Seixal City Health Development Plan
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Messages from the Healthy Seixal Project Technical Co-ordinator and Political Co-ordinator
The Seixal City Health De- The present plan is not only an evolution; it is also a com- Dear citizens and partners, velopment Plan for the Mu- mitment. It represents the commitment of services, struc- nicipality of has proven a tures and citizens who over the months have worked to put The Seixal City Health De- precious instrument for the it together. velopment Plan is vitally deployment of the Health important, in the revision For All Strategy, within the Therefore, we have tried to focus future actions on priority we hereby present, in this Healthy Seixal Project. areas, setting out from higher knowledge, hence a more development phase of the realistic situation, and putting the health gains from those Healthy Seixal Project. It Since 1998, when the Plan interventions in perspective. records the whole partner- was approved, new joint ship work, identifies needs, actions have been estab- The Plan is divided in eight chapters, according to the devises actions and in- lished for health locally, major strategic lines. Each chapter identifies the starting volves community agents. practical knowledge has point through analysis of available information, as well as In this context, health is the been generated on how to promote citizen heath, work the community’s opinion. New goals have been set and goal everyone strives to achieve. habits have been created for intersectoral teams and new ways of evaluating those goals have been found. everybody’s conscience has been raised towards active This Plan is also an exercise of democracy, mirroring the participation on the defence of health and quality of life. In assuming this plan, we state our ambition to do more spirit of cooperation and associative qualities of the Health gains have shown the path we have walked has and to do best. We thank everyone involved wholehearted- Municipality. To live, build and develop, a healthy city no been worth it: we have a deeper knowledge and control ly; they represent the trust and energy which will enable us doubt needs to create conditions which encourage com- over health determinants; various health promotion pro- to build a healthier Seixal together. munity participation and allow for a wholesome experience jects have been implemented, aimed at children and of citizenship. youngsters, women, senior citizens, active citizens and ethnic minorities; wide spaces for discussion have been Technical Co-ordinator Programs developed within the scope of the Healthy Seixal created, such as the Healthy Seixal Forum, which every Celeste Gonçalves Project have direct and indirect influence on different le- two years brings together around 150 institutions and 400 (Public health practitioner) vels (such as social action, education, culture, sports, envi- people to analyse and increase health in the Municipality of ronment, vulnerable groups, and lifestyles, among many Seixal. others), thus globally contributing to the quality and well being of the population. The initial proposal has not always been followed. The Health Development Plan is a work tool which has never- This document reflects in itself the partnership work and theless changed according to new problems and the con- intersectoral spirit needed to put it together. Therefore, on stant need to adapt to changes and find solutions for those behalf of the Healthy Seixal Project, I would like to thank problems. wholeheartedly everyone who cooperated to put this Project together, as well as everyone who, on a daily basis, It must also be mentioned that monitoring health is not helps make it come true. easy. Health information systems leave a lot to be desired, although adequate tools have been created within this Political Co-ordinator scope, like analysis of some health indicators through the Alfredo Monteiro geographical information system and application of opi- (Mayor of Seixal) nion surveys conducted regularly on the inhabitants of Seixal.
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Introduction
“Seixal Saudável - Juntos pela Saúde” (Healthy Seixal – Together for Health): Motto for a Movement with Roots
The Healthy Seixal Project joins together several institutions for the development of health in the Municipality of Seixal. It integrates over 100 institutions, mainly municipal institu- tions, organized according to the following structure:
Political Co-ordinator Technical Co-ordinator
The Mayor of Seixal The Health Authority for the Municipality of Seixal
Officer Group Steering Group Ensures the project is carried Lays down the philosophy and strategy according to the guidelines defined for the project. by the Steering Group.
Healthy Seixal Forum Healthy Seixal Partnership Healthy Seixal Project Office
A grand municipal initiative which joins The group of institutions which, in their own competence Collects and produces information together every Healthy Seixal Project and co-operating across a range of sectors, animate the on the Project; Follows and monitors partner and other interested entities. programs in the Seixal City Health Development Plan. the Health Development Plan along It evaluates the main program areas and with the Project partners. intersectoral projects within the Health Its cooperation with the Project is revealed through Development Plan. signing a Declaration of Commitment to the Project’s principles and developing a set of good practices and plans designed in the Partnership Letter.
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The Seixal City Health Development Plan: A Continuing Process for the Global Development of the Municipality
The Municipality of Seixal has assumed its involvement with the principles of the Healthy Cities movement of the World Health Organization (WHO) in 1991. This commitment was made formal in 1998, following the integration of the Municipality in Phase III (1998-2002) of the WHO European Healthy Cities Network.
To properly address this commitment, a thorough study of the Municipality was made, resulting in the Health Profile for the Municipality of Seixal. This was the first Municipality diag- nosis, about the health of the population and what conditions it. Therefore, it includes a detailed analysis of data and demographical, health, socio-economical, environmental and other indicators.
Based on the results observed with the Health Profile, and together with representatives of different activities in the Municipality, as well as the local community, a second strategic document was put together, where the main intervention lines as to the needs identified in the Health Profile can be found. That document, the Seixal City Health Development Plan, was a guideline for the intervention of the Healthy Seixal Project in Phase III of the Healthy Cities Project.
After the end of the Plan’s timeline, it was reviewed based on a series of designs.
The Health Development Plan’s review for Phase IV is based on:
> The evaluation of the Health Development Plan for 1998-2003 and the Health Profile. > The application for Phase IV (2003-2008) of the World Health Organization’s European Healthy Cities Network.> An efficient management of the processes tied to the Plan’s development, and the improvement of monitoring mechanisms and evaluation. > Assuming the Plan as a dynamic, developing and continually improving process. > Continuously improving the methods to implement the Health Development Plan, creating work groups to develop its greater areas. > Promoting good practices in health, developing a set of principles which aim to assure that developed actions and projects are well guided, and promoting their efficiency.
Adding to these plans, the application to Phase IV and implementation of the Health Development Plan are based on a set of principles which are explained in the Declaration of Commitment signed by the political co-ordinator for the Healthy Seixal Project and its partnership. Which principles underline the review of the Phase IV Health Development Plan?
> Contributing to the promotion and development of health and quality of life in the Municipality of Seixal, and to the application of other basic principles and purposes of the World Health Organization Healthy Cities Project in the Municipality of Seixal. > Supporting the application of the Municipality of Seixal to Phase IV of the World Health Organization Healthy Cities Project. > Supporting the implementation of WHO’s Health for All in the 21st Century principles and strategies, through the reduction of inequalities in health, promotion of healthy lifestyles, environment salubrity, and adequate health, among others. > Supporting the implementation of Local Agenda 21 principles and strategies, promoting a sustainable development and healthy environment which meets present needs and does not jeopardize the possibility for future generations to fulfil their own needs. > Cooperating with the Healthy Seixal Project Partners and supporting the participation of the Municipality of Seixal in the World Health Organization Healthy Cities Network.
Before presenting the Plan, it is important to review the general context it applies to, briefly mentioning some social-demographical indicators for the Municipality.
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Seixal: Past, Present and Future
The building of the Phase IV Health Development Plan involved a review of some of the more representative indicators of actions with impact on health, already developed and to be developed in the future, within the Healthy Seixal Project.
These data will be explained in detail in the review of the Health Profile for the Municipality of Seixal; therefore a brief summary follows.
Municipality of Seixal: What defines it?
It is located on the southern bank of the river Tagus, in the Setúbal peninsula, and integrates the Greater Lisbon Area. It extends over 94 km2.
Figure 1 The Municipality of Seixal in Portugal and in Europe
Corroios Seixal Amora
Paio Pires
Arrentela
Fernão Ferro
Europe Portugal - Mainland and Islands Municipality of Seixal
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The Municipality of Seixal integrates, according to the INE (Instituto Nacional de Estatística, National Statistical Institute) estimate for 2004, around 164 thousand citizens, and is the second most populated municipality in the Setúbal District, eighth in the AML (Área Metropolitana de Lisboa, Greater Lisbon Area) and thirteenth in the country.
The Municipality of Seixal has experience a significant growth, boasting nowadays 140 000 more inhabitants than in the beginning of the 60s. The variation rate, which is represented in Figure 2, has in the last decades surpassed the rates for the Greater Lisbon Area and Mainland Portugal.
Figure 2 Figure 3 Evolution of the variation rates for population in the Resident population of the Municipality of Seixal Municipality of Seixal, AML and Mainland Portugal in 2004, according to age group (estimate)
18.312; 11% 27.499; 17%
20.452; 12%
Mainland
98.452; 60%
Source: Source: National Statistical Institute (Instituto Nacional de Estatística) – Censos 1960, 1970, 1981, 1991 e 2001 Instituto Nacional de Estatística (National Statistical Institute) – Estimates of resident population, by sex and City Council of Seixal – Land Use Plan Division greater age groups and indexes in 31/XII/2004 (new NUTS - Nomenclatura das Unidades Territoriais para Quoted by Seixal em Números – Informação Estatística (CMS, 2003) Fins Estatísticos. Nomenclature of Territorial Units for Statistical Purposes)
Composed by the Parishes of Aldeia de Paio Pires, Amora, Arrentela, Corroios, Fernão Ferro and Seixal, where Amora has the most inhabitants and Seixal the least. The Parish of Arrentela is however the most densely populated, at 2980 inhabitants per km2, followed by Corroios at 2750, Amora at 1868, Seixal at 1044, Aldeia de Paio Pires at 904, and finally Fernão Ferro at a mere 425.
In terms of people distribution by age groups, the biggest group is the 25-64-year-olds (60%), followed by the younger people, up to 14 years of age (17%).
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SEIXAL CITY HEALTH DEVELOPMENT PLAN
Considering the issues reviewed, a new Health Development Plan was devised for Phase IV of the Project, which is represented in general terms in the following figure:
Varying replies aranteeing Gu and making physical Promoting pulsory com activities accessible to health in children vaccination Improving indicator everyone and youngsters principles for population health preventing with higher rates of morbiditymor and mortality Improving acces Fighting Living (together) in to health services sedentary healthy institutions - and supporting habits dependent chronic schools as well as Making Promoting patients work places health care more female health Promoting accessible to the family Improving mobility community well-being conditions and reducing Promoting Fighting architectonical social Promoting Physical mental barriersb Promoting the Improving isolation and health rehousing of people living Activity and the health of ensuring full Improvinging in slums and improving Active Living our women, citizenship Access and experience the quality of life in children and least privileged Quality of Health Improving neighbourhoods youngsters housing Services Reducing Diseases Preventing conditions drug addiction Assuring Encouraging conditions for associations Increasing Improving the quality healthy ageing of urban physical Environmental environment Quality and Healthy Urban Planning in our Promoting Promoting City Mental Health healthy and Social Increasing behaviours for all t Well-Being information and communication Promoting c Developing equity in health Acting on training and a Promoting education for and inclusion of Health Community the most vulnerable Determinants health population p Participation in Health groups Defense for All
m
I
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These greater areas may be divided in sub-themes with attainable goals, specific intervention strategies and unique evaluation methods:
> Acting on Health Determinants > Promoting equity in health and inclusion of the most vulnerable social groups
> Promoting healthy behaviours for all Health Impact
> Increasing Environmental Quality and Healthy Urban Planning in our City > Improving the quality of urban physical environment > Improving housing conditions > Promoting the rehousing of people living in slums and improving the quality of life in least privileged neighbourhoods > Improving mobility conditions and reducing architectonical barriers > Living (together) in healthy institutions – schools as well as work places
> Improving Access and Quality of Health Services Reducing Diseases > Making health care more accessible to the community > Improving indicator principles for population health and preventing diseases with higher rates of morbidity and mortality > Guaranteeing compulsory vaccination
> Promoting Physical Activity and an Active Living > Fighting sedentary habits > Varying replies and making physical activities accessible to everyone
> Improving the Health of our Women, Children and Youngsters > Promoting health in children and youngsters > Promoting female health
General Structure > Assuring Conditions for Healthy Ageing > Fighting social isolation and ensuring full citizenship experience > Improving access to health services and supporting dependent chronic patients
> Promoting Mental Health and Social Well-Being > Preventing drug addiction
Health Development Plan – Phase IV > Promoting mental health > Promoting family well-being
> Promoting Community Participation in Health Defense for All > Encouraging associations > Increasing information and communication > Developing training and education for health
A detailed explanation of these themes will follow.
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ACTING ON HEALTH DETERMINANTS
The definition of health includes, beyond the different features directly related to the individual, also their general context. Therefore, a greater set of elements may contribute, due to their nature and scope, to the promotion of health or, on the contrary, to condition it and put it at risk. It is thus vital to consider the different areas of intervention in the promotion of community health, to promote healthy environments and lifestyles, to encourage positive behaviours and attitudes towards health and to prevent non-transmittable diseases, reducing common risk factors such as: smoking habits, problems related to alcohol and illicit drug consumption, miseating, physical inactivity, and psy- cho-social stress.
The facts... Community opinion...
Figure 4 Figure 5
Unemployed individuals registered in the Seixal Classification of the statement Employment Centre, according to sex “I feel my city offers the same well-being opportuni- and age group, in 2004 ties to everyone regardless of their characteristics”
Men Women
Strongly Disagree Disagree
Undecided Agree
Strongly agree N/A
Source: Source: IEFP - Seixal Employment Centre (2005). Questionnaire survey (CMS & ISPA, 2003/04).. Quoted by Diagnóstico Social do Seixal (Seixal Social Diagnosis) (2005).
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What shall be further done?
> Promoting equity in health and inclusion of the most vulnerable social groups > Promoting healthy behaviours for all
What are the expected results? How are these evaluated?
> Conducting 25% of the inactive immigrant population to professional training or insertion in active life. > Statistical analysis of data from IEFP (Instituto de Emprego e Formação Profissional, Employment and Professional Training Institute) > Increasing in 30% the access of immigrants to health services. > Clinical logs monitoring
> Conducting 20% of inactive people with disabilities to professional training or insertion in active life. > Statistical analysis of data from IEFP
> Increasing social support for people with disabilities in 20%. > Social Security Annual Report
> Increasing in 25% the direction of people included in the Social Insertion Income to professional training or > Statistical analysis of data from IEFP insertion in active life.
> Increasing in 10% the academic level in young and adult school leavers. > Statistical analysis of reports from IEFP and the Ministry for Education
> Exploring the Road Safety Project in the Municipality of Seixal and creating conditions to decrease in 20% > Monitoring the council’s Road Safety Project and analysing the mortality and disability rate due to road accidents. the road accident logs
> Decreasing in 10%, the number of carbon monoxide intoxications in hospital emergency rooms > Analysis of the evolution of hospital emergencies due to carbon monoxide
> Creating conditions for 65% of children under 6 to have no cavities.* > Monitoring the number of cavities in children under 6
* Based on the goals for 2010 established by the Directorate-General for Health through the National Health Plan.
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INCREASING ENVIRONMENTAL QUALITY AND HEALTHY URBAN PLANNING IN OUR CITY
Healthy Urban Planning means planning for the people. It means putting the needs of individuals and communities at the heart of the urban planning process, consi- dering the influence every decision may have in people’s health and well-being. Other goals are tied to this greater goal, such as Healthy Lifestyles, Social Cohesion, Housing, Access to Employment, Accessibility, Local Production of Low Chemical Consumption Food, Security, Equity, Air and Environment Quality, Water and Sanitation Quality, Soil and Mineral Resources Quality, and Weather Stability, which should be part of the work agenda of Healthy Cities. .
The facts... Community opinion...
Figure 6 Figure 7 Evolution of the rate of urban solid waste collected in hermetic containers and through Classification of replies to the question voluntary selective collection “How healthy is your physical environment?”
Hermetic Containers Voluntary Selective Collection
Not at all A little A moderate amount Very much Extremely N/A
Source: Source: City Council of Seixal - Salubrity Department. Questionnaire survey (CMS & ISPA 2003/04).
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What shall be further done?
> Improving the quality of urban physical environment > Improving housing conditions > Promoting the rehousing of people living in slums and improving the quality of life in least privileged neighbourhoods > Improving mobility conditions and reducing architectonical barriers > Living (together) in healthy institutions – schools as well as work places
What are the expected results? How are these evaluated?
> Eliminating 15% of critical areas of contamination of water tables and fresh-water areas and recovering at least > Annual report of the Healthy Urban Planning Group 20% of soil area contaminated by hazardous waste.
> Increasing the volume of treated waste water and the selective collection of solid waste. > Annual report of the Healthy Urban Planning Group
> Establishing an internal regulation to define quality patterns for new housing estates to approve and creating > Annual report of the Healthy Urban Planning Group mechanisms and incentives to encourage their deployment.
> Offering dignified housing conditions to everybody, with connection to water supply and electricity and a safe > Annual report of the Healthy Urban Planning Group waste water draining system.
> Promoting early follow-ups for over 60% of school leavers and/or psycho-social problems identified by teachers > School registers for educational support.
> Creating conditions for 90% of schools to have good environment hygiene and safety conditions.* > School hygiene and safety conditions monitoring
> Reducing work accidents in 20%. > Work accidents monitoring
* Based on the goals for 2010 established by the Directorate-General for Health through the National Health Plan.
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IMPROVING ACCESS AND QUALITY OF HEALTH SERVICES AND REDUCING DISEASES
Access to quality health services is a fundamental right of every citizen and represents an essential condition to prevent and treat diseases. The fast population growth of urban areas often poses constraints at this level and demands quick, more or less differentiated answers from health institutions, and more and more qualified professio- nals.
Health services users must be recognised as important active agents in the promotion of health and general well-being. In this sense, the health promotion and disease prevention actions shall continuously deserve highlights in this new phase of the Healthy Seixal Project.
The facts... Community opinion...
Figure 8 Figure 9 Health services users registered at Health Classification of replies to the question Centres and users with no general practitioner “How satisfied are you with your health?” assigned by Health Centre
Total people registered
Users registered with no general tractitioner assigned
Users registered with no general tractitioner assigned (%) Very dissatisfied Dissatisfied Neither satisfied nor dissatisfied Satisfied Very satisfied N/A
Source: Source: SINUS – Sistema de Informatização Nacional de Unidades de Saúde, (National Questionnaire survey (CMS & ISPA, 2003/04). Health Units Computerisation System), 30/04/2005. Quoted by the ARS Evaluation and Studies Cabinet - Health Sub-Region of Setúbal
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What shall be further done?
> Making health care more accessible to the community > Improving the main indicators for population health and preventing diseases with higher rates of morbidity and mortality > Guaranteeing compulsory vaccination
What are the expected results? How are these evaluated?
> Promoting breast cancer screening in at least 60% of the target population.* > Clinical reports
> Promoting rectum and colon cancer screening in at least 60% of the target population.* > Clinical reports
> Creating conditions for standard mortality rate by AIDS before 65 years of age not to exceed 7/100 000 > Clinical reports individuals.*
> Reducing in 10% the incidence rate of ischemic diseases in people under 65. > Clinical reports
> Increasing in 10% hypertensive patients attendance. > Clinical reports
> Increasing in 10% the satisfaction of users regarding health care services to the most vulnerable population. > Surveys in target population
> Reducing TB in 10%. > Health reports
> Increasing in 10% the coverage of home care regarding continued care. > Yearly reports
> Increasing in 20% the production of culturally adapted informative material regarding access and usage of > Evolution in the number of produced materials, by theme health services.
* Based on the goals for 2010 established by the Directorate-General for Health through the National Health Plan.
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PROMOTING PHYSICAL ACTIVITY AND ACTIVE LIVING
Regular and moderated physical activity is one of the most effective ways to improve health and keep healthy. Being physically active increases energy levels, helps reduce stress and reduces bad cholesterol and blood pressure levels. It also helps prevent and control heart diseases, diabetes, obesity, and osteoporosis, and reduces risk of certain forms of cancer, especially colon cancer.
The challenge of this program is to create different answers which can lead to an active lifestyle, making physical activity accessible to every community group so that it leads to well- -being and gains in health.
The facts... Community opinion...
Figure 10 Figure 11 Classification of the statement: Leisure and Sports Equipment “I am happy with the opportunities I find in my city to practice sports”
Leisures and Sports Equipment
Playgrounds Public Public gardens Private Urban parks Associations Athletic grounds Schools
Athletic tracks
Sports pavilions
Sports rooms
Small sports fields Strongly Disagree Disagree
Greater sports fields Undecided Agree
Open-air pools Strongly agree N/A
Decked pools
Source: Source: Sports and Sports Equipment Division, City Council of Seixal. Questionnaire survey (CMS & ISPA. 2003/04).
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What shall be further done?
> Fighting sedentary habits > Varying existing options and making physical activities accessible to everyone
What are the expected results? How are these evaluated?
> Increasing the number of people of all ages who practice physical and sports activities daily. > Annual analysis of participant logs
> Creating conditions to reduce the percentage of individuals spending most of their free time with sedentary > Surveys in population activities.*
> Promoting an annual increase in the number of disabled people practicing physical and sports activities. > Monitoring the participation of this population
> Stimulating the practice of physical activity in children and youngsters, through the development of work and > Monitoring the participation of children and youngsters in school sports projects articulating with sports collectivises. sports activities
> Advising people on the benefits of physical activity on health, through large sensitisation campaigns. > Evaluation of results of sensitisation campaigns
> Implementing the Cycle Path Plan in the Municipality. > Annual analysis of the realisation of these measures
> Creating at least one group promoting long walks in each parish council. Advising people on the benefits of > Annual analysis of participant logs physical activity on health, through large sensitisation campaigns.
> Enlarging the network of senior citizen leaders for movement and health, within the Project Continuar > Monitoring the participation of new leaders (Continuing).
> Increasing the number of people using municipal sports equipments. > Analysing the evolution of people using each equipment
* Based on the goals for 2010 established by the Directorate-General for Health through the National Health Plan.
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IMPROVING THE HEALTH OF OUR WOMEN, CHILDREN AND YOUNGSTERS
Social changes in the last decades have posed bigger and bigger challenges to families, namely the increasing participation of women as workers.
The extension of compulsory schooling and the challenges and specifics of new work markets confront children and youngsters with new life expectations, but also with new demands and stimuli which must be dealt with daily, in order for their development to be as healthy as possible.
The facts... Community opinion...
Figure 12 Figure 13 Post-Neonatal, Perinatal, Precocious Neonatal, Classification of the statement Neonatal and Child Mortality Rates (per thousand “I am happy with the quality proportion) in the years 1997, 1998, 2000 and 2002 of teaching in my city”
Post-Neonatal Mortality
Perinatal Mortality
Precocious Neonatal Mortality
Neonatal Mortality
Child Mortality Strongly Disagree Disagree Undecided Agree Strongly agree N/A
Source: Source: Public Health Activities Reports of the years 1997, 1998, 2000, 2001 and Questionnaire survey (CMS & ISPA. 2003/04. 2002 (Seixal Health Delegation).
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What shall be further done?
> Promoting health in children and youngsters > Promoting female health
What are the expected results? How are these evaluated?
> Reducing the child mortality rate to 3 (3/1000 newborns).* > Child mortality logs monitoring
> Increasing in 10% workshops for the development of psycho-social competences in children and youngsters. > Workshop monitoring
> Creating at least one group of young health promoters. > Group activities report
> Increasing in 10% the spaces to attend teenagers as to sexual education and family planning. > Evolution of this kind of areas
> Creating conditions so that perinatal mortality rate does not exceed 5,5 and neonatal mortality rate does not > Monitoring the number of perinatal and neonatal deaths exceed 2,5.*
> Reducing in 15% the number of pregnant women smoking during pregnancy. > Monitoring logs related to giving up smoking
> Increasing the community intervention to support women in childbirth and their family (“Saúde Sobre Rodas”, > “Saúde Sobre Rodas” Project monitoring Health on Wheels) to other areas of the municipality and other problem areas (ex.: prostitution, illegal immigra- tion, etc.).
> Evaluating the satisfaction of the “Saúde Sobre Rodas” Project users and analysing behaviour indicators as to > Survey by questionnaire with a sample of people participa- their global health status. ting in the project
> Increasing the number of childcare workshops in 10%. > Workshop monitoring
* Based on the goals for 2010 established by the Directorate-General for Health through the National Health Plan.
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ASSURING CONDITIONS FOR HEALTHY AGEING
In this Health Development Plan, issues are centred in senior citizens self-care, their participation in society and family as well as society involvement.
The approach to issues included in this area is an evolution regarding the former Plan, where this theme was approached as “Improving Senior Citizen Health”. Healthy ageing is a holistic perspective and a positive approach to senior citizens health, positioning ageing as part of the human development.
The facts... Community opinion...
Figure 14 Figure 15 Classification of the statement Number of Senior Citizens in the Municipality of “I am bothered by obstacles (architectonical Seixal, in 1991 and 2001 barriers) found in my city”
Strongly Disagree Disagree Age Undecided Agree Strongly agree N/A Source: Source: National Statistical Institute (Instituto Nacional de Estatística) Questionnaire survey (CMS & ISPA, 2003/04). – Censos 1991 e 2001.
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What shall be further done?
> Fighting social isolation and ensuring full citizenship experience > Improving access to services and supporting dependent chronic patients
What are the expected results? How are these evaluated?
> Increasing the work of senior citizens associations in 20%. > Registering the number of senior citizens included
> Extending support to senior citizens, allowing for home care in weekends. > Analysing the realization of this measure per senior citizen association
> Reducing psycho-geriatric hospital emergencies in 20%. > Monitoring psycho-geriatric hospital urgencies
> Increasing programs on senior citizen health education in 10%. > Program monitoring
> Creating a senior citizen group promoting health peer support groups in each parish council. > Workshop monitoring
> Creating conditions so that senior citizens drinking alcohol several times a week are less than 20%.* > Monitoring through general practitioner
> Creating conditions so that senior citizens with body mass index >=30 is under 11% in men and under 14% in > Monitoring through general practitioner women.*
> Including 70% of senior citizens in day centres and senior citizens associations, through Healthy Seixal Training > Workshop monitoring – Senior Citizen Self-Care.
> Improving the ability to early diagnose the main chronic diseases affecting senior citizens in 20%. > Annual clinical reports
* Based on the goals for 2010 established by the Directorate-General for Health through the National Health Plan.
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PROMOTING MENTAL HEALTH AND SOCIAL WELL-BEING
Among the 10 main death causes identified in the World Health Report (WHO, 2002), three are mental/behavioural – unsafe sexual relations, smoking and using drugs – and another three are significantly affected by mental/behavioural factors – obesity, blood pressure and cholesterol.
In terms of mental health and social well-being, we shall analyse psycho-social phenomena and propose a set of approaches, a result, in this evolution stage of the Healthy Seixal Project, of the development of some formerly faint and informal networks and the urgency of some social phenomena, like increasing immigration and unemployment, among others.
The facts... Community opinion...
Figure 16 Figure 17 Drug addicts living in the Municipality, observed in Classification of replies to the question the CAT (Support centre for drug addicts) in Almada “How would you rate your quality of life?”
Very poor Poor Neither poor nor good Good Age group Very good N/A
Source: Source: Social Diagnosis in the Municipality of Seixal Questionnaire survey (CMS & ISPA, 2003/04).
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What shall be further done?
> Preventing drug addiction > Promoting healthy behaviours > Promoting family well-being
What are the expected results? How are these evaluated?
> Increasing the number of drug addicts directed by the street team to a first appointment with a specialized > Monitoring directed drug addicts who attend appointments doctor in 10%.
> Delaying the average age in which teenagers start using alcohol and “light” drugs. > Surveys in young people
> Increasing in 10% the exchange of used syringes by drug addicts and reducing the transmission of infectious and > Analysis of clinical logs and exchanged syringes contagious diseases.
> Creating conditions for standard mortality rate by suicide before 65 years of age not to exceed 2,5/100 000 > Clinical reports analysis inhabitants.*
> Promoting the training of 20% of health professionals in mental health and the risk factors associated to it. > Workshop monitoring
> Promoting the insertion of 15% chronic mentally ill patients in community programs, in order for them not to be > Log of the number of people included in programs of this institutionalised. kind
> Increasing in 10% early identification of mental disorders and promoting an adequate follow-up. > Monitoring early identified cases and proportionate follow-up
> Reducing in 20% psycho-social risk situations for children and their mothers in the perinatal and neonatal > Monitoring specific indicators for mother-child health period.
* Based on the goals for 2010 established by the Directorate-General for Health through the National Health Plan.
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PROMOTING COMMUNITY PARTICIPATION IN HEALTH DEFENSE FOR ALL
Citizens are not mere users of health services, nor simply receivers of clinical care. Within the Healthy Seixal Project, citizens assume a vital role in the development of community health, promoting the identification of needs ad evaluation of developed interventions.
This implies the creation of conditions to reinforce well-being and quality of life for populations and implies the search, knowledge, understanding and action. To encourage commu- nity participation, namely within the Healthy City Project, is above all a way to participate democratically in the life of a community and to exercise citizenship rights.
The facts... Community opinion...
Figure 18 Figure 19 Classification of replies to the question Associative movement and Municipality Equipment “How available to you is the information that you need in your day to day life?”
Associative movement and Municipality Equipment
Youngsters
Sports
Cultural Associations Youth
Sports
Cultural Not at all A little Moderately Mostly Completely N/A
Equipments Social Action
Source: Source: Municipality of Seixal Web page CMS (CMS, 2006). Questionnaire Survey (CMS & ISPA, 2003/04).
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What shall be further done?
> Encouraging associations > Increasing information and communication > Developing training and education for health
What are the expected results? How are these evaluated?
> Increasing in 20% the existing volunteer network. > Associations annual activities report
> Increasing in 20% the production of culturally adapted information for specific groups. > Associations annual activities report
> Increasing in 15% the number of associates in local cultural, sports and recreational activities. > Annual evaluation of number of associates
> Involving 20% of local social communication technicians in sensitising actions on health and the Healthy Cities > Workshop monitoring Project.
> Supporting the creation of at least 3 mutual health groups related to chronic diseases. > Group establishment monitoring
> Creating at least one “Health Promotion Space” open to community, to animate a centre of resources and > Monitoring the workshops developed here workshops for health.
> Involving 60% of associative managers of retired people associations in workshops for associative managers. > Workshop evaluation report
> Promoting at least 3 workshops for volunteers of partner associations of the Healthy Seixal Project. > Workshop evaluation report in private entities
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HEALTH IMPACT ASSESSMENT
Health Impact Assessment (HIA) is a combination of procedures, methods and tools by which a certain project, program or policy may be judged to their potential effects on population health, as well as the impact those effects will have on different population groups. HIA therefore aims to establish basic conditions to safeguard and improve the health of people directly or indirectly affected by a certain action of proposal. The development of an HIA implies a set of stages which may generally be grouped in 5 steps:
5. Monitoring/Evaluation Proposal How did the process go, what was the impact or effectiveness of the proposal and what results were achieved?
4. Influencing the Decision-Making Process What political and technical actions may be adopted to improve population health and well-being?
3. Appraisal What are the potential impacts of the proposal on population health and well-being and what interventions may be implemented?
2. Scoping What are the parameters and boundaries of the HIA?
Reporting and 1. Screening communicating results Should this proposal undergo an HIA?
HIA implementation is intended to happen as a structural approach of the whole Health Development Plan, and each theme integrating it should benefit from the technical contribute of the HIA. As per the scheme in page 9, the HIA represents the sap of a tree sprouting the central branches of this plan.
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FINAL NOTE
This Plan results from the joint work of municipality institutions, partners of the Healthy Seixal Project, and several structures of the City Council of Seixal, which we feel must be named.
Local Structures Structures in the City Council of Seixal
> Municipal Agency for Energy in Seixal – AMESeixal > City Council Master Plan Division
> Voluntary Firemen Association in the Municipality of Seixal > Occupational Health Cabinet
> Seixal Employment Centre > Social Action Cabinet
> Amora Health Centre > Health Cabinet
> Corroios Health Centre > Sports and Sports Equipment Division
> Seixal Health Centre > Culture, Education, Sports and Youth Department
> Centre for Solidarity and Social Security / Seixal Social Services > Education Division
> Garcia de Orta Hospital > Environment and Urban Services Department
> National Co-operative for the Support of Disabled People > Environment Division
> Seixal Health Delegation > Salubrity Department
> Seixal Santa Casa da Misericórdia (Authority under joint of the Ministry > Healthy Urban Planning Sub-groups of Employment and Social Security and Ministry of Health)
This product would not have happened without the cooperation of everyone, and we thank them for their time, documentation and most of all for the experience they have shared.
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Technical file:
Title: Seixal City Health Development Plan
Edited by: City Council of Seixal
Content and General Coordination: Healthy Seixal Project Office in the City Council of Seixal
Graphics and Illustration: Editions and Graphic Support Sector of the City Council of Seixal
Edition: 500 copies
Printed: Tipografia Popular A. Palaio
Date: May 2006
ISBN: 972-8740-31-X
Legal Deposit:
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Câmara Municipal do Seixal Seixal City Council