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‘Sickness and health have become a continuum’

Professor of Health Psychology Andrea Evers is one of the coordinators of the national Health and Wellbeing programme and of the Leiden-Delft-Erasmus (LDE) programme that goes by the same name. The aim is to use technology to promote our health. LDE has already been working on this topic for some time.

‘The prediction is that half of the Dutch population will be chronically ill by 2040,’ says Andrea Evers. ‘And it is already clear that the main cause of this will be lifestyle.’ We also know that people who already suffer from a chronic disease such as diabetes, kidney disease or arthritis are more sensitive to cardiovascular disease, for instance. Evers: ‘Lifestyle is very important therefore. And if you want to make interventions widely available, you need digital tools.’

Andra Evers
Andrea Evers: 'You can influence people's health behaviour with digital tools.'

Behavioural change

‘It has become clear that finger-wagging doesn’t work if you want to change people’s behaviour,’ says Evers. ‘You have to make it attractive, start with the individual and offer a custom solution. And you have to reward the behaviour that you want to see.’ Evers gives the example of a project such as Benefit for all, an individual health portal funded by the Dutch Heart Foundation and The Netherlands Organisation for Health Research and Development (ZonMw) that she is currently working on in a national consortium with researchers from the LUMC, Delft University of Technology and Erasmus Rotterdam University (LDE). ‘Just by looking around the portal you can save for a pedometer or a blood pressure monitor, or get a discount at a whole range of shops. This is also a fantastic example of public-private cooperation.’ And the portal can also be used for communication between patients and their doctor or another healthcare provider.

Personalised treatment

‘Second,’ says Evers, ‘healthcare is becoming increasingly tailored to the individual, personalised medicine as it’s known. Research has shown that a group of patients with a certain condition do not benefit from one and the same treatment. What works with one person, doesn’t with the other. The consequence is that at the level of the patient, part of the treatment, including the use of medicine, may not be efficient or effective for a particular patient. And third, you can use digital technology to provide personalised care 24/7. If you keep on measuring the effect, you can determine what a patient does and doesn’t respond well to and immediately adjust your approach.’

Different approach for elderly
The elderly and people who do not speak Dutch well require a specific approach.

New basis for healthcare

Evers thinks there could be many more such projects. Within the framework of Health and Wellbeing she wants to form a network of researchers who see opportunities and value in cooperation between experts from the three universities in this field. Evers emphasises that the basis of the Health and Wellbeing project differs fundamentally from what is customary in regular healthcare. ‘We are learning all the time from research about what does and doesn’t work. You have to take that as your basis.’ Our changing society also requires a different approach to people. ‘First and foremost, the approach must be citizen based. Many patients don’t want to be a patient but want instead to focus on what they can still do. Sickness and health are increasingly becoming a continuum that is interlinked with everyday life.’ 

Vulnerable groups

One question is whether if you start using all sorts of different forms of digital (do-it-yourself) healthcare you don’t end up missing the groups that need most careful monitoring, such as the elderly or immigrants who don’t yet speak the language? ‘Yes,’ Evers replies. ‘That is a risk, and we’re having a good old think about it. For vulnerable groups, we are developing a separate approach within the Medical Delta programme for which we have recently received funding. This includes something like a set of guidelines for e-Health and self-management interventions in groups that are difficult to reach.’

Ambitious plans

The LDE plans for Health and Wellbeing are ambitious. ‘We are aiming for useful techniques, and products that will help people and really will improve healthcare,’ says Evers. ‘In the LDE partnership, we want to lead with an interdisciplinary approach that not only improves treatment but also contributes to diagnosis and prevention.’

The first conference on the topic of Health and Wellbeing will take place on Thursday 26 September in Museum Volkenkunde in Leiden: Mind your data. The conference is about privacy and legislation issues in e-Health, research and healthcare. ‘This is something that everyone comes up against,’ says Evers.


Overarching Digital Society project
Evers wants to say something about the background of the Health and Wellbeing project, despite it being rather complicated. Its origin, she says, lies in the wish of the Dutch universities to join forces under a joint theme, which resulted in the Digital Society project of the VSNU (Association of Universities in the Netherlands). To give shape to this, each university sent a delegation of three researchers charged with determining the options and societal needs. One of these was Evers. Together with professors from the other universities, she made an inventory of which themes relating to Digital Society were the focus of the different faculties. This approach led to seven generic themes within the Digital Society theme, one of which was Health and Wellbeing. It was then up to the universities themselves to decide which themes they wanted to join. Health and Wellbeing proved popular: eight universities registered. They each assigned a professor to be coordinator.

Champion of collaboration
Evers became one of the national Health and Wellbeing coordinators, for Leiden, Delft and Rotterdam. She is a fervent champion of collaboration. ‘You can achieve so much more together.’ The eight professors from the national Health and Wellbeing theme meet regularly and have recently launched their own website and newsletter. ‘It really is a fantastic group,’ says Evers. ‘And behind each professor there are of course a lot more researchers because the professors all have their own teams. The postdocs also meet regularly; they coordinate the everyday business.’

Medical Delta
‘One area in which we have already been working together for a long time within LDE is digital technology in healthcare,’ says Evers. ‘The collaboration in that field between the three universities already has a long history in the form of Medical Data.’ The three LDE rector magnifici recently determined new shared strategic themes. Health Society was one and Digital Society another. Evers: ‘These tie in perfectly with our Health and Wellbeing programme. There are already plenty of ideas and plans. For instance, a link could be made with Healthy Universities, which centres the health and wellbeing of our students and staff. Leiden University was the first Dutch University to join the international Healthy Universities initiative, in 2018; it would be fantastic if the other two were to join.’

This is the first article in a series on the Digital Society, Health and Wellbeing programme.

Text: Corine Hendriks
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