 Okay, hello everyone. Good morning, good afternoon, good evening, depending on the time zone you are. Welcome to the first webinar of this biennium of the Wonka Special Interest Group on Policy Advocacy and our webinar today is learning from policies that work, the conversation with leaders. It's pleasure to host you today, myself and Professor Amanda Howe is joining the co-chair of the Special Interest Group on Policy Advocacy with me. We have two great speakers with us. You all know Anna Soudal, immediate past Wonka President and also Florian Hughes from the U.S. State and again a leader in policy. And we also have Pilla with us. Pilla is from Spain and also represent in the Wonka Executive Committee as a member of large. She is helping with us. We are trying, we are experimenting something special today for the first time. We are experimenting the captioning option in Spanish mainly but also Pilla is helping with Spanish but also we will tell if you are, if you are, if you would like to use any other language, whatever it is. I think there are 12 languages that you can have captioning. So you can have translations as captions on your screens. You have already enabled that and I will ask first Pilla to introduce that and then I will go to the speakers. Pilla, thank you very much Pilla and Pilla will be available for. I will keep an eye on the chat in case there are any issues. And please bear with us. We are experimenting this time and if this is a success we can be more inclusive in future. So if there's any issue, let us know. I mean, you can just message us or let us know in the chat if there's any problem. So we will introduce our speakers now. I would like to invite our speakers to introduce themselves, which is better. Anna first. Hello everyone. Organizers, thank you for the invitation. Participants, very good to see many familiar faces and also get to know new ones. I'm a family doctor in Oslo, Norway, university teacher and the immediate past president of Wonka. I followed this group from the start with interest, but this is the first time I've had the opportunity to attend the meeting. So I'm looking forward. Thank you, Anna. Lauren. Thank you, Sanka. Good morning, everyone from Denver. It is good to see you and some faces that I had a chance to meet in Sydney and Amanda and Sanka. Thank you for the opportunity to join Anna on the conversation this morning. I'm a family physician. I work in a rural clinic north of Denver, and I'm also faculty at the University of Colorado, where I do health policy research and teaching and consultative work across a number of different topical areas. And I am currently the immediate past chair of the American Board of Family Medicine here in the US, and we are the organization that sets certification standards for family physicians here in this country. So nice to see you all. Thank you. Thank you, Lauren. We know that you are just after a holiday. So still, thank you for, thank you for attending the meeting without any problem. Yeah, Amanda, would you like to go ahead from this point? Well, I think we are, you know, going to invite our speakers to speak. But yes, thank you, Sanka. So people will probably know me. I was president of Wonka at one point. I'm co-chair of this SIG with Sanka at the present time. And I'm very pleased that so many people have joined us, and then we hope that we can also share the webinar afterwards and the matters that arise through the portal and keep present at the conferences as well. So very nice to be here. And shall we perhaps go to our first speaker, so inviting Anna the way that the meeting will work, I should say, you know, we're going to have our speakers 10 to 15 minutes each. Then we will host some questions and answers direct to them. And then we will have hopefully a discussion in the group we may split into breakout rooms I think because we're quite a big group. And finishing hour and a half length of the meeting a little bit longer if we need it. And we will come back together, of course, in time to summarize your views and take things forward. So thank you very much. Anna. Okay, I've called this presentation Speak Out inspired by a poster approved by the five Nordic colleges in 2023. This is from a textbook in family medicine pointing to 2023. This poster described how we define the principles of of general practice family medicine, the five Nordic countries, and is a policy document in itself, but not my topic for this talk. But I'll, I want to attract your attention to the six principle in this poster. It states, we recognize that social strain, deprivation and traumatic experiences increase people's susceptibility to disease. And we speak out on relevant issues speak out advocacy, in other words. So, for clarification, I looked up this definition of a policy, according to Oxford languages. A policy is a course or principle of action adopted or proposed by an organization or individual speaking advocacy. Another word for me. I know Lorraine will give us some general views on advocacy and policies later. But another word for implementation of policies. There are some requirements for success. We need a clear vision, a convincing narrative, authentic leadership, public engagement and adequate available resources. I will now tell you a story about a policy which started way back in time, but which succeeded and still has impact because it is maintained and followed up. In 2005, this manifestation was published on a full page in one of Norway's biggest newspapers. 200 signatures of people in the Norwegian public health care public working in the field of health care and medicine. Including the newly passed health director on Norway heads of academic department scientists, high profile people from public debate and from public health. Our vision was stated in the headline. It said, we are physicians against increased commercialization and corruption. And we gave some advice to politicians and decision makers, health authorities and the Norwegian Medical Association. Our narrative was elaborated on in the text and don't try to use this automatic translation for this, I will explain. We were referring to the Paris Declaration, which described increased corruption in decisions made by the few affecting the many. Our reasoning we physicians depend on trust in our clinical work in research and in education. And we manage huge collective resources through our clinical decisions. So our concern was that professional activities increasingly were under influence of commercial actors at risk of undermining the humanistic foundation of our role. That is what's described in the text. This trend also contributed, contributes to increased medicalization, over diagnosing and over treatment. Our advice went in short around raising awareness among health personnel about how current trends impact developmental medicine and also discussing the important role doctors have. Ultimately, we wanted to make sure that regulations were in place to prevent professional corruption. The timing was not chosen by on random. Later the same month, the Norwegian Medical Association should discuss and then approve of a new set of rules for collaboration between physicians and big pharma and other commercial agents. I'll get back to the outcome. But first, let's do the list. I said clear vision. We had a clear vision. Represented in the main sentence doctors against etc. The narrative was the description of how commercial forces increasingly increasingly were impacting our professional activities. Yeah, I'll remain there for a while. Did we have an authentic leadership? Let me explain who we were. The initiatives bring out of a group of 12 female family doctors, the 12 Qs. We had a third of a think tank at that time. I had just stepped down as president for the Norwegian College of General Practice and a key issue for me in my time on the board was the risk of professional corruption through golden strings. Stronger and stronger golden strings between doctors and big pharma, which also led to a role in a Norwegian television documentary on the topic just before this call for action. So the 12 Qs were women from all of health care, primarily related to family medicine and public health. Our leadership was based on a common value base and firmly consolidated on that. And together we had a very broad network in all of health care and related fields and you know, Norway is a small country. So also the public swear is is rather small compared compared to many countries. So together we were quite well connected. We put down a list of names we wanted to invite to join this call for action. We shared the names among us, contacted them and gave them just a few days to decide if they wanted their signature included. If they did, they also had to donate a song to cover the cost for the ad. We had already negotiated a price with the newspaper and a good friend would do the layout pro bono. So over a short week, we needed to act fast to avoid sort of reactions. Let me get back to that budget on the parts of those who would not welcome this message were far more generous than ours. They were also equipped with human resources in marketing, for example. So we wanted this to come as a surprise. A media strategy was developed we contacted affiliated people in newspapers radio TV and we're ready to shoot the moment it was published. Norway is a country with strong cultural notions of fairness and collective responsibility for public services. So we expected the public to react positively and by and large, they did. So editorials, comments, essays, interviews and debate took place over the next couple of weeks. And that was a good building up to the medical associations meeting. What were the reactions from Big Pharma predictable, also partly from secondary care colleagues. First, denial, silence, then anger, offence, condemnation. How could we allow ourselves to indicate that colleagues could be professionally corrupt. It is a hard word, but it worked. Okay, support is what we experienced, I mean in the in the longer run. And we received many reactions from people, including colleagues who didn't want to go public. Now what is called currently is called cancelling from platforms didn't exist at that time. But group discipline and social control are not new phenomena. The issues raised became the topics for debates. And we were very happy. So we could go to that medical association general assembly quite well prepared. So we sparked a discussion and we raised awareness. The most important, yeah, and what was the defense collaboration also predictable collaboration is important. We are all in the same boat. I mean from Big Pharma from other colleagues. The pharma money necessary to fund research and professional development. And pharma provides invaluable contributions to medical education and CPD. So those were also on the agenda for the discussions. The most important outcome, however, was that the ground was prepared for the debate at the general assembly. And result the strict set of rules for collaboration between physicians and Big Pharma ever seen, I think also to date. Maybe the most important part, no CPD accreditation for educational activities sponsored by Big Pharma. But it also included restrictions and rules for to secure transparency regarding pharma sponsored research. I would highlight if I said everything was fine. There was a lot of problem and I'm happy we were not in the same social media environment we are currently. I was one of the spokesperson for the campaign and I was known for raising the issue of a many years, not least the president of the college. I didn't bring friends only, but more friends than enemies. Silence and attempts to ignore us. It didn't work as domination techniques in the longer run, which I think has transition value to other examples. If the case is good and there are enough people to support and defend it. It will actually have some impact. But patients is also needed. This spread first to the Nordic Federation of family medicine, which owns the Scandinavian Journal of Primary Health Care and the biannual Nordic Congresses. The federation was established in 2005. And I was also its first president and of course natural for me to take this issue to the Nordic collaboration and in 2007. We had the first almost pharma free conference Nordic conference in Iceland. Now the Congress is run without any pharma support. Next step was our European community. Since 2013, we defined the same goal for the Wonka conferences. And in Copenhagen in 2016, the first pharma free Wonka conference took place in Copenhagen. So far, so good. Let's revisit the process. I think we in large parts fulfill the requirements I listed for you, including adequate resources. And mind you, it was not financial resources. First of all, it was human resources and a well consolidated yet diverse enough group. But we shared ideas and goals. We came from different directions into the same issue. Well connected to different parts of health care. We planned on all levels and steps of the process. How did the policy fear and what is the state of affairs now for Wonka Europe? I'm afraid there has been a reverse move since 2016. The London conference in 2022 maybe not a good example where pharma were deep into the conference. I know that this issue will be raised in Wonka Europe Council this year. Because even if people understand that funding is important, I feel there is a common understanding of the potential reputation of risk for Wonka and for our professionality if pharma involvement is not strictly regulated. What about the global arena? Of course, we were not the only ones in the world who put this issue on the agenda back then. In our global community, big pharma's involvement in Wonka activities was perceived increasingly problematic. The approach I just have described has increasingly also been implemented in Wonka. So the organisation Wonka has put thick firewalls between pharma and individuals if pharma money at all is accepted. As for now, we have a few projects which is partly funded by pharma but with very clear framework and no pharma influence on the content. I know from where I'm speaking the situation in many countries is very different when it comes to funding of education, resilience of health systems compared to my region and my country. So vulnerability to professional corruption is variable throughout the world. Primary care and training for primary care are subject to influence by societal trends and developments and the financial system in the individual countries. I'm very well aware of that. So I know we are in a favourable situation. Welfare and health systems based on social cohesion, equity and solidarity. That's the bedrock of the systems. So that makes it also easier to address fundamental questions like this in a system like ours. But I think there are potential learnings to take from this story. And our global network Wonka can support member organisations to develop strategies to be more independent of pharma money. Synergies is maybe a keyword here but this is offered discussion and I am looking forward to listen and hear your views. So thank you so much for your attention so far. Thank you very much Anna. Bravo. Very interesting example about different levels of groups embracing a policy and then other things shifting it and the recurrence of the themes and of course what you highlighted that it makes a difference what your primary values are. So we often say both in leadership you can do very effective leadership for very bad purposes and you can have policies that are aligned with different sets of values in an organisation so really interesting. Colleagues we were planning to go straight to our second speaker so we could find the synergies between the two. But so unless anybody has anything they are really unclear about. If you are if there's something you really want to clarify then speak otherwise we will go on to Lauren. And just to comment one small thing I noticed that the translation mainly has a problem with the word Wonka. But other than that it's going well. So thank you Anna. Lauren please continue. Thank you. This sounds good and Amanda just a sound and check and you can see the slides okay correct. Okay, thank you. Well what a pleasure to follow Anna and certainly hope that what I'll share today will be complimentary and I can tell from what she just shared that there will be a lot of synergies in many ways between what she just shared and what I hope to convey as well. A couple of notes before I jump in and I'm going to hit start on my stopwatch so I can keep close to keep close to time. The first is I would like to acknowledge that my colleagues in the Farley Health Policy Centre where I'm based at the University of Colorado. As the Farley Centre we are nonpartisan and we are an objective policy research analysis and translation centre. And my colleagues that you see listed at the bottom of the slide, much of the content that I'm sharing today has been co developed with them and I want to give them a proper credit for their contributions to this content. And the other acknowledgement that I'll make from the beginning is that you know I am presenting from what I know which is a US based context and a lot of the policy work that I do is pertinent to how we organize finance and deliver health and health care in this country and so I certainly hope that some of what will be applicable to you and your context and look forward to discussing those differences later on during our webinar today. So starting with a definition that in many ways is complimentary to the one that Anna shared. This is not an officially coined definition of health policy, but this is one that has been a cumulative definition that we have developed as a team in the Farley Centre and that I often use, which is thinking about the work of policy as the work of moving people and systems from ideas to action with the ultimate goal of improving health and promoting wellness. So what does policy look like an action and and I'm not sure if this is an experience that you have had but sometimes when I talk about health policy with my colleagues. They look scared or their eyes glaze over they're not sure what I'm talking about or they think I'm talking about politics, and there can be a fair amount of confusion. I take a broad view on policy. And so these are different activities from my experience of what policy looks like in action. This might involve researching evidence to inform policy design implementation or evaluation. This might be convening stakeholders and decision makers to solve problems together. This might be a might be being a key informant to inform legislation or regulation or educating and mentoring professionals to think about health policy impacts or implications in the work that that that you are doing. And so if you think about these different bullet points and this is not a complete list, but you may think about or identify the work that you do as aligning with some of these different bullet points. I would argue that you may in fact be engaging in health policy work, but you may not have been thinking about it in that context. At the end of the day, why I love policy teaching it practicing it, etc. is that policy skills are tools to make your studies findings if you are engaged in research or your clinical practice experience actionable, which is really important to move health change forward. A couple of notes about policy versus advocacy versus lobbying. I often find that in my context, these terms, particularly policy and advocacy can get confused or conflated with one another. In the Farley Center, we think about policy as the work of really digging in and understanding the problem. It is that you're trying to solve and the work of analyzing designing or researching a wide variety of potential solutions to those problems. That's how we think about the work of policy. When you move into advocacy, you certainly can take that policy research or analysis those products to inform your advocacy work. But advocacy often involves, as you heard from Anna's example, educating stakeholders or decision makers, or asking them to move in a particular direction, which builds upon policy but is a distinct set of activities. And in the US, particularly when it comes to health and health care are, if you are a registered lobbyist health care lobbyist, you will be active in specifically influencing specific pieces of proposed legislation at the state or the federal level, either in direct support or opposition. So a couple other thoughts about the policy. I have a, my next slide will talk about different levels of influence. You can be engaged in policy work at the individual patient level, all the way to the international level as we are in Wonka. A little note about little P versus big P policy. This is not a judgment statement or to say that one type of policy is more or less important than the other. In the Farley Center, when we talk about little P policy, we are referring to organizational or clinical level policy and procedural changes. If we think back to those early days of COVID where our clinical delivery systems or clinics were changing policies, sometimes on a daily basis, early on. That could be considered little P policy. We think about big P policy more so in the realm of legislation or regulation at the state or the federal level. To be engaged in policy. One does not have to be working in or for government in some capacity. I'm currently in an academic environment and I'm working on policy. I've had experiences in the past working with foundations, associations, membership organizations, advocacy organizations, and I've done policy work in all of those different contexts and settings. And then another way to think about policy is to think about your issues of interest. And right now, I don't know about you, but my list of things I want to fix in health and health care would go on for pages and pages and pages. So important to pick an issue that you're passionate about and willing to be patient about the typical change in my career, the issues that I care about, including improving primary care financing and payment, improving how we deliver health care in rural communities and settings. These are things I'm not going to fix overnight by any means. These are our issues I'll be dedicating my career to fixing and improving in one way or another. But these are issues that I care deeply about that will continue to move me forward on days where the policy work can be challenging. So this was the levels of influence slide that I talked about on the previous slide. The big take home points here are to think about which level of influence do you wish to or intend to make your policy change effective. Again, that could be at the individual level in my clinical context, I have to spend a fair amount of time going to going to bat, so to speak, for my patients with their insurance companies to get them the care that they need. And so I'm working on policy. And in this case to advocacy on behalf of my patient or that family and kind of that individual level here in Colorado with the Farley Center I'm very engaged at the state level. But I also serve on committees where I have more of a federal outlook on improving primary care. The bullet points that you see on the right side again will be applicable primarily, I anticipate in the US context, but each of these different levels, whether you're working at the clinic or your health system level community state level, etc. There are different levers of change that you have available to you to impact and formulate policy. If I were just to highlight a couple of examples of the state level in, you know, Colorado, certainly we can make health policy change through legislation, or through judicial actions. But also through how we set the state budget related to health and health care, that's another way to affect change in health policy. So I won't go into just because of time go into detail on these definitions, you'll have these slides available afterward. But as I think about health policy over the years, this is how I have broken down health policy into different skill sets, analyzing policy, how to conduct policy mapping, essentially how to do a landscape analysis of the policy implications of the issues that you care about either from a research or a clinical perspective, how to do policy relevant research, how to an Anna was speaking about this toward the end of her presentation, how to strategically disseminate your clinical experience or your research findings to influence policy. And it's one thing to research or design policy, it's another thing entirely to roll up your sleeves and implement it in the real world. And so how do you operationalize policy. These are certainly different topic areas that in the future would be happy to speak more about at that future webinars if useful. And for a brief story from a policy that I was responsible for overseeing its implementation in my previous role. Prior to coming to University of Colorado. I served as a deputy secretary of health in the Pennsylvania Department of Health. I was into being like a deputy health minister and other contexts, but I was in our public health department in state government in Pennsylvania, where at the time and we still are facing an opioid and heroin epidemic crisis in the US. In the first year of service in Pennsylvania from 2015 to 2019, the crisis had really reached a particularly bad peak, and the governor was intent on trying to address this issue. One of the policy solutions was to create what we refer to as a prescription drug monitoring program. This is a database that includes information about the dispensation of controlled substances as we categorize those in the US. This is database that as a physician prescribing or considering prescribing controlled substances, or as a pharmacist that dispenses those controlled substances before prescribing or dispensing, we can look at this database to identify any red flag behaviors. So if a patient is getting prescriptions from multiple clinicians or getting prescriptions filled at multiple pharmacies, these may be red flags for addiction or diversion of these different substances. I was responsible for overseeing the implementation of this program, and this is a snapshot of the first page of the law. It took the Pennsylvania General Assembly or our elected officials seven years to pass this law. And my first day on this job, my boss, the Secretary of Health or the Minister of Health in Pennsylvania handed me this 11 page law and said, make this a reality. And they said, wonderful, I've never done this before, but we will figure it out and I had a great team. So the ultimate goal of this particular policy was to help clinicians make informed prescribing decisions and to aid regulatory and law enforcement agencies in Pennsylvania with combating fraud, abuse and diversion. That was the ultimate goal as listed in the legislation. And so that was my, that was my vision. That was the vision that was enshrined in the legislation. So how did I implement that on the ground with my team in the first year I focused my team on building a reliable database. I knew that if the data in that database wasn't reliable that physicians or pharmacists using it would not trust anything else that we would do educational programs or otherwise coming out of our office if it was not a reliable tool. Pennsylvania was very late to the party. We were the 49th states to pass this legislation. And so the good thing is we didn't have to reinvent the wheel. We could learn from other states. We could reach out to technical assistance centers. We could review the literature. And so I guided my team with my research background research and policy background, guided my team to practice evidence based policy to move this forward. So this was a picture of me with longer hair back in the day in August of 2016 when it was the official public launch of the prescription drug monitoring program. By the time I departed state service three years later, we had enrolled over 110 clinicians in this tool to use it. We secured nearly $7 million and federal funds to support additional educational programs. I initially hired one person my director that reported to me by the time I left we had hired almost 30 individuals to help advance this program. And I'm so very proud of my team that I worked with it was selected for a governor's award of excellence for their service on this particular program. Last thoughts as I am coming up on time here from my portion. As I think about health policy work. I see so many parallels between how family physicians are trained clinically how we think how we act what we do. That skill set translates to important skills needed to make health policy change. I'll just highlight a couple of options here a couple of thoughts here. Family physicians, we are comfortable navigating complexity and ambiguity in the clinical context. Right. So when our patients come to us and say, I've been dizzy for three years, or I've had this abdominal pain for five months, right. We're not exactly straightforward. Right. And so navigating that complexity and ambiguity is something that we are good at. And so that translates into health care, being very complicated and tedious, often in new territories and so being comfortable with complexity and ambiguity is really helpful when trying to navigate a complex and ambiguous health policy environment. I'll mention one other here that we know how to work well in teams in primary care and in family medicine or as general practitioners, and absolutely, you need to have stakeholder buy and it's crucial for change in health policy so just a couple of thoughts again you'll have these to take a look at. Health policy lessons learned and the work that I have done, I want to highlight a couple of these that relate to and reinforce what Anna shared. Crafting meaningful policy so critical to have a vision for change, where are you going as a group. Fostering trust at every turn, being an honest broker about what you know and what you don't know. Right. That would be really important. I have a couple of thoughts from the bottom section here learning how to clearly communicate to policy audiences. One of the terms we use in the Farley Center often as what we call attic data, a combination of anecdote or story and data. That's not a real term. I think someone long before me coined it but we love to borrow and use this attic data term stories I wish that health policy change could be made entirely with the with a cold hard facts. That is not inspirational. That is not what grabs people that is not what helps at priorities or get focuses the attention of our policymakers stories hook us in. So it said that it's an art of blending stories and data and being as clear, simple and straightforward as possible about the problem and your suggested solutions is very critical. And the last thing I will share here because this also connects to what Anna shared policy requires appreciating the difference between the policy or trying to formulate and the political context in what you're trying to do that work. Policy and politics are not the same thing, but they are very dynamic and interrelated they certainly impact one another. And if you are interested in policy work. This will be a good thing for you if you are a patient person. Policy does not change overnight. Again, if you are willing to be persistent if there is something that really gets under your skin and bothers you and you cannot sleep at night because you want to see it changed. That's probably a good topic for you to focus on and perspective being willing to listen and hear out other people that have different perspectives than you will really elevate your standing as someone that can be trusted and honest broker because you are willing to be a team player and that's very important. And very good. Last I'll share and again you'll have this content information for me if I can be helpful. This QR code will take you to some policy publications that our team produces every week. If that would be of interest to anyone on the webinar and with that, I will stop and Amanda I appreciate your patience with a couple of extra minutes. Thank you. You are very welcome Lauren and again thank you also for that excellent talk and many synergies. I mean it's always a question in a webinar like this colleagues how much we spend time hearing from people with real experience and expertise and how much time we spend interacting with that material but hopefully that wasn't too long. I didn't find that too long. I hope so that's great. What we said earlier and greetings to colleagues who joined us late. We have just finished the two core speakers. What we proposed to do for the second part of the webinar was to allow people to ask key questions so if there is something that you didn't understand from what Anna or Lauren said or something you really want to pick up and query, then let us do that now while we are still together. And then after that because we have 40 people on the webinar which is brilliant. We think we will split up for 20 minutes perhaps in breakout rooms to allow people to have a bit more discussion about how this applies to them and then come back together. Now to ask a question of either Anna or Lauren, we will try to see if you can put up your yellow cans on the toolbar. Okay, Michael from Canada. Hi, great. Thanks. Great. Great talks for those who don't know me, Mike Green. I'm the president of the College of Family Physicians of Canada. I also run a big policy research group here in Ontario. Question for both of you, maybe what Lauren you kind of commented on this. Any thoughts on navigating between those levels of engagement on policy. So, you know, as a researcher, I engage at that kind of policy trusted partner thing we've got, you know, a decades long partnership provide data to the people behind the scenes but as college president or lobbyist pushing certain kind of policies and any thoughts on how you go back and forth between those levels of the policy spectrum when you're trying to move something forward because, you know, you never get it all in one lane. I can jump in first and then have you follow. That's a great question. And I think it, it's going to, you know, it's going to evolve over time based on what is the scope of the problem that you're trying to solve. So once you identify that, how wide is the issue you're trying to solve, and how many populations does it does it impact, and also to understand and map out who was otherwise working in this space. And so that will kind of impact the scope of the work that you that you do. And in terms of moving from, you know, across levels, I think of that as being very fluid. And so you may need to, you know, expand and think at a broader level, or drill down to, you know, a different level depending on the problem and who is working on that who has decision making authority. And what which level are they sitting, you know, sitting at what kind of access to resources or political will. Is there what work has already been done at that, you know, particular level and where you are able to identify a coalition of folks to help you. But at the basic level, it is, what is, what is the scope of problem you're trying to solve. What are the policy lovers that make the most sense to advance that problem and where is that going to, you know, line up if you're trying to solve a problem. At the wrong level with not the with the incorrect policy lever, you're going to run into a log jam. And so the policy mapping exercise that I referenced is an exercise that we walk through to help people identify the right level and the right types of levers to work on to make sure that that is is matched up. So those be some of my initial thoughts and other things that you would. I submit to what you're saying. And I wanted to, to share principle. I'm sure you're familiar with many of you. And that is the kiss principle. Keep it simple stupid. If we as advocates, family doctors around the world, we, we see here's something's wrong here or I want to change this. It's not brain surgery. I was also told that brain surgery is not that difficult to put aside comments, but to start with the small steps to identify as you so beautifully outlined Lauren to to identify the problem. Also identify your own resources to bring it to someone make allies, etc. So starting and for most of us, I think family doctors around the world, we can do advocacy, efficient advocacy where we are. So I would, if I should give one advice, it would be to start where you are in the context in which you are. And then you can see if you can move up the, up the ladder, so to say, to the bigger context. Also, because what you said, again, about persistence and patience, that is absolutely also my, my experience. So it works like yeast, if you just, if you have a good message, and you stick to that, it will also spread. That's all. Thank you. May I add a comment that also may take us into the discussion. Is that okay. Because in our college Michael in the UK Royal College of GPs, we often go up and down the levels to make policy. Because we're a membership organization, and in the discussion I think we will want to say, how does your Wonka member organization make and use policy, you know, we will have some ideas in a policy group in a leadership group about what matters and what priorities are and, you know, try to be clear about why we think that but then we will take it to the members to consult or to have some grass roots discussion maybe even with patients as well to check that are, you know, ideas have authenticity and then that will be fed back up, as it were, to produce a resource, a clear statement, and then that will be dispersed out again. I won't say down, but, you know, so that people can start to use those messages themselves in their place. And the college itself may be doing it at like a government level or with other colleges other specialties you know how it was I think the Canadian college probably the same but it's sort of up and down the level to give the cycle of awareness of learning and that authentic voice so that you know earlier when the chair said that to the Prime Minister, I remember her already talking about that, and it gives that, you know, permission so. Amanda one other thing I just thought of that I'll add here to is that changing levels let's say you're working on an issue at your, your clinic or hospital system level. And all of a sudden you recognize that you know in my context there are state policy leaders that now this becomes like a hot topic that they're concerned about right that opens up a window to now have those conversations and advance policy change at the state level. So, sometimes changing levels of where you're focusing your intent to make policy change means being nimble, and being willing to adjust your, your strategies and the focus and locus of your conversation, based on different policy windows opening up at different levels, and so that's another. And that's what makes policy work for me exciting and keeps you on your toes. Great, thank you Pilar would like to make a comment I think. Thank you very much to all. It is really a pleasure. And I've been, and I've been just watching the chat and all people are really enthusiastic with the two presentations. And there are a lot of comments that support the main messages made by Anna and Lauren, particularly in Spanish so great. Well, I just want to thank you both of you because you really and make a wide perspective of what policy advocacy was but at the same time. Sure, your own experience doing policy advocacy and that is a key element for the rest to be involved in and try with consistency and with the good message to go on working for family medicine and primary health care. It's true that sometimes we look to the window and we see many, many things to work for, but it's really important to focus on a small area and start working and engaging our stakeholders, patients or the colleagues that can reach small and goals attained and then summing up the different goals of different groups to have a big change for all. So thank you very much for your presentation son speak. We have another question in the chat from Monica, which I've translated it says in your experience, what influence does civil society have. So often we see ourselves as family doctors as being, you know, the voice of our communities, you know, the ones who are recognized perhaps as having some professional authority but in terms of making the sorts of policies you raised guys, you know, how much actually has that been driven by what Monica is calling civil society. Shall I try to comment on that depends on what you mean with civil society you mean the general public general society because civil society in some context refer to organizations like Wonka, right, for example with with the WHO. But I think if, if I answer the question as if it was meant the general public, what role it plays a strange thing, looking at because health is so important to people we had a situation here in Norway you know Norway is a very long country and up north. There are long distances to hospitals and people are very dependent on having their local hospital to provide acute care emergency care. And a lot of stories and now the authorities are looking at how to save money. Also in the name of equity throughout the, the country to have equal access to specialist care so people up north should have the same access to very specialized care on the cost of the local hospitals. People go out in the streets with torch manifestations fighting for their hospitals because they see they see that it's a threat. I mean we can die tomorrow if the hospital was not working for us as family doctors and here comes. Maybe it's a little bit on the side of the question but the role of civil society, the general public. It's on us to educate also the public as to how important it is to have doctors and primary care providers who work. I mean continues with the population and with the individuals. I haven't seen it yet but I would have hoped that we could manage to have the public also work in processions towards processions to say we will protect and we need also primary care. And I think because what happened with in Norway, small town up north where the hospital, it was on the plan to shut down emergency services. After these manifestations and the media attention, government changed the decision. So they have their hospital so far. I mean, for another five or 10 years. But yeah, so the role is extremely important to educate and also to reach out to the public. And that is maybe not with the usual policy dialogue words, but other words, the anecdote. I like that word. Thank you, Lauren. You're welcoming you certainly won't find anecdata in the dictionary anywhere I think, but I think it's an effective strategy. I'll add a couple other thoughts and Monica, thank you very much for this really discussion after that. Yeah, perfect. Yeah. No, thank you Monica for this really important question and I'll pick up with what Anna was saying around our role and educating patients, families and communities about how health and healthcare works. That's really important is exhausting work, because it is how we organize finance and deliver health and healthcare, particularly in the US is very, very complex. And it's a black box. And it is, every one of us has a different perspective or a different slice of understanding on how this process works. But to the extent that we can provide education, you know, beyond just the clinical care context is really important. When I think about the civil society as was raised in the question, my mind immediately went to sort of patients and families and involving their voices and their stories in policy change. And relative to the example that I shared, you know, on the prescription drug monitoring program. It was really well and just more broadly the opioid heroin epidemic in Pennsylvania. I absolutely believe that patients and families have been impacted by the disease of addiction. We're front and center with the media front and center with advocacy organizations front and center with elected officials. It is hard to turn your attention away if you are an elected lawmaker to turn your attention away from a mother or a father, brother, sister that is testifying in front of you that they lost a loved one to the disease of addiction or to overdose. It is hard to turn your attention away. And so engaging patients and families to share their personal experiences. Number one, centers us in patient centered policy change as we're all trying to be patient centered and how we deliver primary care. But it also raises the bar in terms of the urgency and the need to act. And so patients and families engaging them and the broader public in important healthcare issues one invites them to the table as really important stakeholders, but also is incredibly strategic from the point of view of garnering the attention of elected officials and holding their feet to the fire because they are the constituents that might be voting for them or not. And the next election. Right. So it's an accountability mechanism as well. Excellent. And we've often said in our, you know, seek teaching sessions if you like that people, you go somewhere and people say well you would say that you're a family doctor, we'd expect you to say that if the patients say it, people listen differently. Great. Thank you so much. Another question that came was not a comment in the chat earlier he now said sometimes stakeholders don't want to hear what we're saying. So I think that's a good challenge for the breakout rooms what we thought as we said colleagues that we would do to give you some airspace for maybe 20 minutes or so is to go into some breakout rooms and and you know the question we particularly going to ask was how can, how does it work with Wonka for you, you know, how do you feel that as a family doctor, you can, you know, your Wonka membership organization or the special interest groups or the conferences or whatever. You know, how is that, how does that help you to make a and use policies and what do you need. I'm going to turn to Sunker and Harris to tell us if we can split up what we thought ideally we would have three groups and Pilar, and we're going to ask you if we can get people who want to go into a Spanish speaking group, if it's possible in the breakouts for you to chair one and report back. Okay, and Sunker and I will do the others and Anna and Lauren can go to whichever whichever you like. Sunker and Harris tell us how it works please. I think Harris should. We're waiting perhaps I will do something that we will do later till the guys have come back to tell us how we can do this. You know, if you don't already know we have a special interest group in Wonka policy advocacy group and we have a membership portal, and you can come there and share ideas share resources. We will point post the link to the webinar when it's recording is uploaded. And we also discuss, you know, conferences or ideas or whatever. There is also a policy advocacy group in Wonka Europe. We liaise with a lot and our co learning from Wonka Europe often sets up its own groups but a lot of their leaders are in our group and vice versa. So there's plenty of opportunity for people to explore with colleagues, you know the issues that have raised today. Sorry, Sunker and Harris now. Hello. Hello. And now the third group we join now. Yeah, we're all back I think some people I know will have left for other commitments or, you know, they've had it too long or whatever, but they heard the speakers often people will divide it like that that's fine. We have brief summary from each group. And then as I said, I invite our two panel speakers to comment and close. Yeah, so from my group, very briefly, group one. We had an example of a view like a new policy approach and more just putting the topic of the webinar that they're going to be running into the chat in case people want to join that. We talked about the build of a new policy. Again, as the others said earlier, the sort of enthusiasts the people who bought the vision the innovators who understand the case for something. And then, you know, testing it through learning conversations, for example in Wonka conferences or through a publication, or through having a consultation with members and then bringing it more formally to executives in their own place or communities or regions or indeed to Wonka except. And we also talked about the challenge of the use of language so that sometimes one has to make a compromise and leave a really classic term out but when is that okay and when is it not. We also use the example of family medicine getting, you know, it's primary care. Well, sometimes we feel no if you don't say family medicine people forget about our specialty. But then in other situations you sometimes have to be pragmatic and hope that the concept is going forward in a document or a policy even if the particular words are not. And then we also talked about different stakeholders needing to have different voices and different terminology so if it's a financial stakeholder. You don't only want to talk money, but they will want to talk predominantly about costs human costs financial costs whatever. And so you have to translate your message without losing the principle behind it. And I think Joe reminded us that in Sydney, we discussed about trying to build some of this learning into a toolkit, so that we, the same Wonka would also take some of these very, you know, important ideas to into a sort of how to do it kit. So we mustn't forget about that. Thank you. Is that okay my group anything you want to add. Okay. I've got I've got to go and get my cable, my computer wants. So please carry on. Okay, I will present from the group to we had six participants from Argentina, Indonesia, Norway, and USA and Sri Lanka. We, we discussed about two main things one is about the challenges around when we, when we go ahead with policy advocacy, I mean advocating and we're going to materialize new idea, etc. So one thing is we thought the first one of the most important thing is is the courage we need to have to go ahead with such an idea. And we also discussed about the challenges like the policymakers, I think this was discussed before as well like how policymakers are reluctant to discuss these things or to take up these things. So this was discussed in detail. And with that we went into another important thing we were thinking and we were discussing about the power of small groups. Because we discussed, we thought we can think big but then we have to start sometimes small otherwise we can never start. So, when in, so, especially Larry pointed out how the, how was, how small groups are really helpful and how small groups can do wonders. Because it's very difficult sometimes to find out like minded people. But when you have a small group at least a few people with you, you definitely know these people are with me and we can start something confidently with these people. So there's the power of small groups and also the right mix in those groups, the gender mix and the different ages, younger people and more experienced, not so young people as well. Because we can, I mean, we can, I mean we can see that importance of sharing experience. Now we can see how many were interested to join this webinar to listen to others experience. So experience is very important because most of the things, most of the problems come to us is not new problems. They have been answered before in different ways. So we discussed the importance of having small groups with right mixed mixture with gender and ages. So, so these are the main things we discussed and also we touched about the importance of giving this idea of evidence based policy. Making an advocacy to our younger generation. In this case, I really liked how Lorraine approached that with the slide with where she compared family medicine training and policy work. I think that's a great slide. I mean, that is a very interesting slide. I think because this is an easy way we can instill the importance of policy advocacy to our younger generation. So these are the main things we discussed. Yeah. Great. Thank you. Oh, lots of stuff. And Pilar, please group three. Okay, thank you very much. We were seven people, Chile, Argentina, Portugal, Ecuador, and as well, Lauren that has a wonderful Spanish, right. So she's able to help me on the summary. We talked mainly and about how to write awareness on what is primary health care, both in civil society on the politician level. And we share different experiences. Margarita from Portugal said that now they do not have enough family doctors, then the citizens ask for a family doctor. They now are asking more than ever to have a family doctor for their home. So the scarcity give us a role. And then, well, Lauren shared really interesting experiences regarding to rise the awareness of those politicians who have an experience with family doctors. They saw they have been they have a family doctor and they families along their lives, and to highlight this role, and as well to leverage the experience of family doctors and patients about primary health care. She can share with us the experience of California project and a foundation of patients for primary care. Please, Lauren. Yes, no, thank you Pilar for that great summary. And one of the questions that we discussed that was raised by Mariana, which was a really, really important one is to advance primary care among our elected officials that may not have a personal experience with primary care or a high quality experience with primary care and how do you bridge bridge that gap. And that certainly has been my personal experience. When I think of high quality primary care, I think of Dr. J. R. Paulson, who delivered me and took care of me until I was 18 and left for college and just retired this summer as my parents primary care physician. So it's a really singular experience that I am sadly discovering in my policy work and how we, you know, finance and pay for health care services in the US is just stupid beyond complex, and it is so mind boggling when I find myself in these rooms with policymakers and politicians and trying to advocate for those changes. I'm increasingly realized I have to start with some very basics, because they don't even understand what I'm talking about about high quality primary care and family medicine. And so a couple of the suggestions that we talked about is to identify those politicians that have had high quality family medicine or primary care experiences and elevate them to share their stories and to be advocates and voices for that. In addition to patient and physician dyads sharing their story and talking about longitudinal relationships can also be really powerful and the third suggestion that we talked about and I put this link in in the chat, which is my colleague, Dr. Grumbach at University of California San Francisco has created an organization very much grassroots to this point called patients for primary care, where they're identifying patients that have had amazing primary care experiences, and are asking them to share their thoughts and this group is creating short and longer YouTube videos of their experiences and these stories are really, really powerful. And again, patient centered family medicine patient centered policy work. These are really important voices that could be elevated in conversations, especially if it's someone a conversation with a politician in which they are a voting constituent that is also very powerful so those are some things that we that we talked about but if there's a policy urgency, or an emergency in my mind, particularly in the US context is the dearth of understanding of high quality primary care and family medicine and I am very that keeps that's what keeps me up at nighttime is how to bridge that gap. Before we even get to, we need to improve how we finance infrastructure to support primary care at like, don't even have that conversation. We don't have it, because there's some basic understanding that we don't have first. So that's the explanation for the, the link that's in the chat. Thank you very much. Lauren, I don't know if that counts as your summary of the event as a whole but I'm going to let you have a think about that and take a breath and turn to Anna, please to just give us some final observations or thoughts to take away with us after this very rich, very long session. Thank you. First of all, thank you. It's been, it's been a great session. I really enjoyed it. And I think we have a lot to build on. It shows we have a lot to build on, not least, we have a global community. We're on different stages in building primary care and family medicine, and we have different levels of resources to do extensive policy or advocacy work. But we can, if we keep it small and simple kiss, we can also learn from each other and support each other in this. I, I'm sure we can. So, let that be, be I'm, I'm also, of course, it goes without saying but you have to believe in what you're doing. I mean, passion is everything passion is maybe. Well, I'm not the native English speaker but you need to be passionate about if you really you really feel for this. If you're passionate and persistent, then it will have, it will have an impact. So good luck to every, every one of us, I would say and thank you again. Thank you. Thank you. Lauren, is there anything else you would like to add. Yeah, a couple of thoughts. The first is, I am incredibly impressed with the policy and advocacy acumen of this group. You know a lot more than maybe you think you know so give yourself a lot of credit. You know, Sanka, I'm glad to hear that that slide resonated with you. In terms of family medicine or, or primary care training experiences in your clinical work there's there's so many skills that we know as clinicians that translates so beautifully to the policy realm. And while there will be a learning curve it may not be as great as what you think it is because you're starting from a really great place, and given the incredible relationships we have with patients those are beautiful stories that we can elevate to tackle all these challenges that we would like to like to tackle so that's And the second thing is, hopefully it's obvious I love, love policy when I think about all the ways I'd love to change how we organize deliver and finance family medicine and primary care policy is a really powerful upstream tool to change the systems in which we provide care to make it work better for us and our colleagues on the clinical side and for patients and families. I invite you to join those of us that love policy work and don't be scared of it. It's so much fun. It's super frustrating, many that's much of the time, but it's also a lot of fun and really powerful and exciting when you can make change happen because you can impact the lives of hundreds of patients and family members through policy work so join us on the policy side. Amanda, may I just add one thing, because we, and it's in line with what said here, we should not forget that policymakers and politicians, they are also people, they are the same kind we see in our surgeries. They have the same problems. They have the same challenges with their children with their old parents. I mean, so we can, we can, we can also mobilize the family doctor in in ourselves in the policy dialogues. That's all. Thank you. It's a beautiful note to end on. Thank you both. I'm going to hand to Sanka actually to formally close the webinar if that's all right. Thank you very much, Amanda. I think that was a great session. I really enjoyed it. Shared your wisdom and just as someone has told. Thank you for your wisdom and friendship. We are a Wonka family. Of course, yes, I echo that. And thank you very much for joining. I think thank you very much our speakers, Anna and Lauren for your kindness to attend and for sharing your experience, the policies that worked and giving us courage to go ahead to realize that just things work, things have worked. So we also can do that. And also, some other senior colleagues and also junior colleagues who shared their views, experience. That was a great session and we would like to see you again soon in a couple of months. And I also invite you to join the, if you're interested to join the Wonka special interest group on policy advocacy and share your thoughts with us. Thank you very much and we the recording will be available on Wonka YouTube soon. And I hope our experiment worked. The translation worked. I can get more feedback from my friends at the list. And we will go ahead with the same infusion. Thank you very much Harris for the discussion yesterday and for hosting today more, more, I mean, relieving me from the most of the technical work. And thank you Pilla for the translation and thank you all for attending. See you soon. Thank you. Thank you all. Bye bye everyone.