Thank you for sharing the WHO film and message Neil. [ https://who.int/news/item/17-03-2022-transforming-health-care-stories-of... ] It rings so true - we've been developing a social movement approach to asthma - Asthma Right Care - that has spread to 17 countries now, and it illustrates all these points. We have advocated for distributed leadership, followership, bringing joy to work, triggering many conversations - inspired by Helen Bevan, UK amongst others - her Twitter account is always great to read:
https://twitter.com/HelenBevanTweet?ref_src=twsrc%5Egoogle%7Ctwcamp%5Ese...
Rather than a top-down campaign, Asthma Right Care has enabled creativity from all those in the "asthma system" and if you go to https://www.ipcrg.org/asthmarightcare you'll see "silent movie" films, giant slide rules, case studies, films created by young people. The aim is to create a bottom up force for change in systems to move away from reliance on episodic acute care to reliance on supported self-management with the right medicines.
As we spread to more countries the most important problem varies. Episodic care might be over-reliance on inhaled bronchodilators without tackling underlying inflammation - despite 30 years of evidence about its importance; or episodic use of hospitals rather than inhalers. But in some countries the conversation about asthma can't even start because of stigma; or the problem is under-diagnosis so that asthma isn't even on the agenda.
We need to engage the whole system, as in some countries access to asthma inhalers is a thorny cost issue.
Our scaling up goals are to go to more parts of each system (pharmacists are very engaged!), to more geographies and to go deeper - to achieve transformational change. Our next challenge is to evaluate the impact not just in terms of behaviour change, but also of our approach: have we achieved our goals of distributed leadership, building trust and improving relations between different parts of the system.
Thanks
Siân
HIFA profile: Sian Williams is Chief Executive Officer at the International Primary Care Respiratory Group in the UK. Professional interests: Implementation science, NCDs, primary care, respiratory health, education, evaluation, value, breaking down silos. sian.health AT gmail.com
