"Growing up healthy in Rotterdam Beverwaard - a multiannual action-research to improve the lifestyle of children and their families"

BASIC CITY DATA

• Population size: 663,900
• Population Growth Rate(%): 0.50
• Surface Area (sq.km): 324.14
• Population Density (people/sq.km): 2048.18
• GINI Index: 0.29
• Main Source of Prosperity: mining, agriculture and foreign remittances

ABSTRACT

Rotterdam has noticed an increase in socioeconomic inequalities between residents in different parts of the city. There seems to be a clear correlation between the health status of citizens and their neighbourhoods. Especially welfare diseases like obesity are increasing, also among children. The present approaches to tackle this problem tend to be mono-functional and lifestyle driven whereas the households are characterized by multiple problems.

The initiative ' Growing up healthy in Rotterdam Beverwaard' is trying to understand this complex context and develop interventions focusing on the improvement of the (experienced) health of children and their families, on the scale of a neighbourhood.

Over the course of 3 years, almost 60 children and their families were closely followed to gather quantitative and qualitative data, through different methods of action research. A family coach was introduced to bridge the gap between the families, the health care professionals and the school. A specially designed lesson program was implemented at school to teach children about positive health and support them in developing their talents.

The data analysis shows insights that are relevant on a larger scale.

BACKGROUND INFORMATION

This integral prevention policy was developed within the framework of "The WHO Healthy Cities Network". How can the city be transformed or developed such that the prevalence of structural diseases like obesity decreases? In what way should the physical environment and the societal structures change in order to provoke the desired behaviours? The covenant between local and national governmental parties, private organizations and commercial companies such as schools, transport companies, sports clubs and hospitals is titled ' Healthy 010, the covenant.’

ORIGINS

Rotterdam has a diverse population with growing social-economic inequalities. There seems to be a clear correlation between the health status of citizens and the specific neighbourhood they live in. Especially welfare diseases like obesity are increasing. The present approaches to tackle this problem tend to be monofunctional and lifestyle driven whereas the households are characterized by multiple problems concerning (un)employment, (un)safety, loneliness, etc. The initiative is trying to understand this complex context and develop interventions focusing on children and their families.

- The initiative tries to stimulate structural health improvements on the population level by implementing a family coach, expanding networks of social services in neighbourhoods and designing new primary school educational programs, with a specific focus on talent development.

- During the 3 years of action research on-site, small improvements in the health status of individual children and their families have been recorded. New networks and collaborations were set up and certain parts of the educational program were implemented in the curricula of the school, that will remain active after completing the initiative. Structural changes in health will need long-term intervention.

- The initiative introduced a role that didn’t exist in the school or family care system before the family coach. The close monitoring of almost 60 children and their families over the course of 3 years was unique, as well as the quantitative/qualitative data collection on a broad range of health and well-being aspects of health. Incorporating a program about health and talent development in regular education is also innovative.

- Positioning the family coach in the school, organizing space in the curriculum for experiments, attracting new partners and organizing platforms to collaborate with all stakeholders involved.

The partners in this initiative were a private local welfare organization (IJsselwijs), a public municipal research & design lab (Veldacademie), a public primary school (RK de Regenboog) and a private theatre company (Building Arts), IJsselwijs provided the family coaches, Veldacademie organized and monitored the research and designed the educational programs and RK de Regenboog offered access to pupils and their families and offered support on the educational programs and data collection. Building Arts was the partner of the educational program and provided resilience training and film production lessons. Third-party local welfare parties and public/private research departments supported the initiative upon occasion.

The initiative was entirely funded by the 'Fonds Nuts O hra', a private fund offering finance for developing innovative health initiatives country-wide. The in-kind contribution was offered by various municipal parties, universities and local welfare organizations.

Existing programs for youth, privately and publicly funded, have been incorporated into the initiative as well.

INNOVATIVE ASPECTS

This initiative can be considered evolutionary in terms of new forms of collaboration in a network of family care and a different approach to improving the health and lifestyle of families.

Families that are less self-reliant are facing multiple problems, which means they have to deal with many professionals. Social workers, financial advisors, housing corporations, school teachers and counsellors. The changing faces of the professionals, the lack of communication between all of them and the limitations of their functions cause the families stress, resulting in withdrawal from the support system. During this initiative, a new role was introduced and tested. A family coach was put in place to bridge the gap between the families, the health care professionals and the school. The coach was an independent professional (not part of any organization) that provided stability and an open vision. They visited the families at home to get a picture of the often complex situation, inventoried the needs and took action to organize the right support. They were also present in the classroom and in contact with the school teachers and student counsellors.

When it comes to improving health and lifestyle the main focus is mostly on nutrition and movement. As much as these factors are of great importance, there are many more variables. This initiative started from the perspective of the model for positive health; a broad approach to understanding people's ability to cope with physical, emotional and social challenges, and to be in charge of their own lives. The model consists of 6 pillars:

bodily functions, mental well-being, meaningfulness, quality of life, participation and daily functioning. Along these pillars, the research was conducted. Data was gathered during the lessons in the classroom, the house visits, observations and questionnaires. This resulted in a valuable overview of what makes a family healthy and how the healthcare system, the community network and the social-spatial characteristics of a neighbourhood play a part in this.

DESIRED CHANGE OR OUTCOME

On the level of personal and talent development, there seems to be a shift towards a higher number of children who choose a higher level of secondary education. Regarding methods, certain interventions from the experimental phase have become more persistent ingredients. Resilience training and talent-building education based on artistic production like film and theatre have become a standard part of the school curriculum in the Regenboog. An active interest in knowledge exchange took place country-wide, and lessons learned have been incorporated into local policy.

Physical health data is being assembled by the teachers of sports education and by........Health indicators consist of Body Mass Index,................., ...data is being reviewed and analyzed by the Erasmus Medical University (prof. dr. lex Burdof). The overall outcomes are compared with federal data of similar groups in order to calculate the possible impact of the local interventions on the scale of a population.

Upscaling is done by SpringCo Urban Analytics. Main outcomes......, ..family coaches keep track of the personal developments of pupils in a diary system (.....)The qualitative data is being reviewed, analyzed, and described by Veldacademie.

a. The innovation focuses on interventions in the primary school environment of neighbourhoods with threatened social-economical populations. Pupils and families formed the main target group.

b. The peer group consisted of 59 children (ages 9-12) and their families (approx. 100 parents/caretakers). To understand the possible impact on the scale of the entire urban population 'household profiles* were being determined. The households of the peer group were represented 11.802 times within the City of Rotterdam (entire population ca. 660.000 persons).

RELEVANCE TO SUSTAINABLE DEVELOPMENT GOALS

Goal 3: Ensure healthy lives and promote well-being for all ages 

Goal 10: Reduce inequality within and among countries