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C ANTONAL I NTERVENTION P ROGRAMMES H EALTHY W EIGHT (CIP) AND G OOD, B ETTER OR B EST P RACTICE? Health Promotion Switzerland Chiara Testera Borrelli.

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Presentation on theme: "C ANTONAL I NTERVENTION P ROGRAMMES H EALTHY W EIGHT (CIP) AND G OOD, B ETTER OR B EST P RACTICE? Health Promotion Switzerland Chiara Testera Borrelli."— Presentation transcript:

1 C ANTONAL I NTERVENTION P ROGRAMMES H EALTHY W EIGHT (CIP) AND G OOD, B ETTER OR B EST P RACTICE? Health Promotion Switzerland Chiara Testera Borrelli Head, Healthy Weight

2 2 Best Practice Context Knowledge Values Best Practice Context Knowledge Values

3 3 General Context: 26 cantons Mountains: 70% of the area Highly federal system, 26 cantons Cantons are in charge of health Cantons large and small (Zürich: over 1, inhabitants; Uri: 57,750) Cantons rich and poor, urban and rural 4 languages / cultures Immigrant population: 20% average; great variation among cantons. Illustration: Federal Office of Statistics 66% 20% 10%

4 Specific Context: origins of CIP initiative 2004: WHO Global Strategy on Diet, Physical Activity and Health 2005: our state-of-the-art report Healthy Weight: In 1999, 20% of Swiss children were overweight. In 2002, 37% of adults were overweight. Costs: CHF 2.6 billion 2005: meetings with almost all Cantonal Health Ministers : comprehensive quality assurance: Best-Practice Framework for Health Promotion : long-term strategy for Health Promotion Switzerland, : National Programme on Diet and Physical Activity,

5 55 Specific Context: CIPs in strategic and knowledge environment Strategies and programmes International level National level Cantonal level WHO WHO-EU EU Commission Global Strategy on Diet, Physical Activity and Health The European Charter on Counteracting Obesity White Book: European Strategy on Nutrition, Overweight, and Obesity-related Issues National Strategy (NPDPA 2008 – 2012) Ensure coordination Promote balanced nutrition Promote integrated approaches to healthy weight Promote regular physical activity Improve therapies and counselling Federal Office of Public Health Federal Office of Sport CH Council for Accident Prevention (BFU) Health Promotion Switzerland Health Insurance Companies Others Strategy Health Promotion Switzerland... Cantonal Intervention Programmes... Departments Sports Teachers Medical practitioners Others Cantonal Intervention Programmes 4 Levels Interventions Policy NetworkingIncrease public awareness Measures Agencies Theory Practice

6 Specific Context: CIPs in strategic and knowledge environment International level WHO Global Strategy on Diet, Physical Activity and Health National level National Programme on Diet and Physical Activity (Goal 4: Integrated approaches to promote healthy bodyweight) Long term Strategy Health Promotion Switzerland Cantonal level CIPs 6

7 CIP: scope, objectives, target groups 4-year programmes Long-term goal (2018): Increase proportion of population with a healthy weight. Strategic goal, first stage ( ): Slow down trend towards increasing overweight among children and adolescents by Target group(s): Children and adolescents (aged 0-16) and influential people around them (parents, teachers, medical practitioners, peers, …). Life-phase perspective (see following slides) Settings: pre-school, school, family, peer groups; any other relevant settings for target groups.

8 8 Life-phase Perspective Family Young Adults Children III Children II Children IToddlers Newborn babies BirthAdolescents + Peer Groups e.g. food supply, advertising, spaces and programmes for physical activity, mobility Environment Settings Pre-school / School Working Life or Higher Education

9 9 Implementation Stages for CIPs 2) End 2008 (19 cantons) 3) July out of 26 cantons have signed contract, and are implementing their programmes 1) End 2007 (6 cantons in process of implementation) Nationwide! Challenges to Practical Implementation Challenge 1: desire for standardised programmes Challenge 2: respect each cantons individual situation Goal: standardised, flexible modules adaptable to each cantons needs

10 10 Best Practice Context Knowledge Values Best Practice Context Knowledge Values Best Practice Context Knowledge Values

11 Values and Principles – in Swiss context Strong basic democracy Respect for cultural differences between members of Swiss German, Swiss French and Swiss Italian linguistic communities – in CIPs All cantons have equal rights / equal duties Shared responsibility for health: e.g. cantons must co-finance programmes Transparency and Accountability: our resources are public money! Respect of autonomy: each canton has different structures, needs and priorities. Already existing projects must be integrated in the CIP Sustainability of the programmes: efforts to anchor measures in existing structures Health equity: focus on vulnerable groups! Focus on health and health determinants Participation Empowerment throughout

12 12 Best Practice Context Knowledge Values Best Practice Context Knowledge Values Best Practice Context Knowledge Values Best Practice Context Knowledge Values

13 The CIP Knowledge Base Scientific knowledge Practice / Expert knowledge Evaluation / Knowledge creation CIP Scientific Knowledge 2005: State of the Art Report Healthy Weight; update due : 5th Nutrition Report Various new scientific resources / surveys (MOSEB) 13

14 Practical / Expert Knowledge 2010 State-of-the-Art Report: Scientific AND Practical Knowledge (Best Practice). Results already being used to improve CIPs. Annual CIP Networking Day for exchange and mutual learning (practice to practice). National CIP Advisory Board with cantonal representatives: source of expert and practical knowledge. Active participation in different national meetings or commissions: important tool to activate scientific / practical / context knowledge. Example: Cantonal Steering Groups, where scientific knowledge is added.

15 Knowledge Creation: surveys, monitoring and evaluation Healthy Weight Monitoring Perspectives: Health Promotion Switzerland – Impact Management Prevalence of overweight-related diseases FOPH Project KoLe Physical activity, nutrition, weight in Switzerland Indicators from Swiss Health Survey, Swiss Household Panel,.. Lamprecht & Stamm BMI trends children and adolescents BMI monitoring by School Medical Services; Lamprecht & Stamm Policy monitoring Policy developments federal / cantonal levels – Dept.s of PHP Stakeholders Stakeholder surveys Landert + Partners / t.b.a. Physical activity, nutrition, weight in general population Population survey - University of Lugano Physical activity, nutrition, weight in print media Media monitoring BEG – Argus, University of Lugano Physical activity, nutrition, weight at Swiss schools Situation monitoring at schools - University of Lugano Investments, services, impacts Own surveys, Health Promotion Switzerland Media Media monitoring Argus, University of Lugano Population Population survey University of Lugano Policy Policy monitoring Dept.s of PHP Evaluation Cantonal Action Programmes WIG (Winterthur Institute for Health Economics), Interface, University of Lugano Evaluation Population Campaign University of Lugano Healthy Weight Evaluations Evaluation action d Institute for Addiction and Health Research (Inst. für Sucht- und Gesundheitsforschung) Evaluation slowUp Polyquest, L&S Self-evaluation Health Promotion Switzerland Meta Analysis – 2010 t.b.a

16 How We Work (strategies) Persuade cantons to become involved in CIP: - Incentives (financial, others): Co-financing and sustaining CIP with tools and methodology - Advocacy: Overweight as a public-health priority - Building leadership: persuade Cantonal Executives to commit themselves to preventing overweight To reach our objectives within CIP: - Integrated approach: promote healthy nutrition AND physical activity - Act on behavioural patterns AND living conditions - Life-phase perspective - Must-do: implement measures at all four levels 1. Interventions for Children and Adolescents (Modules: transfer good practice; avoid reinventing wheel; mutual learning) 2. Cantonal Policy Approach (improve living conditions) 3. Networking within and across cantons 4. Increase public awareness at cantonal level (with national support) - Create / spread knowledge (ongoing and context-relevant)

17 For Example – the Swiss-Italian Canton of Ticino Modules Target groups: children aged 4 to 11, multipliers (e.g. parents, teachers, physicians, care-givers), general population Projects, e.g.: At school: Movimento e gusto (Movement and Gusto / Taste). Train teachers in healthy nutrition and physical activity. Work with parents. Instill healthy culture in schools. Outside School: Pédibus. Promote walking to school and provide safe footpaths / access to school.

18 For Example – the Swiss-Italian Canton of Ticino Policy Approaches Fourchette Verte (Green Fork) for school children: Ensure school caterers adhere to Swiss recommendations on nutrition (Label) Encourage promotion or sale of healthy food in schools (add healthy choices to vending machines for soft drinks and snack food) Networking Work with all other Latin cantons; collaborate with other organisations or departments (of Education); major conference every three years Raise public awareness Intense effort to spread information (articles in consumer and other magazines, radio and TV programmes, events)

19 Summary of Standardised CIP Self-evaluation Integration / expansion of existing projects and institutions / agencies Decreasing development costs – transfer beginning to pay off Most projects respond to structures and living conditions Implemented actions becoming more visible Focus still on Modules Policy awareness improved but still too low Greater awareness of issue of equal health opportunities Improved networking among Latin cantons Certain fatigue among Programme Leaders? Context key to effective implementation Target groups reached? can be measured only in 40% of all projects

20 Lessons Learned Regarding Best-Practice Approach Main lessons learned in CIP implementation Transfer works but context is key. Adaptation must be factored in. Better use made of synergies. Other key aspects: networking and mutual learning (saves resources) Recommendations Best-Practice Framework is:- - a valuable instrument for reflection on and further development of CIP: e.g. concerning equal health opportunities, or sustainability of CIPs - Would be better used at beginning; developing programmes (e.g. CIPs Imitation Award)? Knowledge sharing Update State-of-the-art report – Practical Knowledge. Presentations in cantons and national conferences.

21 21 Thank you for your attention For any further information, please contact: Health Promotion Switzerland Dufourstrasse 30, P.O.Box 311, 3000 Bern 6, Switzerland Tel. +41 (31) Fax +41 (31)


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