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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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