169 General discussion FUTURE OUTLOOK: RECOMMENDATIONS FOR PRACTICE, POLICY AND EDUCATION There was a continuous focus on Solid Start in Dutch policy and practice during the time that this thesis was written, marked by new policy developments that further encouraged prevention and integration. In 2022, an Integrated Care Agreement (Dutch abbreviation: IZA) was signed by a wide range of representatives from the health and social care sector. Solid Start was mentioned as one of the approaches to ensure the future quality, affordability and accessibility of healthcare. Moreover, Solid Start was prominently featured in the healthy and active living agreement (Dutch abbreviation: GALA), published at the start of 2023, to contribute to a healthy generation in 2040 (90). These agreements voiced the ambition to integrate a Solid Start approach in every Dutch municipality. This has been translated into structural funding for Solid Start, enabling municipalities to request specific allocation (Dutch abbreviation: SPUK) funds to 1) initiate, strengthen and secure their coalition, 2) enhance the implementation of Solid Start interventions, and 3) establish regional collaborative agreements. In 2022, the Ministry of Health, Welfare and Sport published the follow-up approach Solid Start 2022–2025 Strong parents, healthy children! that outlines the mission, vision, strategy and actions to provide all children the best start in life. Additionally, there has been an increase in policy developments and research agendas that focus on prevention and integration through cross-sectoral collaboration for other populations. Essentially, the action program Solid Start must be seen as part of this wider movement. In light of these developments, this thesis provides several points of discussion that can inform the optimization of the action program Solid Start and potentially similar initiatives. Multiple implications are addressed in the separate chapters. The paragraphs below describe our overall recommendations for practice, policy and education, based on our lessons learned and methodological considerations. Create a long-term perspective and maintain sense of urgency by positioning Solid Start as the ultimate form of prevention Integrating the structures, cultures and practices of all involved in the first thousand days is no easy task, but the movement that has been initiated is important to sustain over the long-term to make lasting improvements. Considering that fragmentation has accumulated over time, it is reasonable and well-described that integration or transformation extends over a period of multiple years or decades as well (91). Therefore, we recommend positioning Solid Start even more prominently as an ultimate form of prevention and means to improve health, well-being and equity across the lifespan. In this regard, we believe that the IZA, GALA and follow-up approach help to spread the ‘first thousand days-narrative’ and maintain a sense of urgency for the action program Solid Start and cross-sectoral collaboration in early life. Next, the IZA, GALA and follow-up approach can provide the necessary sustained governmental stewardship (including structural funding) to build capacity and sustainability in local actions. It still remains important to allow local 6
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