Creating a sense of urgency and provoking action – An example on the use of heat maps to address perinatal health inequalities

Health outcomes of mothers and their (unborn) children in the perinatal period, i.e., during pregnancy and shortly after birth, can vary by geographical location. This is often due to differences in exposure to medical and social risk factors. Policies aimed at reducing inequalities in perinatal health can provide significant long-term health benefits, especially for (unborn) children. However, a lack of insight into regional perinatal health inequalities means that perinatal health is not always a priority in policy formulation. Novel methods should be used to draw attention to these inequalities, spark interdisciplinary debate and encourage collaborative initiatives. In this commentary, we propose that the development of heat maps that visualize perinatal health outcomes, and risk factors for those outcomes, could be a valuable tool in doing this. Heat maps are a data visualization technique that uses color variations to emphasize value differences between areas. Visualizing health inequalities could potentially create a sense of urgency among (local) stakeholders to initiate polices aimed at improving perinatal health. We illustrate the targeted use of heat maps with an example from the city of Rotterdam, the Netherlands. Large perinatal health inequalities between neighborhoods were visualized in heat maps by a team from the Erasmus Medical Center to bring these inequalities to the attention of the municipality of Rotterdam. Local collaborative initiatives were set up to reduce perinatal health inequalities. These local initiatives formed the foundation for later national policies, including proposals to online implement heat maps regarding perinatal health topics, that are still ongoing today

Social determinants of vulnerability in the population of reproductive age: a systematic review

Background: The health of an (unborn) child is largely determined by the health and social determinants of its parents. The extent to which social determinants of parents or prospective parents affect their own health depends partly on their coping or resilience abilities. Inadequate abilities allow negative effects of unfavourable social determinants to prevail, rendering them vulnerable to adverse health outcomes. Addressing these determinants in the reproductive-aged population is therefore a key approach in improving the health of the future generation. This systematic review aims to synthesise evidence on social determinants of vulnerability, i.e., inadequate coping or low resilience, in the general population of reproductive age. Methods: The databases EMBASE, Medline, PsycINFO, CINAHL, Google Scholar, Web of Science, and Cochrane Library, were systematically searched from database inception to December 2th 2021. Observational studies examining social determinants and demographics in relation to vulnerability among the general population of reproductive age (men and women aged 18-40 years), conducted in a high-income country in Europe or North America, Australia or New Zealand were eligible for inclusion. Relevant data was extracted from each included article and findings were presented in a narrative and tabulated manner. Results: We identified 40,028 unique articles, of which 78 were full text reviewed. Twenty-five studies were included, of which 21 had a cross-sectional study design (84%). Coping was the most frequently assessed outcome measure (n = 17, 68%). Thirty social determinants were identified. Overall, a younger age, lower socioeconomic attainment, lack of connection with the social environment, and adverse life events were associated with inadequate coping or low resilience. Conclusions: This review shows that certain social determinants are associated with vulnerability in reproductive-aged individuals. Knowing which factors make people more or less vulnerable carries health-related implications. More high-quality research is needed to obtain substantial evidence on the strength of the effect of these social conditions in this stage of life

Afname van foetale en neonatale sterfte in Nederland : Vergelijking met andere Euro-Peristat-landen in 2004, 2010 en 2015

OBJECTIVE: To compare changes in foetal, neonatal and perinatal mortality in the Netherlands in 2015, relative to 2004 and 2010, with changes in other European countries and regions. DESIGN: Descriptive population-wide study. METHOD: Data from 32 European countries and regions within the Euro-Peristat registration area were analysed. These countries and regions were grouped into: the Netherlands, Scandinavia, Western Europe and Eastern Europe. International differences in registration and policies were taken into account by using rates from 28 weeks gestation for foetal mortality and for 24 weeks gestation and beyond for neonatal mortality. Ranking was based on individual countries and regions. RESULTS: Foetal mortality decreased by 24% in the Netherlands, from 2.9 per 1,000 births in 2010 to 2.2 per 1,000 births in 2015; neonatal mortality decreased by 9%, from 2.2 to 2.0 per 1,000 live births. Perinatal mortality (the sum of foetal mortality and neonatal mortality) decreased by 18% from 5.1 to 4.2 per 1,000 births. The Netherlands moved from the 18th place in the European ranking in 2004 to the 10th place in 2015. CONCLUSION: Foetal, neonatal and perinatal mortality in the Netherlands decreased in 2015 when compared with 2004 and 2010. The country's position in the European ranking also improved. Explanations for this decrease are related to changes in the areas of organisation of care, population and risk factors. When mortality rates in other European countries and regions - particularly Scandinavia - are considered there is room for further improvement