Inequity In Preventive Care

From the series: inequity in Dutch healthcare

Beeld door Mirthe de Haas
Beeld door Mirthe de Haas
Pia Sophia (redacteur)
Pia Sophia (redacteur) • 25 mei 2022

Prevention is better than cure. Most of us know that. We do our best to eat healthily, and exercise regularly to become as healthy as possible. In any capacity, we do our best to take care of ourselves, but we can't do everything alone. For example, as long as we feel good, we don't know whether there are cells or genetic variations in our body that can make us sick. Fortunately, the Dutch government lends us a hand with this through population surveys. Healthy food, sufficient exercise, free population screenings… what can still go wrong in the context of our health? A lot, unfortunately.

Theoretically a good strategy
People living in the Netherlands are given the choice to participate in health screenings and other preventive measures. Nowadays, this starts around our birth with the 20-week ultrasound and the National Immunization Program, and extends into our last years of life with the population screening for breast cancer and colorectal cancer. Anyone in the Netherlands who reaches a certain stage of life, whether that is birth, puberty, a thirtieth or sixty-fifth birthday, can use these tests. On paper, it's a fantastic idea that leaves little room for inequity. However, reality shows that the inequities that already exist in our society are clearly exposed during mass campaigns like these ones.
Despite the fact that in theory we all receive the tools to be able to live in a healthy physical and mental state, this is not the reality. If you have a low education level, a low income or a migration background, you are at risk of less good physical and psychological health than people with a high education level, a high income and without a migration background. Even in the age of having vaccinations, health campaigns and invitations for population screenings wherever you look.

Numbers expose the problem
In the Netherlands, there is a large-scale screening for three forms of cancer: breast cancer, colorectal cancer and cervical cancer. For the latter, young teenagers are also offered two standard vaccinations. The reason for such large-scale screening for these types of cancer lies within the numbers: every year approximately 15,000 people in the Netherlands are diagnosed with breast cancer, 13,000 people are diagnosed with colon cancer in the same year, and another 1,000 with cervical cancer. Since the start of these population screenings, breast cancer, cervical cancer and colorectal cancer have been detected more often (at an early stage!) and fewer people die from these diseases. There is great health gain. It is therefore particularly distressing that this health gain is not achieved by all Dutch people. People with a migration background, a lower income or from poorer neighborhoods are less likely to participate in population screenings that have such a positive influence on our health. To paint a picture: about 40% of female migrants indicate that they never participate in a population screening.

Health inequity persists
The current form of prevention perpetuates health inequalities. For people with a migration background, a lower income or from poorer neighborhoods, the path to health prevention is not so obvious. This may be because someone finds it difficult to read (in Dutch), or because someone can read what it says, but does not understand what it means and/or what actions they should take. Cultural factors also play a role. For example, in some communities it's unusual to talk about mental health issues, so a campaign like 113 Suicide Prevention may not reach the right people (while the group that needs to be reached is also the group with the highest suicide risk). On the other hand, an anti-vaccination culture has also developed in certain communities, which immediately dismisses a large part of disease prevention.

Knowledge is power
More attention should be paid to the differences between the groups that make the Netherlands a society. Instead of closing our eyes to these differences, we should dive into them. We can no longer afford to say that “it’s just the way it is” that people with a migration background are less likely to talk about mental health than people without a migration background, or that people from certain Dutch communities don’t vaccinate themselves or their children. That suggests that we are powerless, while the opposite is true. I believe that with knowledge we can solve a lot, or at least open a door for those where the door seemed to be stuck. Because at the end of the day we all want the same thing: everyone wants to be healthy, everyone wants their loved ones to be healthy and everyone wants to age comfortably. We must therefore make use of the knowledge we already have, if necessary with the help of professionals. Preferably professionals who belong to the groups with an increased risk of poorer health outcomes, because they are not only strengthened by their professional knowledge, but also by the experiences they bring with them from their background. We need to find out what all groups need in order to reach the level where prevention is indeed a good way to improve health. For one group of people, these needs may lie in an explanation of how the Dutch mental healthcare system works. The other group of people may need to know exactly how vaccinations work and what it means to be vaccinated (or not). And sometimes we already know: it appears that general practitioners play a major role in the participation in population screenings among the groups that are underrepresented now. We can do something with that! Knowledge is power, and the more knowledge one has about the (im)possibilities of preventive care, the more progress can be made here. The same applies the other way around: the more we know about what people need to manage health themselves, the better we can respond to it. We all know that it’s better to prevent than to cure, and everyone has a right to get that chance.


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