GALA lacks a chapter on e-health

In today’s age, where “hands at the bedside” are becoming increasingly rare – and technology and digitalisation are already playing an increasingly important role in our daily lives – it is unreasonable and untenable not to approach health and care from a digital perspective as well. Integrated Care Agreement (IZA)¹ It contains an expanded chapter on digital care, which expresses a vision and expectations for accessible care. The Healthy and Active Living Agreement (GALA) was signed in 2023.² On the other hand, it barely mentions the possibilities and potential of digitization and falls short in this regard.

In the GALA agreement, municipalities, GGDs, health insurers and VWS jointly aim for a healthy and active life with a solid social foundation. The agreement contains a chapter on monitoring, but lacks a broad perspective on digital care and e-health. This is a missed opportunity, because there is also a huge, and so far barely exploited, potential for e-health for a healthy and active life. In order to innovate successfully, it is necessary to explore this path further.

Public health challenges

The Netherlands faces major and urgent public health problems. An ageing population, increasing chronic diseases such as diabetes and cardiovascular disease, and growing health disparities between different socio-economic groups are just some of the challenges here.

These challenges have led to the fact that after the low-impact National Prevention Agreement (NPA),³GALA has seen the light. GALA goes beyond NPA by being aligned with health in all policies.⁴ To develop a broad-based approach. After all, the horizon of GALA is a “healthy generation” in 2040, where healthy and resilient people can grow up, live, work and live in a healthy living environment, with a strong social foundation.

In order to effectively address collective problems, the potential of digital resources and e-health must be carefully studied. Provided that they are appropriately designed and customized to meet the actual needs of the population, e-health can effectively contribute to promoting health and vitality in society.

Prevention and personalized vitality are expected to be enhanced by technology that meets the needs and capabilities of target groups. Both individual and public health can benefit from the right care in the right place, with technological innovations and tools. We describe in familiar healthcare terms how this can be addressed. We use three themes: diagnosis, treatment, and monitoring.

Diagnosing

The first topic concerns population-level diagnosis, which determines where things are going wrong in terms of health and vitality. There are already many good, public sources available that provide a basis for this. Platforms such as Waarstaatjegemeente.nl and the Central Bureau of Statistics (CBS) provide valuable data at municipal level.

In addition, regional images provide a detailed overview of the health status in different regions and neighborhoods. CBS provides the opportunity to achieve widespread prosperity at the regional level.⁵ To monitor. This data can be used to identify where health disparities are most pronounced and in which areas of lifestyle there is room for improvement. For example, if the data shows that a particular area has a high prevalence of diabetes, it can be examined more closely to see whether a specific focus on preventive measures and targeted care could provide an appropriate approach.

Big data analytics can also be used to develop diagnostic and predictive models. Patterns and connections between demographic, social and economic factors that are impossible or very difficult to detect using standard analytics will be discovered and will subsequently help sharpen preventive strategies. In this way, we can work in public health in a more targeted and effective way.

treatment

The second issue concerns intervention or treatment. Where staff and expertise are increasingly scarce, digital care can contribute to the overall health and vitality of individuals and populations. It is essential to determine in advance whether the intervention is compatible with the experiences, capabilities and needs of the individual or community.

There are many examples of how this can be done successfully. There are platforms that contribute to increasing social cohesion in the neighbourhood, which also indirectly benefits the health and vitality of the residents. An example of this is the use of neighbourhood apps through which residents can connect and help and support each other.

Healthy options

Some individuals who need it—and have sufficient health and digital skills—can actively work on improving their vitality, lifestyle, and health with the help of wearables and lifestyle apps. Lifestyle apps can help set goals and track progress. Platforms also offer personalized advice and sometimes rewards, motivating users to make healthy choices.

However, for many people, the solution does not lie in such innovations. They certainly value their health, but other challenges and issues in life require more attention and energy.

Opportunities and leverage points

The “diagnostics” and analyses will reveal specific clusters and patterns of relevant demographic, social and economic factors where opportunities and leverage points lie. The main challenge will be to develop tools and applications with the target group in mind that meet their needs. This could include contacts with neighbours, references to local activities and meetings, compilation of shopping lists and recipes, or reminders and appointments with municipal authorities and UWV.

This type of broad tool does not yet exist. Once the possibilities and convenience are recognized, actual lifestyle and health standards can be integrated. For example, digital life support and training tools could be an asset in the future and could indirectly make an important contribution to public health.

Watching

It is of course essential to know whether the measures and interventions implemented are having the desired effect and whether they are effective. This can be done through data-driven work. The same data available for diagnosis also form the basis for monitoring tools that can be used to determine progress and development in health.

By monitoring trends and linking them to interventions and social changes, they can be evaluated and modified if necessary. Here the approach departs from the typical medical approach, where scientifically based guidelines and protocols provide direction, in consultation with the patient. Prevention and public health interventions are often complex, time- and trend-dependent, and therefore must be flexible and interactive.

Optimal response and advice

The digital world allows for continuous building and improvement. AI/algorithms will be adaptable, and will increasingly generate optimal response and advice based on monitoring and subsequent adjustment, while at the same time determining the interim outcome.

The GALA Monitor is now in place. This monitor looks at progress on the shared GALA goals and the collaboration needed across domains at the local and regional levels. This is important, but it has nothing to do with digital solutions. However, the monitor has a particular focus on reducing health inequalities. The GALA Monitor therefore sets high standards for the development and implementation of digital tools and applications that will contribute to this.

conclusion

Digital healthcare and e-health currently play a limited role. In the future, it could play a crucial role in promoting health and vitality, both at the individual and societal levels. By using predictive models, digital treatment platforms and effective monitoring tools, we can significantly improve the health and well-being of populations.

It is also very important to prioritize digital care in both health and social areas. Only in this way can we ensure that everyone has the opportunity to live a healthy and active life in an increasingly digital world. We therefore see digital care and e-health as having a prominent place in future health policy.