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Samenvatting samenleving en gezondheid (D012137A)
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Samenvatting samenleving en gezondheid gestructureerd
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InhoudsopgaveDeel I: Volksgezondheid en preventieve gezondheidszorg. .............................................................................. 1
1. Overheidsbevoegdheden gezondheidszorg in België en Vlaanderen. ............................................................. 1
1.1 Organisatie gezondheidszorg in België. .................................................................................................... 1
1.1.2. Historiek en beïnvloedende factoren. ............................................................................................... 1
1.2. Bevoegdheidsverdeling Gezondheidszorg in België. ................................................................................ 1
1.2.1. Bevoegdheidsverdeling (2011). ......................................................................................................... 1
1.2.2. 6e Staatshervorming: bevoegdheidsoverdracht in de gezondheidszorg. .......................................... 2
1.3. Sociale zekerheid in België. ...................................................................................................................... 2
1.3.1. Basisprincipes. ................................................................................................................................... 2
1.3.2. Sociale zekerheid werknemers. ......................................................................................................... 3
1.3.3. Sociale zekerheid zelfstandigen. ....................................................................................................... 3
1.3.4. Uitgaven van de uitgaven. ................................................................................................................. 4
2. De verplichte zorgverzekering in België........................................................................................................... 5
2.1. Het RIZIV binnen de RSZ. .......................................................................................................................... 5
2.1.1. Organigram. ...................................................................................................................................... 5
2.1.2. Gezondheidsuitgaven per land (2013). ............................................................................................. 6
2.1.3. Evolutie.............................................................................................................................................. 7
2.1.4. Verplichte ziekteverzekering. ............................................................................................................ 7
2.1.4. Bijdragen. .......................................................................................................................................... 8
2.1.5. Mutualiteiten: opdrachten. ............................................................................................................... 8
2.1.6. Nomenclatuur. .................................................................................................................................. 8
2.1.7. Verzekeringstegemoetkoming geneeskundige verstrekkingen. ....................................................... 9
2.2. Verhoogde tegemoetkoming. ................................................................................................................ 10
2.2.1. Verzekeringstegemoetkoming geneeskundige verstrekkingen. ..................................................... 10
2.2.2. Berekening verzekeringstegemoetkoming geneesmiddelen. ......................................................... 10
2.3. Maximumfactuur.................................................................................................................................... 11
2.3.1. Soorten maximumfactuur. .............................................................................................................. 12
a. Sociale MAF. ...................................................................................................................................... 12
b. Inkomens-MAF. ................................................................................................................................. 12
c. MAF op individuele titel. ................................................................................................................... 12
2.4. Bijzonder solidariteitsfonds.................................................................................................................... 13
3. Volksgezondheid............................................................................................................................................ 14
3.1. Wat is gezondheid? ................................................................................................................................ 14
3.2. Waarom volksgezondheid? .................................................................................................................... 15
, 3.2.1. Wat is volksgezondheid? ................................................................................................................. 15
3.2.2. Wat doet volksgezondheid? ............................................................................................................ 15
3.3. Volksgezondheidsonderzoek? ................................................................................................................ 16
3.3.1. Definitie en doel. ............................................................................................................................. 16
3.2.2. Sociodemografische samenstelling van de bevolking. .................................................................... 16
a. Tijdsevolutie: Epidemiologische transitie. ......................................................................................... 16
b. Momentopname: soiodemografische samenstelling. ....................................................................... 18
c. Tijdsevolutie: vergrijzing. ................................................................................................................... 19
3.2.3. Registratie van sterfte en geboorte. ............................................................................................... 21
a. Registratie van sterfte. ...................................................................................................................... 21
b. Registratie van geboorte. .................................................................................................................. 21
4. Indicatoren van volksgezondheid. ................................................................................................................. 23
4.1. Indicatoren: Kernindicatoren. ................................................................................................................ 23
4.2. Drie concepten van ziekte (illness, sickness, didease). .......................................................................... 24
4.3. Indicatoren met betrekking tot sterfte. ................................................................................................. 25
4.3.1. Zuigelingensterfte. .......................................................................................................................... 25
a. Definities en indeling. ........................................................................................................................ 25
b. Stand van zaken en tijdsevolutie. ...................................................................................................... 25
b. Sterfte op kinderleeftijd. ................................................................................................................... 27
c. Sterfte bij volwassenen. .................................................................................................................... 27
d. Uit sterftetabellen afgeleide indicatoren. ......................................................................................... 31
4.4. Indicatoren met betrekking tot kwaliteit van leven. .............................................................................. 34
5. Determinanten van volksgezondheid. ........................................................................................................... 36
5.1. Enkele modellen. .................................................................................................................................... 36
5.1.1. Dahlgren & Whitehead.................................................................................................................... 36
5.1.2. The Health Field Concept. ............................................................................................................... 37
5.1.3. Determinanten van gezondheid van Blum. ..................................................................................... 37
5.1.4. Epigenetica van Carldwell Esselstyn. ............................................................................................... 37
5.2. Determinanten van gezondheid. ............................................................................................................ 38
5.2.1. Leeftijd en geslacht. ........................................................................................................................ 38
5.2.2. Soiale determinanten. ..................................................................................................................... 39
5.2.3. Leefstijlfactoren. ............................................................................................................................. 40
a. Tabak en roken. ................................................................................................................................. 41
b. Alcohol............................................................................................................................................... 44
c. Voeding. ............................................................................................................................................. 47
d. Beweging. .......................................................................................................................................... 52
6. Preventieve gezondheidszorg. ....................................................................................................................... 55
2
, 6.1. Definities. ............................................................................................................................................... 55
6.2. Indeling. .................................................................................................................................................. 55
6.2.1. Inhoudelijke focus en doelgroep. .................................................................................................... 55
6.2.2. Volgens verloop van ziekteproces. .................................................................................................. 55
a. Secundaire preventie. ....................................................................................................................... 56
b. Quaternaire preventie. ...................................................................................................................... 57
6.3. Bevoegdheidsverdeling preventie in Vlaanderen/België. ...................................................................... 57
6.4. Preventiebeleid in Vlaanderen. .............................................................................................................. 58
6.4.1. Beleidsinstrumenten. ...................................................................................................................... 58
6.4.2. Gezondheidsdoelstellingen. ............................................................................................................ 58
6.4.3. In de praktijk. .................................................................................................................................. 59
a. Organisaties en struturen. ................................................................................................................. 59
7. Gezondheidsbevordering. .............................................................................................................................. 60
7.1. Gezondheid en gezondheidsgedrag bij jongeren. .................................................................................. 60
7.1.1. Gezondheid en welzijn. ................................................................................................................... 60
7.1.2. Seksuele gezondheid en relaties. .................................................................................................... 62
7.1.3. Alcohol, roken en andere drugs. ..................................................................................................... 63
7.1.4. Fysieke activiteit en schermtijd. ...................................................................................................... 64
7.1.5. Voeding. .......................................................................................................................................... 65
7.1.6. Slaap. ............................................................................................................................................... 66
7.2. Conclusie. ............................................................................................................................................... 67
7.3. Invloeden op gezondheid. ...................................................................................................................... 68
7.3.1. Levensstijlgedragingen. ................................................................................................................... 68
7.3.2. Omgevingsfactoren. ........................................................................................................................ 69
7.4. Ontstaan van gezondheidsbevordering. ................................................................................................ 69
7.4.1. Basisprincipes van gezondheidsbevordering. ................................................................................. 69
7.4.2. Actoren gezondheidsbevordering. .................................................................................................. 69
7.4.3. Gezondheidsbevorderende acties................................................................................................... 70
7.5. Gezondheidsbevordering bij jongeren. .................................................................................................. 70
7.6. Theoretische gedragsverklaringsmodellen. ........................................................................................... 70
7.6.1. Individuele modellen. ...................................................................................................................... 71
a. Belangrijkste individuele determinanten. ......................................................................................... 71
7.6.2. Ecologische modellen. ..................................................................................................................... 71
a. Socio-ecologische model. .................................................................................................................. 71
b. Niveaus van omgevingsinvloeden. .................................................................................................... 72
c. Gedragswiel. ...................................................................................................................................... 72
7.6.3. Information-motivation-behavioural skills model (IMB). ................................................................ 73
a. Inention-behaviour gap. .................................................................................................................... 73
3
, b. Bridging the intention-behaviour gap. .............................................................................................. 73
7.6.4. Cognitive dissonance theory (Festinger). ........................................................................................ 74
7.6.5. Elaboration Likelihood Model. ........................................................................................................ 74
7.7. Stappen binnen gezondheidsbevordering. ............................................................................................ 74
7.8. Gezondheidsmatrix: beleidsinstrument voor gezondheidsbevordering. ............................................... 75
7.8.1. Strategieën gezondheidsmatrix. ..................................................................................................... 75
7.8.2. Niveaus gezondheidsmatrix. ........................................................................................................... 75
7.9. Gezondheidsbevordering binnen zorg en welzijn. ................................................................................. 76
7.10. Health Promoting Hospitals. ................................................................................................................ 76
7.11. preventie in woonzeorgcentra. ............................................................................................................ 76
7.12. Stijgende aandacht vor gezondheidsbevordering. ............................................................................... 77
7.13. Modellen voor gezondheidsbevordering. ............................................................................................ 77
7.13.1. Medisch model. ............................................................................................................................. 77
7.13.2. Educatief model. ........................................................................................................................... 78
7.13.3. Sociaal-politiek model. .................................................................................................................. 78
7.13.4. Self-empowerment model. ........................................................................................................... 78
Deel II: Capita Selecta uit de medische sociologie. ......................................................................................... 80
1. Intro: Sociale verschillen in gezondheid......................................................................................................... 80
2. Verschillen in gezondheid. ............................................................................................................................. 84
2.1. Naar geslacht. ......................................................................................................................................... 84
2.1.1. Health-survival praadox. ................................................................................................................. 84
2.2. verschillen tussen sociale klassen. ......................................................................................................... 86
2.2.1. In functie van opleidingsniveau....................................................................................................... 86
2.2.2. In functie van inkomensklasse: ....................................................................................................... 86
2.2.3. Cognitieve ontwikkeling. ................................................................................................................. 87
2.2.4. Kinderarmoede................................................................................................................................ 88
2.2.5. Gezondheidsongelijkheid. ............................................................................................................... 89
a. Niks aan de tand. ............................................................................................................................... 89
b. Ook bij tieners. .................................................................................................................................. 90
c. Bij volwassenen. ................................................................................................................................ 91
d. Bij senioren........................................................................................................................................ 91
2.2.6. Lage opleiding – ook lage levensverwachting? ............................................................................... 92
2.2.7. Laag inkomen – ook slechtere gezondheid? ................................................................................... 92
2.3. Etniciteit. ................................................................................................................................................ 93
2.3.1. Laag geboortegewicht. .................................................................................................................... 93
2.3.2. Sikkelcelanemie. .............................................................................................................................. 93
2.3.3. Perceptie gezondheid. ..................................................................................................................... 93
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,3. Verklaringen voor sociale verschillen in gezondheid. .................................................................................... 94
3.1. Biologische verklaringen. ....................................................................................................................... 94
3.1.1. Verschil mannen en vrouwen.......................................................................................................... 94
3.1.2. Etniciteit. ......................................................................................................................................... 94
a. Sikkelcelanemie. ................................................................................................................................ 94
3.1.3. Leeftijd. ........................................................................................................................................... 95
3.2. Levensstijl. .............................................................................................................................................. 95
3.2.1. Vrouwen en mannen. ...................................................................................................................... 95
3.2.2. Beroepskeuze. ................................................................................................................................. 95
3.2.3. Tabaksgebruik. ................................................................................................................................ 95
3.2.4. Alcoholgebruik. ............................................................................................................................... 96
3.2.5. Risicogedrag in het verkeer. ............................................................................................................ 97
3.2.6. SES groepen .................................................................................................................................... 97
3.3. Sociale mechanismen aan de basis van sociale verschillen in gezondheid. ........................................... 98
3.3.1. Health Survival Praradox: mentale gezondheid. ............................................................................. 99
a. Biologische verklaring. ....................................................................................................................... 99
b. Verschillen in levensstijl. ................................................................................................................... 99
c. Onderliggende sociale mechanismen. ............................................................................................... 99
3.3.2. Sociale determinanten van gezondheid. ....................................................................................... 100
a. Grotere blootstelling aan risico’s. ................................................................................................... 101
b. Eenzelfde blootstelling leidt tot meer gezondheidsproblemen. ..................................................... 101
c. Levensloopeffecten. ........................................................................................................................ 102
d. Ongelijke verdeling van middelen en macht/stigmatisering........................................................... 103
e. Verschillende gevolgen van ziek zijn. .............................................................................................. 103
3.3.3. Sociale determinanten als verklaring voor hogere COVID-morbiditeit/mortaliteit. ..................... 104
3.3.4. Hoe soiale ongelijkheid aanpakken? ............................................................................................. 104
a. Geef elk kind de beste start in het leven. ........................................................................................ 104
b. Gezonde levensomstandigheden voor iedereen. ........................................................................... 104
c. De gezondheidszorg als strijd tegen ongelijkheid. .......................................................................... 105
3.3.5. Werkingsprincipes. ........................................................................................................................ 106
3.4. Samengevat. ......................................................................................................................................... 106
4. Actua sociale ongelijkheid en COVID. .......................................................................................................... 107
4.1. Groepen in kwestbare en precaire situaties. ....................................................................................... 107
4.1.1. Kader van problematiek van non-take-up..................................................................................... 107
4.1.2. Precaire bevolkingsgroepen hebben een groter risico op niet vaccinatie. ................................... 107
a. Bestaande (gezondheids)ongelijkheden en ongelijke toegang tot ziektepreventie. ...................... 107
b. Gebrek aan informatie. ................................................................................................................... 107
c. Procedures. ..................................................................................................................................... 108
5
, d. Angst. .............................................................................................................................................. 108
e. Specifiek ivm gevolgen van de COVID-19-maatregelen .................................................................. 108
4.1.3. Heterogeniteit van de situaties. .................................................................................................... 108
4.2. Proportioneel Universalisme ‘to leave no one behind’. ....................................................................... 109
4.3. Populatie-management........................................................................................................................ 109
4.3.1. Leer je populatie kennen............................................................................................................... 110
a. Maak gebruik van beschikbaar materiaal........................................................................................ 110
4.3.2. Monitor vaccinatiegraad. .............................................................................................................. 111
4.3.3. Zet interventies op volgens het principe van proportioneel universalisme. ................................. 111
4.4. Proportioneel universalisme doorheen alle aspecten v.d. vaccinatiestrategie ................................... 112
4.4.1. Toegankelijke communicatie......................................................................................................... 112
a. Communicatie afgestemd op de context en motivatoren/drempels van doelgroepen.................. 113
4.4.2. Infrastructuur en HR management. .............................................................................................. 113
4.4.3. De programma-manager als centrale figuur in de uitbouw van inclusieve vaccinatiestrategie. .. 113
4.5. Diversiteit ams aandachtspunt in elke stap van de vaccinatieprocedure. ........................................... 114
4.6. Niet te vergeten. .................................................................................................................................. 114
4.6.1. Belang van een goede evaluatie.................................................................................................... 114
4.6.2. Kwaliteitsverbetering. ................................................................................................................... 115
4.7. Take home message. ............................................................................................................................ 115
5. Sociologie – soiale groepen – ziekte en gezondheid. ................................................................................... 116
5.1. Wat is sociologie? ................................................................................................................................. 116
5.2. Sociale groepen begrijpen. .................................................................................................................. 116
5.2.1. Kenmerken van groepen. .............................................................................................................. 116
5.3. Gezondheid en ziekte begrijpen ........................................................................................................... 117
5.3.1. Definitie gezondheid – ziekte: conceptuele chaos. ....................................................................... 117
a. Verschillende gezondheidstheorieën. ............................................................................................. 117
b. Wat bepaalt gezondheid? ............................................................................................................... 117
c. Belang van levensstijl....................................................................................................................... 117
5.4. Sociale determinanten van gezondheid. .............................................................................................. 118
5.5. Disease – Illness - Sickness ................................................................................................................... 118
5.5.1. Disease. ......................................................................................................................................... 118
5.5.2. Illness............................................................................................................................................. 119
5.5.3. Sickness. ........................................................................................................................................ 119
5.5.4. Besluit. ........................................................................................................................................... 119
5.6. Gezondheid en ziekte vanuit vier perspectieven. ................................................................................ 119
5.6.1. Oudheid. ........................................................................................................................................ 119
5.6.2. Oude Grieken. ............................................................................................................................... 119
5.6.3. Middeleeuwen. ............................................................................................................................. 120
6
, 5.6.4. Renaissance: Opkomst van het biomedisch perspectief. .............................................................. 120
5.6.5. Biomedisch versus bio-psychosociale definitie. ............................................................................ 120
5.7. Modellen. ............................................................................................................................................. 121
5.7.1. Biomedisch model. ........................................................................................................................ 121
a. Assumpties. ..................................................................................................................................... 121
b. Kritiek. ............................................................................................................................................. 121
5.7.2. Biopsychosociaal model. ............................................................................................................... 122
5.7.3. Biomedisch verss biopsychosociaal perspectief............................................................................ 122
5.7.4. Sociologisch model. ....................................................................................................................... 123
5.7.5. Evolutionair model. ....................................................................................................................... 123
5.8. Ziektegedrag begrijpen. ....................................................................................................................... 124
5.8.1. Verschillende stadia. ..................................................................................................................... 124
a. Symtomen ervaren (fysisch, cognitief en emotioneel).................................................................... 124
b. Fase 2: De rol van zieke aannemen: the sick role concept (parson) ............................................... 124
c. Fase 3: Contact medische zorg. ....................................................................................................... 124
d. Fase 4: Afhankelijke rol van de patiënt + Fase 5: herstel en rehabilitatie. ...................................... 125
6. Sociale netwerken, buurten en gezondheid. ............................................................................................... 126
6.1. Sociale netwerken. ............................................................................................................................... 126
6.1.1. Verklaringen? ................................................................................................................................ 126
a. Sociale steun.................................................................................................................................... 126
b. Engagement en entertainment. ...................................................................................................... 126
c. Sociale controle en normen. ............................................................................................................ 127
6.1.2. Historiek. ....................................................................................................................................... 127
6.1.3. Negatieve relatie. .......................................................................................................................... 128
a. Homogeniteit sociaal netwerk. ....................................................................................................... 128
6.1.4. Ongelijkheid. ................................................................................................................................. 129
6.1.5. Conclusie. ...................................................................................................................................... 129
6.2. Buurten in gezondheid. ........................................................................................................................ 130
6.2.1. Theoretische achtergrond. ............................................................................................................ 130
6.2.2. Implicaties voor het beleid. ........................................................................................................... 131
6.3. Buurtgerichte zorg. .............................................................................................................................. 131
6.3.1. Aanleiding...................................................................................................................................... 131
6.3.2. Definiëring. .................................................................................................................................... 131
6.3.3. Evoluties in beleid. ........................................................................................................................ 131
6.3.4. Territoriaal werkingsgebied. ......................................................................................................... 132
6.3.5. Gemeenschapsgericht. .................................................................................................................. 132
6.3.6. Gemeeschapsgericht werken. ....................................................................................................... 132
7
,Deel III: Global Health en medische antropologie. ....................................................................................... 133
1. Global Health............................................................................................................................................... 133
1.1. Wat is Global Health? ........................................................................................................................... 133
1.2. Waarom is het belangrijk? ................................................................................................................... 134
1.3. Problemen van Global Health. ............................................................................................................. 135
1.3.1. Levensverwachting. ....................................................................................................................... 135
a. Doodsoorzaken en inkomensniveau. .............................................................................................. 135
b. Distributie van doodsoorzaken. ...................................................................................................... 136
c. Doodoorzaak-specifieke sterftecijfers (per 100 000/jaar). .............................................................. 136
d. Leeftijd gestandaardiseerde doodsoorzaak-specifieke sterftecijfers (per 100 000/jaar). .............. 137
1.3.2. Aandeel van doodsoorzaak. .......................................................................................................... 137
a. Kindersterfte.................................................................................................................................... 137
b.Sterfte van vrouwen bij geboorte. ................................................................................................... 138
c. HIV/AIDS .......................................................................................................................................... 138
d. Malaria. ........................................................................................................................................... 138
e. Tuberculose ..................................................................................................................................... 139
f. Chronische aandoeningen................................................................................................................ 139
g. Cardiovasculaire ziekten. ................................................................................................................. 140
h. Kanker. ............................................................................................................................................ 140
i. Luchtvervuiling. ................................................................................................................................ 141
j. Tabakgebruik. ................................................................................................................................... 141
k. Diabetes. .......................................................................................................................................... 141
l. Alcoholgebruik. ................................................................................................................................. 142
m. Verkeersdoden. .............................................................................................................................. 142
n. Moord.............................................................................................................................................. 142
o. Zelfmoord. ....................................................................................................................................... 143
1.4. Hoe samenwerken?.............................................................................................................................. 144
1.4.1. Idealisme. ...................................................................................................................................... 144
1.4.2. Realisme. ....................................................................................................................................... 144
1.4.3. Liberlisme (pluralisme). ................................................................................................................. 145
1.4.4. Constructivisme. ............................................................................................................................ 145
1.4.5. Drie dimensies van Global Health Governance. ............................................................................ 146
1.5. Functies van Global Health................................................................................................................... 146
1.5.1. Production of global goods. .......................................................................................................... 147
1.5.2. Managen van externaliteiten. ....................................................................................................... 147
1.5.3. Stewardship (leidinggevend). ........................................................................................................ 148
1.5.4. Mobilisatie van globale solidariteit. .............................................................................................. 148
8
,2. Medische antropologie. ............................................................................................................................... 149
2.1. Wat is cultuur? ..................................................................................................................................... 149
2.1.1. Hofstede’s zes dimensies van cultuur. .......................................................................................... 150
a. Machtsafstand: ................................................................................................................................ 150
b. Individualisme vs. collectivisme: ..................................................................................................... 150
c. Masculiniteit vs. femininiteit: .......................................................................................................... 151
d. Onzekerheidsvermijding: ................................................................................................................ 151
e. Lange termijn vs. korte termijn oriëntatie: ..................................................................................... 151
2.1.2. Dimensies van nationale culturen. ................................................................................................ 151
a. Culturaliteit. ..................................................................................................................................... 152
b. Identiteit. ......................................................................................................................................... 152
2.2. Wat is medische antropologie? ............................................................................................................ 156
2.2.1. Culturele constructie van ziekte (cultural construction of disease). ............................................. 157
a. Disease: ‘Objectief’ (ziek zijn). ......................................................................................................... 157
b. Illness: ‘Subjectief’ (ziek voelen). .................................................................................................... 157
c. Emic versus Etic. .............................................................................................................................. 158
2.2.2. Explanatory models. ...................................................................................................................... 159
a. Illness narratives. ............................................................................................................................. 159
b. Idoms of distress. ............................................................................................................................ 160
c. Cultural concepts of distress (CDD). ................................................................................................ 160
2.2.3. Universalistisch versus Relativistische benadering. ...................................................................... 160
2.3. Diversiteitscompetenties in zorg. ......................................................................................................... 161
2.3.1. Diversiteitscompetente hulpverleners. ......................................................................................... 161
a. Generieke competenties: ................................................................................................................ 161
b. TOPOI-Model. .................................................................................................................................. 164
c. Taalbarrière in de zorg. .................................................................................................................... 165
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