There is a dualism in current policy discourses on public health between neoliberal conceptions of health, and health as a product of social conditions. These conceptions also co-exist in the narratives of citizens. In this qualitative study carried out in the Netherlands, we analysed how people living in structural vulnerability perceive the potential tension of this dualism. Whereas the respondents’ narratives undoubtedly reflect the neoliberal view on health responsibility, their life stories revealed how health was a product of intergenerational transmission of poverty, violence and ill health. Neoliberal policies that expect citizens to minimise health risks were seen as unrealistic and raised feelings of apathy and fatalism. Behavioural messages were considered to oppose personal autonomy. Instead, the respondents appeared to envision health as a joint, balanced effort by themselves, their social network and public services. The tension between their own view on responsibility and the neoliberal view negatively affected their sense of self. These feelings were strengthened by the fact that the respondents felt abandoned by a government that calls upon self-sufficiency to deal with problems outside their control. On the other hand, they also stressed the importance of agency, particularly in breaking vicious transgenerational cycles. These findings indicate that the views of people living in disadvantaged neighbourhoods require further elucidation to develop a more nuanced and balanced view on responsibilities for health in public policies, and thus to prevent ignoring the problems faced by people who do not meet the expectations of current neoliberal policies.
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In deze literatuurstudie werden vier databanken doorzocht met behulp van trefwoorden zoals chronic disease, e-health, factors en suggested interventions. Kwalitatieve, kwantitatieve en mixed methods-studies werden meegenomen. Uit de data van de 22 artikelen die werden geïncludeerd in de studie, blijken leeftijd, geslacht, inkomen, opleidingsniveau, etnische achtergrond en woonplaats (stad of platteland) in meer of mindere mate van invloed te zijn op het gebruik van e-health. Het artikel is een Nederlandstalige samenvatting van het artikel: Reiners, Sturm, Bouw & Wouters (2019) uit Int J Environ Res Public Health 2019;16(4)
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IssueIn the Netherlands, the National Public Health Foresight Study (PHF) is published every 4 years, as starting point for national and local public health policy development. As these policies impact citizens’ health and lives, it is important to include their voices. We piloted an approach to strengthen this engagement to learn and to inspire PHF in other (country) settings.Problem descriptionPHF is usually expert-based. Citizen engagement, beyond consultation, is not yet common practice. In the Dutch PHF-2024, we engage citizens both as advisors (citizen council, N = 30 and panel, N = 500) and as target group (focusgroups N = 40). Intentionally the scope is diffuse, allowing for unexpected input. What can we learn from this approach, and how do the citizens contribute to the PHF?Results- Citizens of all ages, backgrounds and education types are well able to discuss health (determinants), data and indicators;- They have intrinsic motivation to contribute to better knowledge, feel responsible for effective engagement and are eager to engage across different backgrounds and population groups;- Integration of outcome into the PHF process is valuable, enriching scientific with experiential knowledge and facilitating results communication;- Fundamental questions, e.g., about foresight time frames (“why look so far ahead as the world is in crisis right now!”) are raised by the citizens, showing that these need to be better addressed in order to make PHF relevant for a broader public.Lessons- More permanent engagement of the citizens is needed to enable learning and development;- earlier engagement in the PHF process may enable joint development of core questions and issues to be addressed;- The results are highly encouraging; piloting this approach in other foresight types and in various contexts is therefore needed to refine and further develop it.Key messages• Citizen engagement can and should be strengthened to include citizen voices in the PHF process, informing policies that impact on their lives.• Citizens of all backgrounds, with their experiential knowledge, can be valuable partners in PHF, that provide important input.
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More than 25!years after Moore’s first introduction of the public value concept in 995, the concept is now widely used, but its operationalization is still considered difficult. This paper presents the empirical results of a study analyzing the application of the public value concept in Higher Education Institutions, thereby focusing on how to account for public value. The paper shows how Dutch universities of applied sciences operationalize the concept ‘public value’, and how they report on the outcome achievements. The official strategy plans and annual reports for FY2016 through FY2018 of the ten largest institutions were used. While we find that all the institutions selected aim to deliver public value, they still use performance indicators that have a more narrow orientation, and are primarily focused on processes, outputs, and service delivery quality. However, we also observe that they use narratives to show the public value they created. In this way this paper contributes to the literature on public value accounting.
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Citizen science – the active participation of lay people in research – may yield crucial local knowledge and increase research capacity. Recently, there is growing interest to understand benefits for citizen scientists themselves. We studied the perceived impacts of participation in a public health citizen science project on citizen scientists in a disadvantaged neighbourhood in the Netherlands. Local citizen scientists, characterised by low income and low educational level – many of whom were of migrant origin – were trained to interview fellow residents about health-enhancing and health-damaging neighbourhood features. Experiences of these citizen scientists were collected through focus groups and interviews and analysed using a theoretical model of potential citizen science benefits. The results show that the citizen scientists perceived participation in the project as a positive experience. They acquired a broader understanding of health and its determinants and knowledge about healthy lifestyles, and took action to change their own health behaviour. They reported improved self confidence and social skills, and expanded their network across cultural boundaries. Health was perceived as a topic that helped people with different backgrounds to relate to one another. The project also induced joint action to improve the neighbourhood’s health. We conclude that citizen science benefits participants with low educational or literacy level. Moreover, it seems to be a promising approach that can help promote health in underprivileged communities by strengthening personal skills and social capital. However, embedding projects in broader health promotion strategies and long-term engagement of citizen scientists should be pursued to accomplish this.
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Since the introduction of Family Group Conferences (FGCs) in the Netherlands, there has been a steady growth in conferences being organised each year. Government policy emphasises the importance of empowering families to strengthen their ability to take responsibility for their own well-being. A recently adopted amendment in the Dutch Civil Code reflects this commitment and designates FGC as good practice. However, there is little knowledge on the application of FGCs in mental health care, let alone in a setting even more specific, such as public mental health care (PMHC). Clients in PMHC often have a limited network. The starting point of this study is the assumption that conferences promote involvement, expand and restore relationships and generate support. Over the next two years, we will research the applicability of FGCs in PMHC by evaluating forty case studies. The aim of our study is to provide an answer to the question of whether Family Group Conferencing is an effective tool to generate social support, to prevent coercion and to promote social integration in PMHC. Although making contact and gaining trust is a goal of PMHC, it is an aim to study whether FGCs can elevate or replace the work of professionals.
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Objective: Health beliefs of overweight adults who did and did not enter an exercise program were compared to identify possible factors that hamper people to increase physical exercise. Method: Participants (n = 116, 78 women and 38 men) were overweight adults without comorbidities. Self-report instruments examined the burden of suffering, beliefs related to physical exercise and obesity, somatic complaints, and obesity-related quality of life of new participants of exercise programs versus sedentary non-exercisers. Results: Mean BMI of exercisers was and of non-exercisers was 34.6 (7.0) and 32.8 (5.8) respectively. The exercisers were more often female, had fathers with less overweight, and considered overweight a more serious health problem. Fear of injury was higher and perceived health benefits were lower in the non-exercisers, who also more often attributed their overweight to physical causes and believed overweight to be irreversible. Body weight, age, education level, somatic complaints, and quality of life of the groups were comparable. Conclusion: With respect to health beliefs, overweight non-exercisers reported more fear of injury and perceived their overweight as more irreversible than exercisers. Considering these factors in intervention and public health promotion may help overweight sedentary people to start physical exercise.
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The vast literature on accountability in the public sector (usually called ‘public accountability’originating from political science and public administration tends to emphasize the positive dimension of holding authorities to account. As formulated by one prominent scholar in the field, ‘[a]ccountability has become an icon for good governance’: it is perceived as ‘a Good Thing, and, so it seems, we can’t have enough of it’ (Bovens, 2005: 182, 183). Accountability has, thus, become one of the central values of democratic rule – varying on a well-known American slogan one could phrase this as ‘no public responsi bility without accountability’.
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From January 2011 until December 2012, forty Family Group Conferences (FGCs) will be studied in the public mental health care (PMHC) setting in the province of Groningen, the Netherlands. Research should yield an answer to whether FGCs are valuable for clients in PMHC as a means to generate social support, to prevent coercion and to elevate the work of professionals. The present study reports on two case studies in which shame and fear of rejection are designated as main causes for clients to avoid contact with their social network, resulting in isolated and marginalised living circumstances. Shame, on the other hand, is also a powerful engine in preventing clients from relapse into marginalised circumstances for which one needs to feel ashamed again. An FGC offers a forum where clients are able to discuss their shameful feelings with their social network; it generates support and helps breaking through vicious circles of marginalisation and social isolation. Findings of these case studies confirm an assumption from a previous study that a limited or broken social network is not a contraindication, but a reason for organising FGCs.
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Powerpresentatie tijdens CORAL symposium.
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