schikbare instrumenten vervolgens niet gerichter samenwerkenom deze bad practices te elimineren? Is het niet dé uitdaging –

willen de zorgkosten ons niet boven het hoofd groeien – dat wegezamenlijk de woorden vinden die zorginhoudelijke duidinggeven aan wat we precies bedoelen met (on)doelmatigheid? Wekunnen dan wellicht denken aan het grote aantal amandelope-raties in ons land, de praktijkvariatie bij hernia’s en bij de zorgrondom de geboorte of aan de keuze tussen watchfull waiting

versus interventiecardiologie om een paar voorbeelden te noe-men. Ongetwijfeld komen er dan weer nieuwe (verdelings)vraagstukken naar de oppervlakte. Dat wel.

CorrespondentieadresPatrick Jeurissen, Celsus Academie, IQ Healthcare,Radboudumc, Nijmegen, e-mail: Patrick.jeurissen@radboudumc.nl.

Abstract

Challenges in public health: four perspectives

The main theme of the Dutch Public Health Congress2014 is ‘perspectives on public health’. This annual con-gress covers for the full spectrum of public health. Thisspectrum reflects a broad range of existing visions onpublic health. Should we focus on promoting a long andhealthy life, reducing health inequalities or improvingsocial participation of the chronically ill? This diversityin visions on public health – captured in the term ‘per-spectives’ – is the main theme of the congress of 2014.

The Dutch Public Health Status and Forecast (PHSF)2014 distinguishes four perspectives on public healthrepresenting the diversity in visions. Four main challen-ges in public health – a long and healthy life, socialinclusion of vulnerable populations, autonomy of citi-zens and patients, and the sustainability of health careexpenditures – lead to four perspectives on publichealth. Every perspective has its own motivations andchallenges, target scenario and strategies. In this spec-trum, the authors of the PHSF describe the content ofthe four perspectives. They show that these originatedfrom several sessions with many stakeholders. Theyalso describe how the different perspectives can beused to make choices in public health policy. Opportu-nities arise if one strategy can solve multiple public

health challenges; dilemmas if a specific strategy isgood for one challenge, but makes another challengeworse.

Four public health experts describe their challenges,opportunities and dilemmas. Walburg gives numerouschallenges in the field of mental health. He spots op-portunities in health promotion: it is not only about theprevention of mental disorders, but also on the promo-tion of positive mental health. Burdorf and Schuring putwork participation in the spotlight. They also describean opportunity: health has a positive influence on la-bour participation. And vice versa: labour participationcan contribute to healthy ageing. Westendorp continueswith the health of the elderly. He appoints the discre-pancy between the subjective health of the elderly andthe much more negative ideas of many health workerson the health status of the elderly. Health care canimprove by relating more on the needs and experiencesof patients. Last, but not least, Jeurissen, shows theurgency of controlling health expenditures and the di-lemmas that brings.

Keywords: public health, forecasting, perspectives,health care expenditure, social inclusion

Spectrum

tsg jaargang 92 / 2014 nummer 3 spectrum - pagina 100 / www.tsg.bsl.nl