The GALA is losing a chapter on e-health ICT & health

In the current era, in which ‘hands at the bedside’ are increasingly scarce – and technology and digitization are already playing a more important role in our daily lives – it is unthinkable and un- credible not to address health and care from a digital perspective as well. . The Integrated Care Agreement (IZA)¹ which includes an extensive chapter on digital care, which sets out the vision and expectations for accessible care. The Healthy and Active Living Agreement (GALA) expired in 2023² on the other hand, it barely mentions the opportunities and possibilities of digitization and is short on that.

In the GALA agreement, municipalities and GGDs, health insurers and VWS aim together at a healthy and active life with a strong social base. The agreement contains a chapter on monitoring, but lacks an overview of digital care and e-health. This is a missed opportunity, as there is also a huge and, until now, barely used potential for e-health for a healthy and active life. To innovate successfully, it is essential to explore this path further.

Public health challenges

The Netherlands has serious and urgent public health problems. An aging population, an increase in 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, after the ill-fated National Prohibition Agreement (NPA)³the GALA has seen the light of day. The GALA goes further than the NPA by being in line with the Health in All Policy⁴ to establish a comprehensive approach. After all, GALA’s horizon is a ‘healthy generation’ in 2040, where resilient, healthy people can grow up, live, work and live in a healthy living environment, with a strong social foundation.

To effectively address common problems, the feasibility of digital resources and e-health needs to be carefully explored. As long as it is designed correctly and tailored to the real needs of the population, e-health can effectively contribute to greater health and vitality in society.

It is expected that deterrence will be enhanced and a specific dynamic achieved through technology that meets the needs and capabilities of the target groups. Both individual health and public health can benefit from the right care in the right place, with technological innovations and instruments. We explain in familiar healthcare terminology how this could be dealt with. We use three themes: diagnosis, treatment and monitoring.

Diagnostics

The first issue relates to diagnosis at a population level, which determines where things are going wrong in terms of health and vitality. There are many good and public sources already available that form the 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 view of health status in different regions and neighbourhoods. CBS provides an opportunity to achieve widespread prosperity regionally⁵ to keep track. This data can be used to determine where health inequalities are most pronounced and which lifestyle areas have room for improvement. For example, if the data shows that there is a high rate of diabetes in a certain neighborhood, a more detailed analysis can be done to see if a specific focus on preventive measures and targeted care can provide an appropriate approach.

‘Big data analytics’ can also be used to develop diagnostic and predictive models. Patterns and links between demographic, social and economic factors, which are impossible or very difficult to detect with conventional analyses, are found and subsequently contribute to further prevention strategies. In this way we could work on public health in a more targeted and effective way.

treatment

The second topic is related to intervention or treatment. Where staff and knowledge are increasingly scarce, digital care can contribute to improving the health and vitality of individuals and the wider population. It is essential to find out in advance if the intervention is in line with the experiences, abilities and needs of the person or the community.

There are plenty of examples of how this can be implemented successfully. There are platforms that contribute to greater social cohesion in the community, which also indirectly benefits the health and vitality of residents. An example is the use of neighborhood apps in which residents communicate and can help and support each other.

Healthy choices

Some people who need this – and who have enough health and digital skills – can actively work on their animation, 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, which keep users motivated to make healthy choices.

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

Opportunities and leverage points

The ‘diagnostics’ and analyzes will reveal some clusters and patterns of demographic, social and economic factors related to them where there are opportunities and leverage points. The main challenge will be to develop tools and apps together with the target group that meet their needs. This could include communicating with neighbours, identifying local activities and meetings, compiling a shopping list and recipes, or remembering and making appointments with municipal authorities and UWV.

This kind of widespread tools do not exist yet. Once the capabilities and convenience are recognized, real lifestyle and health goals can be introduced. For example, digital life support and coaching tools could be an asset in the future and could indirectly contribute significantly to public health.

keep track

It is essential to know whether the measures and interventions implemented have the desired effect and are effective. This can be done through data-driven work. The same data available for diagnostics also form the basis for diagnostic tools that can be used to determine health progress and improvement.

By following trends and linking them to interventions and social changes, these can be assessed and changed if necessary. Here the approach deviates from the standard medical approach, where scientifically based guidelines and protocols provide guidance, in consultation with the patient. Interventions in the field of prevention and public health are usually complex, dependent on time and movement and therefore need to be flexible and reactive.

Best answer and advice

The digital world makes it possible to continuously build and improve. Artificial intelligence/algorithms will be adaptive, and will continuously evolve the best response and advice based on analysis and subsequent adjustment, while determining the interim score.

The GALA monitor is now set up. This monitor looks at progress on GALA’s general objectives and the cross-sectoral collaboration required at local and regional level. This is important, but it has little to do with digital solutions. However, the monitor pays special attention to the reduction of health inequalities. The GALA monitor therefore sets the bar high for developing and implementing digital tools and apps that contribute to this.

Decision

Digital care and e-health currently play a limited role. In the future, this could play a vital role in promoting health and vitality, both at an individual and community level. By using predictive models, digital treatment platforms and effective diagnostic tools, we can significantly improve the health and well-being of the population.

It is very important that digital care is also prioritized in the health and social sectors. 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 argue that digital care and e-health will play a prominent role in future health policy.