Fifteen years ago, Eric Steegers, professor and head of the Obstetrics and Gynaecology department at Erasmus Medical Centre, established the new field of Social Obstetrics. He was also one of the founders of the national action programme Solid Start, which focuses on the first thousand days of a child's life. Shortly before his retirement, Steegers wants to expand this successful approach to many more areas.
'Research conducted by several of my PhD students revealed that the poor conditions in certain neighbourhoods in Rotterdam can cause newborns to fall behind in their development in a way that they are unable to catch up on after two years,' says Steegers. 'We were truly shocked by this. Children who get off to a bad start perform less well at school and are more likely to develop physical and psychological problems later in life.'
It takes more than just good obstetric care
Steegers explains that good birth care alone is not enough. 'Children also need good nutrition, a healthy home and a living environment with enough greenery and places to play. But many children in disadvantaged neighbourhoods do not have any of these things. What’s more, the parents often have debts, are unemployed and suffer from mental health problems. "That has to change", I decided; What's needed is a cross-domain approach. And that started with intensive collaboration with the municipality of Rotterdam, which continues to this day.'
Paving the way for a solid start
Steegers recounts the first municipal initiative, "Ready for a baby", which was launched in 2009, and the "Mothers of Rotterdam" programme, which was set up in 2014 by Erasmus MC in collaboration with the municipality, among others. Vulnerable pregnant women facing poverty, housing problems, domestic violence and other difficult circumstances were assigned a coach. The Erasmus MC then compared the effects of this intervention with those of regular care. Intensive personal guidance proved to make an important contribution to a solid start.
As an advocate for a solid start for every child, Steegers entered into discussions with various ministries, the Social and Economic Council of the Netherlands (SER), the Confederation of Netherlands Industry and Employers (VNO-NCW), construction companies, debt counsellors and urban developers. Which, turns out, worked: everyone said "yes". In 2018, the Ministry of Health, Welfare and Sport (VWS) launched the national action programme Kansrijke Start (Solid Start). By now, it has been rolled out in all municipalities.
'If we do nothing, that gap will only widen'
Eric Steegers
Professor of Obstetrics and Gynaecology
Partnering to develop new knowledge
According to Steegers, new ideas often emerge at the intersection of different disciplines. That is why he works closely with Erasmus University. For example, Steegers conducted research into the relationship between (prenatal) health and inequality together with professor of Applied Health Economics Tom Van Ourti (ESE), professor of Child Poverty Nicole Lucassen (ESSB) and professor of Socio-Economic Transitions Derk Loorbach from the DRIFT research institute.
In addition, Steegers collaborates with professor Arwin van Buuren, Strategic Dean Impact & Engagement. Strategic Dean Impact & Engagement. Steegers is enthusiastic about the fact that making an impact on society has now become a core concept at Erasmus University Rotterdam. 'We analyse how making an impact works in a scientific way. For example, how we managed to bring about the new field of Social Obstetrics.'
Furthermore, Steegers wants to further mobilise the Convergence (a partnership between Erasmus MC, Erasmus University Rotterdam and TU Delft) to develop new knowledge and offer the measures as a package.
Further expanding broad social alliances
Steegers emphasises that it is crucial for people living in vulnerable conditions to better embed the link between the medical and social domains throughout the healthcare system. 'It is unacceptable that we only perform our clever medical interventions and then send people back to the very environment that is making them ill.' He believes that healthcare needs to be provided in a different and innovative way. In the field of healthcare innovation, Steegers is collaborating with Professor of Health Services Management & Organisation (ESHPM) Kees Ahaus.
Steegers therefore wants to devote the last two years of his working life entirely to the further development of a broad social alliance around Solid Start. This alliance will be cross-domain and interdepartmental, and will also involve private partners. For example, by joining forces with the National Programme for Liveability and Safety and construction companies. 'We must take action to reduce the significant health disparities and inequality of opportunity. This begins at the start of a person's life. If we do nothing, that gap will only widen,' concludes Steegers.
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Press enquiries? Please contact Esther Godijn, Press Officer for Sophia Children's Hospital, +31 10 703 32 89, e.godijn@erasmusmc.nl.
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