1. Improving Policy for a Positive Impact on Global Health
Marie Lindquist

2. 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)

3. The vision for global health
Well-being for all

4. 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.

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

6. 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

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

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

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

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

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

12. 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)

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

14. Overlapping evidence ?? Knowledge Information Data ?? Knowledge

15. Overlapping evidence ?? Knowledge Information Data ?? Knowledge!!

16. Conflicting evidence ?? ?? ?? Knowledge Knowledge Information
Data ??
Knowledge
Information
Data ??

17. 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

18. 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)

19. Science within society

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

21. Framework
Political will
Legislation
Resources
Governance

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

23. 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

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

25. 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

26. Sustainable development

27. The Lagom principle

28. Summary
Look closely
Think broadly
Act boldly
Look after