Chapter 1
The big challenge

Reducing health inequalities


With Patricia Heijdenrijk

‘By 2040, we will have collectively managed to ensure that everyone has an equal opportunity to experience good health, regardless of education, income or where you were born. That is my dream’, says Patricia Heijdenrijk, Director Expertisecentrum Gezondheidsverschillen (Expertise Center Health Inequalities) Pharos and Chair Central Mission Team Health & Care. ‘The socioeconomic differences in health are large and persistent: 6 years difference in life expectancy and 15 years difference in healthy life expectancy. Therefore, to realise this dream in 20 years, we must act and think differently now.’

Ripe soil

‘We as a society are ready to join forces on this’, Heijdenrijk said. ‘For example, the Coalition agreement 2021-2025 states that these health inequalities are unacceptable and that firm choices and reforms are needed to increase equity.’ The need for change is supported by the Scientific Council for Government Policy (WRR). In 2018, the WRR observed that while general measures lead to health gains, those at the top of the social ladder have benefited more than those at the bottom. As a result, inequalities are in danger of actually widening in several areas.

Health inequalities

are unacceptable

A broader view

In recent years, there has already been an important ongoing transition to reduce health inequalities: there is an increasing focus on a broader approach to health inequalities, whereby connections are sought with, for instance, welfare, living environment, education, work and income. For example, in the National Policy Document on Health 2020 - 2024 that the Ministry of Health, Welfare and Sport has designed together with municipalities, far more attention is paid to the various determinants of health. Furthermore, it proposes a cross-domain approach. Heijdenrijk: ‘There are great opportunities when we start looking across domains and at all levels for solutions.’

‘The quadruple helix approach plays an important role in this. Equal cooperation between citizens, knowledge institutions, industry and government bodies is the main focus here.’ Heijdenrijk continues: ‘Residents of all districts, neighbourhoods and municipalities actively participate and provide input from the very first idea to the actual implementation. Inclusion must be ensured here; it is essential to reach and involve everyone, people with a lower and higher economic position, people with and without a migration background, etc.  By focusing on the life and experience of all citizens, you get a broader view of health, and an integrated approach can be drawn up.

'But differentiation is a keyword here,' emphasises Heijdenrijk. 'We must not continue to focus on equal opportunities, but on equity. We must recognise that each person has different circumstances and that we need to provide personalised solutions to reach an equal outcome. The soil is ripe for tackling health inequalities. With vision, direction and courage, we can take the next steps in this transition.’

Eight years of working on health inequalities
Learning from the stimulation programme GezondIn

For eight years, 150 municipalities have worked at the local level to set up, improve and strengthen an integrated approach to health inequalities in the stimulation programme GezondIn of Pharos and Platform 31. The idea that health should be approached from different disciplines and perspectives has found its way into local approaches and how local municipalities think and work. Here municipalities consider the involvement of inhabitants – and specifically the target group with a low socioeconomic status – to be an important component. The majority of the municipalities (78%) indicate that they actually do this. This percentage is even higher for the large municipalities (91%). For example, they do this by appointing ambassadors, involving experts by experience, organising co-creation or interviewing residents. According to Patricia the success lies in the responsive approach of the programme. No blueprints were made beforehand. The programme was further developed based on reflection upon the (local) practice.

 ‘The knowledge base is there. The trick now is to continue to secure and deploy this knowledge, so that all the steps we take now ultimately contribute to realising our dream: In 2040, everyone has equal opportunities to experience good health, regardless of education, income or where you were born.’

A sneak peek of the future

2040: Everyone lives at least five years longer in good health, while the health inequalities have decreased by 30%.

What will health & care look like in 2040, based on the five missions drawn up by the Dutch Ministry of Health, Welfare and Sport and published in the Health & Care coalition’s Knowledge and Innovation Agenda 2020-2023? This question is answered via inspiring and informative  future images developed by experts, including Patricia Heijdenrijk. In 2040 not only has the healthy life expectancy increased, but we've managed to achieve something virtually unheard of before: making sure everyone benefits. In the spam of 20 years we have adopted an intergral approach where the focus lies on the life and experience of the citizen. Therefore, equal collaboration within the quadruple helix has become the standard in which all parties focus on equity to develop personalised solutions for an equal outcome.

This initiative is coordinated by Top Sector Life Sciences & Health (Health~Holland).