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The goal is to optimise the quality of life and autonomy of the Flemish

An interview with Mr Jo VANDEURZEN, Flemish minister of Welfare, Public Health and Family

© Diego Franssens

How is the state of public health in Flanders and what are your priorities in this field? The Flemish have a high life expectancy. The life expectancy is continuing to rise and in 2016 it was among the highest in Europe at 80 years for men and 84.5 years for women. The majority of people die of heart and vascular diseases and cancers, as in most Western countries. Respiratory diseases are also still a major health issue. Dementia, a symptom of ageing, is becoming increasingly commonplace as a cause of death. And there are a lot more suicides than in our neighbouring countries, although the trend in Flanders is gradually improving.

Partly thanks to our improved treatments, cancer is becoming a chronic illness. There has also been a rise in other chronic conditions, with above all a rise in multimorbidity. Care paths that focus on a single condition are not sufficient in this. To provide these patients with good care, there has been a paradigm shift from disease-oriented care to care that starts out from the goals that the patient has indicated himself or herself.

With the Sixth State Reform, in Flanders we had the opportunity thoroughly to reform a number of different fields.

In the long term therefore, care funding will be integrated into “Flemish Social Protection”, which will be like a layer on top of federal social security. This will be used to fund the care budgets for those in need of care. From January 1, 2019, it will be expanded with the financing of residential care for the elderly and mobility aids. In the long term, the financing of rehabilitation, and mental health care and home care will also be added to this. The intention is to convert this funding into a “personal” fund, whereby the size of the intervention could be determined by the care profile of the person requesting care: the greater the need for care, the higher the budget that will be assigned.

The transferred powers concerning mental healthcare and the rise in demand for care led to the elaboration of a 2017-2019 Flemish Mental Health Action Plan. The overall objective of the Action Plan is to bolster mental health by means of a high quality preventive health policy and high quality, sustainable, flexible and demand-driven care.

We are tackling the increasing prevalence of dementia (+42.5% by 2035) through the Flanders dementia plan and the development of a reference framework for the quality of life, living and care of people with dementia. Specific housing and respite options are being developed specifically for people with young dementia, and initiatives are being taken for financial accessibility of residential care.

The front line in Flanders is organised both with regard to structures and content so that it is able to form the cornerstone of accessible, effective and high quality health and welfare care. The goal is to optimise the quality of life and autonomy of our citizens.

People with a chronic need for care or reduced capacity to look after themselves mostly want to stay at home for as long as possible. Informal carers must be able to have care and support in their locality to make their work easier to cope with. The Flemish Informal Care Plan groups together over 115 actions to support informal care.

What preventive actions do you support in public health? The updated food triangle and mobility triangle are not only innovative for the Flanders region. The way in which they have been developed also makes them innovative for other European regions.

In the new mental health decree, we not only focus on individualfocused care but also population-focused actions. By doing this we can give a regulatory character to all efforts in the area of imaging, destigmatisation, early detection and intervention and first line interventions for mental health.

Health in all policies is an important factor in prevention. We not only work on this by cooperating with other policy areas (mobility, environment, natural environment, sport, education etc.), but we are also attempting to do this at a local administrative

level. A few recent examples include the “local mobility health indicator” with which status is measured with regard to air quality/ traffic safety/active commuting/traffic noise and the “walkability score index”, which displays a function mix/ road connectivity/ residential density at district level. The latter is a European first which tells spatial planners where gains can be made in terms of air quality, greater mobility and social cohesion; in short, this is an integral approach in achieving health gains.

You wanted to strengthen relations between professional carers and informal carers thanks to two new instruments: www.mantelzorgers.be and a “Samenspraakfiche” (joint task map). Could you tell us more? A number of studies in the past had shown that the lack of useful information was a major setback that was touched upon by informal carers time and again. That is why an informal care expertise point was set up in the Flemish Informal Care plan that provides useful information for informal as well as professional carers on its website www.mantelzorgers.be. ‘Dialogue’ is a scientifically built ‘toolkit’ that aims to allow better communication and cooperation in care between informal carers, patients and professional carers.

In June 2018, you welcomed the new intersectoral agreement for the social sector concluded between the social partners and the Flemish government. How will this agreement improve the quality of care? The VIA 5-agreement provides a full set of measures. The enlargement policy defined will allow for further growth of the offer, which will mean that more people in need of care will be able to be helped. In addition to this enlargement policy, provision is also made for additional employment, as a result of which more members of staff will be available for people in need of care. The agreement involves around 250,000 members of staff. By making the work more appealing for staff members by among others offering a solution to work pressure and versatile and manageable work, and making an effort to increase buying power, a more skilled workforce can be retained.

How does the Flemish Governement support basic and applied health research? Health research is supported by the Flemish Government in a number of different ways. In 2018 1.6 billion Euro of the Flemish Government’s budget was allocated to research and development, of which 26.73% can be assigned to a health topic. The Scientific Research Fund (FWO) and the Special Research Fund (BOF) are two complementary funding channels for non-directed ground-breaking research at Flemish universities. The Flemish Government is also supporting four strategic research centres (IMEC, Vito, VIB and Flanders Make) in terms of health research.

The policy-led health research will mainly be carried out by two research support centres. The Welfare, Public Health and Family (WVG) Support Centre is currently focusing on its research programme on ‘Flemish social protection’ and on current policy matters such as mental healthcare and quality indicators. At the Environment and Health Support Centre, the focus is on charting people’s exposure to environmentally harmful substances and early health signals that can have an effect on exposure to environmentally harmful substances. Flanders plays a pioneering role in this respect at European level (HBM4EU).

Could you give us a few examples of ongoing health research projects backed by the Flemish Governement? In Flanders there are a number of different examples of relevant health research. In the area of basic research, the Flemish Institute for Biotechnology (VIB) is involved in a number of different projects, including intestinal flora research. From earlier studies we know that there is a connection between the composition of intestinal flora and for example overweightness and all manner of conditions such as gastroenteritis and diabetes.

An example of more applied research is the development of a Flemish Child Reflex. Serious psychological and addiction problems in parents can lead to the neglect, mistreatment or abuse of the children who grow up in their homes. The application of a Child reflex allows carers preventively to check what the impact of parental issues could be for the children via contacts with adult clients.

As a result of the recently completed Mirad project, research has been performed into an integrated methodology to bring smart robot technology to the user.

What are according to you the next challenges ahead in public health? Increasingly often, technological changes force us to make societal choices in healthcare with the end goal being to make health gains: are a healthy indoor environment and the application of the WHO Air Quality Guidelines not gold plating? We are striving towards a zero risk as regards the external determining factors that define our health, but we do not want to give up our current (living) standards (e.g. driving a car). Here we are forced to make choices that are not independent from a social platform.

Another challenge is posed by scientific and technological developments and their implications for healthcare affordability. A clear vision needs to be developed on this along with an adequate strategy. The first line plays a role in the translating of new insights into an approach to health problems with consideration for the “relevance” of the care and the avoidance of medicalisation in daily life.

The higher level of education and the increased accessibility of medical information via the Internet is increasingly changing some “patients” into “critical consumers”. They are well informed and expect to enter into dialogue with care providers, weigh up options together and make the decisions that best fit in with their lives.

People who belong to ethnic cultural minorities bring diversity into care situations, which means that the carer has to adapt.

The changing social context – more people are working for longer and are looking to strike a new work-life balance – has a major impact on informal care, for example as a result of the fall in the availability of volunteers and informal care. If, on the other hand, we want to focus on “socializing care” (allowing people to participate actively in society despite limitations and disorders, and to include care as much as possible in that society), we will have to find formulas that support this. For example, combining work and family needs to evolve into combining work, family and care.

The financial and economic crisis has also had an effect on social inequality in the area of health. The first line offers opportunities in the area of care accessibility and a strong signalling function, so as to recognise with other sectors the “social determinants” of health (home and work situation, education, social cohesion etc.) and propose corrective measures.