117 Implementation and experiences of the Solid Start program BACKGROUND Preconception, pregnancy and the first two years of life (the first thousand days) are crucial for children’s development and health, and a decisive period in the emergence of health inequities (1, 2). These avoidable differences in health outcomes (3) that start in early life pose an important challenge (2). Years of research that aimed to understand the nature and scope of health inequities showed both social and medical-related drivers, hence they should be addressed together in reducing health inequities (2, 4-6). Factors such as poverty, housing difficulties, stress and unemployment also highly influence health and wellbeing and cannot be addressed in the medical sector alone. Therefore, as stressed in several recent studies and reports, cross-sectoral collaboration between actors from the medical, social and public health sectors is considered essential to provide every child the best start in life (2, 7-10). Internationally, multiple countries have implemented programs and policy reforms to reduce health inequities by integrating medical and social services in early life (11-14). In the Netherlands, the nationwide action-program ‘Solid Start’ (in Dutch: Kansrijke Start) was launched by the Dutch Ministry of Health, Welfare and Sport (Dutch abbreviation: VWS) in 2018 (15). The program aims to provide each child the best start in life by stimulating cross-sectoral collaboration, with a specific focus towards (future) parents and young children in vulnerable situations. The program strategy is based on the foundations of previous programs that aimed to integrate medical and social services, including the local ‘Ready for a baby’ program in Rotterdam (2008-2012) (16) and the subsequent ‘Healthy Pregnancy 4-All’ programs in several municipalities (since 2011) (7, 17, 18). Solid Start has a comprehensive population-based and upstream strategy, which means that its preventive and supportive measures aim to address the underlying factors that influence health and wellbeing at an early stage, in order to prevent or mitigate problems in later life. Policy measures were implemented for three periods: prior to pregnancy, during pregnancy and after birth, in order to prevent inequity and improve later health and well-being. The measures are aimed at preventing unintended pregnancies, preparing parents better for pregnancy, identifying medical and non-medical problems sooner, and supporting (future) parents in vulnerable situations better. The Dutch government financially supported municipalities to build a cross-sectoral approach for the first thousand days by forming or strengthening integrated ‘Solid Start coalitions’. These coalitions consist of representatives of local organizations and providers working in the medical, social and public health domain, including midwives, obstetricians, maternity care assistants, youth healthcare providers, neighbourhood/social teams, social workers, debt counsellors, and municipal officials. The approach is supposed to be based on local data, challenges and existing networks. Hence, each municipality formulates its own objectives, agreements, actions and strategy to tackle the local problems. Previous studies on collaboration during the first thousand days often focused on either the medical or social sector, or a specific temporal window such as pregnancy or after birth only. For example, several studies within the medical sector in the Netherlands (19-23) and 5
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