Transdisciplinary health improvement in The Hague: ‘Neighbourhoods tell us what they need’
Health conditions and social problems often go hand in hand. To address this complex issue in families in The Hague, researchers, managers, support services, policymakers and residents are joining forces. What are the results of this transdisciplinary approach?
In neighbourhoods in The Hague such as Schilderswijk, Moerwijk and Laak, many families struggle with clusters of problems. Families with housing, work and income worries are at greater risk of poorer health. Clustered health and social problems lead to stress and can also mean health problems negatively influence each other. For example, a combination of health problems such as mental health problems, cardiovascular disease and joint pain.
This clustering of health and social problems is known as ‘syndemics’. An important cause can be underlying factors such as poverty or working conditions. To identify and understand these factors and develop effective policies for solutions, various parties are needed: residents, local authorities, policymakers, healthcare professionals and researchers. And it is exactly this approach that is taking shape in the transdisciplinary collaboration between Leiden University’s Health Campus The Hague and Gezond en Gelukkig Den Haag (Happy Healthy The Hague; GGDH).
Understanding the village
The relationship between our living conditions and disease is central to the work of Nienke Slagboom, a medical anthropologist and drama therapist from the Leiden interdisciplinary programme Population Health Living Lab The Hague. Her doctoral research was on the intergenerational transmission of syndemic health problems in the village of Katwijk.
To understand how health problems cluster in families, she used a mix of quantitative and qualitative methods: counting which health problems occurred together but also talking to healthcare providers in the area and – importantly − getting to know the families themselves, for instance by delving into the history of the fishing village and its residents, and by spending four years following the daily lives of families where cardiovascular disease, joint pain and depression ‘run in the family’. The municipality and health organisations used her insights to develop an integral plan to tackle health in a Katwijk neighbourhood.
Joining forces
Slagboom and her team had already concluded during her PhD that this should be researched in many more places. And as luck would have it, within cycling distance of Katwijk, GGDH proved to be working on the same issues. Here, residents and action researchers had drawn up plans for initiatives to promote health and happiness in the Moerwijk neighbourhood of The Hague.
GGDH consists of various research institutions, public agencies, healthcare providers and health insurers. They have been working together for five years to promote greater collaboration and knowledge exchange with the ultimate goal of reducing health inequalities in The Hague. Slagboom is now part of a research team that is working with GGDH on a multi-system approach to syndemic health problems in families in Leiden and The Hague.
Count and tell
Slagboom almost immediately saw the advantages of such a transdisciplinary partnership. ‘It’s great that managers from the different organisations and policymakers join us at the table. If you want to discuss something, this is where all sorts of people come together. That makes it possible to get all sorts of things done by different parties. For example, we could start this research by consulting GGDH about syndemic problems in families in Moerwijk. Affiliated parties such as the Municipal Public Health Service (GGD) have a lot of contact with families in the neighbourhood via community builders and researchers. What do we already know about the neighbourhood? Which questions should we research more thoroughly? And where should that be? Syndemic research is also a combination of what we call count and tell. First, you have to look closely at the figures to find out which clustered problems you can see. Then you have to look for the life story behind the figures. In the meantime, we are providing feedback about the results at GGDH meetings in The Hague. So they are closely involved in all stages of the research.’
Emancipatory effect
Collaborating with families in neighbourhoods, via the right contacts, has enhanced this approach says Carlijn Ritzen, programme manager at Healthy Happy The Hague. ‘At a policy level we can sit in our ivory tower and come up with all kinds of things that people should do: eat a healthier diet, get more exercise. But that soon becomes abstract. Whereas if you talk to residents, you hear for example that they want to cycle with their children to school but can’t ride a bike. So offering cycling lessons would be really good. Then a neighbourhood tells us what they need. And we can ensure that all sorts of actions at the policy level are coordinated with the various parties so that everyone doesn’t end up doing their own thing. And the fact that residents can have a say also has an emancipatory effect. People feel seen and this spurs them to take action and get others on board with change.’
‘Faint hope’
That people feel seen is clear from the latest residents’ meeting in Moerwijk in The Hague, for example. In the meeting minutes one resident explains how, now things such as street lighting or children’s playgrounds are improving, she is beginning to feel ‘faint hope’ that change is possible. And she would like to be part of that. ‘I now feel that we really are looking at the causes so that we really can do something about the problems. If people see that I, as a trusted and familiar face, am also part of this project, they will hopefully also start to trust it too.’
The research project ‘Countering syndemic vulnerability: A community resilience approach’ by Health Campus The Hague, University of Applied Sciences Leiden and The Hague University of Applied Sciences in collaboration with Healthy Happy The Hague, IVO, GGD Haaglanden and GGD Hollands Midden, the municipalities of The Hague and Leiden will run until 2026. To find out more, please contact Samantha Groenestein or Marieke Breed.
Text: Jan Joost Aten
Banner photo: Fer Troulik / Unsplash
Population Health Living Lab the Hague
Leiden University’s Population Health Living Lab The Hague interdisciplinary research programme focuses on the health of a group of people rather than of an individual. The more medical data you collect about the health of certain groups of people − for example, people living in the same city or neighbourhood − the more you can learn about how the long-term health of people in this group will evolve. To find out more, please contact initiators Mattijs Numans and Egbert Vos.