Work Package 5 at the kick-off meeting in Vilnius
Work Package 5 – Health Promotion & Disease Prevention
Tasks & Timeline
Task 1 – Preparing and updating country reports on the current situation of health promotion and disease prevention in European countries and bringing the information together in a comparative overview
Lead & Co-lead: EuroHealthNet and the National Institute for Health and Welfare Finland (THL)
The core of this task is to facilitate action on chronic diseases through health promotion and disease prevention we need an overview of the current situation in European countries in terms of policies, interventions, and key stakeholders. We will assess the state of development of policies on Health Promotion and Disease Prevention (HPDP) in Croatia, Finland, Hungary, Poland, Serbia and Slovenia. Moreover, we will update 14 existing country reports, developed during the first Joint Action on Chronic Diseases (JA-CHRODIS). Based on this input, EuroHealthNet and THL will produce a comparative overview including new health promotion developments and services. Special attention will be paid to the target groups addressed by the HPDP implementations (see Task 2): children at school, adults at the workplace and older people in elderly care settings.
The country reports will provide policy makers, practitioners, and stakeholders with a quick idea of the situation and key actors in the respective countries. They will also provide an understanding of what is needed in terms of health and other relevant policies and strategies (physical education, anti-smoking laws, employment policies, etc.) and in terms of implementation of good practices for the target groups. In addition, they will present a helpful reference point for more efficient cross-national learning. From an EU perspective, the reports will provide insights into broader health systems organisation as well as be the input for policy dialogues (WP4).
6 new reports, updated reports and an overview report to be published in spring 2018.
Task 2 – Adaptation and implementation of intersectoral good practices in health promotion
Lead & Co-lead: EuroHealthNet and Kronikgune
We know that good practices in health promotion for chronic diseases exist. We now wish to see these winning concepts transferred in different contexts. Drawing on well-proven HPDP good practices identified during JA-CHRODIS, selected project partners will adapt and implement some of these practices into their respective countries and contexts. Partners will focus on three thematic groups:
- Children in schools;
- Adults at the workplace;
- Older people.
In the first year, all partners involved will review and agree on the common framework for systematic assessments of their chosen good practice in relation to their context, including an analysis of the feasibility of the transfer. In addition, partners implementing practices will conceive an action plan and assess and adapt the intervention to their local context.
In the second year, good practice owners and non-implementing partners will support the new implementers and monitor the implementation process.
The good practices that will be implemented on children in schools include:
- The Irish JA-CHRODIS Good Practice “Active School Flag”(ASF). The ASF is an initiative aimed to enhance levels of physical activity for children through developing a physically active and educated school community. It is targeted at school-going children between the ages of 5 and 18 and open to all primary, post-primary, special needs education schools and YouthReach centres.
Elements of the ASF will be implemented by the Piedmont Regional Health Promotion Documentation Centre (DORS, Italy) and by the Institute of Hygiene (HI, Lithuania).
The Dutch JA-CHRODIS Good Practice “JOGG”, which addresses the issue of children and adolescent obesity. It encourages all people in a town or neighbourhood to make healthy food and exercise an easy and attractive lifestyle option for young people, focusing on children and adolescents along with their parents and direct environment.
Elements of JOGG will be implemented by the Directorate of Health (DOHI, Iceland)
- The Greek JA-CHRODIS Good Practice “ToyBox”-intervention, a multicomponent, kindergarten-based, family-involved intervention, focusing on the promotion of water consumption, healthy snacking, physical activity and the reduction of sedentary time in preschool children and their families.
- Elements of the “Toybox” intervention will be implemented by the Directorate of Health and Disease Prevention Malta.
The good practice focusing on adults at the workplace is:
- The Italian JA-CHRODIS Good Practice “Lombardy Workplace Health Promotion Network”. The Lombardy Workplace Health Promotion (WHP) Network aims at promoting healthy lifestyle through different actions and information targeting healthy eating, smoking cessation, increased physical activity, alcohol reduction and safe walking/biking to work. It is a public-private network building on partnerships and collaboration with all workplace main stakeholders: associations of enterprises, trade unions and the regional health system.
- The WHP Network will be implemented by the Andalusian Regional Ministry of Equality, Health and Social Policies (CSJA Spain).
Finally, the good practice focusing on older people in elderly care settings is:
- The Icelandic JA-CHRODIS study “Multimodal Training Intervention in Communities – an
Approach to Successful Ageing”, examined and evaluated the effects of a 6-month multimodal training intervention including nutrition and health counselling in order to prevent health risks among older people (71-90). Preliminary results showed that the intervention design and methodology could form a sustainable strategy for developing and maintaining the health of older people in line with international recommendations.
It will be implemented by the Institute of Hygiene (HI) in Lithuania, by the Institute of Health Carlos III (ISCIII) in Spain and by the Directorate of Health (DOHI) in Iceland.
Preparatory Phase: September 2017 – August 2018 (Situation analyses, feasibility assessments and the implementation strategy ready)
Implementation Phase: September 2018 – April 2020
Task 3 – Support health promotion across the broader health system
Lead & Co-lead: Dutch National Institute for Public Health and the Environment (RIVM) and National Oncology Institute Hungary (OOI)
Real sustainable impact on chronic diseases can only be achieved by applying an HPDP approach within the whole health system and also between different sectors that directly or indirectly influence health. Both intra- and inter-sectoral collaboration are important. Integrated care should include HPDP to prevent and manage chronic diseases proactively and strengthen patients’ own roles in decision-making and disease management. Moreover, HPDP approaches that involve other sectors have proven to be more effective in general, whereas collaborations between health and social services in particular provide good opportunities to reach more vulnerable and/or disadvantaged populations who usually do not participate in health promotion activities, as these people often only use health (and social) services when poor health and related problems have appeared.
We want to identify factors that facilitate and/or hinder collaboration of HPDP approaches within health (and social) care settings, examine efficient ways to work between the health and other sectors, and support synergies between community-based and healthcare services efforts.
We will analyse:
- intra-sectoral collaboration within healthcare that addresses both the prevention and management of chronic diseases (HPDP as part of integrated care practices);
- inter-sectoral collaboration between the broader health system and other sectors that provides opportunities for HPDP.
More specifically, we will:
- Identify and describe good practices of intra- and inter-sectoral collaborations in European countries that aim to prevent or proactively manage chronic diseases, with a specific focus on empowering vulnerable or disadvantaged groups;
- Analyse the success factors and barriers for such collaborations;
- Discuss these factors and how to address them in developing new collaborations with experts/partners involved in other CHRODIS+ work packages;
- Synthesise the insights gained by our work in a recommendations report.
September 2017-August 2018: Identifying and describing good practices and analysing the success factors or barriers for intra- and inter-sectoral collaboration
September 2018-August 2019: Compiling up a list of key success factors and barriers for intra- and inter-sectoral collaboration on HPDP; organising an expert meeting, including Governing Board members, to validate the list
September 2019-Augusut 2020: Organising a final workshop with external experts and reporting to formulate recommendations regarding intra- and inter-sectoral collaboration on HPDP in relation to healthcare
Task 4 – Final overview
Lead & Co-lead: EuroHealthNet and the National Institute for Health and Welfare Finland (THL)
The findings and results of our work on HPDP in CHRODIS+ will be presented in a series of recommendations.
Timeline: May – August 2020
Timeline related to deliverables/milestones
August 2018 – Feasibility studies
April 2019 – Pilot implementations: action plans developed for all pilots, 6 out of 8 pilot implementations underway
February 2019 – Expert meeting to validate the list of key success factors and barriers for intra- and inter-sectoral collaboration on HPDP
April 2020 – Workshop to formulate recommendations regarding intra- and inter-sectoral collaboration on HPDP in relation to healthcare
June 2020 – Report on the implementation of at least 3 pilot implementations, including considerations for feasibility studies
June 2020 – Report assessing the success factors of collaboration between HPDP and healthcare
August 2020 – Series of recommendations to present the final overview
Policy dialogues and Implementation projects
The ASL-TO3 (Italy), via the Piedmont Regional Health Promotion Documentation Centre (DORS) will transfer and implement the ASF in at least 2 schools of the existing Piedmont SHE Network. This Network involves a hundred schools in the region and aims to promote a “whole school approach”, a structured and systematic plan for the health and well-being of all pupils and of teaching and non-teaching staff. ASL-TO3 and DORS plan to propose the activities to all schools of the network, involving primary and secondary schools, and implement the ASF in at least one school in a rural area, and one in a city, based on voluntary recruitment. The aim is to compare and incorporate some of the Irish self-evaluation instruments in a most effective way.
The Institute of Hygiene (HI, Lithuania) works with a network of Public Health Bureaus, which are the main institutions promoting and initiating implementation of public health interventions at municipality level in Lithuania. Two of the Bureaus (one in a rural area, one in a city) will appoint co-ordinators within pilot municipalities and will help to select schools which will commit to enhance the level of physical activity of the children through the development of physically educated school community.
The Directorate of Health (DOHI, Iceland) will implement (elements of) JOGG within the “Health Promoting Community Programme” (HPC), an umbrella for comprehensive health promotion work in municipalities, whose main aim is to support communities/schools to create supportive environments that promote healthy lifestyle, health and well-being for all. The HPC currently covers 12 municipalities and 73 % of Iceland’s population. DOHI wishes to use selected elements from JOGG to improve the quality of the HPC work, including further developing the framework for HPC and schools, improving the programme materials and communication strategy, providing better training for coordinators, supporting further involvement of the primary healthcare in the HPC work, improving the evaluation plan and creating an online tool to collect practical solutions to support HPC and schools in their work.
The Directorate of Health and Disease Prevention Malta will implement the “Toybox”-intervention in the first year of kindergartens, i.e. preschool children aged 3-4 year, rolling out the contents of the good practice in all state kindergartens in Malta and Gozo. This will lead to 2500 children benefitting from the programme. Educators will receive the toolkit covering topics related to a healthy lifestyle, including healthy eating and snacking, water consumption, healthy food for healthy teeth, self-expression and physical exercise. The Directorate will also implement the ToyBox’ evaluation component and carry out an evaluation on behavioural changes in the children by the end of the JA.
The Andalusian Regional Ministry of Equality, Health And Social Policies (CSJA Spain) will implement elements of the Lombardy Workplace Health Promotion (WHP) Network into its own programme called ‘Promoción de la Salud en los Lugares de Trabajo’ (PSLT), in order to re-boost the programme. Since 2012, the Andalusian PSLT Programme has involved nearly 200 workplaces (private and public), with more than 4500 employees directly taking part in it. The main elements identified in the Lombardy WHP Network to be piloted in the implementation within PSLT are: the WHP Network’s accreditation system, the UNI-ISO 26000 concept of sustainability, the online data collection system and relevant ideas for recruitment and long-term adherence to the programme.
HI (Lithuania) will implement the Multimodal Training Intervention in two municipalities (one in a rural context, one in a city) through its network of Public Health Bureaus, the main institutions promoting and initiating implementation of public health interventions. They are currently implementing a cardiovascular disease prevention programme in cooperation with family doctors and refer people at risk to training. The Bureaus organise the training, facilitate lectures on e.g. nutrition and physical activity, and provide individual consultations to enhance lifestyle changes. The main components of the intervention that are being considered for the implementation include the development of a training programme, which would be more suitable for older individuals to improve their physical fitness.
ISCIII (Spain), collaborating with the Aragon Institute of Research in Health Sciences, will work on a pilot implementation of the Multimodal Training Intervention in three locations in Aragon. The Multimodal Training Intervention will be carried out at existing sport facilities and community or social activity centres for >65-year-olds. The activity, including participant input and selected reported functional assessments, will be conducted on a relatively independent structure from primary care but not from ethical evaluation.
DOHI (Iceland) will implement the Multimodal Training Intervention in four municipalities ensuring a good mixture of smaller places and towns. The programme is promoted in, for example, geriatric centres and in local papers and is open to everyone aged 65 and older. After each implementation phase (six months), the approach will be reviewed and adapted. The training phase includes daily endurance training (30 min), at least once a week with a trainer, and strength trainings at least twice a week with a trainer. Training is individualised, but participants will train together as a group and receive monthly lectures about nutrition, training, ageing and physiological changes. Costs arising from this intervention are covered by local authorities and other funding. A comprehensive evaluation plan is in place.
Partners of the work package
Work Package Leaders: EuroHealthNet
Partners of the project:
1/National Institute for Health and Welfare Finland (THL)
2/ ASL-TO3 (Italy) via the Piedmont Regional Health Promotion Documentation Centre (DORS)
3/ Directorate of Health and Disease Prevention (Malta)
4/ Institute of Hygiene (Lithuania)
5/ Directorate of Health (DOHI, Iceland)
6/ Andalusian Regional Ministry of Equality
7/ Health and Social Policies (CSJA, Spain)
8/ Institute of Health Carlos III (ISCIII (Spain)
1/ Kronikgune (Spain)
2/ Croatian Institute of Public Health (CIPH, Croatia)
3/ Institute of Oncology (OOI, Hungary)
4/ Health Service Executive (HSE, Ireland)
5/ Neurologic Institute Carlo Besta FINCB (Italy)
6/Kauno Klinikos (Lithuania)
7/ Ministry for Health (Malta)
8/ National Institute for Public Health and the Environment (RIVM, Netherlands)
9/ Institute of Public Health Serbia (IPHS, Serbia)
10/ Ministry of Health (Italy)
11/ Semmelweis University (SU, Hungary)
12/ National Center of Public Health and Analyses (NCPHA, Bulgaria)
13/ Vilnius University (Lithuania)
14/ Ministry of Health (Portugal)
15/ National Institute of Geriatrics, Rheumatology and Rehabilitation (NIGRiR, Poland)