カネヤ (KANEYA) トス用安全ネット KB-398 [分類:野球 トスバッティング

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
Lycksele
15 municipalities
260 000 inhabitants
Dorotea
- sparsely populated,
Åsele
- 70% lives in the major two cities
- 80% lives by the coast
- Range: 0.4 – 48.4 inhabitants per km2
55 200 km2 (1/8 of Sweden)
- Second largest in Sw., as large as the Netherlands
Varied landscape with mountains and coastal areas
Vindeln Robertsfors
Vännäs
Bjurholm
Nordmaling
Umeå
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
- Pilot
Identify core
components
Local
commitment
Upscaling
Maintenance
Research
and policy
expectations
Picture 9
Integration
Development
Västerbotten Intervention Program (VIP)
Main component: invitation to a health examination within the PHC
at the age of 40, 50 and 60 incl a follow up councelling session
140 244 examinations (2011-12-31)
99 844 participants, out of those
37 799 has participated twice (10 yrs in between)
140 000
120 000
100 000
80 000
Norsj ö
Norsjö
60 000
Västerbotten
40 000
Number
of examinations
Antal hälsoundersökningar
Antal deltagare
Number
of participants
1985
1987
1989
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
2011
2008
2010
2004
1986
1988
1990
1992
1994
1996
1998
2000
2002
2006
Norsjö
Lycksele
Vindeln
Umeå
Sorsele
Bjurholm
Nordmaling
Vännäs
Robertsfors
Storuman
Vilhelmina
Skellefteå
Malå
Dorotea
Åsele
20 000
Picture 10
VIP
SMR Males
Västerbotten
Sweden
- One way to
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
•
•
•
•
Picture 12
Interactive information, education
Active young role models – coaches
Web (www.tobaksfri.se)
Annual newspaper
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
5
Sverige
Sweden
Västerbotten
Västerbotten
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 –– 12
12years
years
13 – 15 years
The unborn baby
6 – 9 years
16 – 18 years
0 -18 months
1- 5 years
For a healthier county
Picture 14
The Salut programme progress over time
VII
15
10
Intervention
development
V
Pilot area
implementation
Dissemination
IV
County wide
implementation
Modules
Age (years)
VI
5
III
II
I
0
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
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•
•
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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