The health of Rotterdam’s residents is worse than that of the average Dutch citizen. Professor of Public Health Lex Burdorf (Erasmus MC) calculated that the lifespan of the average Rotterdam resident is one and a half years shorter. There are also big differences within the city: residents near Nesselande metro station live eight years longer on average than residents near Maashaven metro station. We asked Lex Burdorf where these differences come from and what the solution is to this pressing "Rotterdam issue": 'It’s not an individual problem, but a problem of how society is designed.'
The aforementioned figures are from a 2018 interview, in which Burdorf also advised focusing on a strict anti-smoking policy, increased participation in society and a healthy start for all children, for example with a school breakfast. This healthy start has taken off in Rotterdam in recent years for children who need it. Erasmus MC’s Department of Public Health conducted research into the effects: 'No researcher expects children’s learning performance to improve dramatically just because of a school breakfast. But we did see some other things that were incredibly interesting', Burdorf recounts. 'For example, volunteers are needed to serve the breakfasts. In Delfshaven, women with whom the school had previously barely had any contact came to help out. Mutual contact between parents also improved. Other conversations took place, and we ended up identifying problems among hard-to-reach groups sooner than might otherwise have been the case.' That means the social effect is much more important than the health effect.
Health inequalities start when kids are still wearing nappies
The seeds of lower life expectancy and fewer healthy years of life are sown early on, according to Burdorf: 'You can already see this in schools. There are children who can’t even muster two minutes of focus. They grow up in a neighbourhood where different norms and values apply than in the rest of society, and then they face postcode discrimination for the rest of their lives.' Getting a school breakfast helps – the communal ritual creates calm in the classroom. 'We’re trying to support those schools in Delfshaven, because this initiative is incredibly important. Fortunately, funding for the school breakfast has now been secured, but it shows how much effort is needed for something that could be so simple.'
Staying healthy while working
Another thing that Burdorf says should not be so difficult to tackle is a healthy working environment. Health problems are the main reason why people drop out of the workforce, which is undesirable at a time of shortages in the labour market. 'How can we make the working environment healthier? Bicycle schemes are a good example. There should really be a lot more of those! They’re better for people’s health, better for air quality, and fewer parking spaces are needed.' However, Lex Burdorf sees too little cooperation between different levels of government in this field. 'One isolated branch of government might decide, ‘we should tax that’, and then it’s given no further thought.'
Air pollution continues to contribute to many diseases in Rotterdam. 'The major cities want zero-emission zones, but the government does not. Economic power always wins out over public health discussions, even though we’ve shown how many gains can be made by addressing this issue – especially for vulnerable people, the elderly and children.'
At its core, the health issue relates to how we design society
According to Lex Burdorf, making residents of Rotterdam (and Dutch people in general) healthier is ultimately a matter of how we design society. Be it smoking, exercise, nutrition or alcohol intake: 'You can call these individual problems, but my field teaches us that the real problem is how our society is designed.'
No silver bullet
What advice does he have for the new mayor of Rotterdam, Carola Schouten, to make the city healthier? 'The school breakfasts show us that there are no silver bullets to solve our problems. We often require a combination of measures, or a measure that has a combination of effects. It’s important to realise that', says Lex Burdorf. 'Organising a school breakfast in Rotterdam can increase social cohesion to an extent that isn’t easily achieved in any other way. Connecting with others is done through shared facilities, such as a school breakfast.'
Playing outdoors is important for everyone
Furthermore: 'People need to play outside again – adults as well as children.' His research into the play behaviour of Rotterdam children shows that socially vulnerable children in particular benefit most from play facilities in the neighbourhood. 'Especially in those neighbourhoods, you should make sure that you have small play facilities everywhere, on every corner.' The way the city is designed is very important for adults as well. 'Sometimes, small things can create big problems. The green light on the set of traffic lights to get from Erasmus MC to the park on the other side of the street lasts for such a short time that elderly people are barely able to make it across. These are barriers we aren’t aware of.'
Finally, if Lex Burdorf could introduce one measure in the Netherlands with a proven positive effect on public health, it would be free childcare for all. 'In Scandinavian countries, it has been shown to be the great equaliser, but for some reason we refuse to understand that in the Netherlands. It’s also good for women’s labour force participation. This again comes down to how we design our society in the Netherlands.'
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More information about prof. dr. ir. Lex Burdorf.
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