Area-based interventions to ameliorate deprived Dutch neighborhoods in practice: does the Dutch District Approach address the social determinants of health to such an extent that future health impacts may be expected?
OBJECTIVE
We studied the local manifestation of a national procedural program that addressed problems regarding employment, education, housing and the physical neighborhood environment, social cohesion, and safety in the most deprived neighborhoods in the Netherlands. We aimed to assess if such a program, without the explicit aim to improve health, results in area-based interventions that address the social determinants of health to such an extent that future health impacts may be expected.


METHODS
We used standardized questionnaires and face-to-face interviews with 39 local district managers. We analyzed the content of the area-based interventions to assess if the activities addressed the social determinants of health. We assessed the duration and scale of the activities in order to estimate their potential to change social determinants of health.


RESULTS
Most districts addressed all six categories of social determinants of health central to the procedural program. Investments in broad-based primary schools, housing stock, green space, and social safety seemed to have the potential to result in district-level changes in social determinants. The scale of activities aimed at employment, income, educational attainment, and the social environment seemed too small to expect an impact at the district level.


CONCLUSIONS
We conclude that the area-based interventions addressed the neighborhood environment to such an extent that future health impacts of the Dutch District Approach may be expected. The health effects in the long term might be more substantial when area-based interventions were devoted more to the improvement of the socioeconomic circumstances of residents.
Department of Public Health, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands. Electronic address: m.droomers@amc.uva.nl.
Mariël
M
Droomers
Department of Public Health, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands. Electronic address: j.harting@amc.uva.nl.
Janneke
J
Harting
Department of Public Health, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands. Electronic address: b.jongeneel@amc.uva.nl.
Birthe
B
Jongeneel-Grimen
Department of Health Promotion, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands. Electronic address: loes.rutten@maastrichtuniversity.nl.
Loes
L
Rutten
Department of Public Health, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands. Electronic address: jetty.vankats@gmail.com.
Jetty
J
van Kats
Department of Public Health, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands. Electronic address: k.stronks@amc.uva.nl.
Karien
K
Stronks
D000288:Administrative Personnel / Q000523:psychology*; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009313:National Health Programs; D009426:Netherlands; D015397:Program Evaluation / Q000379:methods; D011610:Psychosocial Deprivation; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012449:Safety; D017062:Small-Area Analysis; D064890:Social Determinants of Health; D012931:Social Environment; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013997:Time Factors
Area-based intervention; Environment and public health; Intervention studies; Population health intervention; Social determinants of health