Abstract

More and more people in the Netherlands suffer from chronic diseases or are at increased risk of developing a disease or health condition. An ageing population and unhealthy lifestyles are contributing factors. This places great demands on the health care system, making disease prevention more important than ever. To that end, the Dutch Ministry of Health, Welfare and Sport has entered into agreements with various parties. These include the Integrated Care Agreement (Integraal Zorgakkoord, or IZA) and the Healthy and Active Living Agreement (Gezond en Actief Leven Akkoord, or GALA). One of the goals of these agreements is a shift in focus from treating illness to health and prevention. They aim to achieve this by encouraging cooperation between the medical (care) and social (local government) domains.

Cooperation is inherently complex, as multiple levels of government are involved. The agreements apply nationally. They are translated into regional visions and implemented locally. The National Institute for Public Health and the Environment (RIVM) carries out a range of studies to assess the outcomes of these cooperative efforts. To gain a more accurate impression of the state of affairs and relevant challenges, RIVM has combined the findings of these studies'.

The studies show that cooperation between the medical and social domains has increased and that they are taking measures which are beneficial to health and well-being. That includes initiatives such as the Kansrijke Start (Promising Start) programme for children and the fall prevention programme for seniors. There are also areas for improvement. At regional level, municipalities and health insurance companies are still slow to make choices and agree on the allocation of responsibilities. The parties need to become more decisive in this regard.

Challenges previously identified by RIVM continue to apply. It is particularly difficult to ensure participation in initiatives by people with health problems who are living under difficult circumstances due to e.g. debt. Furthermore, for example, there is uncertainty among the municipalities regarding the structural funding of activities.

RIVM therefore advises that the parties involved continue to commit to more and better cooperation at all levels. At a national level, constancy, stability and clarity are desirable. At regional level, leadership, coordination and a shared vision are required. At local level, it is important to start implementing the plans, allowing for a tailored approach.