Role of primary care Role of primary care and health and health

professionals in professionals in community community resilience resilience

Reflections from WHOReflections from WHO

Elke JakubowskiProgramme Manager, Public Health

WHO Regional Office for Europe

9 June 2015SUMMER SCHOOL SLOVENIA

“The health of the unity is the health of the community.(…)Combination is the antidote, combined interests, recreation, combination to secure the best air, the best food and all that makes life useful, healthy and happy.(…)

May we hope that the day will come when every mother will become a health care nurse, when every poor sick person will have the opportunity of a share in a district sick nurse at home!(…)”

Florence’s wisdom on community health

And a more recent personal experience related to resilience

Presentation covering

• Challenges to community health • Case examples of strategies

• A 5 point change agenda towards community resilience

By 2050 …

• Life expectancy is close to 90 years;

• One third of Europeans are over 65 years;

• 4 out of 5 people live in cities;

• Net migration differs dramatically between countries;

• Cardiovascular mortality continues to fall;

• Cancer incidence has increased by 30 per cent;

• Premature digestive and liver disease mortality remains high

• Global warming and extreme weather events increase further

Harder times ahead for communities

• Rapidly ageing populations

• Migration favouring the cities

• De-population in rural communities

• Over-populations in metropolitan regions

• Decreasing number of jobs in local communities

• Decreasing qualified employees

• Diminishing capital

• Infrastructure deterioration in rural communities

• On-going health challenges (risk behaviour, climate change)

“a slow-burning crisis is emerging”…

Julio Frenk Lincoln Chen

and 17 Commissioners Lancet 2010; 376: 1923-58

Health professionals in the 21st century

• "the current medical training model, which annually consumes about 100 billion USD per year worldwide, no longer works".

• "fragmented, static and outdated"

• "under-financed institutions".

– The Lancet 376(9756): 1923-1958. 2010

The stake of professional education

• Mismatch of competencies to needs

• Professional silos and weak teamwork

• Gender stratification

• Hospital dominance over primary care

• Primary care not well integrated with public health

• Labour market imbalances

• Weak leadership for population health and health system performance Abraham Flexner

Health professionals fit for purpose?

Presentation covering

• Challenges to community health • Three case examples of strategies

• A 5 point change agenda towards community resilience

Example 1: Teaming up for a good start in life

http://www.fruehehilfen.de/

Example 2: PC networking to combat drought

www.health.vic.gov.au

Example 3: A mega community in Auerberg

• Unification of 14 communes into one alliance community with 30,000 people

• Mayor: “Everybody can polish her church tower but has to widen the outlook beyond it”

• Development of a joint tourism concept

• Attracting new citizens through selling attractive and subsidised land for new homes to young families

• Establishment of three inter-generation houses operated through volunteers

Presentation covering

• Challenges to community health • Three case examples of strategies

• An 5 point change agenda towards community resilience

A 5 point agenda for change

1. Transforming professional education

2. Transforming training and practice

3. Transforming health services

4. Transforming funding

5. Strengthening community interventions

Knowing where to go, what to do

Transforming health professional education

Instructional• Competency-driven• Local-Global• Inter + trans-professional• IT empowered• Educational resources• New professionalismInstitutional• Joint planning• Academic systems• Networking• Culture critical inquiry

EnablingActions

10 Reforms

• Align accreditation

• Strengthen global learning

• Enhance investments

• Mobilize leadershipGoal

Professional education for

equity in health

Goal

Professional education for

equity in health

Source: Education of Health Professionals for the 21st century: A Global Independent Commission, 2010

Transforming training and practice

Working differently with different disciplines

At workplaces: everybody is important, rethink hierarchies

When facing shortages: Can we substitute? Use telemedicine solutions?

The importance of postgraduate inter-disciplinary education, training and practice

Transforming practice

Understanding, engaging and empowering patients and people

► 11:11 www.youtube.com/watch?v=LnDWt10Maf812. Apr. 2011 - 11 Min. - Hochgeladen von TEDx TalksProfessor Bas Bloem ( @basbloem ) is a consultant neurologist at the Department of ...

From god to guide

Source: Adapted from National Voices (2013); WHO (2015)

Malcolm

& Barbara

Live-in carers

Dementia specialist

Out-of-hours

doctor

Alzheimer’s social outreach worker

Social worker

Oxygen service

Wheelchair service

Physiotherapist

Equipment service

Occupational therapist

Community dentist

Dietician

Speech & language advisor

Continence adviser

GPDistrict nurse

Consultant

Transforming services: from provider driven …

Source: Adapted from National Voices (2013); WHO (2015)

Malcolm

& Barbara Live-in carers

Dementia specialist

Out-of-hours

doctor

Alzheimer’s social outreach worker

Social worker

Oxygen service

Wheelchair service

Physiotherapist

Equipment service

Occupational therapist

Community dentist

Dietician

Consultant

Speech & language advisor

Continence adviser

GPDistrict nurse

People-centred health services

delivery

Coordinated

Continuous

Endowed with rights and

responsibilities

Led by whole systems thinking

Evidence-informed

Shared accountability

Empowering

Goal-oriented Holistic Ethical

Respectful

Collaborative

Co-produced

Comprehensive

Equitable

Sustainable

Preventive

… to people centred

Transforming funding

Strengthening community interventions

Intervention Focus

Quick Wins0-5 years

Longer Term Gains- Over five years

Resilience • Violence prevention

• Prevention of Post natal depression• • Family support projects

• Bullying prevention

• Mental health in the workplace

• Psychosocial groups for older people

• Parenting programmes

• Depression prevention

• Pre-school programmes

• Prevention of conduct disorder

• Multi-systemic therapy for juvenille offenders

• Detection and care for intimate partner violence

Your experience?