Conference Agenda

Obesity rates among populations have increased dramatically in the last several decades resulting in an emerging global epidemic. World Health Organization (WHO) now views obesity as a more significant global health risk than underweight and malnutrition, signaling a paradigm shift in approaching weight and health. Obesity is in its nature a global epidemic that requires both global and national responses side-by-side.

Although several individual-level risk factors for obesity can be identified, at the population-level the rate of obesity is determined by a complex interplay of genetic, environmental, behavioral, socio-economic, political and cultural factors. Due to the growth of the obesity epidemic, the societal effects it creates are also increasing and have the greatest impact among vulnerable and disadvantaged groups.

Drawing from anticipatory, collaborative and network governance, this study aims to build up a theoretical model of robust preventive health governance in the public health context to address public health issues at the national level from the preventive health perspective. Previous research (e.g. Ansell et al. 2024) have applied robustness to turbulent and crisis situations, but a gap exists in linking it to creeping crises (Pot et al. 2023 as a notable exception) and public health responses to epidemics.

The key for governance is stakeholder engagement in the policy planning, formulation, implementation and monitoring. In addition to governments, international organizations, civil society, private sector entities and healthcare sector with different sets of logics are needed with each actor referring to their area of expertise in order to tackle the social effects.

Empirically, this study investigates how and with what means of governance the obesity epidemic is being confronted in the Netherlands through the National Prevention Agreement (NPA). Second, this paper investigates how the national health policy measures implemented in the Netherlands respond to the WHO policy guidelines. The Dutch government has recognized that overweight and obesity are growing national health problems that need to be addressed before the situation becomes more serious.

The results show, how collaborative features, such as local networks have been created and new stakeholders have been brought in to strengthen the planning and implementation of NPA and which stakeholders have been involved in each of these as well as their roles in it and how they together form the robust preventive health governance framework to address health promotion objectives. Robustness in governance evolves around the collection of longitudinal data that allows for more accurate and reliably policy interventions, highlighting the anticipatory nature of preventive health.

Theoretical implications of the paper refer to the application of Dutch "polder model" based on mutual understanding, cooperation and bottom-up problem solving (Saarloos & Dijck 2017) in aiming to solve various social challenges in cooperation between the government and members of civil society. Robustness requires existing structures like the polder model to succeed, hence the question becomes, can this be applied to other countries that do not have such in place? This provides the groundwork for robust preventive health governance that can be applied also more broadly in different policy settings.

In the face of an aging population and the prevalence of chronic diseases, the World Health Organization (WHO 2022b) promotes the development of patient-centered, multi-professional, and multiorganizational care approaches, such as health pathways. While this integrative approach is being promoted in France, its deployment represents a major challenge, marking a break with the compartmentalised city/hospital

approach. In aging rural areas like the Haut Cantal, which is landlocked and sparsely populated, the stakes are crucial to ensure access to quality healthcare. Our study delves into the local deployment of a territorial health pathway in this region, shedding light on the obstacles and levers to its successful acceptability.

We employ the situated acceptance model (Bobillier Chaumon 2016; Lai et al. 2020), a comprehensive framework for analysing the acceptability of a management dispositive by examining users' relationships with the dispositive (personal dimension), with the work organization (organizational dimension), with other users (interpersonal dimension), and with their job (professional dimension). This model is particularly well-suited for our research, as it allows us to capture the multifaceted nature of the implementation process.

The analysis of the qualitative data collected was conducted using a thematic approach, combining both a priori and a posteriori coding. This methodology was chosen to deepen our understanding of the modalities of acceptability in a specific rural context, taking into account the nuances and particularities unique to each interviewed actor.

Our results show that the level of knowledge of this system varies significantly among professionals, leading to a fragmented acceptability of the health pathway. Several barriers to acceptability were identified, including cognitive overload, perceived loss of autonomy, and the reconfiguration of work collectives. Nevertheless, actions such as training and clear communication are promising avenues for improvement.

This research contributes to knowledge on fostering successful public collaborations (Cristofoli, Meneguzzo, and Riccucci 2017) and expands the application of the situated acceptance model to a new context. Our findings proved valuable insights for effectively implementing territorial health pathways and promoting their acceptability by stakeholders, ultimately contributing to improving healthcare delivery in rural areas.

Objectives: The health of a population can be improved by recognizing the importance of social determinants of health (Petiwala et al., 2021). Therefore, the non-health sector has a role in contributing to healthy societies as well (Chircop et al., 2015). Also, intersectoral collaboration between health care, social care, and other sectors has been widely advocated by among others the WHO (2014). Besides, the participation of citizens – or coproduction – plays an increasingly important role for improvement of people’s health and wellbeing (De Weger et al., 2022). However, the process of how coproduction and intersectoral collaboration may jointly contribute to improving health, is little understood. The aim of this study is to gain insight into the barriers and enablers of intersectoral collaboration that includes co-production with citizens.

Methodology: The study takes place in The Hague, the third largest city in the Netherlands. The initiative monitored within this study is called ‘The connectors’ and takes place in a deprived neighborhood with a healthy life expectancy of eleven years less than in advantaged neighborhoods in The Hague (Municipality of The Hague, 2022). ‘The connectors’ is an intersectoral collaboration of professionals and citizens with various (professional) backgrounds and working for different organizations, focusing on accessible support for (mental) health in the neighborhood.

Participatory Action Research (PAR) was used as our methodological approach, and is characterized by a combination of data collection, reflection and action that aims to improve health (Baum et al., 2006). This approach is triangulated with a Coordinated Action Checklist (CAC) and a Composed Network Analysis (CNA) to gain more insight into the process of intersectoral collaboration including co-production. The CNA we aimed to gather information on the network of professionals and citizens involved in the initiative, while the CAC focusses on the quality of the collaboration.

Results and implications: Preliminary results show the forming of a star network around the team members of ‘the connectors’, consisting of both citizens and professionals from diverse sectors. Moreover, citizens involved in the initiative are of great value for the co-production due to the size of their network of local citizens. However, citizens acting as a linking pin between the professionals and their own network of citizens are also vulnerable, both due to the lack of expertise in providing care and because they live in the same neighborhood as where they provide support to fellow citizens. Therefore, they feel they have no time off and are often confronted with the problems in the neighborhood. All in all, to improve the co-production within the intersectoral collaboration, more intensive support is desired for citizens working in the facilities that provide bridging functions, such as community centers.

Additionally, we observed conflicts within organizations at different levels in terms of commitment given to the collaboration. Professionals experience a different degree of involvement and therefore commitment to helping citizens compared to managerial level that strictly follows the rules and protocols. These rules and protocols prevent organizations from intersectoral collaboration including coproduction, even though this would benefit the healthcare.