Julkinen terveydenhuolto Rotterdamin metropolialueella, Pascal Bisscheroux

1. Pascal Public Health in the
Bisscheroux
Rotterdam Metropolitan
5th November Area
2009
10-11-2009

2. TERVEYSASEMAT
2 10-11-2009

3. 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
3 10-11-2009

4. Area: 20 regional municipalities, 11 boroughs
4 10-11-2009

5. 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
5 10-11-2009

6. And in Rotterdam?
Economic transition
Ethnic diversity
Unemployment
Low educational level
Safety/homeless/drugs/prostitution
Environmental Problems

7. 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
7 10-11-2009

8. 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
8 10-11-2009

9. 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

10. 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 standard
package per inhabitant (15 Euro). They can purchase
additional services (preventive projects, advice, policy
documents)
10 10-11-2009

11. 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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12. 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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13. Neighbourhood monitor : social index
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14. Health Policy Rotterdam
City, Work: City, Clean air:
- Employment / participation - Clean air
- Urban development
School, Youth Neighbourhood/adults,
- Healthy School - Health promotion through primary
- Mental health care (GP, physiotherapist)
- Sexuality /relationships - Health information for the public
- Reducing perinatal mortality
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15. Connecting and dissecting
AWBZ WMO
€
Zvw WWB
PC
Van Klacht naar Kracht
DBC Local community
Ketenzorg care Pilot Klink
Perinataal
Etcetera
15 10-11-2009

16. Challenge
Working to the local measure
Expert opinion <> locally expressed needs
Involving private partners
Integrating cure and prevention
Getting Health insurers interested
16 10-11-2009