Improving Policy for a Positive Impact on Global Health Marie Lindquist

What is health? “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (WHO)

The vision for global health Well-being for all

How can policy influence well-being Some definitions Policy a plan, course or principle of action adopted or proposed by an organisation or individual intended to guide, influence and determine decisions, actions, and other matters Health policy (WHO) Health policy refers to decisions, plans, and actions that are undertaken to achieve specific health care goals within a society.

To improve global health Policy must address all factors causing or influencing the ability of all people to achieve a state of well-being

There are many causes of disease Environmental pollution Lack of (clean) water Poor quality food Insufficient food Overcrowding Poor sanitation Poor housing Stress Poverty Violence Unsafe work Poor infrastructure Lack of health services Parasites Bacteria Viruses Fungi Infectious diseases Injuries Poisoning Malformations Immune disorders Metabolic problems Degenerative disease Social, economical and environmental causes Non-communicable diseases

To achieve the goal of well-being we need to move absence of disease reasons for feeling well

Body versus mind Well-being is a state of mind is measured subjectively

Improved policies for global health must define not only objectively measurable goals but also goals based on people’s perceptions and aspirations

To be effective Policies should be drivers of positive result needs-based evidence-based

The role of science Knowledge Information Data Enabling evidence based and wise decisions that improve well-being

Collecting and managing data (which needs transformation to be useful) The role of science Enabling evidence based and wise decisions that improve well-being Generating new knowledge through analysis, interpretation and communication Organising and providing information that is meaningful, valuable and relevant Collecting and managing data (which needs transformation to be useful)

Science is evolving we don’t always have the evidence we need most decisions are based on some level of uncertainty

Overlapping evidence ?? Knowledge Information Data ?? Knowledge

Overlapping evidence ?? Knowledge Information Data ?? Knowledge !!

Conflicting evidence ?? ?? ?? Knowledge Knowledge Information Data ?? Knowledge Information Data ??

Good intentions ≠ good result ART rollout in Africa Female patients got lactic acidosis and died People in rural areas who developed peripheral neuropathy could not walk to clinic – died of AIDS NNRTI resistance mutations are commonly observed in both mothers and infants after single- dose nevirapine

Old wisdom? prudence or wisdom in the management of affairs Dost thou not know, my son, with how little wisdom the world is governed (Axel Oxenstjerna, Swedish statesman 1583–1654)

Science within society

Policy must take into account infrastructure for delivery, monitoring and follow up of interventions cultural beliefs and behaviours influencing treatment success

Framework Political will Legislation Resources Governance

Fail fast – learn fast – improve fast Evolving evidence requires responsive and flexible approach Agile principles Fail fast – learn fast – improve fast

Fail fast – learn fast – improve fast Evolving evidence requires responsive and flexible approach Agile principles Active, incremental work involving all stakeholders from the beginning, with frequent but efficient reviews so that any errors can be corrected as we go along, achieving the intended result and avoiding blame at the end Fail fast – learn fast – improve fast

Quality management principles Learning systems Quality management principles Quality Management Quality planning assurance improvement control

Building a no-blame culture The human factor Having real dialogue Good communication skills/practices Trust and good will Transparency Really putting people first Building a no-blame culture Integrity of science/scientists Accepting mistakes

Sustainable development

The Lagom principle

Summary Look closely Think broadly Act boldly Look after