The environment is a health issue and therefore as in previous sessions about health systems and innovation the individual needs to be placed at the centre of the solutions. That said is the 8 tonne lifestyle feasible? Should the onus be put on the individual or on governments?

A total transformation is needed to build in sustainability to health and healthcare. We need leadership and willingness for this change to happen.

Another link to an earlier session is food security and climate change! Some worrying statistics shown by Professor Beniston!

Is technology and innovation as presented yesterday the solution? Technology though uses resources, electricty and produces a lot of waste which in turn contributes to global warming and unsustainable use of resources.

Climate change really got on the agenda when an economic perspective was taken. Sustainability needs to be accounted for from an economic perspective and develop a triple bottom line. Health co-benefits need to also be accounted for, but it is not all about the money and showing everything in financial terms.

So in conclusion another complex challenge that we need to address… That said low, middle and high income countries are all faced with the challenges of sustainability, climate change and chronic conditions. No one has yet to find the solution for these problems so we can all learn from each other’s experiences.

This challenge also includes globalisation and technology. These bring both benefits to health, but are also drivers of changes in nutrition.

In thinking of the double-burden this needs to be looked at from the individual, family, community and national perspective. The double-burden exists at all these levels, the drivers are the same including food insecurity and poverty. Both of these concepts in the past have been associated with malnutrition, but now are also factors in over nutrition.

After discussing health systems another system’s approach is needed in looking at food systems, from farm to plate. What we produce and where is impacting diets throughout the world. Is a western appetite for tropical products causing obesity and chronic diseases in low income settings as we are shifting what is available in these countries. Trade and investment are areas outside of the health system as is agriculture, but food is the essence of health and illness. The Right to food is not only the Right not to starve, but also the Right to the right food!

Rather than notes from Janet Voute’s presentation a series of questions:
What role for the food industry? How can we work with the food industry as public health specialists? Should we work with the food industry? The International Diabetes Federation a partner with Nestle how can that be?

In linking the Nestle presentation to Geoff Rayner’s a question who is/should be the conductor in the issue of addressing food systems?

Changing a paradigm Geoff Rayner proposes addressing ecological health and its link with human health. The common NCD risk factors are diseases of our modern civilisation. He also shows the complexity of the issue and multiple factors contributing to changes in what and how we eat. This how and what we eat also has a link to the environment and developing a sustainable environment. So far the policy response has failed as it has been too soft. Rethink diet around environmental limits.

Summary of a fascinating session:
- double burden
- obesity is everywhere
- need to look at food systems, from farm to plate
- advertising for food versus public health budgets
- commitments soft versus hard
- industry and its self-regulation
- healthy foods being produced by the industry that also taste good
- complicated issue, the individual versus the system
- the market forces that hamper company’s good intentions

Innovation is not only using new technologies, but also approaches, activities and interventions.

Innovation also needs to be adapted to the context or even contexts in a given country.

The example from the Skylight shows an innovative approach throughout the development of a new technology. Innovative funding, use of technology in all phases of design, prototyping and implementation.

How can these aspects be used to address innovation in global health?

Innovation is addressing the problem to find a solution. Failure may be the result, but it is part of the learning process. Is there the opportunity to fail in global health? Also is there the space to innovate in global health?

Two key issues from this session that have been touched upon in other talks are scalability and sustainability. Should these issues be built into the innovative process?

Conclusion (if possible) – people need to come first and the technology and innovation have to come into play to help with the solution.

To link this session with the inspiring intervention by Dr. Venkatapuram yesterday evening interesting to hear people involved with health systems speak about issues of equity. In looking at the issue of chronic disease inz addressing equity we need to move beyond focusing on diseases, elements of the health system and focus on the individual. We are not addressing the issue of chronic diseases for preventing diabetes, giving hypertension medicines, performing surgery, but to improve the health and well-being of indviduals. Professor Golay described this humanistic medicine.

Andy Williamson closes the session saying he feels encouraged and that fragmentation and sustainability are key factors that need to be addressed. People are not just chronic or acute patients, they go between these silos. Sustainability needs to be addressed as with chronic conditions the relationship between the individual and the health system is long-term and an investement for both sides.

Final question: How can the health system in its redesign take into account the individual with a chronic disease’s perspective?

The issue is complex, but we are here to find the solutions. To add to this challenge we are in a situation of a global crisis,  which impacts how we will be able to address this challenge, but also contributes to its severity. 

How to address this:
Systemic approach
Questionning what and how we do the things we do
Shift in acute to chronic care
Reorganising health systems
Moving away from disease based approaches
Redefining the role of hospitals 
Changing the roles of healthcare workers and the types of healthcare workers we will need
Multisectoral approach

That is the scientific and political perspective…

The Philosopher’s perspective – address justice and look at what we want the society we live in to look like. Also how was the decision made to include some NCDs and exclude others from the High Level Meeting reflect certain interests and exclude a global ethical debate on what should be done. This exclusion was also linked to lack of inclusion of true frontliners from the debate.

The Frontliner’s perspective – a wider approach to health taking a societal, sociological and cultural perspective is needed. Listening to our patients and tailoring response to the individual, their family, culture and society. Again the view from the frontlines is what type of society do we live in that creates the risk factors for chronic diseases, but also places barriersnto care.

The individual with a chronic disease’s perspective – avoiding feeling helpless!
Freedom given by new treatment options.
Sharing experiences with others getting on with their lives, day to day of living with a condition and interactions with peers is the most important thing in helping people deal with their condition.
Access to information about your chronic condition.
Coping strategies: learning and laughing (getting on with life, making a game of a chronic condition).
A new form of interaction with your healthcare provider.

Programme design and interventions are complex and need to take into account so many aspects. The challenge is also how these interventions are scaled up to the “real world”.

Key words were synergy, integration, partnerships, primary health care, clear targets, organisation of health systems, access to medicines, adapted solutions, reorientation, 

Interesting point by Dr. Belhadj about the need for a movement! As participants of the GHF we are part of this movement and hopefully the GHF will give the chronic disease community the momentum to take the guidance and what we know works forward!
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Very honest view of the transition that needs to happen for organisations as well in addressing NCDs from the MSF perspective. Does the WHO also need to have a transition as an organisation to be more effective in addressing NCDs?

No real solutions proposed, but hopefully that will come from the Frontliners and their experiences presented over the next few days.