Author: Annemieke Groenenboom

Individuals in lower socio-economic positions (SEP) live on average up to 9 years shorter and up to 25 years longer with disease than those in higher SEP. “The tide can only be turned with an intersectoral approach of the underlying causes of these health disparities,” say UU scientists Carlijn Kamphuis and Jantien van Berkel. Lilian van der Ven (UMC Utrecht) is already building a collaborative approach. While they know how to find each other, they are looking for more input, especially from scientists in governance and technology. 

Carlijn Kamphuis. Jantien van Berkel and Lilian van der Ven will talk about these pressing topics during our Lunch & Learn lecture, on March 21. See more information here.

Carlijn Kamphuis & Jantien van Berkel, Associate Professor and Assistant Professor at the Interdisciplinary Social Science Department, Utrecht University (UU) 

People with lower socio-economic status (SEP), who are they? 

Van Berkel: “Individuals who are in a vulnerable position, for example due to a lack of financial resources or an insecure housing situation. They frequently have fewer years of education and a lower income. Yet they may also encompass, for instance, highly educated individuals struggling with chronic illness, individuals from immigrant backgrounds, or isolated elderly persons. The group is more varied than is commonly perceived.” 

“Health inequalities between people with higher and lower SEP have been increasing for years. Those in the lower SEP category experience an average life expectancy that is up to 9 years shorter and spend more years in a state of perceived poor health. For women, this discrepancy is 23 years, while for men, it amounts to as much as 25 years. They are prone to enduring chronic conditions, such as type 2-diabetes, obesity and depression.” 

What causes these health inequalities?  

“This is due to a variety of mostly external factors that are more unfavourable for people in lower than in higher SEP, such as an insecure housing situation, insecurity or nuisance in the neighbourhood, tough working conditions (or not having a job), poverty, and a lack of social support,” adds Kamphuis.  

“Feelings of social insecurity, for example due to an uncertain housing situation or financial stress, are very decisive. That limits your sense of autonomy. The Dutch government aims for self-reliance; nevertheless, at the same time individuals have to follow all kinds of rules, with sanctions imposed in case of non-compliance. Those who have a stable living situation and enough money to make their own choices feel more in control and are less likely to have health problems.” 

‘’For years, health promotors focused on lifestyle advice, but in doing so they ignored people’s real problems. A single father in debt who cannot feed his children breakfast needs financial help more than nutritional advice. However, in practise, it is challenging to achieve this, due to barriers between the experts and agencies involved. For instance, dieticians and municipal Work & Income employees have different priorities and budgets. Moreover, pressure on these sectors is high, and many experts are not inclined to take on ‘additional work.”  

What is the solution? 

Kamphuis: “We know by now that there is no silver bullet. The system of care and assistance requires a significant overhaul. This entails establishing one unified vision (like Health for all Policies) and one comprehensive long-term budget, along with fostering close collaboration among all experts and agencies involved. Not everyone needs to know everything, but they should operate from a common goal and have the ability to refer to appropriate help.” 

How can other researchers contribute? 

According to Kamphuis, one of the biggest challenges is achieving consensus on a unified vision involving diverse stakeholders. “We, as researchers, contribute to a piece of the puzzle by identifying the roots of health disparities and providing policy suggestions, but how can we make them resonate with policymakers and matching with the needs of people in lower SEP themselves? An important step is to continuously involve all these groups in our research – something we are increasingly doing.”  

Van Berkel adds: “And to what extent should we remain involved to ensure that policymakers use our recommendations? We are independent researchers, yet we aim to reduce health inequalities. We would like to discuss these questions with critical friends: other researchers, particularly in the fields of public administration, technology, and (food) environment. But also external stakeholders, including health insurers, interest groups like Pharos and FNO Zorg voor kansen, and, of course, people in low SEP or other vulnerable positions.” 

Lilian van der Ven, Prevention Coordinator at the Julius Center for Health Sciences and Primary Care, UMC Utrecht 

How is the Julius Center working on reducing health inequalities? 

“We focus on both patients and individuals outside the hospital: how to prevent them from ending up in hospital? This starts with creating internal support for a preventive approach. The aim is to pay attention to lifestyle, from diet and exercise to stress-causing factors such as financial problems, in all patients – in addition to their illness.” 

“Our role is mainly to identify the need for help and to refer them to support close to the patient. That is why we are building a lifestyle network together with regional and national partners. So that eventually patients from all over the Netherlands can get appropriate support. This is in the interest of patients, but it should also lead to less work for our care providers. After all, we are heading for a healthcare crisis. Additionally, our efforts are also put towards weaving prevention into the Medical School Curriculum.” 

Does the Julius Center itself do research? 

“Certainly, for example on the health effects of renovations in vulnerable neighbourhoods. This is often participatory research: we collaborate closely with professionals and neighbourhood residents. Working through community leaders in the neighbourhood, we create support for our research and go door-to-door. It is an intensive process, but it yields more results than traditional research. We gain richer insights and solutions that really fit the context and needs of participants.” 

“We also have a poverty and social inclusion expert on board. Being an expert by experience, she acts as a liaison between researchers and the research target groups. This involves tasks such as assessing the relevance of a study for the intended audience and providing guidance on using language and approaches that makes a study more accessible.” 

“This interactive method yields results, as we frequently find our recommendations echoed in  policies, for example from the Municipality of Utrecht. In this way, we extend our role beyond research, not only accumulating insights but also initiating preliminary steps toward practical changes.” 

How can other researchers contribute to this? 

“I see a number of opportunities to make our research easier. This could involve harnessing technologies, such as employing them to chart individuals’ living conditions or to offer technological assistance for lifestyle guidance. I am confident that colleagues at Eindhoven University of Technology (TU/e) and Wageningen University & Research (WUR) hold valuable insights in these domains.” 

“In addition, there is already a lot of data available on the living situation of people with lower SEP. By using each other’s data, we save time and participants are questioned less. However, identifying researchers who possess pertinent data and determining how best to leverage it remain questions. We would love to work together!” 

Lunch & Learn session: Equality in Health 

Want to know more, or do you see opportunities for collaboration? During our free online Lunch & Learn session, Carlijn, Jantien and Lilian will elaborate on their research and there will be plenty of room for ‘matchmaking’. Register here for the Lunch & Learn session on March 21, 2024.