Five years of reducing health inequalities: what have we learned?

FNO’s Healthy Futures Nearby programme began in 2015 with a total of 46 projects to reduce health inequalities among families living in poverty. There are major inequalities in health in the Netherlands. For example, people with lower education die earlier and live more years in poor health than people with higher education. For the overall evaluation study, Wageningen University & Research and the Verwey-Jonker Institute opted to ‘keep a close eye’ on the projects so that interim lessons could be learned.

Four approaches

The researchers identified four approaches in the projects. The first was a bottom-up approach, in which participating families determined what would happen. Secondly, there was a social network approach, with local residents and professionals working together. Thirdly, there were approaches that involved training of professionals, such as community workers. And finally, there were projects where people were offered a specific lifestyle programme, such as quitting smoking or healthy exercise. Most projects involved a combination of approaches, with an emphasis on one of them.

Reduced health risks

The evaluation study showed that the Healthy Futures Nearby programme helped to reduce the health risks for participants and to improve their perceived health. It also revealed that the best way to reduce health inequalities was to adopt approaches that focus on diversity within the target group of socially vulnerable families. This involved taking account of the context in which people live and the causes of stress in the daily lives of families.

In addition, the study showed that taking account of the conditions in which families live is a more effective way of getting them involved in activities. It also helps to be aware of existing neighbourhood activities and of people’s experiences with social workers or social networks.

Working from a basis of trust

Lenneke Vaandrager is associate professor Health and Society at Wageningen University & Research. She explained what it takes to get people involved and ultimately to support them: “It starts with listening to people and taking them seriously so that they feel on an equal footing. Sometimes it’s a major step just getting them to a meeting. Families need to feel that they have space and opportunities, but so do professionals.” According to Vaandrager, health or a healthy lifestyle is not always the first priority for this group. “Projects involving low-threshold meetings, where people are welcome without anything being required of them and where they are listened to, are very important.”

What doesn't work, in Vaandrager’s view, is for someone to develop a ready-made course for weight loss and to organise a venue and invite everyone. “No one feels compelled to attend. There’s a high threshold and people feel in advance that they won’t succeed. You might have a good product to sell, but you need a different approach. It’s better to visit people, chat to them at their front door, and then invite them along.” It should be pointed out that the programme ran from 2015 to 2020 and most activities took place before the corona pandemic.

Contributing in their own way

Some project participants became role models for others and attracted people from their own networks. They often saw this active role as valuable, Vaandrager emphasised. Vulnerable families may feel they matter when asked to actively contribute in a project, which in turn can enhance their self-confidence. In another context, we found vulnerable families overwhelmed by the responsibilities given to them in the project, leading to feelings of stress and withdrawal from the project. People need to have space – in terms of both time and mental space. Involvement comes in different forms. Someone can respond to plans, get involved in implementing them, or come up with everything in a bottom-up fashion. Everyone can make a valuable contribution in their own way.”

In 2021, FNO will launch a new programme that will run for ten years. FNO believes that such a timeframe is needed in order to achieve greater health gains for families and to measure the health impacts in the long-term.