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April 14, 2016
100 Million Healthier
Lives
International Forum
Goethenburg, Sweden
Co-Presenters
Jesper Ekberg, Director of Public Health, Jönköping
Goran Henriks, Chief Executive of Learning and
Innovation, Qulturum, County Council of Jönköping,
Sweden
Anette Nilsson, Development Strategist, Jonkoping
County
Soma Stout, MD MS, Executive Lead, 100 Million
Healthier Lives
We have no disclosures
Our Time Together Today
Why? “From sick care system to a health and
wellbeing system”
World Café –design improvement in priority
areas
Bright spots
How can I get involved?
Figure 1
Source: The Lancet 2011; 377:1877-1889 (DOI:10.1016/S0140-6736(11)60202-X)
Why we have a sick care system
Borrowed with permission from Rob Janett
36% Reduction in Hospitalization Rate for Patients with Diabetes
Data from Cambridge Health Alliance
The need for a life course view
Exposure to toxic
stress in early
childhood may
lead to as much as
a 40x increase in
rate of chronic
disease by the
time you’re 50.
Equity as a System Property
The life expectancy of
Denmark and Zambia in
the space of a few miles
10 - 25 year difference in
life expectancy
depending on where you
are born.
Adapted from McGuinnis et al.
Interaction
Intervention
possibility slim
When the external becomes internal:
How we internalize our environment
Allostatic Load
Inadequate
Transportation
Long
Commutes
Housing
Lack of social
capital
High
Demand-
Low Control
Jobs
Lack of
access to
stores, jobs,
services
Crime
Stress
Stress
Stress
Stress
Stress
Stress
Source: Anthony Iton, MD, JD,
SVP, The California Endowment
Interrelationship between the health, wellbeing
and equity of people, communities and
populations
Health, wellbeing and equity
Individual, family
SocietyCommunity
Identity: An unprecedented collaboration of change
agents pursuing an unprecedented result:
100 million people living healthier lives by 2020
Vision: to fundamentally transform the way we
think and act to improve health, wellbeing and
equity.
100 Million Healthier Lives
Theory of change – 100 Million
Healthier Lives
Unprecedented collaboration
Innovative improvement
System transformation
100 Million People Living
Healthier Lives by 2020
Our Broad Measurement Framework
Health & Wellbeing:
• Mental
• Physical
• Social
• Spiritual
Life expectancy
How we approach our work
Leading from within
Leading together
Leading for outcomes
Leading for equity
14
6 Core Strategies
Create a health care system that is good at
health and good at care
Create bridges between health care, community
public health and social sector
Develop health communities
Scale up peer to peer supports
Develop new culture and mindsets
Create enabling conditions
15
Case Study: Childhood asthma
at Cambridge Health Alliance16
17
Where are the children? Who has access to them?
Where are the resources? Who isn’t thriving?
Partnership between schools, public health, and
primary care
Clear accountability for every child, shared registry
Partnership with school nurses
Proactive outreach to patients by the primary care
team to get them controlled on asthma
medications.
Healthy Homes assessment through public health
partnership.
Childhood Asthma
Childhood Asthma Outcomes
0%
2%
4%
6%
8%
10%
12%
Jan-2002
(N-Pilot = 125)
(N-Rest = 18)
Jan-2003
(N-Pilot =369)
(N-Rest = 30)
Jan-2004
(N-Pilot = 479)
(N-Rest = 209)
Jan-2005
(N-Pilot =596)
(N-Rest = 643)
Jan-2006
(N-Pilot = 926)
(N-Rest = 880)
Jan-2007
(N-Pilot = 1097)
(N-Rest = 889)
Jan-08 Jan-09
% P
ati
en
t C
ou
nt
Pilot Sites (PEDO & SOPED) Rest of CHA
Goal <=0.5%
Childhood Asthma:
% Patients with Asthma Admissions
Childhood Asthma:
% Patients with Asthma ED Visits
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
Jan-2002
(N-Pilot = 125)
(N-Rest = 18)
Jan-2003
(N-Pilot =369)
(N-Rest = 30)
Jan-2004
(N-Pilot = 479)
(N-Rest = 209)
Jan-2005
(N-Pilot=596)
(N-Rest = 643)
Jan-2006
(N-Pilot = 926)
(N-Rest = 880)
Jan-2007
(N-Pilot = 1097)
(N-Rest = 889)
Jan-08 Jan-09
% P
ati
en
t C
ou
nt
Pilot Sites (PEDO & SOPED) Rest of CHA
Goal <= 2%
An Example from Jonkoping: Social sustainability and equal health
Everyday life
Support for bodyand mind
Primary Care
2016
-04-
Specialised care
Health
Gadamer´s definition – health is ”that you in joy can be
occupied with your own life tasks”.
New definition of health
The Microsystem Festival March 1–4 2016plus.rjl.se/microsystemfestival
Help people to help each other
Passion för livet
The Microsystem Festival Mach 1–4 2016plus.rjl.se/microsystemfestival
Do ”self-management” most possible
Patrik Blomqvist, patientstödjare Eje Grennborg, rehabinstruktör
The Microsystem Festival Marh 1–4 2016plus.rjl.se/microsystemfestival
Redefine where health is established
Stadsparken, Jönköping
The Microsystem Festival March1–4 2016plus.rjl.se/microsystemfestival
Simple to come in simple to get out
• Dörr här
Find alternatives to medication
Primaliv, NorrahammarSpira, Jönköping
The Microsystem Festival Marc 1–4 2016plus.rjl.se/microsystemfestival
Doctors cannot do everything
Digitalisation – let us optimize the opportunities
What´s wrong with him
Involvement in a new way
Image courtesy of Region Jönköping
County
Thepa entinthecenter Thepa entasapartoftheteamandtheirneedsandpreferencesatthecenter
Pa entneedsandpreferences
How to think about involvement?
Health
LiteracyShared
Decision-Making
Feedback for
Improvement
Patient Partnership
In Health
Patient Partnership
In Redesign
Ref: Galina Gheihman, Kvarnefors, Henriks 2015
Health for life
Strengthening the residents themselves to affect their health and quality of life by making awareness and releasing their own resources
Passion for life
https://www.youtube.com/watch?v
=BJ7TZ-n-044
Winner of ”Social innovation in ageing –The European Award” 2014
Moore to life - cafés
• Building empowerment
within young adults 20-29
years
• Believing in their own
capacity in the interaction
with others
Health promotion and early support
I statement
Ref;Sir John Oldham OBE MBA
Digital support
Work place
Community
Care
School
Health Café for people withchronic disease- Self-management- Co-design- Empowerment - live a goodlife with high life quality
Everyday life
Support for bodyand mind
Primary Care
Specialised care
Health and Care
PortalsPersonal
E-services
Self help groupsHealth guides
Exploring the population –
need segmentation
Hints…
1. Economically exposed children
2. Truancy
3. High school
4. Ill health in working life
5. Violence
6. Abortion teenagers
7. Overweigh/obesity
8. Physical activity
9. Breakfast every day
10. Alcohol consumption
11. Smoking
12. Smoking pregnant
13. Self reported health
14. Dental health
Local population profile based on health dialougues and socioeconomic data
Habits
Life
situation
Age, socioeconomy, diagnosis, risk factors,
inhabitants with high risk of heart disease
Family
history
How’s life in Forserum?
Let’s explore a
few of these
areas together
48
Shared priorities “The What’s”
1. Close equity gaps (price of admission)
2. Help veterans to thrive
3. Address and improve social determinants across the continuum
4. Improve wellbeing of indigenous communities
5. Help all kids have a great start to life
6. Make mental health everybody’s job and take a prevention
approach
7. Engage people in their own health (nutrition, exercise, sleep,
stress, food security) and reduce burden of chronic disease
8. Improve employee health and wellbeing
9. Create wellbeing in the elder years and end of life
Let’s try it!
1. Children/families
2. Veterans
3. Refugees
4. People with mental health issues
5. People with chronic disease or at risk for
chronic disease
6. People who are aging
7. Others?
“I will not live and unlived
life…”
Introduce
yourself
with a poem
51
Questions We Invite You to Consider As
You Think About Your Work
Leading from within: Why does this matter to me? What would
courageous leadership look like for me in this space?
Leading from within, leading for outcomes: Whose life will get
better because we were here? Which populations?
Leading for equity: Who isn’t thriving in terms of their health and
wellbeing? What would it take for that to change? Where are the
assets (including in the population?
Leading together: Who has strengths and assets? How can we
partner with each other and with people with lived experience in a
way that builds a community of solutions?
Leading for outcomes: What would it take to facilitate real
transformation in the health and wellbeing of people, systems and
communities? How can we change the system to design it from
the perspective of health and wellbeing?
52
We invite you to:
1. Join the movement (www.100mlives.org/join)
2. Make your collaboration an example of what’s
possible.
• With each other
• With others across sectors who hold a piece of
the puzzle.
3. Create a vision and set measurable aims; learn
your way to getting there.
4. Be part of changing the systems that don’t work.
5. Make equity part of your job.
53
5 Questions We Invite You to Consider
As You Think About Your Work
Whose life will get better because we were here?
How will you know that?
How can we partner with each other and with people
with lived experience in a way that leverages our
abundance and builds a community of solutions?
Who isn’t thriving in terms of their health and
wellbeing? What would it take for that to change?
What can we do to facilitate real transformation in
the health and wellbeing of people, systems and
communities?
How can we change the system?
54
