Corporate social responsibility, governance, substainable development

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Sustainable health in Rotterdam, The Netherlands

Julie Huibregtsen
Policy Co-ordinator, Municipal Health Service of Rotterdam

Julie Huibregtsen is currently working as a Project Leader for the implementation of social marketing in the Health Service. She has been trained by, amongst others, Professor Jeff French, Clive Blair Stevens and Sarah Cork. Julie says, "Social marketing has changed my professional life...it opened up new opportunities to address public health issues and to work on sustainable health."

Rotterdam’s ambition is to see those of its citizens who are at a health disadvantage catch up to the national average. This is not only important for the wellbeing of Rotterdammers who are less healthy, but also for the socio-economic strength of the city. A good level of health creates more self-reliance and decreases the use of health and social services. Good health also means that more Rotterdammers actively contribute to a vital and resilient city.

Because of the stubborn nature of health inequalities, especially among groups of lower socio-economic status, the programme Working Together on Good Health (WTGH) is based on a new approach. Instead of placing the problem, illness or other disorder at the centre, WTGH makes the approach itself the central element, meaning in this case a local, area-based activity occurring close to, and together with, the affected people. It is aimed at improving perceived health. The intended goal is to improve by 10% the perceived health of Rotterdammers with moderate to bad health perception within two disadvantaged areas. We chose to improve perceived health over absolute health because it is easily identifiable by the individuals themselves. Moreover, perceived health is measurable in the short term. We don’t have to monitor results over a period of 20 years which is often the case with absolute health. This is of particular significance for the local politicians who have to be able to defend the policy.

When you ask someone what they find most important in their life, “health” is the answer you hear most often. Health is the most important issue in a person’s life. But Rotterdammers experience health inequalities on many different fronts. According to most public health indicators, the citizens of Rotterdam score below the rest of the country on average. They have a lower life expectancy and experience fewer years of good health. They also perceive their own health as bad to moderate 30% more frequently than the national population

Low average health scores often occur together with other situations such as social isolation, low perceived emotional health and problems associated with obesity or addiction. The solutions usually focus on the problem, illness or disorder and proceed to address that. However, such an approach offers little toward reducing health inequalities based on socio-economic differences in the long term. This is because, by focusing only on the immediate problem, the underlying contextual causes of health inequalities remain unaddressed. Only through addressing the underlying causes can lasting improvements in health be realised. Only then are you starting to deliver sustainable health.

That is why the WTGH programme takes a different approach: an area-based, active approach undertaken closely with the people themselves. The approach is aimed at improving their perceived health, how they themselves can take an active part in that improvement, and the conditions necessary to complete the initiative.

Health as a means and a goal

Good health is not only an outcome, but also an important precondition for both wellbeing and prosperity. Achieving widespread good health is therefore not only a primary aim in itself but, just as importantly, a means for achieving other desired social outcomes. By thinking in this way, we are able to create a broader context so that together with our many partners, both within and outside the traditional health domain, we can make, in a permanent way, a larger impact on health. In practice this has led to a wider range of much stronger collaborations. By presenting health as a means to other ends and not just a goal in itself, more doors were opened. We found a larger number of interested partners, and we encountered a greater willingness to work together. At the same time, it liberated us from having to be the local ‘health police’.

Creating awareness and creating agendas

The WTGH programme is designed to create awareness about the contribution that better perceptions can make to a socially and economically stronger city. Permanent political and social attention to the broad theme of health is both a goal and a means to achieving this and thus a way to place health higher on the political and administrative agendas.

Commitment to sustainable health

The role of government is changing. It is becoming less of a developer and more of a director or facilitator, encouraging partners and citizens themselves to invest long term and to join forces in creating activities that will boost the perceived health of local citizens.

Social marketing’s contribution

To develop this way of thinking and working we have relied on social marketing. This mindset has helped us look beyond our own knowledge and experience and really deepen our programme. For example, we ran focus groups in one of the target areas. We found that for some groups of citizens, health is still described in terms of safety. For other groups, sickness is described in terms of ‘being in the hospital’. So when you’re not in the hospital, you’re healthy, and consequently not receptive to health messages! One of the tools we use is the District Health Broker (DHB). The DHB has the task of identifying the needs, barriers and opportunities within the area; of getting involved in the neighbourhood, getting to know people, professionals and voluntary organisations; and of looking for synergy based on deep insight into the real and perceived benefits and barriers of people’s health.

In summary:

Based on our experience, to make an effective contribution to sustainable health it is important to:

Involve other departmental interests outside Health, such as Environment, Economics and Safety, and moreover to involve them by presenting health as a means to other ends not just as a goal in itself;
Investigate in-depth the underlying reasons why people act as they do. Do not stick to citizen participation in your programme, make sure it is thoroughly grounded in citizens’ insight;
Focus on perceived health so that benefits can be realised in the short term.