Good care is only possible when there is solidarity in society

Good care is only possible when there is solidarity in society

Jan De Maeseneer about the importance of social cohesion

Jan De Maeseneer

Prof. dr. em. Family Medicine and Primary Health Care, University of Ghent

Healthcare in Flanders places a strong emphasis on social cohesion, whereby the care is embedded as much as possible in the fabric of society. That does, of course, ensure that people have more direct access to care, but there is more. This approach also has a major impact on the involvement of people in a community - and so on the quality of life of society.

“Connecting care” is the striking way Jan De Maeseneer describes this approach. The emeritus professor in general practice medicine is one of the founders of the Flemish approach, and a worldwide authority in the organisation of general care that is directly accessible to the citizen, so without referral. Even though he is retired, De Maeseneer is still an important advisor to the government, and as such assists in giving direction to the fight against corona. In short, he is a general who has fought many wars, who does not view the battle from behind the safety of the front, but even today still fights in the trenches.

De Maeseneer is, for example, one of the architects of the division of Flanders into so-called primary zones, which makes the concept of connecting care possible.

“You must organise primary care around a critical mass of, say, 100,000 people. That is now, for example, also being done in Estonia, and there are other countries that have adopted this way of working. Next, you must bring together care for welfare and health. There are, after all, no problems that are only biomedical. Every problem has health components and welfare components.”

But the success of your approach depends on social cohesion, maintains De Maeseneer.

De Maeseneer is, for example, one of the architects of the division of Flanders into so-called primary zones, which makes the concept of connecting care possible.

“You must organise primary care around a critical mass of, say, 100,000 people. That is now, for example, also being done in Estonia, and there are other countries that have adopted this way of working. Next, you must bring together care for welfare and health. There are, after all, no problems that are only biomedical. Every problem has health components and welfare components.”

But the success of your approach depends on social cohesion, maintains De Maeseneer.

“You can only organise good care if there is a foundation of solidarity in society. If there are groups who do not talk to each other, you cannot create involvement which, for example, enables informal care. At the same time, the mechanism also works in reverse: good care close to people strengthens social cohesion, because then people feel that they count in society. And the feeling that you count immediately makes you more prepared to do things for others.”

Care is thus a means of promoting social cohesion – and consequently social justice and the openness for other cultures and differences. According to Jan De Maeseneer the degree to which people are open to diversity is in itself an indicator for the success of your care system.

“The ultimate test of whether your care system works well are election results. Do you see a lot of far right voting? Then you’re not doing things very well. It means that you are not succeeding in contributing via care to the essential connection between people, to give them the feeling that they belong. You must then begin by organising your primary care better. Who are you not reaching? Who is falling by the wayside?”

If you want to promote social cohesion through the care system, you must also change the education system, is the conviction of the emeritus professor in general practice medicine.

Social cohesion

“If you want a new type of care, then you also need a new type of healthcare provider. Your care system must be supported by people who look at both care and themselves in a different light. That demands fairly radical changes in the occasionally rather rigid educational curricula.”

But there is also a price to improving care, realised Jan De Maeseneer.

“Too much money is being spent on hospitals. According to the OECD, only 14% of the budget goes to primary care; it should be 30%. I would argue for acute hospital beds to be cut and the focus shifted more to collective support and prevention. Why can’t part of rehabilitation take place in society itself? The hospital should be a place where you spend as little time as possible, only for the operation. And finally: do not forget mental health. That remains in all countries something of a problem child.”

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