1. Session 8 Pierre L.-J. Ritchie Co-Chair

2. Principles Promotion of Informed Choice Managing Change Inter-sectoral / Interdisciplinary Health dynamics / Biosphere dynamics/ Urban dynamics Include evolutionary & historic knowledge / perspectives What works as well as problems Integration / Promote Connections & Synergies Setting Priorities – Value added that has not been done / requires a new science plan organized within a systems analysis framework Normative (in Context)

3. Issues / Problématiques (1) What do local planners, city / national politicians need & want? What makes for informed choice by these policy makers? Definition of Health & Well-being: Adopt WHO definition? Definition of Health System: Adopt PAHO definition? Define Urban Ethical / values implications & resolution of dilemmas Is development of Standards (‘gold’ or minimal) a goal? Identify Targets of Opportunity Identifying the Drivers Identify existing data bases

4. Issues / Problématiques (2) How to cope with ‘Everything’ re: inclusion in whole or in part the State of the Science topics How to create an inventory of models (including choice of models) / build on existing work How to mobilize trans-disciplinarity How to address access How to address intra-urban heterogeneity / inequities Limit or not the focus on cities of particular sizes; in particular, informal components and whether to include mega-cities How to include evaluation of outcomes in the Health Science Plan, including unintended consequences

5. Issues / Problématiques (3) Science / Cities partnerships Private / Public partnerships Professional Association partnerships Local – National Science Academy partnerships

6. WHO definition Health is a state of complete physical, mental and social well-being and not merely the absence of disease of infirmity.

7. PAHO definition Group of public and private for/non-profit national and sub-national institutions that endeavor to protect the health of the people. Essentially, the health system is the health sector categorized (with linkages) according to core functions (financing, provision of inputs and service delivery/coverage), main actors (government and consumers/households) and outcomes (health, fairness in financing and responsiveness. WHO defines the goals of health systems as: (i) Improving the health of the population they serve; (ii) Responsiveness, i.e., responding to people’s legitimate expectations; and (iii) Fair financing, i.e., providing financial protection against the costs of ill-health.

8. Session 8 Dov Jaron Co-Chair

9. Why systems analysis Integration rather than reduction –Cannot predict output by separate analysis of individual elements Understand interactions Eliminate unimportant factors Make informed predictions Propose changes, remediation to influence health Allow for powerful visual presentations

10. System Properties Nonlinear Stochastic (non deterministic) Multifactorial – interrelationships between factors –e.g. hurricane/resources/policy –e.g. spending 75% of income on health leads to greater poverty Multidimensional (health/wealth) –e.g. changes not along curve but curve changes position what is the extra dimension?

11. Different vantages Hierarchical –Individual – family – neighborhood – city - -region – global –Each hierarchical level may interact with other levels –Differences between developed and developing countries –Each level influenced by personal and social behavior, cultural and spiritual background, education –Each level influenced by external factors Factorial, time dependent –Nutrition, obesity, water, waste, crime, accidents, war etc. –Factors at each level may be different –Influenced by historical information and perspective

12. Requirements What other analyses are there –Can they assist in our task? –Can they be integrated into ours –How not to duplicate other efforts? Sensitivity analysis –Which are the important factors (may not be obvious from the start)

13. Next? What to focus on –Agree on definition of health –Agree on initial set of parameters to be included –Agree on basic needs for health –Agree on goals of program, on target audience –Factors that can make significant change to improve health –Factors that can influence (policy makers, practitioners) –Do we have quality data? What data can be included in a systems approach? What are the gaps, what new data should we seek? Outcome measures (monitoring) –Have we made a difference