This is what Rotterdam needs to do to help its citizens become healthier

Academics at Erasmus MC devote a lot of research to public health in Rotterdam. But does…

If you want to tackle the root causes of problems in a city like Rotterdam, more intensive collaboration is needed between science and public servants, says Burdorf. Does the municipality really make such little use of research?

“A huge amount of knowledge is available, but it doesn’t – let me choose my words carefully – always reach the right people at the right time. At the Research and Business Intelligence department, where I work, we try to connect the two as much as possible. One example where this takes place is in the knowledge workplaces the municipality set up together with Erasmus University. We try to play a coordinating role between different parties to bring everyone in contact with each other. This is also something we do at our annual knowledge festival.

“But essentially it’s correct. There is a great deal of scientific research we don’t utilise. Because there’s not enough time, because people don’t see the importance, or simply because of a lack of the competencies needed to use such studies. It’s also difficult to evaluate where you can find valuable knowledge. A frequent stumbling block for people is that these scientific publications often lack a perspective for action.”

Is that a fair assessment?

“It is my firm belief that science gives us the answer to how something works, but science is not responsible for telling us what we should do. That mandate belongs to politics and the administrative system.”

Burdorf states that it sometimes seems that politicians are not looking for academic knowledge to resolve a problem. Instead, they randomly pick and choose the facts that support their own perspective. Is this something you’ve experienced?

“That happens. Part of the reason is that there is a high degree of nuance in science with a lot of leeway for interpretation, and scientists often contradict each other. But there is simply no easy way to link research and policy. Recently a scientist calculated that a new intervention would cost us a bit more than the one already in place, but it wasn’t much more effective. That was reason enough to say that the municipality should scrap the intervention. But it’s not so simple. Other interests also play a role. The alderman in question may have made certain promises in his election programme. Then it is a perfectly legitimate reason for him – even if this is the only reason – to stick to his decision.”

It’s even more unusual if an alderman wants something that demonstrably doesn’t work or is even counterproductive. How do you deal with that?

“There are those who feel that civil servants must always comply with whatever an elected representative asks. And in the end, it is in fact the elected representative who has the final say regardless of which way the decision goes. But if we know the alderman wants option A while there are more reasons to choose option B, it’s possible to discuss the matter. What’s more, it is your duty to do so. That’s what we refer to as public-sector professionalism. You serve politics, but you also serve public interests. So you have to ensure that all perspectives are presented, even the ones that aren’t aligned with the wishes of politicians.”

Are you advocating for adversarial public servants?

“Not exactly adversarial public servants, but I think it would be healthy to embed some kind of organised internal opposition. You have this in the corporate world and I believe you’ll find it in personal situations as well. The political-administrative sensitivity that is so important in high-ranking officialdom sometimes has too much influence on the lower levels of the organisation. One then asks: is this what the alderman wants? Or: is there political support for this? In fact, in my opinion the question should be: what is best for the city? A public servant who has worked here for twenty years sometimes understands issues better than an alderman who only holds office for only four years. If you then propose alternatives, knowledge and scientific research could play an important role.”

What can scientists do to ensure that, for example, Rotterdam’s public servants do more with their research?

“In general it can be said that there needs to be more focus on valorisation. I recently called a professor to ask if he would give a workshop on public-sector professionalism. He had written an excellent book on the subject, but had already published two more scientific articles since then and he didn’t want to spend so much time dwelling on this subject anymore. While that’s understandable, you’re left with nothing more than that one publication. If you want research to be converted into practice, it takes time, sometimes money, a great deal of patience, and a willingness to explain your research to professionals. You have to be prepared to make this investment.”

Erasmus MC wants to ‘possibly expand’ its ties with the city

Lex Burdorf doesn’t assign all the blame to the municipality. Academia itself has to accept that it has a role to play. Ernst Kuipers, Chairman of the Erasmus MC Executive Board, responded that he ‘sincerely’ supports Burdorf’s argument. “We feel it is Erasmus MC’s responsibility to focus significant resources on the health of Rotterdam’s residents. I can therefore confidently say that Burdorf’s call has not fallen on deaf ears. On the contrary: Erasmus MC annually invests many times more than the two hundred thousand he mentioned on initiatives for this purpose.”

As an example, Kuipers mentions programmes focusing on improving acute care and mental health care and promoting healthy weight. He also referred to prevention programmes such as early detection of contagious diseases and cancer. “In this context I would like to cite the bowel cancer population screening that was launched in Rotterdam nine years before it was implemented in the rest of the country. In addition to the people mentioned by Lex Burdorf, countless others Erasmus professionals are involved in these initiatives. We want to continue these efforts together with the new municipal executive and the new alderman, and, where possible, expand our activities.”