Università di Padova!

Master in Comunicazione delle Scienze!Padua, 31 July 2015

Communication skills and tools in the field of Health Determinants, Health Promotion and Reduction of Health Inequities

Dr Erio Ziglio!Former Head!

European Office for Investment for Health and Development!World Health Organization, Regional Office for Europe!

!Guest Lecturer!MCI, Innsbruck

Leading for change

!! (Blind man)!!https://www.youtube.com/watch?v=Hzgzim5m7oU#action=share

Lessons, Skills, Tools

Challenges

Outline of this Lecture/workshop

Context

Padova 2015

A fast changing world

A fast changing Europe….

A Changing Climate

Source: Climate Change 2007: The Physical Science Basis http://www.ipcc.ch/pdf/assessment-report/ar4/wg1/ar4-wg1-chapter10.pdf

An Urban Planet

Source: World Urbanisation Prospects | 2005 Revision http://www.un.org/esa/population/publications/WUP2005/2005wup.htm

More People Aged 65+ than Under 5

% o

f Glo

bal P

opul

atio

n

0%

4%

8%

11%

15%

1950 1960 1970 1980 1990 2000 2010

Data Source: !

UN, Department of Economic and Social Affairs - Population Division, World Population Prospects: The 2008 Revision, Estimates, 1950-2010. Low-fertility variant, 2010-2050http://esa.un.org/unpd/wpp2008/peps_population-by-age-and-sex_5x1.htm

The WHO European Region is composed of 53 Member States

Health is not equally distributed in Europe...

!6–8 years difference (with picks up to 30–35)

Milan

Moscow

Padua

Lisbon

Just a map....?

Challenges

Lessons, Skill, Tools

Context

WHO Member States

The Venice Office has two main functions:

1. To monitor, review and systematize the policy implications of emerging research findings on the social and economic determinants of health.!

!2. To provide a set of services to increase the European

capacity to promote population health and reduce health inequities.

Determinants of Health

Population Health

Social Economic

EnvironmentalGenetic

Health System

Determinants of Health

Population Health

Social Economic

EnvironmentalGenetic

Health System

Health 2020 and its scientific backing

Challenge 1: Address the cause of the cause

What good does it do to treat people’s illnesses, and then send them back to the conditions that made them sick?

Challenge 2: Health is more than health care

Health is created…

…where people live, work and play

Challenge 3: Social Determinants of Health

“…where people are born, play, grow and age”

Challenge 4: Health Inequities

“…systematic differences in health status between different socioeconomic groups. !

These inequities are socially produced (and therefore modifiable) and unfair”.

Source: Whitehead M, Dahlgren G. Levelling up (part 1): a discussion paper on concepts and principles for tackling social inequities in health. Copenhagen, WHO Regional Office for Europe, 2007!

Norwegian Ministry of Health, 2007

Challenge 5: Social Gradient

Source: Spanish Min of Health/Comunidad Gitana (2009) Hacia la Equidad en Salud!

http://www.gitanos.org/upload/86/09/Diptico_MSanidad_FSG.pdf

Source: Spanish Min of Health/Comunidad Gitana (2009)

% People never used dental care services

Source: Spanish Min of Health/Comunidad Gitana (2009)

% Health problems, 35-54 years old male

Challenge 5. Health is more than drugs and prescriptions…

Of some icebergs we know the exact dimension, when, how, what, etc… of others we barely see their tip

Social construction of health

Disease!!

!

Illness!!

!

Sickness

Health and Illness Behaviour

Lets start with your experience....

Health and Illness Behaviour

Lets start with your experience....

•Type of symptoms ! (+ cultural variation)!!•Personal knowledge!!•Lay referreal systems!!•Access to health services! (+ personel +cost)!!•Past experience!!

DECISION

DECISION

DECISION

Factors influencing illness behaviour 1. Visibility and of signs and symptoms!

2. Perception of seriousness of symptoms!

3. Extent to which symptom disrup family, work, etc!

4. Frequency, persistence and frequency of recurrence!

5. Tollerance threshold (affected individual and other..)!

6. Available information +cultural assumptions!

7. Basic needs that lead to denial!

8. Needs competing with illness responses!

9. Competing interpretation assigned to symptoms!

10. Treatment AAA + cost of taking actionSource: D. Mechanic (1978) Medical Sociology, New York: Free Press

Models of Doctor-Patient communication

Lets start with your experience....

Models of Doctor-Patient

Coma!!Infectious!!NCD and degenerative !!Future

Challenge 6: Bridge different worlds....

Risk conditions

Health status

Psychosocial risk factors

Behavioural risk factors

Physiological risk factors

1.Poverty!2.Low education/occupational status!3.Dangerous, polluted environment!4.Discrimination!5.Low political and economic power!6.Large gaps in income!7.Poor housing inadequate access to! cheap, healthy food

1.Hypertension!2.Hypercholesterolemia!3.Compromised immune system!4.Genetic factors

1.Smoking!2.Poor diet!3.No exercise!4.alcohol

1.Isolation!2.Lack of social support!3.Low self-esteem !4.Self-blame!5.Low perceived power and control!6.hopelessness

Source: Labonte 1993, adapted by E. Ziglio

Challenge 7. The “Social Immune System…

!

!!!!!!!!!

Source: http://www.cancertruth.net/the-immune-sytem-our-first-line-of-defense/

Lessons, Skills, Tools

Context

Challenges

Lesson 1. Check the decision-making style

“We don’t like their sound. Groups of guitars are on their way out.”

Decca Records executive Dick Rowe, rejecting the Beatles, 1962

Rational-deductive

Models Mixed

Incremental

Models of decison-making

Rational-deductive

Recognize a problem exists!

Identify the nature of that problem!

Identify alternative solutions!

Rank priorities!

Make predictions on the risks and consequences!

of the various alternatives!

Come to a decision

The incremental

• Decision-making focuses only in those decisions which differ incrementally from existing policies!

!• Only a small number of policy alternatives are

considered!!• For each policy alternative only a restricted

number of important consequences are evaluated

• The problem confronting the decision-making is continually redefined to make the problem more manageable!

!• There is not one decision or “right” solution, but a

“never-ending series of attacks”!!• The decision is the result of “give and take”

processes!!• “Muddling through”

The incremental

Decision-Making Matrix

Desirability

Feasibility

0

01

Rating scale for Desirability

Very Desirable

A policy decision will have positive effect and little or no negative effect; social benefits far outweigh social costs; the decision is justifiable on its own merits.

Desirable A decision will have positive effect with minimum negative effect; social benefits are greater than social costs; the decision is justifiable in conjunction with other items.

Undesirable A decision will have negative effect; social costs are greater than social benefits; it may only be justifiable in conjunction with another highly desirable item.

Very Undesirable

A decision is judged to have a major negative effect; social costs far outweigh any social benefits; not justifiable.

Source: E. Ziglio (1991)

Rating scale for FeasibilityDefinitely feasible

A policy decision can easily be implemented; no further research and development required; the necessary resources (financial, staffing, etc.) are available at present; no major political obstacles; acceptable to the generic public.

Possibly feasible

Some indication that the policy decision can be implemented; some research and development still required; available resources have to be supplemented; some minor political obstacles and/or further considerations may have to be given to public reaction; although some indication exists that this may be acceptable.

Possibly unfeasible

Some indication that the policy decision cannot be implemented; major research and development needed; large-scale increase in resources needed; major political obstacles and/o not acceptable to a large proportion of the general public.

Definitely unfeasible

Implementation of a policy decision is unrealistic; unprecedented allocation of resources would be needed; politically unacceptable and/or unacceptable to the generic public.

Source: E. Ziglio (1991)

Decision-Making Organizational Environment

Cooperative Conflicting!

Certain

!Uncertain

Logos

Ethos

Pathos

Lesson 2. There are at least 3 entry points....

Lesson 2. Cont.Food habits in Finland - population aged 15-64 years (1978-2007)

Butter on bread Vegetables daily Skimmed or 1 %-milk

Women

0

20

40

60

80

78 80 82 84 86 88 90 92 94 96 9820

0020

0220

0420

06

Men

80 82 84 86 88 90 92 94 96 9820

0020

0220

0420

06

Source: National Public Health Institute T (KL)/ Health Behaviour among the Finnish Adult Population (AVTK)

Kylie Minogue

Lesson 2. Cont.

“Orphan in the making, father stroke, mother HIV”

Lesson 2. Cont.

Meet…

Marco Maggie!Antonio Szuszanna!Anatoly Margareta

Carlos Elena!Mario Rebecca!Peter Tatjana

Inequities can be “inherited” and develop during the life cycle

Baby

Baby

Aged 10

Aged 10

Aged 20

Aged 20

Aged 45

Aged 45

Carlos, Elena, Mario, !Rebecca, Peter, Tatjana

Marco, Maggie, Antonio, !Szuszanna, Anatoly, Margareta

Aged 60!Died from massive stroke or other cause

Aged 60!Retired early to spend time with his/her grand-children and travel

Adapted from: D. Harrison (2007)

Lesson 3. Check info-seeking behaviour

Lesson 3: cont.Tailor information using appropriate media and format

Vs

Lesson 4: Focus on solutions

Korányi Hospital, Budapest, Hungary

Source: Ziglio, E_ et al. (2003) Health Systems confronting Poverty, WHO; Copenhagen

Lesson 4: cont.

National Health Service in Blackpool, UK

Lesson 4: cont.

Source: Ziglio, E_ et al. (2003) Health Systems confronting Poverty, WHO; Copenhagen

Lesson 5: Use the power of story telling

Alla Sokol, founder, St Petersburg Urban Gardening Club

Source: Ziglio, E_ et al. (2003) Health Systems confronting Poverty, WHO; Copenhagen!

http://www.euro.who.int/InformationSources/Publications/Catalogue/20030814_1

Lesson 5: cont.

Lesson 5: cont.

Source: Ziglio, E_ et al. (2003) Health Systems confronting Poverty, WHO; Copenhagen

A good image is worth 1000 words

Lesson 6. Use images not only number...

Source: Vienonen, M, (1999)

Intersectoral incentives, innovative practices

• Integrated Budgets!!• Joint-post funding

MORE LESS

Isolated programmes

Power structures

System rigidity

Lack of incentives

“Territorialism”

Lesson 7: Implementing change!! ! (the race to be 2° or 3°)

• Greener !!• Wealthier!!• Fairer!!• Smarter!!• Healthier

They do it in Scotland....

They do it in Promurje, Slovenia.....

Source: www.euro.who.int/eprise/main/WHO/Progs/SED/socmarketing/20051024_3

Slovenia - MURA

Slovenia - MURA

Lesson 8: Think “ASSETS”!! ! (not only deficiencies/needs...)

Needs L

H Assets

H

L

Minimizing Needs, Maximizing Assets

Your!Community

H: High!L: Low

1. What is the problem?!!

2. How do we know about this problem?!!

3. How has this problem arisen?!!

4. Why does this matter?!!

5. Why act now?!!

6. What would help tackle this problem?!!

7. What would we like policy-makers to consider?!!

Lesson 9: Good policy briefings

Lesson 10: 15 seconds communication

Photo: Czabanowska, Maastricht University