New introductions to the same conclusions: a textual analysis of health inequalities in Dutch policy

Health inequalities are a major concern in many countries including The Netherlands. Policy documents describe strategies to reduce health inequalities. However, it often remains unclear what the problem of ‘health inequality’ entails and how the proposed solutions can support populations at risk of adverse health outcomes. Therefore, this study explores how health inequalities are represented in Dutch health policy documents and which assumptions and silences support the described problems and proposed solutions. Drawing on the framework ‘What’s the problem represented to be?’ (WPR), a discourse analysis of four Dutch national and local health policy documents was conducted from 2016 to 2020. The policy documents were coded in two phases: the initial phase used open coding followed by thematic coding using the WPR framework. Across the policy documents, health inequalities were represented as an urgent problem without a cause, solutions as individual responsibility, and health inequalities were mostly attributed to lower socioeconomic status. This representation includes assumptions and silences, indicating a meritocratic view of health. Although there has been a slight shift to a more complex and contextual understanding of health inequalities in more recent health policies, the proposed solutions remain inspired by a meritocratic way of thinking. The underlying meritocratic assumptions in health policies seem dominant and overshadow the complex and interactive narrative of health inequalities. More reflection and complexity-driven policymaking is needed to provide a broader understanding of health inequalities as a complex story in complex practice.