Bringing the health service and social services closer together

Body, mind and social factors all affect our health and are all interconnected. A person is more than a complex biological machine. A person is a social being embedded in a network comprising family, friends, school, workplace and leisure activities. A good network is good for health. 

A literature review carried out by the University of Freiburg shows, for example, the influence that material factors (e.g., working conditions) and psychosocial risk factors such as stress or social isolation (loneliness) have on the development of diseases. Stress increases the risk of developing cancer by 47 per cent and the risk of psychiatric disorders by as much as 85 per cent. Social isolation increases the risk of cardiovascular disorders developing by 26 per cent and the risk of dementia by 27 per cent. Stress and social isolation can also affect the use of alcohol and tobacco, both high-risk activities. 

Conversely, these psychosocial factors can also have a positive effect. According to the literature review, social integration reduces the likelihood of developing musculoskeletal disorders and dementia. 

Other studies show that a large proportion of people receiving welfare benefits in Switzerland have chronic illnesses, mental health issues and a poorer quality of life. There is a link between poverty and health.

On the whole, then, it is not surprising that socially isolated individuals have a two to five times higher risk of dying prematurely (source: Obsan Dossier 27). A large number of studies show that social support has a major positive impact on life expectancy. This integrated approach to health is based on what is known as the biopsychosocial model, which combines body (bio), mind (psycho) and social milieu.

Let’s take a typical example of an elderly woman who has a fall in her kitchen and requires surgery in hospital. She would like to return home as quickly as possible. However, her family members are overwhelmed by the task of caring for her, have fallen out with each other and are not sure that they can cope with the burden. A new setting now has to be established in which everyone is involved: the patient, her family, doctors, care providers, etc. Her discharge from hospital must be planned carefully and a supportive environment needs to be created and maintained. What is the best solution for the patient and for the family? 

In cases like this, the health service and social services may be operating in two unconnected worlds: healthcare professionals in one and social workers in the other, with health insurance and accident insurance on one side, and invalidity insurance, supplementary benefits, welfare benefits, etc. on the other. The funding systems are separate, tasks are fragmented in a 
way that is no longer in keeping with modern life, and the legal provisions are largely uncoordinated. 

«Es geht um Therapien und Angebote, die gut ineinandergreifen, und um Netzwerke, die komplementär und aufeinander abgestimmt sind.»

“What we need to do is open up these isolated worlds by building more and stronger bridges between them,” says Simona De Berardinis, Head of National Addiction Strategy at the FOPH. “What we’re aiming for are well-integrated therapies and services, and networks that complement and are coordinated with each other.” It is important for specialists to have some understanding of how the other players within the overall system function and what they offer, and to seek to coordinate with them. In many cases it is also necessary to find a common language because the jargon and thought processes are so different.

Marianne Jossen, Head of National Strategy for Non-communicable Diseases, adds: “These bridges are also important in terms of cooperation between the different authorities, and more specifically between the FOPH and the Federal Social Insurance Office (FSIO) because integrated health promotion can only succeed on a foundation of cross-sector and interprofessional collaboration.” 

Health 2030, the Federal Council’s health policy strategy which, among other things, defines greater emphasis on coordinated care as one of its objectives, forms the basis of this undertaking.

The FOPH has initiated a number of measures designed to improve the situation, all based on the bio- psychosocial model, which include promoting interprofessional collaboration in healthcare and integrating the E+E approach (early detection and early intervention). A study commissioned by the FOPH also looked at the conditions necessary for success when establishing interprofessional collaboration at the interface of the health service and social services.

Other measures include work related to forward health planning, the palliative care and dementia platforms, stakeholder networking and knowledge sharing, for example in the form of events such as this year’s stakeholder conference or round tables offering specialists the opportunity to discuss psychosocial determinants of health. 

Das BAG fokussiert bei der Umsetzung auf bestimmte Schlüsselereignisse. Ereignisse im Leben, die Ressourcen aktivieren können: der Übergang von der Schule in die Ausbildung, der Tod eines nahen Menschen, Schwangerschaft und Geburt, Krankheit, Arbeitslosigkeit, Scheidung, Trennung, Lebensende etc. Denn gerade bei diesen Schlüsselereignissen kann ein guter Austausch zwischen Gesundheitswesen und Sozialwesen entscheidend sein.