10-11-2009

Public Health in the Rotterdam MetropolitanArea

Pascal Bisscheroux

5th November 2009

TERVEYSASEMAT

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Content

Where are you and what’s the problem ?

General profile of the municipal public health service

(GGD)

What do we actually do ?

Challenges

Discussion

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Area: 20 regional municipalities, 11 boroughs

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What’s the problem ?

The Netherlands are lagging behind internationally (life

expectancy, perinatal mortality).

Large contribution of lifestyles (smoking, alcohol, exercise,

nutrition, diabetes, depression) to chronic diseases.

Large effects of SES on Health

Large regional differences in Health

And in Rotterdam?

Economic transition

Ethnic diversity

Unemployment

Low educational level

Safety/homeless/drugs/prostitution

Environmental Problems

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Profile GGD

- Unique expertise in integrated approach of health issues

- Strong in networks of health care: mental health, primary

health care, youth health care, disaster medicine, science

- Strong in local cooperation with municipalities and

neighbourhoods.

- Often on the edge of what legally acceptable

- Innovation

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Systematic approach (if possible)

Health policy:

epidemiological analysis / needs assessment

Stakeholders and politics

expert advice on interventions (best practice, evidence

based)

4-year policy cycle, interconnected with national level

management in the field: creating alliances, facilitate,

in frameworks

subsidies on behalf of Rotterdam City (50-80 million)

implementation of GGD products and services

evaluation

Key figures

GGD: municipal service , ownership of Rotterdam City and

working for 20 regional municipalities through

“gemeenschappelijke regeling Openbare Gezondheidszorg

Rotterdam Rijnmond (OGZRR)”

Region 1,2 million inhabitants (city/region = 50/50)

Organisation: 733 fte / 1.000 workers (2009)

Budget approximately € 124 m, from which € 48 subsidies

for other organisations

Legal basis: Public Health Act

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For citizens and councils

Standard activities throughout the region (basis: Public Health Act)

Regional Municipalities constitute General Board of Public Health Care Rotterdam Rijnmond.

Regional Municipalities pay per inhabitant for standardpackage per inhabitant (15 Euro). They can purchaseadditional services (preventive projects, advice, policydocuments)

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Focus on the citizen

Products:• Policy on youth (health) care• Environmental health• Mental health• Management of preventive health

programmes• Infectious Disease Control

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Products and services• Tuberculosis, screening, treatment• Epidemics large and small: New Flu, Norovirus, scabies• Policlinic STD• Promotion of sexual health• Information on air quality• Healthy Building and constructing• Supervision of hygiene in public builings• Legionairs Disease• Investigation of health complaints

(environmental > clusters)• Domestic violence/child abuse• Care fore homeless, addicts• Local networks• Primary care and obesity• Health monitoring (Health surveys etc)• Public health forecast on local level (N=40) • Youth health• Deprived areas --------->

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Neighbourhood monitor : social index

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City, Work:

- Employment / participation

City, Clean air:

- Clean air

- Urban development

School, Youth

- Healthy School

- Mental health

- Sexuality /relationships

Neighbourhood/adults,

- Health promotion through primary

care (GP, physiotherapist)

- Health information for the public

- Reducing perinatal mortality

Health Policy Rotterdam

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Connecting and dissecting

AWBZ

Zvw

WMO

WWB€

PC

Local communitycare

DBCKetenzorg

Van Klacht naar Kracht

Pilot Klink

Perinataal

Etcetera

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Challenge

Working to the local measure

Expert opinion <> locally expressed needs

Involving private partners

Integrating cure and prevention

Getting Health insurers interested