'Gezond en Gelukkig Den Haag' improves health through local, integrated approach

Platform for connections

Gezond en Gelukkig Den Haag (GGDH) is a platform that connects organisations from social and medical domains. Other than the municipality of The Hague, participants include health insurers, general practitioners, the GGD and GGZ, welfare organisations, hospitals and educational institutions. GGDH was created by various initiatives in the The Hague region that were simultaneously working on various approaches to integrated care. Actions to achieve more collaboration between the social and medical domain were initiated by general practitioners as well as politicians and welfare organisations. The zeitgeist was therefore in favour of starting the collaboration Gezond en Gelukkig Den Haag in 2018. This happened under the supervision of Jet Bussemaker, chairman of GGDH and professor of policy, science and social impact, in particular in healthcare, at Health Campus The Hague.The challenge for GGDH is to achieve successes in the complex environment of many different organizations, which all have different interests.

“Connection is a golden keyword for GGDH,” explains Marjolein Oudshoorn, GGDH program manager. “The biggest gains we've made so far are the bridges that have been built. Not only between professionals from different disciplines, but also between professionals and contacts in the informal networks in a number of neighbourhoods.These informal networks have proven to be extremely effective in reaching local residents. Because the key figures are close to the residents, they can build a relationship of trust and identify problems at an early stage. In that case, they can refer and possibly also guide the citizen to the right care provider. This is a major win because otherwise local residents often only see a social worker when the problems have become much too complex. Moreover, because the care providers work better together, it is much easier for the contact persons to refer them to the right institution”. An initiative by the GGD to create a mobile health team that goes to community centers instead of citizens having to go to them further reduces the barrier to asking for help and is an example of successful collaboration under the GGDH umbrella.

Community-up approach

An example of an informal network that has proven to be very successful is the Schilderswijk Mothers. This initiative has been running since 2013, and consists of a group of 20 trained contact women who have a large network in the neighborhood. They support other mothers with small and big problems. For example, when filling out forms, with financial questions or with parenting problems. The Schilderswijk Mothers are trusted and respected in the neighborhood and can identify problems and, where necessary, ensure that formal support is initiated. This approach has proven to be effective and possibilities for implementation in other neighborhoods is examined. “The approach cannot simply be adopted one-on-one, because each neighborhood is unique, with different characteristics, population and problems. But the presence of an informal network between residents and care providers is very beneficial. That is why we are now looking at how this can be set up in Moerwijk.”

Another advantage of the connection with informal networks is that it makes residents feel comfortable to express and implement their knowledge and ideas for the neighborhood. Marjolein Oudshoorn: “We notice that local residents often have valuable knowledge and come up with good ideas. The healthcare providers and the municipality can gain a lot by seriously considering these 'community up' ideas and implementing them where possible. And perhaps even more important is that residents feel heard and gain confidence in the care providers and the municipality. The informal networks have therefore also proved to be very important in this respect.” Residents who experience that they can influence their living environment more often take the initiative to make and keep their neighborhood clean, safe and green. And that strengthens social cohesion. And social cohesion in turn contributes to well-being, both for the individual and for the collective.

Lifestyle as a medicine

Projects are initiated within various working groups that promote health. Prevention is central to this, because many diseases of affluence, such as obesity, diabetes and cardiovascular diseases, are the result of an unhealthy lifestyle. Moreover, these diseases of affluence are overrepresented in neighborhoods with low socio-economic status. That is why GGDH focuses on lifestyle interventions such as more exercise, healthier food, adequate rest and/or sufficient sleep to prevent these diseases.

A project that effectively combines the community-up approach with lifestyle interventions is the development and adaptation of a Combined Lifestyle Intervention (GLI) that is adjusted to the living environment of the neighborhood residents. Marjolein: “In those projects we see that enormous gains are already being made by listening to each other and hearing the different perspectives. This generates understanding for each other's points of view and activates both the municipality and the residents to take these obstacles seriously and to come up with alternatives. This willingness to take action is necessary for lifestyle interventions to be successful, which in itself is a very complex task.”

Other initiatives that run on the theme of Lifestyle as Medicine are the National Diabetes Challenge and Diablend. 

Powerful Basic Care

Another success story is the integrated approach Powerful Basic Care. At Health Point Laakkwartier and SHG Health Center Spoorwijk, the general practitioners have started working with a 4D model, which not only looks at physical complaints, but also asks about the mental, social and societal environment. This gives the GP a better idea of the situation and what the causes of the complaints may be. Collaboration has also been sought and strengthened with the social domain, with which structural consultation is now taking place. Research has now shown that this method has positive effects for both the patient and the GP. That is why GGDH have invested in structurally continuing this working method and expanding it to other neighborhoods in The Hague.

Check out the website of Gezond en Gelukkig Den Haag (NL) for more information.