Presentations Health and Culture 18 09 24

1- Jes Lunde Today’s program and welcome

Representatives from Rotterdam City Council Committee visit Aalborg Municipality Introduktion by Alderman Jes Lunde

Aalborg Kommune

Todays program

9.00 Welcome and overview of Aalborg Municipality. 9.30 Introduction to the Danish Health care System 10.00 Identification of issues and target groups 10.20 stretch your legs- short brake 10.30 From data to action 11.30 joint discussion 12.00 Lunch and walk

13.00 Culture as a ”cure” 14.00 North Urban Art studio – try it yourself 15.30 Coffee and conclusions

Aalborg Kommune

Aalborg Municipality • 223,000 inhabitants – population growth (around 1%) • 3rd largest municipality (98 in total) • An attractive city for students – with more than 40,000 students • The Municipality employs 18,000 people – the largest workplace in the region • Visionary business strategy • Denmark's leading conference city • An international airport – 1.5 million travelers annually (2023)

Aalborg Kommune

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Aalborg Municipality City Council Finance Committee

Finance & Business

Urban & Spatial Planning

Senior Citizens & Care

Climate & Environment

Mayor’s Office

Urban Development

Rehabilitation

Municipality buildings

Business Aalborg Construction Corporate Services Financial Department

Mobility and Infrastructure

Home Care and Practical Assistance

Climate Water

Cleaning and Meal service

Environment

Home Nursing

Public transport

Health & Culture

Health

Employment & Welfare

Children and Family Department

Daycare Services

Social Services

Public Schools

Job and Education

Schools for children with special needs

Culture Leisure and Rual Districts

Children & Youth

Cities and Nature

Care Centers

PPR – Pedagogical and Psychological Counseling

Committee for Health and Culture

Aalborg Kommune

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City Council Finance Committee

Finance & Business

Alderman Jes Lunde (B)

Urban & Spatial Planning

Senior Citizens & Care

Vice Alderman Torben Froberg Poulsen (V)

Jane Østergaard (F)

Climate & Environment

Vibeke Merete Gamst (C)

Health & Culture

Evald Lange (A)

Employment & Welfare

Rikke Pedersen (C)

Children & Youth

Rosalina Svane Schmidt (Ø)

Aalborg Kommune

In the administration, we have three departments: Culture, Health, and Leisure and Rural Districts. Culture

Health

Leisure and Rural Districts

The Culture Department Aalborg Libraries Aalborg City Archives KORMA Kunsthal Nord Trekanten Cultural Center

Health Strategy Secretariat Aalborg Health Center and Rehabilitation Center for Health Promotion Public Health Nursing Dental Care Center for Mental Health Center for Applied Municipal Health Research

Public Education and Projects Rural Districts Aalborg Sports Park Elite Sports Aalborg

Aalborg Kommune

The prime focus In Health and Culture, we focus on creating synergy between health, leisure, rural areas, and culture

Aalborg Kommune

The aim is to provide the citizens of Aalborg Municipality with the opportunity to live a good, healthy, and meaningful life.

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Aalborg Kommune

We achieve this by developing integrated solutions with a focus on presence and quality.

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Aalborg Kommune

Dette billede efter Ukendt forfatter er licenseret under CC BY

We invite citizens and partners to engage as collaborators in dialogue and the development of solutions, and we strive to ensure that working with Health and Culture is uncomplicated—even when dealing with complex matters like Mental health.

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2 -Theo Coskun Præsentation

City Council of the Municipality of Rotterdam Committee on Care, Welfare, Culture and Sport - Godmorgen / God eftermiddag alle sammen - Tak for at have os her! - Vi håber at vende tilbage til Rotterdam med en masse viden og indsigt Theo Coskun, committee chairman Mark Jongsma, First advisor to committee

18 September 2024

City Council of the Municipality of Rotterdam • • • •

Represents all citizens of Rotterdam Highest administrative body of the municipality 45 council members Directly elected for 4 years

Committees Governance • Committee on Governance, Organisation, Finance and Public Safety • Committee on Audit of the Accounts Urban and economic development • Committee on Transportation, Port, Economy and Climate • Committee on Housing, Building and Environment - Sub-committee on developmentplans Social • Committee on Care, Welfare, Culture and Sport. • Committee on Employment, Debt and Poverty Reduction, Social Bias, Education and National Program New Perspective on Rotterdam-South - Sub-committee on the Organisation of Public Education

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Rotterdam, the city: facts & figures 2024: • • • • • •

670.435 residents (still growing) 176 nationalities Relatively young population (44% up to 39 years), but getting older 7.023 Danish people in the Netherlands of which 610 in Rotterdam (2022) Europe’s largest port Modern, high-rise city (291.224 houses)

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Dansk Sømandskirke In 1970, the first and only Danish Seamen's Church opened in the Netherlands. The new building, which was made possible by a national collection in Denmark, is located at Coolhaven in Rotterdam.

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Maersk The biggest container shipping company in Rotterdam is Danish

Titel van deze presentatie | Naam Achternaam | Datum Plaats.

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20th of September

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Thank you for listening

3- Torben Kjeldgaard Introduction to the Danish Tree-Part Healthcare System

Introduction to the Danish Three-Part Healthcare System V/Head of the Health Department, Torben Kjeldgaard

Health Care Management

The Ministry of Health ​

The Danish Health Authorities

The tree-part Health care system

REGIONS/HOSPITALS

MUNICIPALITIES

GENERAL PRACTITIONERS

The Role of the Regions Five regions • Elective hospitals – Planned Surgery and treatment

• Emergency hospitals • Specialized hospitals – advanced treatment

• Highly specialized hospitals • Psychiatry

The Role of the Municipalities 98 Municipalities - primary welfare Health department • Prevention and health promotion – Diet, smoking Alcohol, Exercise • Elderly care • Home nursing care • Emergency nursing • Rehabilitation and training • Health services – Children, youth • Public dentalcare for children and young (0-21 years)

Aalborg Kommune

32

Aalborg Municipality City Council Finance Committee

Finance & Business

Urban & Spatial Planning

Senior Citizens & Care

Climate & Environment

Mayor’s Office

Urban Development

Rehabilitation

Municipality buildings

Business Aalborg Construction Corporate Services Financial Department

Mobility and Infrastructure

Home Care and Practical Assistance

Climate Water

Cleaning and Meal service

Environment

Home Nursing

Public transport

Health & Culture

Health

Employment & Welfare

Children and Family Department

Daycare Services

Social Services

Public Schools

Job

Schools for children with special needs

Culture Leisure and Rual Districts

Children & Youth

Cities and Nature

Emergency Nursing

PPR – Pedagogical and Psychological Counseling

Care Centers 32

The Role of the General Practitioners (GP’s) • Primary healthcare – Gatekeepers in the healthcare system • Referral system • Prevention and health advice • Collaboration with Municipalities and hospitals

Financing

TAXES

BLOCK GRANTS

CO –FINANCING FROM THE MUNICIPALITIES

Spending…

Regional and Cluster management

The Health Structure Commission – today • Changes in the disease landscape – aging population with multiple chronic diseases • geographical and social inequality - Rural areas many with many elderly people, relatively lower income and education = more health challenges combined with shortage of healthcare professionals especially general practitioners outside the big cities • Increasing expectations of the healthcare system • Fragmented patient pathways and responsibility • Imbalance between primary and secondary healthcare

Differences between us?

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Organization and Structure: In Denmark, the healthcare system is divided into five regions responsible for hospitals and specialized treatment, while the 98 municipalities handle prevention, rehabilitation, and home care. In the Netherlands, the healthcare system is more centralized, and municipalities have less responsibility for healthcare services. Instead, there is a system of private health insurance that all citizens must have.

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Financing:In Denmark, the healthcare system is mainly funded through taxes, and healthcare services are free at the point of use. In the Netherlands, citizens pay for health insurance, and there is a mix of public and private healthcare providers.

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Collaboration between Sectors: In Denmark, there is close cooperation between regions, municipalities, and general practice, organized in health clusters round emergency hospitals. In the Netherlands, the collaboration between different healthcare providers is often more fragmented, with a greater focus on competition among providers.

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Patient’s Role: In Denmark, there is a strong focus on patient involvement and coherent patient pathways, especially for elderly and chronically ill patients. In the Netherlands, patients have more freedom to choose their healthcare providers, ich can also lead to more complex and fragmented pathway

4- Torben Kjeldgaard Identification og Issues and Targetgroups

Aim To support policy makers in providing initiatives to improve public health at all levels.

The Health Profile

At the national level more than 180.000 people have filled out the questionnaire with questions about: • Health in general • Physical and mental well-being • Stress • Social relations • Health behavior, Smoking, Alcohol, Physical activity and Diet • Diseases and Health problems • Etc .

In Aalborg almost 4.000 people have filled out the questionnaire within total 85 questions.

The focus is primarily on: • Social inequality in health • Mental health • Citizens with several chronic diseases

How do we use data? • Making a health policy for the municipality • To support policy makers in providing initiatives within health promotion and prevention Examples: • Reinforced efforts in selected social housing areas • Center for Mental Health

Examble 1:

Reinforced efforts in selected social housing areas

Result from Healthprofile 2013 Denmark

Aalborg Kommune

Aalborg Øst

Grønlands-kvarteret

Løvvangen

Daily smoking

17,0

14,4

32,7

24,8

31,4

Inactivity

16,4

15,8

24,3

18,6

37,3

Weight (BMI>29,9)

14,1

14,2

32,4

24,3

15,3

Bad mental health

10,7

10,8

33,8

22,4

14,7

Not good self-rated health

14,8

13,4

28,8

26,7

20,9

High stress level

21,3

19,8

34,8

31,8

22,0

Bad sleep quality

11,0

10,1

33,8

23,3

19,1

Reinforced efforts in selected social housing areas

Focus areas will include: • Health consultations, screening, and referral to other services • Smoking cessation programs • Physical activity utilizing the facilities in the local area • Collaboration with local actors • Collaboration with other municipal employees in the area • Conducting and participating in relevant courses, lectures, etc.

Key words for the effort are proactive recruitment and services customized to the people in the particular area. Special focus on residents with psychological/mental issues, young people from 16 years old who are transitioning to adulthood, and vulnerable men.

Example 2: Center for Mental Health

Aalborg Kommune

Mental Health 35.750 People in Aalborg Kommune

19,5 %

Population 16+ with poor mental health 47

Aalborg Kommune

Stress 56.650 People ind Aalborg Kommune

30,9 %

Population 16+ with high score on stress scale 48

Center for Mental Health Open and Calm – Prevention of stress, anxiety and depression

Mental health in secondary education

Culture on prescription

Knowledge center function

5- Anders og co From data to action

Introduction to collaboration from data to action Anders Kallestrup Mortensen Matias Gjerløv Hartmann Maria Qvistgaard Katrine Helenius

Aalborg Kommune

Outline 1. Introduction to the collaboration with youth education 2. Presentation of the collaboration model - From data to actions 3. Healthy Youth’s efforts and services to youth education

Introduction to the collaboration with youth education Anders Kallestrup Mortensen

Aalborg Kommune

The Danish education system

Primary School

Youth education

University/ Bachelor’s degree

Aalborg Kommune

Aalborg Kommune

The partnership consists of 4 elements Network Cross-sectoral and joint initiatives Youth profile and model for cooperation Health services

Aalborg Kommune

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Health services – Stepped Care Model Step 3 – Individual services

Step 2 – Targeted group services

Step 1 – Universal service

Presentation of the collaboration model from data to actions Matias Gjerløv Hartmann

Aalborg Kommune

Youth profile survey • Online survey – every second year • Primary school - mandatory • Youth education – invited to survey

Aalborg Kommune

Data collection

Youth profile and model for cooperation

Follow-up

Planning

Services and interventions

Aalborg Kommune

From data to actions - target groups • Meeting with management from youth education • Conference • School Board • Parents • Data presented in the SSP Structure • Teens

Aalborg Kommune

Fælles om ungelivet

Aalborg Kommune

The Icelandic Prevention Model

Sund Ung Maria Qvistgaard Katrine Helenius

Aalborg Kommune

What and who is Sund ung?

Aalborg Kommune

Becoming Sund Ung

Aalborg Kommune

High school and jobcenter for youth

Aalborg Kommune

The health nurse system in Denmark

Aalborg Kommune

Individual health talks, groups and teaching

Aalborg Kommune

Events

Aalborg Kommune

Conversations about …..

Aalborg Kommune

Exercise

Food

Aalborg Kommune

Caffeine

Sleep

Aalborg Kommune

Friends and relationship

Aalborg Kommune

Screen

Gambling

Aalborg Kommune

Abuse (emotional)

Nicotine

Aalborg Kommune

Health

Drugs

7- Wilma Jansen Youth Care in Rotterdam

Youth care in Rotterdam system, trends and developments Aalborg, september 2024 Wilma Jansen PhD, knowledge broker and senior researcher, city of Rotterdam

System, trends and developments in Netherlands

25-9-2024

81

Mental well being in youth (HBSC studies)

Source: HBSC study 2023

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System change in 2015 Municipalities are responsible for:

Public health act:

Youth act:

Preventive youth health care

Preventive interventions

Youth care

Youth care?

25-9-2024

Youth mental health care, ambulatory and residential

Parenting and youth support, foster care, residential care

Care for youth with intellectual disabilities

Youth protection and probation

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Increase in use of youth care in Netherlands in last decades

25-9-2024

2000

2009

Parenting and youth support services

40.000

90.000

Youth mental health services

140.000

280.000

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Number of youth receiving youth care since 2011 500

458

450 390

400

350

350

350

407

418

431

464

423

363 345 300

300

250 200 150 100 50 0

2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 Source: Statistics Netherlands

Development of costs and budgets

Source: AEF 2023

System, trends and developments in Rotterdam

25-9-2024

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Youth care system in Rotterdam

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Prevention and well-fare services

Freely accesible services: • Preventive interventions • School social workers • Child and youth social workers (like streetcorner coaches) • Youth and family health centres • Practice nurses at GP

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Local youth care & Neighbourhood support teams

Locally provided care and support: • Neighbourhood support teams • Care and support programs at school • day programs • Family support programs • Basic youth mental health care services • Support for informal caregivers

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Specialized Youth care& Youth protection/probation

Regionally procured specialized youth care: • • • • • • • • •

Specalized ambulatory care Daycare Foster care Residential care Emergency care Youth protection Youth probation Forensic care Closed juvenile care

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Percentage of 0-18 year olds receiving youth care (2022)

Type of youth care

% in Netherlands

% in Rotterdam

Total youth care

13.4%

9.4%

►of which in local teams

►15%

►27%

Out of home care

1.3%

1.5%

Youth protection

1.2%

1.5%

Youth probation (12-22 years)

0.3%

0.7%

CBS data 2022

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Challenges for Rotterdam

Deal with growing/high demand for youth care Deal with growing/high costs for youth care Deal with shortages in labor force Optimize provision of youth care (good acces, proper care) Improve youth protection chain

Thank you for your attention

Reserve dia’s

25-9-2024

96

Education system in the Netherlands In the Netherlands freedom of education is a constitutional right.

Anyone may provide education. Private schools may have a religious or ideological character, unlike publicly run schools.

Aims of the Youth Act

Activate, restore, strengthen own capacities to solve problems

De-medicalize, normalize by improving parenting practices

Timely tailored integral care

Prevention, early detection and support at affordable price

Strengthen professional decision making, decreasing procedures