Jolanda, please tell us a bit about yourself and your background. How has your experience contributed to your role in Invest4Health?
Originally Dutch, but with experience from living in Oslo, Norway and Sodankylä, Northern Finland, before I settled in Sweden about 25 years ago, I feel like a real European and love to meet and collaborate across cultures and borders! In the ’90s, parallel to the start of my Ph. studies on pupils’ health at local elementary schools in Finland, I had a part-time job as a project secretary. About twenty years later, I finished my PhD in paediatrics in Sweden. During those years, I achieved practical experience as a primary care dietician, strategic experience as an R&D officer creating conditions and funding opportunities for research and development among clinicians, and leadership experience as the public health director in the county of Östergötland, Sweden. This mix of experiences is what I brought to my current job as the strategic lead of the healthcare transformation processes towards more person-centred and integrated care, health promotion, and disease prevention at Region Skåne, Sweden. The aim and outcomes of the Invest4Health project are essential as a lever and driver to achieve this transformation in the direction of prevention and health promotion, a field that’s driving me as a person, as a former public health director and as the project coordinator. With my PhD in paediatrics and health, I am also excited to contribute with experience and perspectives to the testbed Skåne focusing on mental health and wellbeing among children.
What are the significant achievements or milestones in the project’s first year of Invest4Health, and how satisfied are you with the partnership?
The first milestone and significant achievement is the fact that we received the EU Horizon funding, which confirmed the importance and relevance of Invest4Health in transformation processes to meet the complex societal and healthcare challenges in collaboration, also regarding governance and investments.
The first year, we started with a kick-off where we created trust, relationships, and, yes, real partnerships to invest our time and efforts for the standard and shared purpose with Invest4Health. The partnership has been developed by online meetings in different constellations on the initiative of various partners. It has been strengthened even more during our latest physical project meeting in October, with a design based on co-creation.
An important lever during this year has been the consciousness, understanding and identification of interdependencies among and between the different work packages. There has been a strong engagement, other meetings and a lot of work to tackle these interdependencies that needed to be clearly described in the application to achieve the deliverables and milestones to be achieved in the project. Understanding and handling the interdependencies between the fields of research and the testbeds and finding different and innovative ways to meet different needs and outcomes for researchers and practitioners have been crucial achievements this year.
Last but not least, as the project coordinator, I am proud that we have achieved the deliverables and milestones described in our application for the first year. Here, I highlight the launch of our website as an important information platform for those interested but not immediately involved in the project.
Finally, what do you consider the most important task and challenge of the second year of Invest4Health?
I would say the most important and challenging task at the same time is now to get the testbeds up and running within the context of Invest4Health and linked to the other parts of the project to achieve the research and innovation outcomes that contribute to the societal and health care transformation needed. Here, the common understanding of Smart Capacitating Investments (SCI), the different business models and the organisational readiness are examples of important issues that we have been working on during the last year but that now need to be applied and adjusted to the conditions in the four different scenes of the testbeds.
Also, citizen engagement at different ecosystem levels is an important but challenging part of Invest4Health that we need to increase our focus on in the project. Citizens are one of the stakeholders in the project as a whole, but also in the four testbeds; the citizens’ roles as stakeholders vary, though. Regarding stakeholders, mapping, understanding stakeholder relations and including them more or less in Invest4Health is also an essential upcoming task in the coming months. Here, a dialogue and understanding of social franchising will be central.
Bengt, please introduce yourself and share a bit about your background.
I am a telecommunication engineer by profession and have spent the first 30 years of my career with private telecommunication companies. During these years, I have been heavily involved in developing international technologies related to telecommunication networks and handset technologies. In 2010, I decided to do something completely different in life and started a small family-based consultant company to work with innovation from the regional economic development perspective. I became closer and closer to health care, the digitalisation of care, and an innovative perspective on healthcare systems. Today, I am employed by Innovation Skåne, an innovation intermediator owned and controlled by Region Skåne. I am mainly involved in innovation initiatives with the primary objective of dealing with innovation and transformation at a system level. But with the individual/person/patient in focus.
That said, I use the competencies and experiences I gained during my years in the telecom industry. It is all about being curious about complex problems, trying to understand the dynamics of complex systems and organisations, and doing that while keeping the user, customer or patient or any other human being in focus and ensuring that whatever you develop should create value for someone with a need.
The challenges we face in societies are highly complex and concern multiple stakeholders. Otherwise, they could have been resolved already. To have a chance to address challenges like these, we must improve our capabilities to collaborate for a shared purpose. We must identify and understand the incentives of actors that should be involved to get these actors out of their respective comfort zones and be prepared to contribute to the shared purpose. A significant enabler for this to happen is a good understanding of the economic perspective on collaboration. Who is prepared to pay for what? Could we claim that we invest in social values such as health? How do we share “the payback” when capitalising on our investment? Invest4Health is all about this, and I would like to contribute and be a part of the team that makes it happen.
In your role’s perspective, what is the most critical aspect of Invest4Health, and how do you approach overcoming these challenges?
The main objective of Invest4Health is to define how to invest in health promotion initiatives so that we can reduce or at least redistribute overall costs for reactive care. The result of that recipe is tasteful for nations, regions, and municipalities, so they are prepared to copy the recipe and apply it to their respective challenges.
The logic for driving health promotion and disease prevention initiatives differs entirely from providing healthcare. So, in the project, we have to ensure that all partners understand and acknowledge the differences and are prepared to adopt the health promotion logic within their respective research and innovation tasks.
Another challenge is that the project is a part of the “research and innovation actions” within the Horizon Europe program. As such, we must keep a constructive balance between the research and innovation perspectives. Some of the work packages in the project are more research-heavy, while others are more towards innovation. During the implementation of the project, we learned that many more interactions among the work packages are required than expected. Our role in the project management team is to ensure that these conditions do not become a problem but rather a helpful tension that drives the project towards its objectives.
As a last question, what does success look like for Invest4Health? What would you say to that? What outcomes would make you feel like the project is accomplished successfully?
The purpose of innovation is not only to identify and implement new ideas. A necessary condition is that the solution provides value. Increasing value means success. This translates into the importance of the god, and innovative solutions could scale at a pace higher than the pace at which the challenge grows in severity. In Invest4Health, we have proposed a concept for scaling called Social Franchising. Consequently, the desired outcome is that, more than expected, regions find the Social Franchising proposition to be an offering they cannot refuse.
Joanna, please tell us about your work in the past years and how you became part of the Invest4Health team. Is it also true you have a hand in writing the Invest4Health project proposal?
For 18 years, I worked in the NHS (UK), ending up as Director of Research and Evaluation at the Health Education Board for Scotland (now Public Health Scotland). I experienced the highs and lows of health promotion and disease prevention being treated as ‘soft’ funding. What followed were unconscious steps to build understanding and narratives about doing things differently: running a private consultancy for 6 years with several of the 40 assignments in the UK and Europe exploring how to show added value from health spending; securing Interreg IIIC funding for the former One North East Development Agency (UK) to run a network of European regions identifying best practice and localised policy recommendations for securing added value from health investment and spending in 4 areas: local procurement, inclusive employment, capital investment and health innovation. This was Health ClusterNET in its first iteration. We then got funding for a health programme project EUREGIO III Use of Structural Funds for health investment in the 2000-2006 and 2007-2013 SF cycles. The evidence from EUREGIO III informed (i) a WHO/EU Policy Briefing How health systems can address health inequities through improved use of Structural Funds (2010) and (ii) the EU Council ConclusionsTowards Modern, Responsive and Sustainable Health Systems. A range of subsequent projects and assignments continued this thread by exploring different ways stakeholders can work together – including citizens and patients as equal partners – to generate health and wellbeing solutions in an unstable world. Although evidence was available at the turn of the Millennium, the impacts of the 2007-2009 financial/economic crashes and the COVID Pandemic showed that hospital-centric care models and related silo-based approaches in public funding were no longer fit for purpose. Meanwhile, digitalisation and data – if combined – provide opportunities for more agile and personalised health benefits at scale.
In parallel to HCN, from 2012-2018 I co-founded and helped run a time-limited think tank, with Steve Wright and Fausto Felli, that explored how to invest in innovative social infrastructure for the common good across EU regions. This led to us contributing to project management and providing expertise for a High-Level Task Force chaired by Prof. Romano Prodi (10th President of the European Commission). In this, one of the working groups I coordinated came up with the idea of smart capacitating investment. The result was a European Economy Report Boosting Investment in Social Infrastructure in Europe (2018). In turn, this led to an Erasmus Knowledge Alliance project (a4i) again involving SHCN, that brought together social care providers and private investors (commercial and ethical banking) to develop and pilot training to generate business cases for investment using innovative and/or traditional financing options.
The learning from all of the above became the basis for thinking about the need for new financial and business models for health promotion and disease prevention. And so, Invest4Health was created. Although I led the writing of the proposal, it benefited immensely from the input of other partners and the priceless value of their own paths to Invest4Health.
How does the project’s current state compare to what was initially proposed? Have there been any unexpected twists so far? Do you expect any?
It has sometimes felt necessary to remind people that the project is not about implementing health promotion and disease prevention interventions. It is about developing, introducing and testing new financial and business models – with serious citizen involvement – in financial decision-making in regional testbeds. We can be tempted to think we are working through a linear process with this project. That is rarely true. Fundamentally, it is a learning process with twists and turns. Identifying, untangling, understanding and merging different threads of knowledge as they are generated by the work packages and at the project level. So yes, I expect more twists and turns as early assumptions are challenged – and survive or are discarded.
Then, a second tranche of EU regions will be involved to run simulation exercises that help revise the models, processes, and data utilisation and then have them piloted again. And this led to a validated package of models, guidance, and resources to scale up and replicate I4H elsewhere in the EU and beyond using a social franchising approach.
On a personal note, you participate in the project actively, what part of the project has been the most satisfying or fulfilling for you, and why?
I believe that I4H can be a game changer for sustainable and meaningful investment in health promotion and disease prevention that happens at scale but with localised benefits. What is most satisfying is being involved with a lot of very smart and committed people with different but complementary expertise who have bought into the need to do things differently.
Any other thoughts you would like to share, for example, the most important message you would like to share from the WHO event where you recently represented the project.
We are developing and testing smart capacitating investment-driven business and financial models based on the premise that it is better to pre-empt than repair. This means sharing resources and risks (and genuine citizen involvement) to find more novel and sustainable ways to fund health promotion and disease prevention. This has special global relevance for investing in care for health and wellbeing in low-resource settings – found in all six WHO regions, although needs and circumstances differ. I hope we can increasingly show that the knowledge and resources being generated by the project has relevance beyond Europe.