Table 1. Illustrations of findings reported in the results section
1a | The knowledge broker and the civil servant responsible for health were in close contact during the collaboration. After having read the policy document on poverty, the knowledge broker invited the civil servant to discuss this document in a meeting, together with two other experts. The civil servant agreed to such a meeting during which the knowledge broker and the scientific experts underlined the relationship between poverty and health and specified policy alternatives that could reduce the negative effects of poverty on health and vice versa. After this meeting the civil servant sent an email to the knowledge broker in which he formulated the central points that he had understood as being important in the relationship between health and poverty: |
“Taking health into account increases the urgency of combating poverty. Our goal is to breach the vicious circle of poverty and bad health… | |
Recommendations… The municipality should make their intention to broaden the themes more concrete!” | |
Expressions such as these indicate increased awareness of and consideration of the relationship between poverty and health and of policy alternatives as well as of the importance of adopting cross-sectoral policy alternatives. | |
Source: email communication, 2011 | |
1b | As a result of the activities of the knowledge broker—in terms of agenda setting and the specification of policy alternatives that could reduce the negative effects of poverty on health and vice versa—the poverty policy document was rewritten to include a separate section on health: |
“.. Health policy | |
The previous chapter mentioned the fact that poverty is accompanied by all kinds of problems in the area of health. Research demonstrates that people in disadvantaged districts are more likely than people in other districts to have poor health and do not live as long without health problems. Within the municipality, the Public Health Service is responsible for the collective health of all people of Amsterdam. … By combating poverty, the city district aspires to reduce deprivation when it comes to health.” a | |
Source: Uitwerkingsplan Armoedebestrijding, Version 1.0, January 2012 | |
Examples of alternatives integrated into the poverty policy document: | |
“A health insurance company (Agis, part of Achmea) and the municipality have established a fund to finance projects on health aimed at improving the health of households that live on a minimum income. An example of a successful health intervention has been developed by the Public Health Service in South Limburg together with a group of dieticians entitled ‘Good food need not cost much’. People who receive debt assistance learn during meetings how they can manage to buy healthy food on a small budget. Other examples of successful interventions in the area of health promotion for households living on a minimum income can be found at www.Loketgezondleven.nl ” a | |
1c | Some policy alternatives were not integrated into the poverty policy document because they were considered to be too scientific, too abstract, not suiting policy practice or coming from too great a distance. This is how the civil servant commented on the meeting mentioned under 1a: |
“Kirsten, What an extraordinary conversation this morning. Two worlds, each with their own language. And so far removed from each other, while we could be of great use to each other. As a result of this morning I have made a to-do list. It helps me to focus…” | |
Where the civil servant speaks of two worlds, he means those of science and policy, each with their own language. This comment illustrates the policy-science gap that the civil servant experienced during his meeting with the knowledge broker and the experts who specified the policy alternatives. | |
1d | Examples of alternatives that were integrated into the economic policy document: |
Page 37: “The retail and hotel and catering industry … is an important element in terms of quality of life and in welfare” | |
Page 38 “… the growth in the number of freelance workers in the construction industry has been very strong… This type of entrepreneur is also vulnerable.” a | |
Page 42: “The scale of the informal economy is of course unknown… Because people might have the idea that certain activities should be hidden from the authorities, this holds back potential growth. This also holds back official emancipation and participation effects and certainties such as legal protection and continuation of payment when ill.” a | |
Page 42: “The task in terms of the sectoral structure … involves strengthening those sectors that are of importance for living conditions, livability, welfare and health of citizens and the investment climate…” a | |
Page 46: “These green and blue areas (green areas: public parks and gardens; blue areas: lakes and canals etc. K.L.) in… are… hardly known… In economic terms, these partly uncultivated and undiscovered areas in the district provide possibilities for strengthening the social climate and the welfare and health of the inhabitants. Recreation is important in stimulating people to have an active lifestyle.” a | |
Page 50 II: “The fashion industry It is worth considering the possibility of apprenticeships.” a | |
1e | Example of an alternative that was not integrated into the economic policy document: |
Page 45: In the section on the hotel and catering industry, the knowledge broker asked whether it would be possible to develop policy on alcohol and happy hours. The civil servant informed her that alcohol policy is national policy and the happy hours are municipal policy (not policy at a district level). | |
1f | Illustration of the integration of health into the mid-term review: |
Page 17: “Not everyone is aware that taking part in sports is healthy; far from it. To reduce overweight and obesity among children, the pilot called JOGG (Young People at a Healthy Weight) was started in 2011… especially younger citizens (but also their parents!) are stimulated to start taking part in sports and to pay attention to their health. First results are positive.” | |
Source: Mid-term review | |
1g | To support the alderman during the launch of the city-wide agreement on health between the municipality of Amsterdam and a health insurance company, an internal memo was written by the senior civil servant who was also the knowledge broker’s key informant. This document explained how the city district was allied to the city-wide agreement on health. The argument was reinforced by referring to our research. |
Summary of the content b: | |
The internal memo for the alderman describes the city district’s general and specific engagement with the agreement entitled “Amsterdam together for better health” [Amsterdam samen gezonder] which was set up between the municipality and a health insurance company. The general engagement emerges from “active integration in …policy” and through a district-oriented health policy that includes the following elements: | |
- The Young People at a Healthy Weight program [JOGG] that was set up in a part of the city district; | |
- Healthy public policy research; a | |
- The policy document of the PHS, which indicates that this city district was the first to develop a more district-oriented and integrated policy. | |
The specific engagement of the city district with the agreement “Amsterdam together for better health” is that the city district works on more integration between care and welfare in one area of the city district. |