Role of primary care and health professionals in community resilience Reflections from WHO Elke Jakubowski Programme Manager, Public Health WHO Regional Office for Europe 9 June 2015 SUMMER 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: Health professionals in the 21 st 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 "fragmented, static and outdated" "under-financed institutions".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): 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

Example 2: PC networking to combat drought

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 professionalism Institutional Joint planning Academic systems Networking Culture critical inquiry Enabling Actions 10 Reforms Align accreditation Strengthen global learning Enhance investments Mobilize leadership Goal Professional education for equity in health Goal Professional education for equity in health Source: Education of Health Professionals for the 21 st 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 DWt10Maf8 12. Apr Min. - Hochgeladen von TEDx Talks Professor Bas Bloem ) 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 GP District 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 GP District 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 Wins 0-5 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

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