Editorial: Dealing with complexity can be rather complicated
Dear reader,
The world will not evolve past its current state of crisis by using the same thinking that created the situation (Albert Einstein) The world is ordered • The world is predictable • Every cause has one effect • The whole can be understood by understanding its parts • The world is chaotic • The world is unpredictable • Any cause can lead to more than one outcome • The sum of the parts is less and different than the whole RESPONSE IS PREDICTABLE RESPONSE IS UNPREDICTABLE • A car is a complicated system • A jumbo is a complicated system • A children’s birthday party is a complex system • The stock exchange is a complex system Humans respond to patterns, the first pattern that comes to mind triggers our response In former days, seeing a big yellow face, with big white teeth and big paws meant “run or you are a big cats lunch” • Psychologically we Can’t keep more than a few things in mind at any one time Can’t easily detect connections between seemingly unconnected objects/facts Can’t easily anticipate behaviour more than a step or two ahead Dörner, 1996 • Simple Scientific World View o Linear, output is proportional to input o Additive o Simple rules yield simple results o Stable o Predictable o Quantitative o Normal distribution • Complex Scientific World View o Nonlinear, small changes may diverge o Multiplicative o Simple rules yield complex results o Unstable o Limited predictability o Qualitative plus quantitative o Inverse power-law distribution West, 2010 Gauss – Bell curve Circa 1800 Pareto – Inverse Power-laws Circa 1900 • Simple Scientific World View o Linear, output is proportional to input o Additive o Simple rules yield simple results o Stable o Predictable o Quantitative o Normal distribution • Complex Scientific World View o Nonlinear, small changes may diverge o Multiplicative o Simple rules yield complex results o Unstable o Limited predictability o Qualitative plus quantitative o Inverse power-law distribution West, 2010 Gauss – Bell curve Circa 1800 Pareto – Inverse Power-laws Circa 1900 Complexity Science and Complexity Theories represent a convergence of different types of ideas and theories to address the non-linearity and dynamics of the real world systems, often known as complex adaptive systems Note: no system can every be completely described • Characteristics of a Complex Adaptive System Non-linearity Open to environment Self-organization Emergence Pattern of interaction Adaptation and evolution Co-evolution …
…well, this is what I found on a website when I followed the invitation by a colleague to “have a look at a great introduction to complexity in health”. I must admit that I was somewhat perplexed when I read this cryptic text. And I guess you understand why. But I was also fascinated: Wow, a text which itself reflects its topic! So I spent a couple of minutes trying to understand it, in order to appreciate its “greatness” and also to test my analytical fitness. And when I discovered a “download pdf” button, I followed it with mixed feelings. After a very long and complicated (!) registration procedure, the download link led me to the powerpoint slides of a really interesting lecture by Joachim P. Sturmberg, a complexity guru. When I had a look at the first slides, I discovered that what I first found on the website was just the mashed bullet points – without slide titles and images – of that presentation.
What I learnt from this experience: (1) I shall not confuse complicated with complex. (2) Looking complicated does not mean that a matter is really complex. Perceived complexity can also just be the result of a technical error (when I visited the academia.edu website again today, I discovered that the cryptic text has been replaced by a proper preview of the presentation) or an intellectual trap (I was looking for something “complex”, so I took the text provided on the website as it was, without questioning it).
Anyhow, believe me or not: health systems are in fact complex adaptive systems. Ask Sturmberg. Or others. And if you like to learn more about complexity and how to deal with it in public health and health care, just join me in the upcoming MMI Network meeting “Health-y answers to comple#ity: Are we able to move beyond the control panel?” hosted and organized by our Belgian partners Memisa and Be-cause Health. See you in Brussels, in November!
Thomas Schwarz, Executive Secretary
Medicus Mundi International Network
MMI Network: Events, news, resources
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Network event: Memisa / Medicus Mundi International
Health-y answers to comple#ity: Are we able to move beyond the control panel?
Brussels, 27-28 November 2013, Medicus Mundi International Network meeting hosted by Memisa and linked to the annual seminar of Be-cause Health. The seminar will take place on 28 November at the Egmont Palace in Brussels. If the event’s title is confusing, this might even be intentional: the conference is all about providing health care in a complex environment and how to deal with this complexity. The Assembly, a Board meeting and workshops of the Medicus Mundi International Network are scheduled for 27 November. Register now for the seminar! A specific invitation (and registration form) to the MMI Assembly will be sent to the Network members and partners in October.
> Register now for the seminar! www.bit.ly/mmi2013-brussels
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Network event: Medicus Mundi Switzerland
Universal health coverage and global health beyond 2015
Basel, 6 November 2013. How can global health policy be structured to ensure that even the poorest people in developing countries have access to health services? That’s one of the topics of the ongoing international debate on the new development goals for the period beyond 2015. The World Health Organization (WHO) is advocating universal health coverage (UHC) as a way of making health services affordable and accessible to all. At its this year’s symposium, Medicus Mundi Switzerland will be discussing how UHC is defined and what form it should take in the light of the new development policy agenda..
> Announcement: www.medicusmundi.ch/mms-en/services/events/symposium2013
> MMI discussion paper on UHC: www.medicusmundi.org/en/contributions/news/2013/mmi-uhc-discussion-paper
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MMI Network members
Annual Reports 2012
Some more Network members have published their annual reports 2012:
- action medeor: http://medeor.de/de/medeor/action-medeor/jahresberichte.html
- Doctors with Africa Cuamm: www.mediciconlafrica.org/relazione-annuale-2012
- Medicus Mundi Italy: www.medicusmundi.it/en/component/content/article/126-report-annuale-2012/341-rapporto-annuale-2012.html
- Medicus Mundi Spain: www.medicusmundi.es/famme/publicaciones/memorias/memoria_medicusmundi_2012
- Medicus Mundi Switzerland: www.medicusmundi.ch/mms/network/basics
Collection of annual reports: www.medicusmundi.org/en/network-resources/network-reporting
International Health Policy: MMI Updates
Bits and pieces of news on international health policy: each “MMI update” is 140 characters or less – these are the rules of the game on twitter. Just enough for a headline, eventually an author, a date, the source – and a link to the website where you find the full information. Have a look at some of our “tweets” published during the last month. As usual, it’s a bit much, so take it or leave it.
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Health systems strengthening
Health services, health financing
Health systems research
- Health systems in times of global economic crisis: an update of the situation in Europe
http://bit.ly/18UmoeY - Legislation on the for-profit private health sector in east and southern Africa. Jane Doherty http://www.equinetafrica.org/bibl/docs/Diss%2099%20privsector%20laws%20Aug2013.pdf
- The role of research in the right to health and the universal provision of health care. M. Torres Tovar, P. de Paepe
http://www.socialmedicine.info/index.php/socialmedicine/article/view/719 - Open for abstracts: 3rd Global Symposium on Health Systems Research, Cape Town,30 Sept-3 Oct 2014
http://tinyurl.com/odmeas9 - Enhancing the role of traditional medicine in health systems: Strategy for WHO African Region now discussed at RC63
http://www.afro.who.int/index.php?option=com_docman&task=doc_download&gid=8577&Itemid=2593
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Universal health coverage
- Universal Health Coverage: A commitment to close the gap. WHO et al.
http://www.savethechildren.org.uk/resources/online-library/universal-health-coverage - Just published: September contributions to Global Health Governance journal. Focus on UHC
http://blogs.shu.edu/ghg/category/complete-issues/ - Recommendations arising out of technical discussions on UHC, for consideration at upcoming WHO SERAO session
http://www.searo.who.int/mediacentre/events/governance/rc/66/6.pdf - The way to #UHC: ideas beyond the dominant paradigm. De Allegri & Sieleunou
http://bit.ly/17YYmm1
See also below:
Health beyond 2015
Twitter: #UHC
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Human resources for health
Migration of health professionals
Third Global Forum on HRH
- Consultation on outcome document of Third Global Forum on Human Resources for Health
http://bit.ly/1dFJcnR - WHO policy dialogue on internat. health workforce mobility and recruitment, May 2013: technical report
http://bit.ly/18mKmBe - Global health workforce crisis. Key messages. Fact sheet by GHWA
http://www.who.int/workforcealliance/media/KeyMessages_3GF.pdf - Europe concerned about mobility of health personnel. Linda Mans reports from Oslo consultation meeting
http://getinvolvedinglobalhealth.blogspot.ch/2013/09/europe-concerned-about-mobility-of.html - Community health workers can accelerate progress towards universal health coverage in sub-Saharan Africa. Biodun Awosusi
http://bit.ly/16VYPWj - Systemic Management of Human Resources for Health: An Introduction for Health Managers. Necochea et al.
http://reprolineplus.org/resources/systemic-management-human-resources-health-introduction-health-managers - Health workforce brain drain: From denouncing the challenge to solving the problem. Cometto et al.
http://bit.ly/18mwTcI - Physician emigration to USA is increasing for most countries in Sub-Saharan Africa. Tankwanchi et al.
http://www.plosmedicine.org/article/info:doi%2F10.1371%2Fjournal.pmed.1001513 - Interventions for supporting nurse retention in rural and remote areas: an umbrella review. Gisèle Mbemba et al.
http://www.human-resources-health.com/content/11/1/44/abstract
Twitter: #HRH, #healthworkers #healthworkerscount, #3GFHRH,
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Access to medicines and vaccination
Medical research and development
Neglected diseases
- Access to safe medicines. Journal of Health Diplomacy, first issue
http://www.ghd-net.org/journal-health-diplomacy-volume-1-issue-1 - Canada and access to medicines in developing countries: intellectual property rights first. Joel Lexchin
http://www.globalizationandhealth.com/content/9/1/42/abstract - Marcus Müllner on dealing with conflicts of interest in the regulatory decision making process
http://fb.me/2lnXZ9XGt - Strategic plan for NTDs in African Region 2014–2020 aims to control, eliminate, eradicate targeted NTDs
http://goo.gl/dixadQ
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Women’s and children’s health
Sexual and reproductive rights and health
- The new women’s health agenda. Ana Langer talks to Fiona Fleck
http://www.who.int/bulletin/volumes/91/9/13-030913/en/index.html - Policy directions to improve women’s health beyond reproduction. Flavia Bustreo et al.
http://www.who.int/entity/bulletin/volumes/91/9/12-109785/en/index.html - Accelerating action towards universal health coverage by applying a gender lens. Judith Rodin
http://www.who.int/entity/bulletin/volumes/91/9/13-127027/en/index.html - At the crossroads: transforming health systems to address women’s health across the life course. F. Bustreo et al.
http://www.who.int/entity/bulletin/volumes/91/9/13-128439/en/index.html - Women’s health beyond reproduction – a new agenda. Special theme issue of WHO Bulletin, September 2013
http://www.who.int/bulletin/volumes/91/9/en/index.html - Analysing progress on commitments to the Global Strategy for Women’s and Children’s Health. PMNCH 2013 report
http://www.who.int/pmnch/knowledge/publications/2013_pmnch_report/en/index.html - Fee exemption for maternal care in SS Africa: Review of 11 countries and lessons for the Region. Richard et al.
http://bit.ly/1ff1Kzq - Annual under-five deaths down from 12.6 million in 1990 to 6.6 million in 2012. Still, 18,000 children die every day
http://www.childmortality.org - Global child deaths down by almost half since 1990. Promise4Children report
http://www.who.int/mediacentre/news/releases/2013/child_mortality_causes_20130913/en/index.html - Why maternal mental health should be a priority. Sara Gorman
http://buff.ly/13PmExR - The Killer Gap: A global index of health inequality for children, World Vision report
http://www.worldvision.ca/ABOUTUS/Media-Centre/Documents/KillerGapreport.pdf - Closing the killer gap in children’s health inequality. The Lancet
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2813%2961919-4/fulltext - New article by Dr. CarissaEtienne regarding accountability on women’s & children’s health
http://bit.ly/16vuCcy - Fee exemption policies for better maternal health… New tools, new knowledge? Karen Van der Veken
http://e.itg.be/ihp/archives/fee-exemption-policies-maternal-health-tools-knowledge/#sthash.lTO4l3gP.dpuf
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Equity and human right to health
Social determinants of health
Poverty and social protection
- A wholesale approach to policymaking is the key to tackling inequality. Angel Gurria, OECD
http://www.theguardian.com/global-development/poverty-matters/2013/sep/18/policymaking-tackling-inequality - Civil society urges decision-makers: Step up action to tackle health inequalities! EPHA press release
http://www.epha.org/a/5817 - Report on health inequalities in the European Union. European Commission staff working document, September 2013
http://epha.org/IMG/pdf/report_healthinequalities_swd_2013_328_en.pdf - WHO Europe: Social determinants of health report
http://bit.ly/16aRDkJ - Poverty, health, and societies of the future. Jim Yong Kim & Margaret Chan
http://uhcforward.org/publications/poverty-health-and-societies-future - Socioeconomic development to fight malaria, and beyond. Jürg Utzinger and Marcel Tanner
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2813%2961211-8/fulltext - Does investment in the health sector promote or inhibit economic growth? Aaron Reeves et al.
http://www.globalizationandhealth.com/content/9/1/43/Abstract - Global reach, local depth, and the future of health equity. Ted Schrecker
http://www.socialmedicine.info/index.php/socialmedicine/article/view/569 - How inequality is killing us. Susan Rosenthal reviews “The Spirit Level” (Wilkinson/Pickett, 2011)
http://susanrosenthal.com/articles/how-inequality-is-killing-us
Twitter: #SDH, #HIAP
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Global health governance and policy
WHO reform
- Economic governance for European health. Remco van de Pas
http://getinvolvedinglobalhealth.blogspot.ch/2013/09/economic-governance-for-european-health.html - Global health governance after 2015. Gorik Ooms et al.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2813%2961964-9/fulltext - NGO letter to WIPO Member States: Concern over inviting industry to “WIPO Forum” during the General Assembly
http://www.twn.my/title2/intellectual_property/info.service/2013/ipr.info.130901/36631220523fac4833c71.pdf - Global governance for UHC: Could Framework Convention on Global Health hold it together? Brolan et al.
http://bit.ly/14Cgx0l - Governance for health in 21st century”, WHO_Europe 2013 http://www.euro.who.int/__data/assets/pdf_file/0019/171334/RC62BD01-Governance-for-Health-Web.pdf
- The framework convention on global health. Lawrence O Gostin et al. WHO Bulletin early online
http://www.who.int/bulletin/online_first/12-114447.pdf - Mapping the donor landscape in global health: Malaria. Jen Kates et al., August 2013
http://bit.ly/1b8Lmil - Japan’s strategy for global health diplomacy: why it matters. Shinzo Abe
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2813%2961639-6/fulltext - Global health boomerang – The risk of seeing past and present as prologue. Tom Paulson
http://www.humanosphere.org/2013/09/global-health-boomerang-the-risk-of-treating-past-and-present-as-prologue/ - A special role for WHO in creation of a living global health governance constitution. M. Holsington
http://bit.ly/16We8OZ - Can “comatose” WHO reclaim its role in crowded global health governance landscape? van der Rijt/Pang
http://bit.ly/18mHPXN - Discussion paper on WHO’s role in global health governance: slow progress; weakest link in overall reform process?
http://www.euro.who.int/__data/assets/pdf_file/0019/196210/63wd15e_WHO-Reform.pdf - WHO’s budgetary allocation and disease burden. Ikuma Nozaki
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2813%2961930-3/fulltext - Mobilizing for health – beyond the current crisis: Towards an organic & cohesive World Health Movement. Jaime Breilh
http://www.socialmedicine.info/index.php/socialmedicine/article/view/676
Twitter: #globalhealth #healthgovernance
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Health beyond 2015
MDGs and SDGs
- JUST RELEASED: Health in the Framework of Sustainable Development. UNSDSN thematic report
http://unsdsn.org/files/2013/09/SDSN_Report_DRAFT_Sep15_final1.pdf - The draft UNSDSN report is open for public comments until 15 October 2013
http://unsdsn.org/thematicgroups/tg5/tg5_resources/ - UNSDSN thematic reports on post2015 development agenda: overview of topics covered
http://unsdsn.org/resources/ - Beyond2015 campaign: Key civil society messages on post2015 development agenda and process
http://www.beyond2015.org/sites/default/files/Appendix%201-%20Messaging%20Paper%20English.pdf - Realizing the right to health for everyone: The health goal for humanity. Go4Health, Sept 2013
http://www.go4health.eu - Heads of State adopted outcome document on disability & development at the UN General Assembly http://goo.gl/Av1EjN
- High stakes at the UN on the Sustainable Development Goals. Jeffrey D Sachs
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2813%2961956-X/fulltext - Planetary health – a new vision for the post-2015 era. Richard Horton
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61936-4/fulltext - A healthier global health agenda. Kent Buse and Sarah Hawkes
http://bit.ly/1fwTZCM - What can the UN General Assembly do for global health? Lancet Editorial
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2813%2961959-5/fulltext - Action for Global Health position paper on how the post2015 global framework should deliver on health.
http://bit.ly/16EcAsC - Global health governance after 2015. Gorik Ooms et al.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2813%2961964-9/fulltext - Global health governance after 2015. Reply by Michel Sidibé/Kent Buse
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2813%2961967-4/fulltext - A sustainable future with dignity for all. UNDG synthesis of “world we want” post2015 consultations
http://www.worldwewant2015.org/millionvoices - What role have the MDGs played in keeping health issues on the global Agenda? What have they helped/hindered? ODI
http://www.developmentprogress.org/blog/2013/08/27/health-and-development-bridging-gap
See also above:
Universal Health Coverage
Twitter: #health2015 #post2015 #UNGA #globalhealth
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Other topics
- 63rd session of WHO Africa Committee
http://www.afro.who.int/en/sixty-third-session.html - WHO Regional Committee for Europe met in Izmir: Key agenda items
http://bit.ly/18UoNWW - Sixty-sixth Session of the WHO SEARO Regional Committee, 10-13 September 2013 in New Delhi
http://www.searo.who.int/mediacentre/events/governance/rc/66session/en/index.html - WHO: Public Health and Environment Newsletter (just published: August/September issue)
http://www.who.int/phe/e-news/en/index.html - The Global Burden of Disease: Generating evidence, guiding policy. Regional policy reports by IHME
http://www.healthmetricsandevaluation.org/gbd/publications/policy-reports - The European Mental Health Action Plan focuses on goals & actions to strengthen mental health & well-being
http://bit.ly/15T1DTD - Core health indicators in the WHO European Region 2013, with a special focus on noncommunicable diseases
http://goo.gl/QVQTAO - Health2020 – the European policy for health and well-being – is becoming a reality
http://goo.gl/YsRhXT - As funding declines for nonprofit product development targeting global health concerns, innovation becomes key
http://bit.ly/1baijdc - How global tax reform could transform Africa’s fortunes. Kofi Annan
http://www.theguardian.com/commentisfree/2013/sep/05/g20-africa-global-tax-reform - The promise of eHealth in the African Region
http://goo.gl/KFp99L - Promoting healthy ageing in Africa. Situation analysis and way forward. Report presented at WHO AFRO RC63
http://bit.ly/1gVzkpO - Health literate populations are the core of effective health systems. Rene Loewenson et al. in: Equinet newsletter
http://equinetafrica.org/newsletter/index.php?issue=151#1 - The top 10 causes of death. Updated WHO fact sheet
http://www.who.int/mediacentre/factsheets/fs310/en/index.html
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