Picture 1 Community systems for NCD prevention and control - based on experiences from Västerbotten County, Sweden
Dr. Maria Nilsson, Epidemiology and Global Health Centre for Global Health Research, Umeå University
Picture 2 Presentation over view
• Why do we need community systems for NCD prevention and control? • Why should local governments care? • Three examples of interventions • Joint criteria´s • Some lessons learnt
Picture 3 The County of Västerbotten
Sorsele
Malå Storuman
Norsjö Vilhelmina Skellefteå 15 municipalities Lycksele
260 000 inhabitants Dorotea - sparsely populated, Vindeln Robertsfors Åsele - 70% lives in the major two cities Vännäs Umeå - 80% lives by the coast Bjurholm - Range: 0.4 – 48.4 inhabitants per km2 Nordmaling 2 1 55 200 km ( /8 of Sweden) - Second largest in Sw., as large as the Netherlands Varied landscape with mountains and coastal areas
Picture 4 Why do we need community systems for NCD prevention and control
• To reach out – maximize the potential - systems enables a combination of population-based and individually based strategies • For capacity and response - infrastructure/organisation, policies and plans, access to key actors and partnerships • For sustainability - coordination, resources and mandate
Picture 5 Why should local decision makers care?
• Healthy citizens - local communities most important resource • To reduce costs for health care • To identify and reduce local gaps • Can enact policies and plans to reduce NCD:s – be part of the solution
They have the means for - surveillance - reducing exposure levels of risk factors - management through strengthening local systems
Picture 6 Three examples of interventions - tradition of sustainability
• Västerbotten Intervention Program (VIP) - started in 1985 • Tobacco Free Duo - started 1993 • Salut - started 2005
Picture 7 The start – looking back
• A problem - CVD-mortality, - Cancer, - Obesity, oral health problems and mental illness • Political decision - do something! • Targetgroups and pilot areas selected - middle aged - youth 12-15 yrs - unborn baby – 18 yrs • Key functions and partnerships identified - health care, - health care incl dental care, schools, local business, NGO:s, churches - health care incl dental care, pre-schools, schools, NGO:s, churches • Core components identified, discussed and decided with partners
Picture 8 Steps in the process
Initiation Identify core - Pilot components
Local Upscaling commitment
Maintenance Integration
Research and policy expectations Development
Picture 9 Västerbotten Intervention Program (VIP)
Main component: invitation to a health examination within the PHC 140 000
at the age of 40, 50 and 60 incl a follow up councelling session 120 000 140 244 examinations (2011-12-31) 99 844 participants, out of those 100 000 37 799 has participated twice (10 yrs in between)
NorsjNorsjöö 80 000
60 000 Västerbotten
40 000 NumberAntal hälsoundersökningarof examinations NumberAntal deltagareof participants 20 000
1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 Norsjö Lycksele Vindeln Umeå Sorsele Bjurholm Nordmaling Vännäs Robertsfors Storuman Vilhelmina Skellefteå Malå Dorotea Åsele Picture 10
SMR Males VIP - One way to Västerbotten Sweden look at effects
SMR Females
Västerbotten Sweden
Mortality data, Population in Västerbotten 40-76 yrs, 1970-2009. Source: Swedish Registry for cause of death
Picture 11 Tobacco free Duo - Organisation within the county council - The school is the arena
Main components: • Tobacco free partnership (12 yr old and adult) • Signs a contract valid till the end of grade 9 • Membership card – discounts and lotteries • Interactive information, education • Active young role models – coaches • Web (www.tobaksfri.se) • Annual newspaper
Picture 12 It is possible to reduce young people’s smoking
Boys and girls smoking decreased during the seven year long evaluation period while no such change was found nationally
30
25
20
% 15
10 MARIA NILSSON
Sverige 5 Sweden VästerbottenVästerbotten
0 1994 1995 1996 1997 1998 1999 2000 2001 Picture 13 A Child health promoting program
Moduls based on the childs different ages Selected intervention components and partnerships judged most appropriate for the age 10 ––1212 years years 13 – 15 years
For a healthier county
The unborn baby 6 – 9 years 16 – 18 years
0 -18 months 1- 5 years
Picture 14 The Salut programme progress over time
VII
15
VI
Intervention
10 development V Pilot area implementation
Dissemination
Age Age (years) County wide IV Modules implementation
5
III
II 0 I
2005 2010 2015 Calender time (years)
Picture 15 Joint criteria´s
• Start based on an identified health problem • Dialogues between politicians and population • Infrastructure for prevention with a base in on going work • Identified core competencies • Carefully selected intervention components • Inform, educate and train • Keep it ”modern” • Evaluate – Interventions in focus – research to support
Picture 16 Some lessons learnt
• One must understand and meet the public’s expectations • Prevention is a team sport • Intervention providers need feed back • Every partner also has an agenda of their own • Joint venture researchers and health care: a good combination • Without impetus from decision makers the journey will be short