How do system actors bend the rules of the system to mitigate socioeconomicinsecurity and enhance health among vulnerable populations?

Research Line: Preserving Health / Seed Call: i4PH April 2024

Socioeconomic health inequalities persist in the Netherlands, posing significant challenges to individuals facing socioeconomic insecurity. Research indicates that individuals in such circumstances experience shorter life expectancy and are more likely to encounter health issues earlier in life compared to those in more financially stable positions.

Currently, approximately one in six adults in the Netherlands grapples with socioeconomic insecurity, encompassing uncertainties about finances, housing, employment, health, and social networks.

Despite the presence of an extensive social welfare system in the Netherlands, comprising various social security arrangements, financial allowances, and benefits, navigating this system remains daunting for many individuals, especially those in vulnerable positions. This complexity can perpetuate socioeconomic insecurity and health inequalities, as individuals with multiple needs do not fit into predefined categories, hindering access to essential support services.

Objectives and route to impact

In response to these challenges, this project seeks to explore innovative approaches to promote socioeconomic security and improve health outcomes for vulnerable populations. Through close collaboration with system actors (e.g. frontline professionals and public servants) who bent system rules, and by doing that, successfully helped people in socioeconomic insecurity, the project aims to address the following research questions:

1. How do frontline professionals and public servants navigate the complexities of the social welfare system by flexibly interpreting or bending its rules to improve individuals’ socioeconomic security? What challenges do they encounter from superiors or colleagues, and how do they justify their actions?
2. What are the impacts of bending-the-rule practices on the health of vulnerable populations, from the perspective of frontline professionals and public servants?
3. How can insights from these practices be translated into intervention and implementation strategies to promote behaviour change among system actors, contributing to systemic transformation in socioeconomic security and health?

The long-term goal of this project is to facilitate systemic change within the social welfare system, ensuring that it effectively supports individuals in need, particularly those with multiple needs. By fostering behaviour change among system actors and promoting more inclusive practices, the project aims to reduce socioeconomic and health inequalities in the Netherlands.

Methods

The project adopts an appreciative inquiry approach, focusing on strengths and positive experiences to explore frontline professionals’ practices within the social welfare system. Qualitative interviews with system actors, including frontline professionals and public servants, will be conducted to understand how discretionary behaviour enables breakthroughs for individuals in socioeconomic insecurity.

Additionally, co-creation workshops involving interview participants and individuals with experiential knowledge will be organised.

Contribution to cross-EWUU collaboration

This consortium represents a collaborative effort between Utrecht University (UU), University Medical Center Utrecht (UMCU), and Wageningen University & Research (WUR), fostering transdisciplinary collaborations to address complex societal challenges. Principal Investigators from UU oversee project activities, leveraging expertise in qualitative research, institutional change, and health policy. Partners contribute complementary expertise in public health, epidemiology, public policy, and citizen participation, fostering mutual learning experiences and preparing for future grant applications to further advance research in socioeconomic security and health.

Team

• Dr. Carlijn Kamphuis – UU Interdisciplinary Social
  Science
• Dr. Jantien van Berkel – UU Interdisciplinary Social
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• Sanne Verra, MSc – UU Interdisciplinary Social
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• Dr. Maikel Waardenburg – UU School of Governance
• Dr. Maartje Poelman – WUR Chair group Consumption and Healthy Lifestyles
• Dr. Marielle Jambroes – UMCU Public Health