Picture 1 Community systems for NCD prevention and control - based on experiences from Västerbotten County,

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

Norsjö Skellefteå 15 municipalities

260 000 inhabitants - sparsely populated, Åsele - 70% lives in the major two cities Vännäs Umeå - 80% lives by the coast - Range: 0.4 – 48.4 inhabitants per km2 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 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