Wednesday was World Health Day. Health organization WHO calls for the world to be healthier and fairer for everyone. COVID-19 increases health inequality, also in the Netherlands. Especially in certain groups the physical and mental well-being has deteriorated.
“The corona crisis increases existing differences,” says Jet Bussemaker, chairman of the Council for Health and Society (RVS). “We will soon all be able to get out of the crisis with coronakilos. But you will see: they are not evenly distributed.
It is also becoming clear which groups are vulnerable, says Laura Shields-Zeeman, head of mental health and prevention at the Trimbos Institute. “In a recent SCP report you see that the physical and mental well-being has deteriorated, especially in certain groups in vulnerable situations, such as young adults, the elderly, the less educated, people with a non-Western migration background and self-employed people with precarious working conditions.”
The story behind the averages
We live in a prosperous country with innovative care and a relatively large number of healthy citizens. How big can the health differences be? For the answer to that question, we have to look at the story behind the averages.
“We have one of the best health systems. Yet many people do not know how to find their way around it,” says Bussemaker. You can have reasonably healthy citizens on average, but in cities such as The Hague and Rotterdam, the health differences between neighborhoods are large. “This applies, for example, to the number of years that people live and the years in which people live in good health.”
Often there is a negative spiral
Consider the stress of having problematic debts. Or a couple who are constantly living together in a small house because of the pandemic, which threatens domestic violence. Or the student who can get healthy food in the canteen, but is also tempted by the snack bars near school.
These are just a few examples that show which factors can negatively affect our psychological and physical health. There is often also a negative spiral, says Shields-Zeeman.
“Mental health problems can worsen social complaints.”
Laura Shields-Zeeman, Trimbos Institute
“For example, you see that insecurity about work and income causes stress, mental complaints and sleeping problems. Conversely, you also see that mental health problems can exacerbate social complaints.”
‘You better take away stress’
The pandemic actually confirms what we have known for some time: some people are more affected by health problems than others. Policy makers have long focused on the individual and behavioral change, says Bussemaker. “And that has been quite successful, look at smoking. But you also see that the number of quitters among the highly educated is much higher than among the less educated.”
“People who experience stress have something else on their mind than a healthy meal.”
Jet Bussemaker, chairman of RVS
The focus was also too much on providing information. “If people had more knowledge of how bad things are, they would change their behavior. But people who experience a lot of problems and stress have something else on their mind than a healthy meal on the table in the evening. on depriving that stress. That is a matter of patience. “
Time for action
The RVS issued advice on a new, broad approach to health inequalities on Wednesday. Prevention must again play an important role, for example by creating a healthier living environment. “We now argue for an area-oriented approach and for the implementation of concrete measures, such as a sugar tax,” says Bussemaker. “It is quickly said that you affect the individual freedom of citizens. But you have to weigh that against what it means that young people do not choose their own cradle.”
“To promote health, you need the whole of society.”
Jet Bussemaker, chairman of RVS
Health problems must be tackled in a targeted manner in regions and neighborhoods where problems are piling up. “So not one general plan for The Hague, but a little more focus on Southwest than Benoordenhout.” And perhaps most importantly: “To promote health, you need the whole of society. To do that, you also have to look beyond healthcare.”
According to Shields-Zeeman, it is important to invest in meaning for people who are disadvantaged. “A nice intervention is Individual Placement and Support (IPS), for example. You help someone with psychological problems to find meaningful work.”
Shields-Zeeman also argues for better cooperation between policy domains and care domains, for example between primary care and the social domain (part of the municipality). “Debt assistance programs are a good example. Or, for example, the Thrive Amsterdam initiative, in which the municipality of Amsterdam, the GGD, mental health care and other parties work together to promote the mental health of citizens.”