H20-Communique-FINAL-for-distribution

H20HEALTH SUMMIT
INTERNATIONAL
13 & 14 November 2014 • Melbourne
The H20 International Health Summit (H20)
13 – 14 November 2014
Hotel Windsor, Melbourne, Australia
Communique
_______________________________________________________
1. We, the attendees at the inaugural H20 International Health Summit (H20), met on 13
th
and 14
th
November 2014 at the Hotel Windsor in Melbourne. The event was co-hosted
by the World Medical Association, the Australian Medical Association and AMA Victoria
and welcomed health professionals, academics and thought leaders to discuss a wide
range of health and related social issues on the eve of the G20 Leaders’ Summit in
Brisbane. Topics included ‘health as a wise investment’, the burden of non-
communicable diseases (NCDs), the social determinants of health and the health
effects of climate change.
2. We congratulate Dr Mukesh Haikerwal AO, Chair of Council of the World Medical
Association, Dr Tony Bartone, President of the Australian Medical Association (AMA), and
Prof Brian Owler, President of the AMA Victoria, for their initiative and tireless efforts in
organising the Summit and the professionals and staff responsible for its success. We
also thank the sponsors and supporters of the H2O, including the Victorian Government,
Avant Mutual Group, BOQ Specialist, CSL, Global Health, MDA National, Medibank Private,
Melbourne Pathology, NAB Health, Telstra Health and TressCox Lawyers.
3. We challenge the common assumption that health spending in Australia is unduly high
or unsustainable. However, given rising public expectations and ongoing fiscal
constraints, we believe that health systems must explore more effective ways to
collaborate and target resources to prevent illness and deliver better health outcomes
for all. New funding models should reward outcomes rather than activities, while
modern data collection and analysis should generate insights into population health
dynamics. A health system focused on patients and outcomes, rather than suppliers
and processes, offers exciting opportunities for the future.
4. We forward this statement to the G20 leaders to underline the case for investing in
health as ‘the greatest social capital’. We call for a global effort across sectors to
tackle the world’s most pressing health challenges through a renewed focus on
preventative care, holistic government policy and the social determinants of health.
We present the following summary of Summit proceedings and recommendations to
further inform the debate.
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H20HEALTH SUMMIT
INTERNATIONAL
13 & 14 November 2014 • Melbourne
Health is the Foundation of Economic Growth
5. Health is the foundation of economic growth, yet has been omitted from the global
G20 agenda. While the Brisbane G20 Summit pursued goals of economic stability and
growth, the H20 emphasised the economic, social and personal importance of public
health and health investment. It argued that economics and health are not discrete,
clearly bounded domains, but are intimately connected and dependent on each other
for success. Poor health reduces economic productivity, increases social costs and
affects individual quality of life. Adequate investment in health is therefore a
prerequisite of national and global economic success.
Health in Victoria
6. Victoria enjoys high standards of healthcare service, although issues of poor
indigenous health remain. Commercial opportunities and improved health outcomes
are generated by the State’s world-class research institutions and their professional
and academic partnerships. Victoria has also invested in improving the health of
refugees in recent years. Moving forward, the funding responsibilities between federal
and state governments should be clarified, primary and preventative care improved and
the flow of patient information facilitated by modern technology. Victoria has a strong
record of public health promotion and its Healthy Together Victoria programme
1
is
encouraging positive lifestyles in schools and communities around the State.
Health as a Wise Investment
7. Public health spending should be reframed as a wise investment in economic growth
and social equity. Australia’s health spending remains marginally below the
Organisation for Economic Co-operation and Development (OECD) average and its
health system, although complex, is held in high regard. However, an ageing
population, growing patient expectations and technological developments are
increasing budget pressure, and more efficient pathways must be sought.
The USA has worse outcomes than other OECD nations despite spending significantly
more, for example, and debate should focus on the quality and effectiveness of budget
allocations, rather than obsess about aggregate figures or the number of hospital beds.
Governments must acknowledge and address the social determinants of health in the
nation as a whole, as well as indigenous communities. The AMA supports universal
access to affordable health care and will continue defending the current health system.
The ‘creative dissatisfaction’ of health professionals should be harnessed through
meaningful consultation with policy makers to produce broadly supported reforms.
1
http://www.health.vic.gov.au/prevention/healthytogether.htm
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H20HEALTH SUMMIT
INTERNATIONAL
13 & 14 November 2014 • Melbourne
Health Research
8. Every $1 invested in Australian health research generates $2.17 in health benefits and
commercial returns
2
. Research has produced breakthroughs in global health, not least
in the fight against acquired immune deficiency syndrome (AIDS). Research aggregates
a range of basic, clinical, social and operational approaches and, alongside better
public health provision, will help combat new infectious threats spreading through
global connections. Investment in multidisciplinary medical research and effective
partnerships should remain a spending priority, with the bionic eye exemplifying what it
can achieve.
Value-Based Health Care
9. Measuring and reporting patient outcomes to the individual physicians responsible
presents a powerful tool to improve personal, and therefore national, medical
performance. While discussions of cost immediately divide funders and services down
predictable and intractable lines, a focus on outcomes aligns the interests of all
stakeholders. The standardisation of outcome measurement builds evidence to support
long-term planning and enables international comparisons and the adoption of best
practice.
Global Health and Investment
10. Economic growth has improved global health, and countries such as China have made
significant strides, although spending in South Africa has been less effective.
Corruption and maladministration must also be acknowledged and tackled around the
world to maximise budget outcomes. Australian aid strengthens health services in the
Asia-Pacific region to improve health, growth and stability. The Red Cross faces
increasing violence and harassment in its work in conflict zones, and the security of
health workers and facilities must be strengthened for its mission to succeed. World
leaders must prioritise ‘the health perspective’, preserve the health of the planet as well
as its inhabitants and address the underlying social determinants of health.
2
Access Economics, 2008. Exceptional Returns: The value of Investing in Health R&D in Australia II.,
http://www.asmr.org.au/Publications.html
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H20HEALTH SUMMIT
INTERNATIONAL
13 & 14 November 2014 • Melbourne
Australian Support for Foreign Health Systems
11. The Australian Government’s aid program promotes Australian interests by encouraging
sustainable economic growth to reduce poverty in the Indo-Pacific. A stress on
accountability and outcomes strengthens its effectiveness. Australia also provides
assistance to Africa and elsewhere and has pledged $42 to international efforts against
Ebola
3
. The Government integrated AusAID and the Department of Foreign Affairs and
Trade in 2013, aligning the aid and diplomatic arms of Australia’s international policy
agenda. Australian aid includes goods and services such as building health clinics and
immunising children, strengthening local services, including health care, and encouraging
policy dialogue and reform. It works with government partners, funds non-government
organisations (NGOs) and contributes to international agencies.
The Social Determinants of Health
12. Health outcomes are significantly affected by wider social factors, including early
childhood development, income inequality, social stratification, workplace and domestic
stress, social exclusion and discrimination, unemployment, community networks,
substance abuse and the affordability of good food, housing and transportation. A
sustained bi-partisan effort to improve public health must produce long-term investment
in education, training, public transport and other infrastructure, instead of ‘micro-
shuffling’ health administration. Collaboration between government departments is vital
as synergies from transport, housing, utilities and education can significantly improve –
or degrade – public health.
Health Care Reform
13. Given rising demand and economic strictures, health providers must embrace the
technological and organisational innovations transforming other commercial sectors to
deliver better patient outcomes at lower cost. Consideration of horizontal connections,
rather than in-depth analysis of isolated components, will offer many opportunities for
change. Health must learn from modern commerce and offer personalised, customised
services responsive to individual needs in a new world of technologically driven
communication, competition and choice.
3
http://foreignminister.gov.au/releases/Pages/2014/jb_mr_141128.aspx
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H20HEALTH SUMMIT
INTERNATIONAL
13 & 14 November 2014 • Melbourne
Health IT
14. The collection and analysis of Big Data will improve service planning and individual
delivery while imbedded and wearable devices will help individuals achieve ‘the
quantified self’. Supply-driven systems based on procedures, hospitalisations and
clinicians will evolve into e-enabled platforms, organised around the patient experience,
which prize value and outcomes, drive down costs and improve safety and
accountability. IT solutions should be designed and implemented in consultation with
the clinicians who will use them to ensure their support and exploit the power,
convenience and ubiquity of smartphones and mobile devices.
Non-Communicable Diseases (NCD)
15. Non-communicable diseases, including cardiovascular complaints, cancers, chronic
respiratory failure and diabetes cause over 60% of global mortality
4
. The NCD epidemic
threatens service sustainability and population health in Australia and around the world.
NCDs can be caused or exacerbated by tobacco, physical inactivity, alcohol misuse and
unhealthy diets, but rather than blame patients for lifestyle choices, attention must be
given to the social determinants which drive them. Greater emphasis on primary care and
health literacy will reduce the incidence of diabetes, hypertension and other problems,
while structured care plans and clinician teamwork will reduce avoidable admissions to
hospital. Action against smoking has been effective, and disinvestment in tobacco shares
by Australia’s superfunds should be pursued.
Mental Health
16. No condition is as prevalent, persistent or has the range of personal and social impacts
as mental illness. Early interventions and effective treatment must be complemented by
policies to address social inequality and other exacerbating factors. Improved
professional training and both universal and targeted interventions should be delivered
through a sustained and coordinated cross-government approach in partnership with
NGOs and communities.
4
World Health Organization (WHO) NCD Surveillance strategy; http://www.who.int/ncd_surveillance/strategy/en/
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H20HEALTH SUMMIT
INTERNATIONAL
13 & 14 November 2014 • Melbourne
Successful Ageing and Dementia
17. The pursuit of ‘successful ageing’ could increase the quality of life and sustain the
workforce productivity of Australia’s ageing population while reducing disability and
hospital expenses. Dementia is an increasing issue, but its incidence can be reduced
through better health in youth and middle age, while the experience of suffers can be
eased by better care and more community understanding. Dementia is not an inevitable
part of ageing, and research into its causes and treatment must be pursued.
Health and Climate Change
18. Human health and modern society rely on a stable climate and biologically diverse
environment. Clinicians should therefore use their expertise and the respect in which
they are held to urge prompt and decisive international action to reduce carbon
emissions and limit the extent and impact of climate change. Australia and other
nations can maintain economic growth while ‘decarbonising’ their economies through
the electrification of transport, greater energy efficiency, the replacement of coal with
renewable sources and reforestation. Enlightened urban planning can also reduce heat
stress and encourage physical activity, improving the state of both the planet and its
ever growing population.
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H20HEALTH SUMMIT
INTERNATIONAL
13 & 14 November 2014 • Melbourne
Key Recommendations for Change
• Government should acknowledge health spending as a wise investment in future economic
growth and social equity.
• Health care systems should be organised around the patient experience, prioritise
outcomes rather than activities, drive down costs and improve quality and safety. New
consumer-centric health services should deliver equity, choice, autonomy, confidentiality
and the local provision of services, as well as the highest standards of care.
• Decision makers should put a greater emphasis on primary and preventative care to limit the
incidence and severity of chronic disease and reduce acute admissions and hospital expenses.
• Health care systems should pursue excellence and effectiveness, as well as efficiencies. There
should be clear funding responsibilities to avoid duplication of services and minimise unmet
need.
• All government policies should consider their impact on health and coordinate to support
public health. Cross-departmental action on the social determinants of health, from income
inequality to poor housing and transport, will improve the health and social outcomes for
disadvantaged citizens and social groups.
• Health literacy should be promoted to empower citizen lifestyle choices regarding diet,
exercise, smoking, alcohol and related issues. Public health campaigns should broaden
their scope and magnify their impact.
• Action must be taken to improve the prevention and treatment of non-communicable
diseases through improving the social determinants of health for disadvantaged social
groups and strengthening provision and collaboration in primary care.
• ‘Successful ageing’ should be promoted across sectors to reduce the personal toll and
growing social costs of dementia in Australia’s ageing society. Further research into the
causes and treatment of dementia must be pursued.
• Action to tackle mental health issues should include greater funding for research, public
education and early intervention.
• Clinicians should be consulted in the design and implementation of health IT and
embrace its potential to gather, aggregate, analyse and share information to improve
patient health outcomes and public health provision and efficiency.
• The ‘creative dissatisfaction’ of health professionals should be harnessed through
meaningful consultation with policy makers to produce broadly supported reforms.
• Investment in health research should be prioritised to unlock rich commercial
opportunities for the nation as well as dramatically improve health outcomes in a range
of domestic and global health issues.
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H20HEALTH SUMMIT
INTERNATIONAL
13 & 14 November 2014 • Melbourne
• Modern methods of Big Data collection and analysis should be encouraged to generate
insights into population health dynamics.
• Surgical and other patient outcomes should be discussed with the clinicians responsible
to improve standards and ensure the use of best practice. Standardisation of outcome
measurements will support long-term planning and allow national and international
comparisons to be made.
• Government should support international efforts to tackle newly emerging infectious
threats such as Ebola as they pose a serious cross-border threat in today’s globalised
society. Developed nations should work to strengthen government, growth and public
health systems in low-income countries to improve their resilience and health provision.
• Governments, military organisations and non-state actors should agree and respect
effective measures to safeguard the security of emergency health workers in combat zones.
• Donor and recipient governments and supra-national organisations must acknowledge and
tackle corruption and maladministration in the provision of health services in the
developing and more developed world.
• Heath professionals should organise and campaign for state and national health reform and
broad social change, as well as take concrete action in their local communities.
• Medical professionals should understand the potential health impacts of man-made climate
change and lobby for effective action to reduce carbon emissions worldwide and protect
the biosphere humanity relies upon.
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