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Julkinen terveydenhuolto Rotterdamin metropolialueella,Pascal Bisscheroux
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10-11-2009
Public Health in the Rotterdam MetropolitanArea
Pascal Bisscheroux
5th November 2009
TERVEYSASEMAT
10-11-20092
10-11-20093
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