CECHR symposium

1. Handling Uncertain Futures Thilo Kroll University of Dundee School of Nursing & Midwifery

2. “For my part I know nothing with any certainty, but the sight of the stars makes me dream.” Vincent VanGogh

3. Uncertainties Who decides? Who creates and dominates risk perceptions? (Beck, 2006) Risks are socially constructed and replicated in discourses in different ways by different groups in society over time “Black Swans” (Taleb, 2010): what you don’t know is far more relevant than what you do know (extreme events; the highly expected not happening)- serendipity

4. Beck, 2006, 293 A B A C C B Contextualism – no global risks – local management Hierarchical risks – peripheral: Tschernobyl B A A Global environment C B Differential social vulnerability Transnational Actor-Network – SARS, BSE, Bird flu

5. Challenges Health: obesity/CVD/stroke/diabetes Climate: weather patterns/clean water/air Economy: widening income disparities Population: longevity/ageing with disabilities/migration Technology: dependency/resources/technology literacy

6. Health Dementia Demographic ageing is proceeding rapidly in China, India and Latin America. The number of older people in developing countries will have increased by 200% as compared to 68% in the developed countries in the 30 years up to 2020 (ADI, 2008) Even now, most people with dementia live in developing countries; 60% in 2001 rising to 71% by 2040 (cf ADI, 2008) Obesity Currently more than 1 billion adults are overweight - and at least 300 million of them are clinically obese. Current obesity levels range from below 5% in China, Japan and certain African nations, to over 75% in urban Samoa. But even in relatively low prevalence countries like China, rates are almost 20% in some cities. Childhood obesity is already epidemic in some areas and on the rise in others. An estimated 17.6 million children under five are estimated to be overweight worldwide. (cf. WHO, 2003)

7. Uneven societies and health risks Pickett & Wilkinson, 2007

8. Technology Wireless world Information explosion (information overload, erosion of privacy) Social connections and online networks the world now spends over 110 billion minutes on social networks and blog sites… social network or blog sites are visited by three quarters of global consumers who go online, after the numbers of people visiting these sites increased by 24% over last year. The average visitor spends 66% more time on these sites than a year ago, almost 6 hours in April 2010 versus 3 hours, 31 minutes last year. (Nielsen, 2010, June) Tele-medicine and tele-care on the rise

9. Connecting the dots Obesity – urbanisation – life-style change - technology dependency (e.g. car use) – early onset – secondary conditions (stroke, CVD, diabetes) – health care expenditure (resources), increasingly technology-focused management – insurance promotes/bars access Compound vulnerability From a model of social determinants of health towards an ecological model of health(Bronfenbrenner, 1979)

10. Science: Promise and investment – An example Genetic research Issues of ‘Geno-literacy’ (Kroll & Naue, 2010) Who isnot at the table?

11. Science Impact (focus on making a difference) Contextual Translation (beyond lab and bedside) Methodological pluralism (‘RCTs=confirmation but not innovation) Systematic road mapping: synthesis, exploration, experimentation, synthesis (MRC Framework for the Design & Evaluation of Complex Interventions; NIH Roadmap for Medical Research) Accountability: Participatory governance ‘governance in action’ is about characterising the pattern that emerges from the interactions of a range of political actors of which the state is only one…Participatory governance can be understood as the regular presence of these persons and groups when making policy decisions in the respective policy fields (cfNaue & Kroll, 2010)

12. Knowledge claims and epistemologies Reality and knowledge as social constructions (Berger & Luckmann, 1966) or ‘Science (or what is offered as such) is localised in a field of knowledge and plays a role in it’ (Foucault, 1969, p. 2003). “All typifications of common sense thinking are themselves integral elements of the concrete historical, socio-cultural Lebenswelt within which they prevail as taken for granted and as socially approved. Their structure determines … the social distribution of knowledge and its relativity and relevance to the concrete social environment of a concrete group in a concrete historical situation” (Schutz cf. Berger & Luckmann, 1966, p. 28) Forms of knowledge: scientific, serendipitous, practice, experiential

13. Knowledge mobilisation Knowledge networks and Communities of Practice (Wenger, McDermott & Snyder, 2002) “groups of people who share a concern, a set of problems or a passion about a topic, and who deepen their knowledge and expertise in this area by interacting on an ongoing basis” (p. 4) From linear knowledge transfer models (traditional evidence-based practice approach: Knowledge generators (scientists) and knowledge users (practitioners, patients) to interactive, localised, multi-stakeholder knowledge networks (Nutley, Walter & Davies, 2007; Wyke & Kroll, 2009)

14. Education Specialism? Problem-focused training? Diversification of skills?

15. Towards a new knowledge brokering renaissance wo/man?

16. Meeting complex challenges and uncertainties Inter- and transdisciplinarity Innovation (out of the box in addition to inside the box thinking) Translational activity and knowledge mobilisation Public involvement and participatory governance (Naue & Kroll, 2010) Ecological model of the determinants of health and well-being

17. Conclusion Increasing complexity and uncertainties requires ecological approach to health Participatory governance (different information and knowledge field than before, promoted by technology) Creativity, lateral thinking, innovation through multiple forms of knowledge production and continuous exchange