Area-based interventions to ameliorate deprived Dutch neighborhoods in practice: Does the Dutch District Approach address the social determinants of health to such an extent that future health impacts may be expected?

• Published in: Preventive medicine 2014-04, Vol.61, p.122-127
• Main Authors: Droomers, Mariël, Harting, Janneke, Jongeneel-Grimen, Birthe, Rutten, Loes, van Kats, Jetty, Stronks, Karien
• Format: Article
• Language: English
• Subjects: Administrative Personnel - psychology; Area-based intervention; Biological and medical sciences; Environment and public health; Environmental aspects; Female; Health; Health Promotion - methods; Housing; Humans; Internal Medicine; Intervention studies; Interventions; Interviews as Topic; Male; Medical sciences; Miscellaneous; National Health Programs; Netherlands; Population health intervention; Prevention and actions; Program Evaluation - methods; Psychosocial Deprivation; Public health. Hygiene; Public health. Hygiene-occupational medicine; Residence Characteristics - statistics & numerical data; Retrospective Studies; Safety; Small-Area Analysis; Social Determinants of Health; Social Environment; Social factors; Socioeconomic Factors; Surveys and Questionnaires; Time Factors
• ISSN: 0091-7435; 1096-0260
• DOI: 10.1016/j.ypmed.2014.01.009

Abstract Objective We studied the local manifestation of a national procedural program that addressed problems regarding employment, education, housing and the physical neighborhood environment, social cohesion, and safety in the most deprived neighborhoods in the Netherlands. We aimed to assess if such a program, without the explicit aim to improve health, results in area-based interventions that address the social determinants of health to such an extent that future health impacts may be expected. Methods We used standardized questionnaires and face-to-face interviews with 39 local district managers. We analyzed the content of the area-based interventions to assess if the activities addressed the social determinants of health. We assessed the duration and scale of the activities in order to estimate their potential to change social determinants of health. Results Most districts addressed all six categories of social determinants of health central to the procedural program. Investments in broad-based primary schools, housing stock, green space, and social safety seemed to have the potential to result in district-level changes in social determinants. The scale of activities aimed at employment, income, educational attainment, and the social environment seemed too small to expect an impact at the district level. Conclusion We conclude that the area-based interventions addressed the neighborhood environment to such an extent that future health impacts of the Dutch District Approach may be expected. The health effects in the long term might be more substantial when area-based interventions were devoted more to the improvement of the socioeconomic circumstances of residents.