Work Package 5 at the kick-off meeting in Vilnius

Health Promotion & Disease Prevention

Work Package 5

OBJECTIVES

Work Package 5 (WP5) aims to improve the knowledge and practice on health promotion and disease prevention across Europe.

In recent years, health promotion and disease prevention (HPDP) have been proven to be cost-effective and efficient in reducing the burden caused by chronic diseases.

Working with twenty-two partners from fourteen countries, WP5 builds on the successful results from the previous Joint Action CHRODIS. WP5 focuses primarily on: 

  • analysing and assessing countries’ health promotion and disease prevention strategies;
  • implementing good practices with projects specifically targeting children, the working population, and older people;
  • and better integrating health promotion and disease prevention in the healthcare and wider social care systems.

Who will benefit most from this activity? The primary beneficiaries will be practitioners, policymakers and other stakeholders, who can learn from results such as country reports, recommendations for the implementation and transfer of health promotion and disease prevention practices, as well as through intra- and inter-sectoral collaboration. Ultimately, however, it will be European societies and citizens who will profit the most from healthier lives.

TIMELINE

TIMELINE OF KEY ACTIVITIES

August 2018 – Feasibility studies

April 2019 – Pilot implementations: action plans developed for all pilots, with 6 out of 8 pilot implementations underway

February 2019 – Expert meeting to approve 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 from 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

TIMELINE CHART

IMPLEMENTATION PROJECTS

Our work on HDPD will see partners implement a range of recognised good practices from JA CHRODIS:

ASL-TO3 (Italy), via the Piedmont Regional Health Promotion Documentation Centre (DORS) will transfer and implement the Irish JA-CHRODIS Good Practice “Active School Flag” (ASF) in at least two schools in the Piedmont SHE Network. This Network involves 100 schools in the region and aims to promote a whole school approach, to improve the health and well-being of all pupils as well as teaching and non-teaching staff. ASL-TO3 and DORS plan to propose the ASF to all schools in the network. This will include primary and secondary schools. In addition, they plan to implement the ASF in at least one school in a rural area and one in an urban area. This will be based upon voluntary recruitment. The aim is to compare and incorporate some of the Irish self-evaluation instruments in a locally specific context.

The Institute of Hygiene (HI, Lithuania) works with a network of Public Health Bureaus who are the main institutions promoting and initiating the implementation of public health interventions at the municipal level in Lithuania. Two of the Bureaus (one rural, one urban) will appoint coordinators within pilot municipalities that will help to select schools, which will commit to enhancing the level of physical activity of their children through the development of a physically educated school community.

The Directorate of Health (DOHI, Iceland) will implement (elements of) Dutch JA-CHRODIS Good Practice JOGG within the “Health Promoting Community Programme” (HPC). HPC is an umbrella for a comprehensive health promotion approach in municipalities. The main aim is to support communities and schools in creating supportive environments that promote a healthy lifestyle 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 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 primary healthcare in HPC work, improving the evaluation plan and creating an online tool to collect practical solutions to support the HPC and the schools in their endeavours.

The Directorate of Health and Disease Prevention Malta will implement the “ToyBox”-intervention in the first year of all state kindergartens, i.e. for preschool children aged 3-4 year.. This will lead to 2,500 children benefitting from the programme. Educators will receive the toolkit covering topics related to a healthy lifestyle. This includes 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 CHRODIS PLUS.

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). The main aim is to re-invigorate the PSLT programme. Since 2012, the Andalusian PSLT Programme has involved nearly 200 workplaces (private and public), with more than 4,500 employees directly involved. 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 rural, one urban) through its network of Public Health Bureaus, which are the main institutions promoting and initiating the implementation of public health interventions. They are currently implementing a cardiovascular disease prevention programme in cooperation with family doctors who refer people at risk to a training programme. The bureaus organise the training programmes, facilitate lectures on 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 at three locations in Aragon. The Multimodal Training Intervention will be carried out at existing sporting facilities and community or social activity centres for over 65-year-olds. The activity, including participant input and selected reported functional assessments, will be conducted with a structure relatively independent from primary care but not from ethical evaluation .

DOHI (Iceland) will implement the Multimodal Training Intervention in four municipalities, thereby ensuring a good mixture of villages, towns, and cities. The programme is promoted in geriatric centres, 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 minutes) at least once a week with a trainer, and strength training sessions at least twice a week with a trainer. Training programmes are 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.

MAIN TASKS

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

Leaders: EuroHealthNet and the National Institute for Health and Welfare Finland (THL)

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. For this purpose:

  1. we will assess the state of development of policies on Health Promotion and Disease Prevention (HPDP) in Croatia, Finland, Hungary, Poland, Serbia and Slovenia
  2. 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 is paid to the target groups addressed by the HPDP implementations (see Task 2): children at school, adults in the workplace, and older people in a care setting.

The country reports will

  • provide policy makers, practitioners, and stakeholders with a quick idea of the situation and key actors in the respective countries
  • 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.
  • present a helpful reference point for more efficient cross-national learning
  • provide insights from an EU perspective into broader health systems organisation as well as be the input source for policy dialogues (WP4)

Timeline:

Six 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

Leaders: EuroHealthNet and Kronikgune

We know that good practices in health promotion for chronic diseases exist. We now wish to see these effective concepts transferred into 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:

  1. Children in schools;
  2. Adults at the workplace;
  3. 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. Additionally, 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) is an initiative aimed at enhancing three levels of children’s physical activity through developing a physically active and educated school community. ASF 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 ASF will be implemented by:
    • Piedmont Regional Health Promotion Documentation Centre (DORS, Italy) and
    • Institute of  Hygiene (HI, Lithuania).
  • The Dutch JA-CHRODIS Good Practice “JOGG” 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:
    • Directorate of Health (DOHI, Iceland)

  • The Greek JA-CHRODIS Good Practice “ToyBox”-intervention is a multicomponent, kindergarten-based intervention. It focuses 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:
    • 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 to promote a healthy lifestyle through different actions and information that targets 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 the main workplace stakeholders: associations of enterprises, trade unions and the regional health system. The WHP Network will be implemented by:
    • Andalusian Regional Ministry of Equality, Health and Social Policies (CSJA Spain).

Finally, the good practice focusing on older people in 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. The work included 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:
    • Institute of Hygiene (HI) in Lithuania
    • Institute of Health Carlos III (ISCIII) in Spain
    • Directorate of Health (DOHI) in Iceland.

Timeline:

Preparatory Phase: September 2017 – August 2018 (Situation analyses, feasibility assessments and getting the implementation strategy ready)

Implementation Phase: September 2018 – April 2020

TASK 3: SUPPORT HEALTH PROMOTION ACROSS THE BROADER HEALTH SYSTEM

Leaders: The Dutch National Institute for Public Health and the Environment (RIVM) and the Hungarian National Institute of Oncology (OOI)

A real and 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 (or social) services when poor health and related problems have appeared.

We want to identify the factors that facilitate and/or hinder collaboration between 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:

  1. intra-sectoral collaboration within healthcare that addresses both the prevention and management of chronic diseases (HPDP as a part of integrated care practices);
  2. inter-sectoral collaboration between the broader health system and other sectors that provides opportunities for HPDP.

More specifically, we will:

  1. Identify and describe good practices from 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;
  2. Analyse the success factors and barriers for such collaborations;
  3. Discuss these factors and how to address them in developing new collaborations with experts/partners involved in other CHRODIS+ work packages;
  4. Synthesise the insights gained by our work in a recommendations report.

Timeline:

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 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 approve the list

September 2019 – August 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

Leaders: 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

KEY EXPERTS AND ORGANISATIONS

Claudia Marinetti - Euro HealthNet, BelgiumAndrew Barnfield - Euro HealthNet, BelgiumAnne Lounamaa - National Institute for Health and Welfare, Finland
LEADER MISSION STATEMENT

“We are proud to lead the health promotion and disease prevention section of CHRODIS PLUS, which will not only contribute to a healthier Europe, but to a fairer one too. Our work will aid the much-needed shift towards prevention and promotion. We will address health inequalities and chronic diseases together. This will be of benefit to all; it will make health systems more sustainable, support the sustainable development goals, and most importantly, help citizens to obtain their right to the highest attainable standard of health, regardless of their social and economic status.”

LEADER AND TASK LEADERS

Work Package Leader: EuroHealthNet

Contact:

Work Package Leader: National Institute for Health and Welfare Finland (THL)

Contact:

MEMBER ORGANISATIONS

Implementing Partners

1/ ASL-TO3 (Italy), via the Piedmont Regional Health Promotion Documentation Centre (DORS)

2/ Institute of Hygiene (Lithuania)

3/ Directorate of Health (DOHI, Iceland)

4/ Directorate of Health and Disease Prevention (Malta)

5/ Andalusian Regional Ministry of Equality, Health and Social Policies (CSJA, Spain)

6/ Institute of Health Carlos III (ISCIII (Spain)

Additional Partners

1/ Kronikgune (Spain)

2/ Croatian Institute of Public Health (CIPH, Croatia)

3/ National 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)

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