Health is everything
In the field of public health in the last decade a transition has been underway moving from a central policy steered by national government to a health movement in which schools, employers and care providers are all active parties. All of the parties involved are working together on the Dutch National Prevention Program “Alles is Gezondheid...” (Everything is Health). Dr Marleen Bekker is evaluating this program in collaboration with Maastricht University for the Netherlands Organisation for Health Research and Development (ZonMw).
Bekker switched from nursing to policy research fifteen years ago. “In the hospital my experience had been that people who are sick get well quicker when they are in a specific social and physical environment, and handle their illness better if they are in a stimulating environment,” she says. “The medical care they are given only has a limited influence. This is also true for maintaining good health.”
Wagging your finger doesn’t work any more
In the past government would operate as a unilateral driving actor, but now new insight is emerging that shows the reach and impact of health measures taken by government depend on social organizations and the commercial sector. Government is better off making use of the knowledge, the networks and the direct access to the target audiences that these organizations have. Moreover, these organizations also profit from more active participation, as health is strongly associated with resilience, autonomy, school performance, productivity and a conscious life style.
Bekker: “Wagging your finger doesn’t work any more. People are asking more and more hard questions about health risks. That’s why it’s important that there is cooperation between government and society.” Bekker has looked at a number of case studies, in Brabant among other locations, in which developers of care products exhibited their products to members of senior citizens' associations. This enabled the seniors to ask their questions directly, about the possibilities of living at home longer, for example. Bekker: “In the present situation, there are all these layers in between, like care providers and insurers who are reluctant to innovate because of the financing structure.”
Non-smoking red carpet
A different case study was made out of a vitality program held at a large ROC college in the northeast of the Netherlands (15,000 students, 2,000 staff). It is aimed at raising awareness among students and teachers of the importance of physical health and mental resilience. “Students visit all the faculty rooms to get things started,” Bekker explains, “and some material products have also been developed to forward the cause. Banners promoting vitality, for example, and a non-smoking red carpet that can be rolled out in front of the entrance.”
Away from the ivory tower
Bekker is enthusiastic about the case studies. “But the evaluations we carry out are independent and critical. What are the benefits? Actual effects on illness can’t really be measures until ten or twenty years have passed. We look at how plausible it is to create conditions for health effects to complement standard government policy. Are new networks with new partners being formed? Is knowledge being freely exchanged and is awareness growing? From what we are observing a strong impulse is still needed.”
Researchers need to evaluate and analyze the government’s integrated policy approach using a multidisciplinary method. In addition, the government wants an action-led approach. Bekker: “Nothing new for government policy wonks, but new to health researchers. You have to be prepared to leave your comfort zone as a scientist to share midway observations to allow policy makers to improve their strategy. If research shows that the approach being used is not complete nonsense, you have a way of strengthening the societal relevance and valorization of the research team.”
- Evaluation of the National Programme on Prevention ‘Everything is Health’