at Maastricht University

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Welcome
at Maastricht University
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• Where are the fat people in public health?
  How to engage with users and non-users in public
  health?
• Klasien Horstman
• Caphri 2 April 2012

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• Tensions public health-user centeredness
• Public health is offered by public institutions
  to healthy citizens
• Targeting the public/society (not individuals)
• Assumption non-users must be transformed into
• users of top down interventions
• Context gap life worlds ph/LSES them and us
  distrust state
• Result crisis in authority/trust

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• Meaning of user centeredness strategy of risk
  governance/management of post modern democracies
  
• - users should play a role in the production
  of knowledge, in the design, the development, the
  implementation and evaluation of public health
  programmes and technologies
• - users to be considered experts, embodying
  knowledge
• - institutions and users interact, co-produce
  each other
• - user centeredness results in more socially
  robust and authoritative public health
  institutions

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• Public health user centeredness
• - Tradition of moral paternalism (top down ph)
• Replaced by expert (EBM) driven paternalism (top
  down ph)
• Undercurrent of participative community based ph
  since 1970s (participative research)
• Currently hesitating turn in public health
  towards users, communities, neighborhoods, voice,
  dialogue, the other.

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• Two models of user centeredness
• Instrumental. Dialogue, listening, motivating
  etc. is considered as instrumental for successful
  implementing expert based interventions. Sticking
  to the own ph agenda.
• Intrinsically. Learning from users because of
  the added value of their knowledge and
  willingness to change the ph agenda based on
  users feed back.
• In practice the instrumental model dominates,
  many experiences of users/non users not taken
  seriously as such.

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• Example National Vaccination Programme RIVM
• - on the one hand interested in perspectives of
  people with respect to vaccination ( many
  questionnaires, interviews, focus groups)
• - on the other hand no structural voice channels
  from local practices through regional physicians
  etc. to the RIVM, and turning away (in many
  respects) from non-users and non-standard users.
• Evading non users missing insight in practices
  of non-users (which is a main task of the RIVM!).
  

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• Questions
• How to engage users and their social embeddings
  in public health?
• How does the rather individualistic notion of
  user/citizens relate to socially embedded
  practices of users (culture of class notion of
  community?)
• How to organize voice in all phases of public
  health (research, design, development,
  implementation etc.) and how to learn from this?
• How to balance the many different user
  perspectives?
• How to balance epidemiology and users statistics
  and life stories the mean and the particular?
• How to relate user centeredness and professional
  authority?
• How to prevent that now, instead of ebm, user
  centeredness becomes the new standard and
  ideology?