access to care and the safe delivery of that care.
The take home message is of digital healthcare supplementing and supporting the existing workforce, with the prospect of autonomous systems replacing both the mundane aspects of care and enhancing the personal care of many with complex needs.
Daniel Steenstra: using AI to improve access to healthcare
At the start of the COVID19 pandemic two EHHF members, Dr Charlyn Belluzzo and Prof Daniel Steenstra, joined forces with other experts to found OnKai Inc. Collectively they have experience in artificial Intelligence, blockchain, complex digital systems, design management, entrepreneurship, healthcare delivery, innovation, military intelligence, management of complex multi-stakeholder projects and in public health. Since then, others with skills in healthcare data, policy, pharmaceutical development and user-interface design joined the team.
The team’s ambitious vision is enabling equitable and effective healthcare, with an initial focus on underserved communities in the US. Their ‘HelloKai’ smart grid is the first AI-based platform for all stakeholders, that bridges the gaps in healthcare by aligning health care professionals with foundations, researchers, service providers and more to achieve better outcomes for their communities. Using disruptive innovation and co-design principles, the initial focus is the US where a large portion of society do not have access to healthcare. Specifically, ethnically and racially diverse populations are ‘underserved’; besides lacking access to healthcare they are also excluded from participating in clinical trials.
So far, the team developed and validated the Artificial Intelligence platform in collaboration with wide variety of large partners – from research to clinic application. For example: Burroughs Wellcome Fund, sister organization to London-based Wellcome Trust, a $800M endowment non-for-profit fund, through which healthcare researchers are active on the grid to make sure their projects are relevant and that their findings can be applied.
The current focus is on supporting the local healthcare professionals in underserved communities. The team is starting to work with local clinics and associations in several states. On ‘HelloKai’ smart grid these healthcare stakeholders can gain knowledge, resources and connect to others to collaborate towards effective solutions.
COVID exposed the consequences of lack of diversity in clinical trials as racially and ethnically diverse people had unpredicted reactions to vaccines and medication. The FDA in the US since issued a directive for participants in clinical trials to represent more accurately the targeted patient population. This is very challenging for pharma companies to achieve using their centralised model of drug development. Diverse people might have to travel far, lack in support at home and in insurance for unrelated conditions. Also, they are not familiar with and lack confidence in the pharma sector. These significant challenges are difficult to overcome and will result in poor recruitment and retention. OnKai’s smart grid offers a new indirect approach: underserved people and communities are more likely to trust their local healthcare professionals and clinics. OnKai enables healthcare professionals and clinics to develop expertise and capacity. It uses AI to connect stakeholders; they can collaborate with their peers and others to share knowledge or develop solutions for delivering better healthcare. The grid will simultaneously enable healthcare professionals and clinics who want to take part in clinical trials to acquire capabilities to become investigators and trial sites. Thus, underserved communities will engage in clinical trials, forming a decentralized network of diverse nodes that is complementary to the existing centralised system of hub & spokes.
The grid technology will increase diversity by providing better healthcare and building clinical trial capabilities in underserved communities. This will be a win-win for all: to meet the FDA requirements for market authorization; accelerate and improve efficacy of new medicines and improve health of underserved communities. After the grid is more firmly established in the US, the company aspires to expand to other territories including Europe.
Kristine Sorensen: Championing the European Health Union
Championing the European Health Union means advocating for the need to build a Europe where all people are as healthy as they can be throughout their lives. A manifesto describes the vision and political goals, and all are welcome to sign the manifesto as a pledge of support. The initiative is facilitated by the European Health Forum Gastein and the Robert Bosch Foundation in partnership with a wide range of organizations pursuing the same ambition.
In 2020, an invisible virus swept through Europe, leaving hundreds of thousands dead and many others with severe disability. Economic activity has crashed, forcing governments to intervene in ways that would have been unimaginable. This will not be the last pandemic. There will also be many other threats to health, including the effects of climate change, antimicrobial resistance, and much else. We cannot continue with life as before. We have to safeguard our societies but in ways that are proportionate to the dangers which threaten them. We must welcome the clear statement by the European Commission President Dr Ursula von der Leyen in her September 2020 “State of the Union” address, setting out the necessity to create a stronger European Health Union (EHU), building on recent efforts by the European Commission to take action on cross border health threats.
The governments of the European Union’s Member States, in successive Treaties, have committed to a high level of human health protection. In the Charter of Fundamental Rights, they have committed to humanity, dignity, and solidarity. In the Sustainable Development Goals, they have committed to a sustainable future for all. They are also all committed, as members, to the Constitution of the World Health Organization. However, these safeguards for health are not, on their own, sufficient. As European Health Union champions we, therefore, call on our political leaders, meeting together in the European Council and the Conference on the Future of Europe, to take the next step, to commit to creating a European Health Union.
The European Health Union is not shaped by political will alone. The manifesto will only have impact if we upskill and orient ourselves towards a different future. A future that is people-centered and built on dignity. Use your voice, vote and competencies to help us pave the way.
More information can be found here: https://europeanhealthunion.eu/
Matthijs Zwier: Health Pact Utrecht: Co-creating health with ‘magic dust’
Where does this happen? Utrecht is the fourth largest city in the Netherlands, a fast-growing historical city in the centre of the Netherlands, currently Utrecht celebrates its 900 year anniversary. Currently, there are roughly 360.000 Utrechters. The city will grow continuously and will reach over 400.000 citizens by the year 2028. This means they will encounter a lot of challenges, also regarding public health. Thinking about these challenges we are proud that Utrecht decided to choose ‘Healthy Urban Living for Everyone’ as its main focus, more than a decade ago. This becomes visible on many different levels. In Utrecht we look at health from a positive and broad perspective, we are aiming towards ‘health in all policies’, ‘health equity’ in all policies and we work on themes as poverty and behaviour to make this city a healthy city for everyone. To achieve all these ambitions, we collaborate and co-create with citizens, professionals, experts, local, regional and national organisations and initiatives. In the city we are building a broad dynamic network, a coalition of the willing called ‘the Health Pact Utrecht’ where everybody who wants to make a contribution to ‘Healthy Urban Living for Everyone’ is welcome. Main goal is to make use the growth of the city as a healthy and inclusive growth, in a participative, multi-level governance approach. The Health Pact Utrecht is illustrative for Utrecht’s ambitions.
Why do we need a bit of magic?
In Utrecht there are many health and well-being initiatives and programmes started by citizens, professionals and their organisations, municipality and local entrepreneurs. However, gaps are seen as well; in reaching specific groups of citizens and in missing linkages between initiatives and/or organizations. Impact can be increased once knowledge, expertise and initiatives are co-created and combined. The Health Pact Utrecht organises and facilitates this process, by providing a platform for individuals and networks. Specifically focussing on experience knowledge and the perspective of citizens, and linking this specific knowledge with, professionals, entrepreneurs, initiators and researchers. To ‘combine’ those totally different perspectives (political, public, private and privately) we need a bit of magic. The collaboration and relations in the network are based on five general beliefs:
- We will achieve more together;
- Every contribution counts;
- We connect to what is already present;
- We look at what is possible;
- Laughter is healthy.
The municipality of Utrecht is one of the many partners of the Utrecht Health Pact. As stated before, every organisation and/or individual in Utrecht, that wants to contribute to health is welcome to join the network. As of now we have 27 partners in the network. The goal is to inspire each other, work together and learn from each other in the field of health and wellbeing. The network was launched back in 2019 with a big fe4stival called ‘the Healthy Ideas Festival’. During this Festival we brought together 15 initiatives from different backgrounds and over 20 ‘orange-crate pitchers’, people and organisations that pitched their ideas!
The role that the municipality of Utrecht takes was chosen deliberately. They operate as a ‘participating government’ which is based on guiding principles as: do not take the lead, do not focus on project results and do not impose how to work on health or wellbeing. Instead, be responsive and connect with what is already happening in the city and we facilitate and support existing energy, activities and initiatives.
The core team of the Health Pact Utrecht consist of a hand full of enthusiastic and energetic people. We take an active role in driving the network. We do this by building relations, share stories and organizing surprising encounters and events. In reality this means drinking lots of coffee with as many people in the city as possible. In other words, to build a network you have to be the network. Being a resident of Utrecht besides the ‘professional’ role is a huge advantage in the ‘knowledge’ of the city. The ‘agenda’ is therefore based on the urgencies that are seen and felt in the city. In this way we connect people, organisations, knowledge and initiatives based on the ‘real’ challenges that the city is facing.
All this calls for a modest role as a government. It is a lesson in letting go and giving (back) trust, changing ownership and allowing additional perspectives. We do this from the conviction that this stimulates people and organisations to take action and contribute to Utrecht’s challenges on public health.
This way of working is appreciated by our partners in the city and leads to great results. The basic method or way of working within the Health Pact Utrecht can be described in the following four principles:
- We aim for a (prevention) movement and thereby create team awareness in the city for the challenge ‘Healthy urban living for everybody!’
- Co-creation in equal cooperation with the city.
- Facilitate a breeding ground for cooperation and initiative on health and wellbeing.
- It is not about citizen participation: it is about government participation.
Sprinkling the magic dust
The Health Pact is an extra impulse for Utrecht’s movement towards Healthy Urban Living for Everyone. A lot is already happening in the field of health and wellbeing in Utrecht, there are wonderful initiatives and projects executed by citizens, professionals and their organizations and entrepreneurs. The Utrecht Health Pact offers a dynamic and growing network for the city. There is still much to gain if we combine initiatives, knowledge, skills and strengths. And thus, to enlarge the impact on health and wellbeing in this city, together. Citizens, professionals, volunteers, initiators, entrepreneurs, municipality, organizations, authorities: everybody contributes!