‘Researchers have been talking over each other’s heads for years’

Practical science

How can we make healthcare more effective? Let’s start by walking to the beat of the same drummer, suggests professor Johan Mackenbach.


NAME: Johan Mackenbach 
AGE: 64
STUDY: Medicine
CAREER: Professor of Public Health, Erasmus MC


Johan Mackenbach, Professor of Public Health at Erasmus MC, conducts research in social epidemiology, medical demography and health policy. He’s also involved in the Erasmus Initiative Smarter Choices for Better Health, which aims to contribute to healthcare worldwide by making smarter choices. For his research Mackenbach focuses on two issues, prevention and health inequality.

How does this work?
‘Erasmus University employs many, many researchers across a wide array of faculties, who are all active in the field of health and healthcare. For years they’ve been talking over each other’s heads. The economists at Woudestein on the east side of town, the medical researchers at Hoboken on the west side. Now, researchers at Erasmus School of Economics, Erasmus MC and the Erasmus School of Health Policy & Management will be putting their heads together.’

What do you mean by prevention?
‘All in all, the Dutch share some twenty unhealthy behaviours, like smoking, sitting for extended periods of time, and skipping fruit and vegetables in their diets. Let’s use quitting smoking as an example. Research done by behavioural economists shows that while people tend to be risk-averse, they also tend to care more about the here and now than about the future. When you don’t care about the future so much, you’re less likely to give up smoking. Most prevention programmes, however, are based on concepts derived from health psychology, and they suggest a different approach to changing behaviour. For instance ‘social norms’: people are more likely to give up smoking if their friends are opposed to it. I’m hoping that various concepts from different academic disciplines will in fact reinforce each other, so that we can develop more effective prevention programmes.’

How will the general public notice?
‘We plan to collaborate with the city of Rotterdam to start up small-scale experiments, using test subjects who will be presented with a wide choice of situations. For example: ‘Imagine you’re with friends at a bar and you’ve just decided to quit smoking. What would you do?’ That’s a good way to discover the effect of the social norm. The next step would be to try and change the social norm in a school class or company department by influencing a local opinion leader. Step three then becomes having people in a city neighbourhood adopt healthier habits, for instance by engaging family doctors to help them set a new social norm for smoking in public areas.’

You also research health inequality. What does that mean?
‘It means people from lower-income and lower-wage communities get sick more often and have shorter life expectancies. We’ve known that for ages. The question is, which measures will effectively narrow the margins? To this end we’ll evaluate policy measures taken in the Netherlands and other countries, to see how effective they are. To name one, from 2000 on, the Netherlands significantly increased spending on healthcare, while changing the healthcare insurance system drastically by introducing basic insurance. We’d like to find out whether these measures have increased or decreased levels of health inequality.’

Will findings only be relevant for the Netherlands?
‘No, we have international ambitions. Although all the research is being done locally, we believe other countries may also benefit from the results. Say, it turns out that changing the level of insurance deductibles leads to greater differences in people’s health – in that case, it would be fair to assume the same thing goes for countries with a similar system.’ 

TEXT: Sjoerd Wielenga 
PHOTO: Marcel Bakker

Johan Mackenbach