FebraryFebraryFebraryFebrary 14th 202014th 202014th 202014th 2020

Health disparities andthe importance of thefirst 1000 days

Bart Looman

Program manager healthy youth

• Life expectancy: 6 years.

• 15 years difference in living in good

health

• More chronic diseases.

• Care has a worse outcome

Life expectancy, CBS, 2017.

Socio economic

health disparities

Some figures

Smoking during pregnancy

Source: Trimbos / Monitor Rookvrije Start

Obesity: household income

Source: CBS / RIVM(2018)

A system focussed on closing the gap?

Dyslexia declarations are far more

common on schools with a high

income and Dutch speaking

population than on schools with a

lower income and / or migration

background.

Source: Onderwijsinspectie 2019.

8,50%

46,50%44,00%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Laag Midden Hoog

Dyslexia declarations in primary educationrelated to the education of the parents

A system focussed on closing the gap?

The teacher shortage in primary education in Amsterdam is 11.6 % on

average

Highest income population schools: 5.4 %

Lowest income population schools: 18.7% (with some schools reaching

40%)

Source: BBO 2019.

Strong

� Solidarity and acces to care

� Cure sector

� Innovation and research

Weak

� Organisation and control

� Affordability

� Prevention

� Vulnerable groups

Bron: WHO, 2018 en OECD, 2015

Health system

The Netherlands

1st 1.000 days: large impact on development of the

child

Source: TNO Child Care

Brain development Fysical development

Lingual development

Social emotional learningMental development

Healthy weight

“The first 1000 days are crucial for a

healthy development and for fair

chances in life. You can only get one

chance for an optimal start. It’s our duty

to try and give every child the best start

possible.”

Hugo de Jonge, Minister VWS

Why is a healthy start soimportant?

11

• Huge step

• National coalition

• Involving municipalities

• Creating local coalitions

Too much

• Oriented on relation professional - woman

• risk assessment and interventions

Too little

• focus on the community approach

• Person centred care / professional sensitivity

• Adressing the system

Program

Healthy start

•Culture

•Low health literacy

•Stress and adverse childhood experiences (ACE)

Person centred care: sensitive professionals

within the first 1000 days

• Enter care too late

• Worse outcome of care

• Communication issues

• Expectations

• Not asking questions

• Education on sexual health

• Unplanned pregnancies

• Questions about the position of the father

Amsterdam: great example centering approach

1. Cultural sensitivity

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obtainobtainobtainobtain, , , ,

readreadreadread, , , ,

understandunderstandunderstandunderstand, and , and , and , and

useuseuseuse healthcare healthcare healthcare healthcare information in order to make information in order to make information in order to make information in order to make

appropriate health appropriate health appropriate health appropriate health decisions.decisions.decisions.decisions.

2. Sensitivity on Health literacy

3. Sensitivity on stress and ACEs

Adverse Childhood Experiences

Effect of Adverse Childhood Experiences

Felliti & Burke

The primary determinants of disease are mainly economic and social, and therefore its remedies must also be economic and social.

Geoffrey Rose, The Strategy of Preventive Medicine

Ten Tips For Better Health

Donaldson, chief medical officer UK

Ten Tips For Better Health

Donaldson, chief medical officer UK

1. Don't smoke. If you can, stop. If you can't, cut down.

2. Follow a balanced diet with plenty of fruit and vegetables.

3. Keep physically active.

4. Manage stress by, for example, talking things through and making time to relax.

5. If you drink alcohol, do so in moderation.

6. Cover up in the sun, and protect children from sunburn.

7. Practise safer sex.

8. Take up cancer screening opportunities.

9. Be safe on the roads: follow the Highway Code.

10.Learn the First Aid ABC - airways, breathing, circulation.

Ten Tips For Better Health

Gordon, Bristol University

1. Don't be poor. If you can, stop. If you can't, try not to be poor for long.

2. Don’t be a lone parent.

3. Don’t live in a deprived area. If you do, move.

4. Don't work in a stressful, low paid manual job.

5. Don't live in damp, low quality housing or be homeless.

6. Be able to afford social activities and annual holidays.

7. Don’t be disabled or have a disabled child.

8. Don’t be unemployed.

9. Don't live next to a busy major road or near a polluting factory.

10.Use education to improve your socio-economic position.

Factors that influence health

• Dutch health is good on average but differences are big

• The gap is not closing; the (health)system is not focussed on prevention and vulnerable

groups

• A lot of change can be made in the first thousand days

• Healthy start is huge step but,

• We have work to do on:

• A community approach

• Sensitive professionals on culture, health literacy and stress

• Influencing the socio-economic factors on health

• Avoiding the ‘behaviour trap’

Take home

Questions?

Bart Looman

B.looman@pharos.nl

The end