Do you want equal care? Don’t treat people the same

Care will become unattainable for more and more patients in 2040, warn director Patricia Heijdenrijk of expertise center Pharos and vice-chairman of KAMG Astrid Nielen. ‘We still have sixteen years to train new generations of doctors and policymakers in a different way.’

Astrid Nielen, doctor Society + Health (M+G)/youth health

Opinions differ widely about what the world will look like in 2040. For example, there are visionaries who hope for a society in which virtually all communication and services are digital and all citizens are self-reliant. Others expect full integration of care domain and living environment. A more realistic picture of the future, however, is that we will get a bit of both in 2040: less care will be available from doctors and nurses, we will make more use of e-health and remote care, and there will be more attention for a healthy lifestyle and living environment.

low literate

Patricia Heijdenrijk, director of Pharos

But is that vision of the future feasible for everyone? Even now, healthcare is not equally accessible, understandable or applicable for everyone, says Patricia Heijdenrijk of Pharos. ‘Currently, about one in four people has limited health literacy. For example, 2.5 million people are low literate. In addition, one in five people is not digitally skilled. These people have difficulty understanding information about illness or find it difficult to follow medical advice properly. They drop out when they fill out a questionnaire, when they get an app to ‘coach’ their health or have to tell their complaints to a chatbot based on artificial intelligence, AI.’

More backlog

In addition, health inequalities are increasing. Astrid Nielen of KAMG: ‘People in vulnerable situations – such as poverty, poor housing or heavy work – are more likely to develop health problems and die sooner. What worries us is that despite all efforts, that gap is not narrowing. As a result, there are specific patient groups that are not yet vulnerable, but will be vulnerable in the future. The elderly, new migrants, people with practical training, people with a small or no support network or people living in poverty, are even more disadvantaged. And all those groups are growing.’

Gap widens

The gap in health inequalities is expected to widen in the coming years. Heijdenrijk: ‘It is an accumulation of risk factors. People get chronic stress from poverty and poor housing. This has physical consequences, but also mental impact: it is more difficult to take good care of yourself. As a result, unhealthy choices are lurking: snacks instead of fruit or, in case of pain, an extra paracetamol rather than going to the gym or physiotherapist. Over time, chronic conditions arise that could perhaps have been prevented, such as cardiovascular disease, diabetes mellitus type 2 and COPD.’ Nielen adds: ‘Societal developments such as polarization don’t help either. Confidence in taking vaccinations, for example, has fallen alarmingly to a dangerously low level. And the general practitioner, who is generally experienced as approachable and trusted, is increasingly overloaded.’

‘At the moment 2.5 million people are low literate. In addition, one in five people is not digitally skilled’

For everyone

Another contributing factor to the widening gap is that people with limited health skills are usually not included in the development of new (digital) healthcare applications. ‘An important condition for digitization in healthcare is that it can be used by everyone,’ says Heijdenrijk. ‘Many artificial intelligence (AI) datasets lack information from these people, because they are more difficult for researchers to reach. But if you don’t include these groups, chances are they won’t use the resource – the questionnaire, app or application.’ Nielen also identifies this problem in scientific research: ‘These groups are underrepresented or absent. I think that researchers and developers should make more of an effort to reach these people in a different way and thus still get input.’

View too limited

The most important solution is more connection between the social and medical domains, according to both professionals. Heijdenrijk: ‘The biggest gains are in preventing disease and shifting the focus from disease to health. That requires good health policy and cross-domain cooperation in the district, for example between the GGD, district teams and schools.’ Nielen: ‘Only a medical perspective is too limited to tackle health differences. You have to look at how you can improve the living environment and public health in a district-oriented, target group-oriented and tailor-made way. With a strong ‘neighborhood network’ you can often make progress on several themes at the same time.’

Promising Start

There are plenty of examples of the results of the strategy of joining forces with different parties to achieve one or more public health goals. Nielen: ‘Doctors Society + Health are regularly involved in projects of the municipality to create a healthier climate in urban residential areas. More green and
better air quality encourages people of all ages to go outside more, exercise and socialize. Another example is the Kansrijke Start project, in which we work with broad local coalitions – maternity care, youth health care municipalities and with the support of Pharos – to ensure that children of parents in vulnerable situations start their first thousand days as healthy as possible. At the same time, we are working through Promising Start to reduce health inequalities, with a focus on themes such as nutrition, poverty and stress.’

Experience experts

In addition to integral cooperation between professionals, it is also important not to talk about people, but with people, emphasizes Heijdenrijk: ‘This applies to research and development, but also to assistance. For example, Pharos started the project ‘A smoke-free life for everyone’. “Giving up smoking is more difficult when you’re dealing with stress and debt. Help is often not easily accessible because of the costs, the offer is not in line or smoking is treated as a separate problem. That is why we ask people as experience experts what works for them. We then work with them and various professionals to tackle smoking at the same time as other problems.’

‘The elderly, new migrants, people without a support network or people living in poverty are even more disadvantaged’

Invest in health benefits

Finally, what tips do the experts have for doctors? ‘Focus on person-centred care’, Patricia Heijdenrijk advises. ‘If you want equal care, don’t treat people equally. Some patients benefit from more information about their disease or treatment. In addition, comprehensible communication must become compulsory material in the training. Society will need that in sixteen years’ time.’ Astrid Nielen fully agrees: ‘If you are discussing treatment options, ask in the shared decision-making conversation what the disease means for someone’s life and look at the underlying factors and social causes of the disease. Then you can also determine together where health gains can be achieved. You can also take signals from patients to authorities and government. Whether that concerns fewer points of sale for tobacco or simpler language in letters. Only then will there be change.’

Astrid Nielen is a doctor of Society + Health (M+G)/youth health and works as a strategic medical advisor at the GGD Amsterdam. She is also chair of the scientific association AJN Jeugdartsen Nederland and vice-chair of Koepel Artsen Maatschappij + Gezondheid (KAMG), the umbrella organization of eight scientific associations of (profile) doctors M+G involved in prevention and public health.

Patricia Heydenrijk is director of Pharos, the center of expertise that is committed to reducing health inequalities. Health differences are differences between groups of people in terms of life expectancy, number of healthy years and self-perceived health. Factors that contribute to health inequalities are education, income, poverty, living environment, social environment and participation.

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2023-05-25 06:00:00

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