Written Summary Sarphati Symposium 2021

The third Sarphati Amsterdam Symposium – the first online- is opened by Karien Stronks, professor of public health at Amsterdam UMC. She thanks the audience for being there rather than going ice-skating, but then again, the Corona crisis has shown the importance of today’s topic. Almost one year into the pandemic, it has become visible why inclusive public health is necessary. Social differences have become visible, and some –medical – voices have proved to be dominant over others. During this symposium, it will be assumed that everyone embraces inclusive public health. Yet It is rather difficult to achieve this, so today’s symposium should help us learn from each other and provide practical tips.
Stronks continues with an introduction to inclusive public health, of which we can distinguish two definitions. Firstly, there is public health in the sense that it is not excluding any particular group people – ranging from gender to ethnicity to sexual orientation to socio-economic background to level of education or any other factor that may impact the health of the group. People are the subject of public health, and they should all be included. Secondly, there is the research process. All too often, public health professionals have a very narrow definition of what public health entails. We can have a more inclusive public health practice when we consider people to be co-creators rather than just subjects, and are open minded and broad in orientation and scope of public health. Sarphati Amsterdam is a research institute, that provides research that serves as basis for policy. Inclusive research means that we do not exclude any particular groups. We have to ask ourselves, for example, how diverse the Sarphati Cohort actually is. We need to include more children of parents of lower education. We also need a more inclusive perspective, for normative, as well as effectiveness reasons.

The first plenary presentation is by Charles Agyemang, professor of Global Migration, Ethnicity and Health at Amsterdam UMC. He lectures on the inclusion of migrants and ethnic minority groups in health research, and the challenges and opportunities that this brings. He starts by stating that besides the human rights aspects, there are many benefits to inclusivity: the overall health of the population increases, which leads to lower costs. Migrants matter.
The most pressing issue that professor Agyemang observes is the lack of data on migrants’ health. This is necessary to asses risk factors and to identify vulnerabilities. Yet only 25 of 53 countries in Europe collect migrant health data, and all studies specifically on migrants are done in the US. Covid-19 has clearly shown how migrants are disproportionately hurt by the virus. Yet only in the UK and the US, where they collected data of migrants, they were able to issue messages directly aimed at migrants.
It is difficult to gather better data, because we are dealing with very fragmented health information systems, disaggregation of health and legal hurdles to combine existing migrant status data with health data. Still, through linkage techniques and cohort studies there has been done great work to include minorities in health research.
Yet what is really necessary is a national Office of Minority Health, which among others can ensure sustainable funding. The inclusion of migrants and ethnic minorities should be mandatory, and this can only be achieved through structural funding – preferably through a national office.

The second plenary presentation was on inclusive communication, by Corine Meppelink, Assistant Professor of Persuasive Communication at the Uva. Meppelink is specialised in health literacy, and she provides tips to make health communication more inclusive.
Health literacy is linked to literacy proper. This means that people who have low health literacy are more difficult to reach with written information. At the same time, they need information the most, as people with low health literacy are most often hospitalized. Comparatively, the Netherlands is doing quite well, but still 29% of the Dutch population have inaccurate health literacy. Meppelink provides a list of tips and tricks that can be used in health communication: Visualize the message, check if the language is not too difficult (B1), use an active voice and concrete language, avoid jargon, be brief, focus on behaviour, use tested material with a clear layout.
Meppelink encountered the questionnaires of the Sarphati cohort in her capacity as mother, and she analysed it from a health literacy perspective. She encountered a very complex question, enquiring into ‘organised moving activities’ (georganiseerde beweegactiviteiten) a word that is clearly not B1- level. Yet she also saw very good question regarding eating dinner in front of the television. Overall, many of the questionnaires were quite long and overwhelming.
Communication is always more effective if it is developed with the target audience. This is also something that Sarphati Amsterdam is already doing, but which of course could always be improved.

The third plenary lecture is on inclusive participation by Christine Dedding, Associate Professor Participatie (Amsterdam UMC). She proposes a research method called participation action research (PAR), a method that makes use of the power of proximity between researchers and those who participate in the research, making them co-creators. This is especially valuable for children and people in lower socio-economic groups. Dedding holds that as researchers, we do not manage to address the gap between science and society, and the only way we can do this is by getting to know each other. As long as we value cognitive knowledge over emotions, and we do not involve all people in our descriptions, we have a distorted view of reality. There is no evidence without contextual knowledge. What does it mean if someone is not attending an intervention? Does our health education material connect to the people we seek to address? PAR assumes that everybody is knowledgeable and is action oriented. The research method is taking action, because this is a powerful way of knowing. In normal research, we are hesitant to change things when we are measuring data, but PAR is not about collecting data, but about generating them together. All of this is only possible when we get to know our participants. Rather than asking people to come into our environment, we ask to come to theirs. We want to generate joy, empowerment and embodied knowledge. This will be hard, because working together is really hard. Yet we should consider this as productive frictions, because it means that something is at stake.

After the plenary lectures, the audience was devided in parallel sessions, discussing the plenary lectures more in depth. The notes on those discussions can be found in the collection of presentations. Within the break-out rooms, there were also several pitches, which can be found in the collection with pitches.
After the closing remarks, three pictures were shown, made by illustrators who attended the parallel sessions to capture them. The pictures can be found in the collection of the parallel sessions.

Karien Stronks closed the symposium by asking the directors of Sarphati Amsterdam, Jaap Seidell and Arnoud Verhoeff on how they are going to make sure that Sarphati Amsterdam will be more inclusive in the coming year. They responded by stating how happy they were that Sarphati Amsterdam is surrounded by such a motivated community. Most of these challenges require long time commitment. The three points on which Sarphati is going to focus next year are: more inclusive participation and communication; more diversity in research methods; and the education of the research community. We need funding and time to do so, but hopefully the Sarphati Cohort can become an example by doing so. We should be more inclusive, but this may never mean that we leave it up to the citizens: we have to get the institutions on our side.

Karien Stronks then thanked everybody for attending rather than going ice-skating, and closed the symposium.