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 .