“The right data show you how big the health problem is, and the right information gives you an idea of how to solve it.”
Interview with Peter Achterberg, RIVM
From data to policy
“It is a long and complex road from gathering data and adding evidence to making recommendations and then developing health policies. In the Netherlands, we collect a lot of data, which is then synthesized into analyses, reports and web sites, and linked to evidence that ultimately defines important parts of our national and regional health policies.
We often forget that there are lots of people involved at the beginning of the process who are collecting data in many different areas. If this stops, it means that certain issues will disappear from the agenda or that emerging issues will be missed and you will be confronted with them too late. You may also lose the chance of a better understanding and improved knowledge – the kind of knowledge you need for action.”
Comparison is good
“I realize that sharing and comparing data can be a political challenge. We know some countries will always be at the top, although I know that each of them has certain issues where they are NOT at the top. There is a danger that we focus too often on blaming and shaming at the negative end of comparisons, but really these comparisons should generate ambition in countries to progress and move up as the data show that it can be done!
International comparisons give our analyses an added dimension – they have really worked in the Netherlands. They helped us to see problems we were not aware of, and made us look to other countries and ask ourselves how they achieved their good results and whether we could share their good practices. WHO has often done so as well, with very illustrative data from the Health for All Database, which is still a valuable tool for country comparisons.
About a decade ago, we produced a report on perinatal mortality in the Netherlands. It showed that our ranking had fallen by international comparison to unexpected levels. It took some time for the message to gain momentum – it had to be repeated several times – and you need awareness from people in the field and the media to bring the topic to public and political discussion. But this eventually led to policy changes and huge efforts to address the underlying problems. Actions were then undertaken in the areas of prevention and health care quality improvement.”
“It is my view that the health inequalities issue, which is central to public health, is also a health information inequalities issue. This also makes it very difficult for countries with these health inequalities to make progress. They can benefit in particular from sharing best practices, especially in the health information area.
Because of its experience with health information and its ability to bring stakeholders together, I trust and feel confident that WHO/Europe can and should act as the major leading party in this huge effort and that RIVM, together with other future partners, should aim to give this effort the necessary momentum and sustainability. Health data and information (“intelligence”) are always of the utmost importance but are hardly ever seen as urgent.
It is important to see how other countries are doing, and what we can learn from each other. Working from an international perspective is the ultimate test to see how you are doing nationally, and so testing your knowledge and expertise against others. I am really committed to getting other countries involved in this joint effort with WHO/Europe to improve European health data and information.
My vision is that the new health information portal, an online resource we are currently developing as part of the initiative, will not only become the place to go for health data, but also for instruments and tools in health information. I hope it will help in identifying how to find and use evidence, and to know where the relevant expertise is and whom to open a discussion with.
The health portal is the first tangible tool we can give countries, but as soon as they start using it, they will see that they can contribute as well.”
Coordination long term is needed
“Because there are several players in the area of information and data in Europe – including the Organisation for Economic Co-operation and Development (OECD), WHO, the European Commission and Eurostat – this can create coordination problems, but major steps towards better coordination are being taken. Sustainable funding is also an issue. I have seen many relevant projects being set up, collaborations established and then the funding ended. If you are lucky, all the gold that has been dug out is then lying around somewhere on the internet, and if you are unlucky it has disappeared fully into a drawer somewhere. And then a project on the same issue is set up again.
Currently, WHO works with experts on various specific occasions, but I would like to see WHO/Europe having a more constant central role, bringing together and working with many expert networks more often, and collaborating with organizations such as OECD and Eurostat to ensure that overlaps and repetitions are avoided and available knowledge and expertise are shared.
This initiative, I feel, could be crucial in gaining support for the implementation of WHO’s Health 2020 strategy by involving Member States and other partners in a very direct way.”
A flexible initiative
“For the time being the initiative is project based, under the umbrella of RIVM, so we don’t need a separate structure of staff, a building, board of directors, and so on. This also reflects the changing vision of national governments facing the current economic crisis and their reluctance to support new institutes, for example, where you lose flexibility and face burdens of administration. Right now there are 4–5 people at RIVM working on the core of the initiative, and 3–4 information technology specialists focusing on the portal technology.
We also support WHO in bringing experts together, so there are many more people from all over Europe involved in a flexible way.”
Expanding our collaboration with WHO
“Collaboration with WHO has always been positive for us. The Netherlands has historically contributed a lot to the Organization. Our Government has a WHO partnership programme for staff secondments and joint projects. RIVM has, for instance, recently signed an agreement with WHO/Europe to work on antimicrobial resistance, and this health information initiative is another example.
I do get asked the question “What is in it for the Netherlands?” and I can say that part of our aim is to participate in international networks and test our knowledge and experience. I also share the ambition of my director for RIVM to be one of the best public health institutes in Europe, and therefore you need to collaborate, to be out there in the world. This initiative can help us to do just that.
The initiative we have just established with WHO is in both our interests, and we hope to bring in others, making it a partnership that everyone can join, and ultimately speeding up the process of bringing evidence to policy-makers.
Our project, however, is meant to be a crystal: it should grow larger in an organized way and we also want to commit other Member States, we cannot do it alone. Making sure we really work closely together with as many partners in the field as possible will be another major challenge.”
About Peter Achterberg
Peter Achterberg is Senior Advisor at the National Institute for Public Health and the Environment (RIVM) in Bilthoven, the Netherlands. After joining RIVM to produce their first national health report, he describes his current work there as “getting as many international comparisons as possible into our national health policy preparation”. He has worked in various international projects and advisory groups and initiated the new initiative on health information between RIVM and WHO/Europe. Dr Achterberg first studied biochemistry and psychology and has a medical PhD in the area of cardiovascular metabolism.