Let’s start with a couple of widely used definitions.
- Public health is the science and art of preventing disease, prolonging life and promoting human health through organized efforts and informed choices of society, organizations, public and private, communities and individuals. (Winslow, 1920)
- Diplomacy is the art and practice of conducting negotiations. (Berridge, 2005)
Art is the only noun appearing in both definitions, hence it is quite clear that combining (public) health and diplomacy is an artful thing and as such makes a perfect topic of a Young Forum Gastein workshop.
But putting humour aside, health is a so-called wicked problem, a systemic problem which is not static, it is cross-disciplinary, and it cannot work on a basis of the “global one size-fits all solutions”. Each health system is different, and it not only deals with the “obvious”, structural issues – it is built within the respective culture, upon singular national values, and as such, is highly qualitative. These reasons really resonate with the word “art” being used in the context of public health as a global issue, because, in its constant efforts to work beyond governments, to connect different competencies and forces, always taking into account different determinants of health, global health is a form of art. Appearing 160 years ago at the International Sanitary Conference in 1851, it began establishing its role and soon it became one of the key factors in international collaborations. As we all know, nowadays, health is as much of a political issue as it is a social and financial one. With all its advances, it requires very strong infrastructure and governance, and all of this relies on health diplomacy and negotiation on both the national and international level.
Having all this in mind, the global health expert Michaela Told from the Global Health Centre Geneva decided to focus our attention on a state-level issue which includes different stakeholders – the usual suspects such as the Ministry of Health and the Ministry of Finance, but also some other ministries, such as the Ministry of Trade and the Ministry of Foreign Affairs. This specific issue was tobacco ban, with the question of how to convince the Prime Minister of the State of Bloomia that what the Ministry of Health wants for health is more important than the income, taxes and the general public opinion. Soon it became pretty obvious that the health system cannot function properly within the State without the well-developed set of negotiation skills, which have again and again proven indispensable. The question of how to convince and include all of the stakeholders within and outside of the health system and get them on board with certain policies thus becomes one of the key strategy points for each public health professional.
The second day of the workshop was dedicated to the Austrian health care system. After receiving a brief introductory lecture on the Austrian health system we were split in 3 groups with the task of coming up with a solution to strengthen primary health care. With assistance from Austrian colleagues who helped us with answering various questions on specifics in interactions between the multitude of stakeholders in their health system we came up with 3 quite different but surprisingly supplementary proposals. The first group presented a complex and extensive proposal with an emphasis on incentives for young and experienced physicians, aiming to make career choice of becoming a general practitioner in primary care more attractive. The second group suggested government incentives to professionalize primary care through ‘primary care packages’. These packages, for example the care around birth, request a multidisciplinary approach and can be incentivized through accountability on outcome of the whole package. Finally, the third group emphasised on structural and individual measures to make general practice, particularly in rural settings, more attractive for medical professionals.
The three groups presented their ideas to a panel formed by Dr. Josef Probst from the Main Association of Austrian Social Security Institutions, Mr. Florian Bachner from the Austrian Public Health Institute, Katharina Hawlik from the Federal Ministry of Labour, Social Affairs, Health and Consumer Protection, and Dorli Kahr-Gottlieb from the EHFG.
After studying each proposal they decided that Group 1’s idea was the most feasible and interesting for strengthening the Austrian primary healthcare service.
The winners received a certificate, a small present and posed proudly in front of the cameras.
These two days were a fantastic opportunity for Young Gasteiners coming from various different countries to learn and feel what are the challenges and opportunities in health diplomacy. Developing negotiating skills and understanding the dynamics of power are essential if young public health professionals like us want to make a difference in public health. Moreover, learning about the specific example of a country like Austria taught us how the theory can be put into practice. Also, our diverse backgrounds hopefully gave the Austrian health professionals some good ideas on how to improve the primary healthcare system.
Young Forum Gastein is, above anything, a network. As such, social programmes are almost as important as workshops or lectures. It is in those spaces where we build connections that will be fruitful in the future and where we exchange experiences and knowledge influenced by the different backgrounds that we all have.
The social programme in Vienna was a fantastic opportunity to do all of this. Thanks to our host, we had the opportunity to have dinner on a terrace, enjoying the beautiful Austrian weather and the famous “Wiener Schnitzel”. Among the highlights it is worth mentioning that Josef Wenninger joined us, remembering old Gastein times.
We don’t know what will be our next YFG stop, but we know that we can’t wait for it!!
Winslow, C.E., 1920. The untilled fields of public health. Science, pp.23-33.
Berridge, G., 2005. Diplomacy: Theory and Practice. Palgrave Macmillan UK.
Véronique Bos, Boven IJ-Hospital, Amsterdam, The Netherlands
Matej Vinko, National Institute of Public Health, Ljubljana, Slovenia
Alberto Mateo, National Health System (NHS) North West, The United Kingdom