CANTONAL INTERVENTION PROGRAMMES

HEALTHY WEIGHT (CIP) AND

GOOD, BETTER OR BEST PRACTICE?

Health Promotion Switzerland

Chiara Testera Borrelli

Head, Healthy Weight

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Best Practice

Context

Knowledge

Values

Best PracticeContext

Knowledge

Values

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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 1,332’700 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%

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 ▐ 2004-2006: comprehensive quality assurance:

Best-Practice Framework for Health Promotion▐ 2006-2007: long-term strategy for Health Promotion

Switzerland, 2007-2018▐ 2006-2008: National Programme on Diet and Physical Activity,

2008-2012

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Specific Context: CIPs in strategic and knowledge environment

International level WHO Global Strategy on Diet, Physical Activity and Health

National levelNational Programme on Diet and Physical Activity 2008-2012

(Goal 4: Integrated approaches to promote healthy bodyweight)

Long term Strategy Health Promotion Switzerland

Cantonal levelCIPs

CIP: scope, objectives, target groups

▐ 4-year programmes▐ Long-term goal (2018): Increase proportion of population with

a healthy weight.Strategic goal, first stage (2007-2010): Slow down trend towards increasing overweight among children and adolescents by 2010.

▐ 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.

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Life-phase Perspective

Family

Young AdultsChildren III

Children II

Children IToddlersNewborn babies

Birth Adolescents

+ Peer Groups

e.g. food supply, advertising, spaces and programmes for physical activity, mobility

Environment

SettingsPre-school / School Working Life

or Higher Education

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Implementation Stages for CIPs

2) End 2008 (19 cantons)

3) July 201022 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 ImplementationChallenge 1: desire for standardised programmesChallenge 2: respect each canton‘s individual situationGoal: standardised, flexible modules adaptable to each canton‘s needs

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Best Practice

Context

Knowledge

Values

Best Practice

Context

Knowledge

Values

Best Practice

Context

Knowledge

Values

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

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Best Practice

Context

Knowledge

Values

Best Practice

Context

Knowledge

Values

Best Practice

Context

Knowledge

Values

Best Practice

Context

Knowledge

Values

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 2010▐ 2005: 5th Nutrition Report▐ Various new scientific resources / surveys (MOSEB)

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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.

Knowledge Creation: surveys, monitoring and evaluation

Healthy Weight Monitoring

Perspectives: Health Promotion Switzerland – Impact Management

Prevalence of overweight-related diseasesFOPH Project “KoLe“

Physical activity, nutrition, weight in SwitzerlandIndicators from Swiss Health Survey, Swiss Household Panel,..

Lamprecht & Stamm

BMI trends children and adolescentsBMI monitoring by School Medical Services; Lamprecht & Stamm

Policy monitoring Policy developments federal / cantonal levels – Dept.s of PHP

StakeholdersStakeholder surveys

Landert + Partners / t.b.a.

Physical activity, nutrition, weight in general populationPopulation 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, impactsOwn surveys, Health Promotion Switzerland

MediaMedia monitoring

Argus, University of Lugano

PopulationPopulation survey

University of Lugano

PolicyPolicy monitoring

Dept.s of PHP

Evaluation Cantonal Action ProgrammesWIG (Winterthur Institute for Health Economics),

Interface, University of Lugano

Evaluation Population CampaignUniversity of Lugano

Healthy Weight Evaluations

Evaluation action dInstitute for Addiction and Health Research (Inst. für Sucht- und Gesundheitsforschung)

Evaluation slowUpPolyquest, L&S

Self-evaluationHealth Promotion Switzerland

Meta Analysis – 2010t.b.a

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 levels1. 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 cantons4. Increase public awareness at cantonal level (with national support)- Create / spread knowledge (ongoing and context-relevant)

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.

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)

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

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. CIP’s

Imitation Award)?▐ Knowledge sharing

Update State-of-the-art report – Practical Knowledge. Presentations in cantons and national conferences.

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Thank you for your attention

For any further information, please contact:chiara.testera@promotionsante.ch

Health Promotion SwitzerlandDufourstrasse 30, P.O.Box 311, 3000 Bern 6, SwitzerlandTel. +41 (31) 350 04 04 - Fax +41 (31) 368 17 00www.healthpromotion.ch