GROZ: From national to local

From national to local: that is the dream of Jan Smelik, chair of Austerlitz Cares and general coordinator of Nederland Zorgt voor Elkaar (The Netherlands Care For One Another - NLZVE) and member of Theme Team of the societal theme Health & Care. ‘We must move towards a system in which health and a healthy living environment are central’, says Smelik. ‘Citizens must live, work and go to school in a healthy environment, and that takes place in the neighbourhood. So we are really talking about the local level.’

Smelik is not the only one who holds this opinion. Various care initiatives, set up locally by citizens, are mushrooming. ‘We counted them again last year’, says Smelik. ‘We have 1500 initiatives on the radar: 5 years ago, there were only 500 initiatives. You can see an enormously rapid growth of care- and welfare-oriented initiatives and citizens collectives.’

Many of these local initiatives are members of regional networks, which are affiliated as a member of NLZVE. ‘Netherlands Care For One Another is a nationwide network of citizens collectives. For us, it is about residents who organise things together.’  An example of such a collective is Austerlitz Cares, the care cooperative that Smelik founded in the village where he lives.

‘Local initiatives are the citizens. It is the living environment that organises it: that is the basis of the movement from care to health.’ - Jan Smelik, chair of Austerlitz Cares and general coordinator of The Netherlands Care For One Another

Citizens in the central role

‘Local initiatives are the citizens’, says Smelik. ‘It is the living environment that organises it: that is the basis of the movement from care to health.’ Smelik advocates decentralisation of care, with more attention and energy for the neighbourhood level. The regional system will support the local system, after which the national system will further support the regional system.

‘That pyramid, with the national level on top and local on the bottom, has to tilt’, says Smelik. ‘In fact, the local level must become leading: everything below it must be subservient to the upper level. And at the top of that model are the citizens, who organise their own care, both the formal and informal care. The regional level must be in line with this and be complementary to what is organised locally.’

From triple helix to quadruple helix

Since 2019, citizens have been more explicitly involved in the Mission-driven Top Sectors and Innovation Policy: we have evolved from the triple helix, in which companies, government and knowledge institutions had a place, to the quadruple helix where citizens are now an equal partner too. ‘And it’s about time’, says Smelik. ‘After all, citizens know best what is needed in their own neighbourhood.

The care and prevention measures that are important to keep the residents healthy vary between neighbourhoods: they must fit within the environment. In a neighbourhood where many people live with debt, you should focus on debt counselling. In another neighbourhood, there may be a lot of loneliness, which means you have to focus on organising social activities.

‘This is not a movement that says: we design one concept and then we roll out citizens collectives everywhere’, says Smelik. ‘You have to take care of what is needed locally.’

Paradigm shift

In addition, national healthcare policy does not yet have the right focus. Although that focus has already shifted from disease and care to health and behaviour, another paradigm shift is needed: the focus must shift from the individual to the community. ‘Communities must play a much more important role in policy’, says Smelik.

‘The problem is that, in the Netherlands, we have always regarded citizens as individuals’, he explains. ‘The government tackles many health problems with campaigns that influence behaviour at an individual level. But many of these problems accumulate in the vulnerable segments of the population, and they are not responsive to this type of campaign.’

Indeed, it has been shown that individual preventive measures tend to increase the health differences between people with low and high socioeconomic status. ‘You really have to design preventive actions in a completely different way by targeting communities. People are prone to copy each others’ behaviour. For a healthy living environment, you have to target the whole environment, not just the individual.’

GROZ

At Health~Holland, we also see an important role for citizens and the focus on health instead of care. GROZ was launched in 2018 to stimulate this. Smelik also played an important role here. ‘GROZ is actually the first movement from Top Sector LSH in which local initiatives are the starting point, in which we strive for a different way of organising health and care’, says Smelik.

‘It really is the reversal of traditional care: how can we make health available to the population?’ The emphasis is on strengthening the connection and collaboration between formal and informal care and health. The informal aspect takes place in the local citizens collectives.

Smeliks’ extensive experience with citizens collectives came in handy: ‘One of the most important things we have learned is that enabling people to participate in society and make a difference according to their ability is an important element in healthy ageing. That keeps you young, and that keeps you healthy. Just having a hospital or doctor nearby is not enough. And that is our focus as citizens collectives.’

This interview is also published in Year in Preview 2021, which is filled with the most important developments in the Dutch Life Sciences & Health sector and provides a glimpse of what’s on the map for 2021. Read the Year in Preview here!

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