In its recently published report on the future of healthcare , the Social and Economic Council of the Netherlands (SER), doesn’t mince its words. If we want healthcare to be accessible to everyone in the Netherlands, and keep costs under control, stringent measures are required. Prevention. It’s the only way, insists the SER. Much more prevention. Not simply in the workplace and in schools, but in our communities and in the way we design our environments. But it’s precisely this crucial aspect that we, as a society, can’t seem to achieve. And although more is being done in the field of prevention, it’s still far from enough. So now, the SER is also making a direct appeal to us, the city and placemakers.
Each year, the Netherlands spends 85 billion on care. It doesn’t take a maths whizz to predict that the demand for care will only increase in the future. So far, our response has been to expand healthcare provisions, implement efficiency measures and stimulate market forces. And by now, we all know how successful that has been. Each year, a tiny share of the public health budget goes to prevention. Our healthcare system simply isn’t designed around preventive care. But if we don’t learn to do better soon, the system will be in ruins.
The concept of health is evolving. Until recently, health was defined as the presence or absence of a condition or disability. Those not diagnosed with an infirmity were healthy and vice versa. As such, health was simply a matter for the care sector. But this approach is changing. For example, the Dutch family doctor Machteld Huber introduced the concept of ‘positive health’, which encompasses no fewer than six dimensions. In addition to physical functions, it defines health in terms of mental well-being, a sense of meaning, quality of life, daily functioning and the extent to which someone feels an active participant in society.
When it comes to these aspects, let people’s living environments play a central role. As city makers, we can help to ensure everyone leads healthier, fitter, happier lives, and let them know that they count in society. By giving cyclists and walkers ample space. By building sustainable homes. By creating space for community hubs and vegetable gardens. But above all because residents in these inclusive neighbourhoods and cities look after, and care for, one another.
In this urgently-needed prevention revolution, we can make the difference. How? By ensuring that the six pillars of positive health drive area (re) development from now on. By daring to embrace an integral healthy approach, tailored to the specific location and its residents. And never cutting corners.
Impossible? Far from it. Cities such as Zurich and Copenhagen are making great strides and Utrecht is also making headway by putting the health of its inhabitants at the heart of its policy. Complex? Yes, absolutely. It demands close cooperation and coordination with a wide variety of stakeholders. A compelling business case has yet to be developed. It means innovating. Experimenting and, occasionally, failing. Investing without being 100% certain of a successful result. Many of you are already doing this. Imagine what would happen if we shared our know-how, skills and experiences. Wouldn’t it bring us closer to achieving positive health in the Netherlands?
This column appeared on Gebiedsontwikkeling.nu
Photocredits: Niels Wiese