It is a harsh reality. People on low incomes and with a low education are more likely to be ill, receive less good care when they are ill and have considerably fewer healthy years of life than people who have more money and a better education. The fact that this is the case in countries where people on average have a low income will come as no surprise to anyone. But it is also the case in rich countries, for example with people living in disadvantaged neighbourhoods and people with a migrant background.
How can this so-called health gap be closed in a sustainable way? That is an important question that the researchers of the Health and Society (HSO) group are asking themselves. 'Our aim is to support people, communities and institutions in gaining control and ownership of the factors that influence their health,' says Laura Bouwman, researcher at HSO.
The researchers at HSO do not do research on people, but do their research together with people in their daily environment - i.e. in neighbourhoods, schools, sports fields and care farms. 'Our approach of participatory research is based on the solutions and possibilities of the people themselves. In Rwanda, for example, we work with expectant and young mothers in districts where the growth of children is lagging behind. By listening to their stories, we discover how they shape their lives and what challenges they face. How is breastfeeding and supplementary feeding going? How are things in the family? Is it possible to grow food? What about access to care? Are there facilities nearby or does a high-pregnant woman or a mother with a small baby have to walk tens of kilometres to get to a health centre?'
These are lengthy processes, in which the researchers really build a bond with the families they often visit. 'So we don't come flying in with a plan developed beforehand behind our desk,' says Bouwman. 'On the contrary! We start from the possibilities, impossibilities and the strength of people themselves in their own living situations. We distil from the stories what the preconditions are for taking good care of your child in difficult circumstances. Because there are also children who grow well. What choices and solutions contribute to this? We are going to look at how we can further expand and disseminate these best practices, for example through women's groups, so that others also benefit from them. And we will also involve other actors who have a role to play in this, such as care providers at health centres'.
Laura Bouwman describes HSO's approach in working together with people to reduce inequality. 'We want people to be proud, to feel co-responsible, because the solutions fit in with their living environment and situation.' Sustainable impact is the key concept: 'We want to help build sustainable relationships and create sustainable connections, not only between people, but also between people and nature, for example, so that there is commitment and the structures remain in place, even when the project is finished and we are gone'.
Improving perceived health
Closing the health gap is a matter of the long term. It is of the utmost importance to know which approach really works. For FNO, the researchers from HSO have evaluated the 'Gezonde Toekomst Dichterbij' programme that aims to increase the chances of families in disadvantaged situations in the Netherlands. Laura Bouwman: 'In 'Gezonde Toekomst Dichterbij' the focus is on improving perceived health: eating healthier, exercising, stopping smoking and drinking less alcohol. Using a so-called realistic evaluation, we analyse what works for whom, in which situation. In this way we discover what really works in reducing health inequalities. Essential are, for example: a respectful attitude of professionals, such as welfare workers towards families and taking the underlying problems of poverty seriously'.