Reducing health inequalities has been a challenge for decades. People with a relatively low level of education have a shorter life expectancy compared to those who have gone on to higher education. In an effort to tackle this inequality, the city of Zwolle initiated the community-based approach Zwolle Healthy City in 2010. The programme is aimed at encouraging healthy behaviour in neighbourhoods where the educational level of residents is lower than average. Wilderink examined which key elements in this approach contributed to its success according to the professionals and policymakers involved.
Involving all stakeholders in the approach
One key factor for success proved to be opting for an integrated approach in which the municipality collaborates with a variety of local organisations, such as the Municipal Health Service (GGD), schools, welfare organisations and sports services. This ensured that everyone who had an influence on the complex system that causes health inequalities became involved. Moreover, working closely with residents ensured a better match between the approach taken and the wishes, needs, motivations and talents of the residents. Factors such as support, coordination, assurance, profiling, monitoring and cooperation with both private organisations and residents have also been identified as important.
Participatory action research
Participatory action research proved to be a useful way of facilitating cooperation with residents. This emerged from research with children (aged 8-12) and senior citizens (aged 65+) in the neighbourhood. The use of participatory research methods such as Photovoice, which enabled children themselves to work as photographers to investigate how their neighbourhood could become healthier, had a positive impact on this collaboration. The children and seniors who took part in the research emphasised that participation should above all be fun and educational.
The insights from Wilderinkâs thesis are important for the further development of the Zwolle Healthy City approach and may inspire integrated approaches across the country aimed at reducing health inequalities.