5th Nordic Health Promotion Research Conference

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• 5th Nordic Health Promotion Research Conference
• June 17th, 2006 at Esbjerg Højskole
• COMMUNITY-BASED INTERVENTIONS
• Department of Health Promotion in the County of
  Ribe in Denmark
• Kirsten Enevoldsen
  kie_at_ribeamt.dk

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Disposition

• The Danish health policy
• Prevention and treatment recommendations and
  evidence of 30 minutes a day
• Policy goals in the County of Ribe
• Physical activity as health promotion
• Activities in the County of Ribe
• Corporation
• Networks and partnerships in theory and praxis
• Elderly festival an example
• New structure for health promotion

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The Danish health policy Healthy throughout
life

• The elements of Healthy throughout Life
• Risk factors
• Major preventable diseases and disorders
• Target groups
• Settings for promoting health

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The Danish health policy Healthy throughout
life

• Risk Factors
• Tobacco smoking
• Alcohol consumption
• Diet
• Physical inactivity
• Obesity
• Accidents
• Working environment
• Environmental factors.

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The Danish health policy Healthy throughout
life

• Major preventable diseases and disorders
• Non-insulin-dependent diabetes
• Chronic obstructive pulmonary disease
• Cardiovascular diseases
• Preventable cancer
• Musculoskeletal disorders
• Mental disorders
• Hypersensitivity disorders (asthma and allergy)
• Osteoporosis

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The Danish health policy Healthy throughout
life - has this political target.

• for physical activities
• The total of physical activities should
  increase strikingly, and physical activities
  should be a natural part of your everyday life

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Prevention and treatment30 minutes a day

• Many people do wish to live more healthy, and
• would like to be more physical active.
• Exercise and physical activities
• can be a part of your everyday life.

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Prevention and treatment30 minutes a day

• Slogan
• Use your body at least 30 minutes daily
• Since 2003 this has been the slogan
• of the Danish National Board of
• Health in its campaign for the
• promotion of physical activity
• amongst adults.

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Policy goals - County of Ribe

• Physical activity has high priority these years
• The efforts are aimed towards the entire
  population throughout their lifespan

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Policy goals - County of Ribe

• An example of doing community-based interventions
  in corporation between the County and the NGOs

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Policy goals - County of Ribe

• Physical activity
• central elements Local commitment
• Local - leading and political - priority
• Network use the established structures
• Working together - professionals and NGO
• Make it a natural part of everyday activities
• Long-term priority

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Policy goals - County of Ribe

• The efforts are based on
• The highest possible evidence and
• an approach which include the
• community ?

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Physical activity as health promotion

• Even small amounts of physical exercise and
  physical workouts have a positive effect on some
  diseases resulting from one's lifestyle

Source Danish National Board of Health (2003).
Handbook of Physical Activity
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Physical activityHealth impact

• Aerobics exercise is associated with improving
  the risk factor profile for
• cardiovascular disease
• greater mobility
• ability to carry out daily functions
• lower fracture rates
• greater bone density
• better cognitive skills
• less depression

Source International Union for Health Promotion
and Education (2000) The Evidence of Health
Promotion Effectiveness. Shaping Public Health
in a New Europe
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Physical activitySocial impact

• Physical activity for elderly can lead to
• improvements in interaction between older people
  and those around them
• this social aspect may give improvement in mood
  and cognitive skills
• Identifying one as in a group can enhance
  feelings of self-efficacy and well-being

Source International Union for Health Promotion
and Education (2000) The Evidence of Health
Promotion Effectiveness. Shaping Public Health
in a New Europe
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Physical activityEconomic impact

• Estimates of cost per life-year saved of
• 330, and 1100
• per health event avoided

Source International Union for Health Promotion
and Education (2000) The Evidence of Health
Promotion Effectiveness. Shaping Public Health
in a New Europe
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Activities - County of Ribe

• Exercise on prescription
• Rehabilitation, chronic obstructive pulmonary
  disease and cardiology problems
• Hale and hearty elderly training less mobile
  elderly at home
• Chair exercise - gymnastics for the less mobile
  elderly.

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Corporation - County of Ribe

• How to work together with the Non Government
  Organizations (NGO), administrators, politicians
  and private businesses
• How to create network and partnerships
• A unique tradition of sports on a voluntary basis
• Association Denmark

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Corporation - County of Ribe Elderly management
group

• Purpose
• to give ideas and inspiration
• participation
• Members are representatives of
• Private
• NGO
• Professionals from primary health care and the
  county.

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Networks and partnerships in theory and praxis

• Partnership
• Partners in a partnership are
• mutually reliable of each
• others resources and will in
• many circumstances be equal
• partners

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Networks and partnerships in theory and praxis

• Network
• A network consists of several independent
  organisations that together can achieve a target
  which could not be achieved alone.
• (Chisholm 1998)

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Networks and partnerships - in theory

• Bangkok Charter for Health Promotion in a
  globalized world Actions
• advocate for health based on human rights and
  solidarity
• invest in sustainable policies, actions and
  infrastructure to address the determinants of
  health
• build capacity for policy development,
  leadership, health promotion practice, knowledge
  transfer and research, and health literacy
• regulate and legislate to ensure a high level of
  protection from harm and enable equal opportunity
  for health and well-being for all people
• partner and build alliances with public, private,
  nongovernmental and international organizations
  and civil society to create sustainable actions.

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Networks and partnerships - in theory

• 75 municipalities are using partnerships
• Many are not working - and not being used!

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Networks and partnerships - in theory

• Key elements for successful partnerships
• Mutual respect for each others core business and
  role
• Shared understanding of the issue or problem
• Definition of roles and responsibilities each
  will have and agreement that they are appropriate
• Willingness to address and resolve conflict
• Renegotiation of roles as necessary
• Recognition of each partners need for
  satisfaction with their role.
• Source Harris, Wise et al. (1995)

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Networks and partnerships - in theory

• General barriers in working with partnerships
• Lack of commitment and skills
• Lack of shared, achievable goals
• Differences in outlook
• Professional rivalry
• Imbalance in the contributions of resources
• Lack of understanding of different organisational
  cultures
• Source Naidoo Wills (2003)

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Networks and partnerships - in praxis

• Collaboration between the organizations!
• The Heart Association participate in sports
  arrangements
• The sports association get a hold of members
• Patient organisations arrange sport activities

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Networks and partnerships - in praxis

• Danish Gymnastic Organisation
• Largest sports organisation in Denmark
• The number of members are increasing
• remarkably these years

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Networks and partnerships - in praxis

• University of Southern Denmark
• Evaluation of exercise on prescription
• Evaluation of a patient association and
  self-management course How to live your life
  with a chronic disease
• Student assistants
• Bachelor projects

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Elderly festival come and join in

• Target - present activities from the whole county
• Inspiration for both body and soul
• The three campaign words are
• Happiness
• Exercise
• Social life
• These campaign words perfectly cover the target

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For the eye soul..the bodyand humor
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Private companies...
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Students.

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Patient association and self-management
How to live your life with a chronic disease
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And it is all about partnership and network -
local commitment and how to get new habits in
your everyday life ?
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Health promotion and prevention is about ..

• how to change things change structures,
  conditions of life and behavior patterns in
  society
• - and everybody needs to take part in it

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New structure for health promotion

• The government reform
• Responsibility for health promotion
• Provide better service for the citizens
• County Municipality

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Thank you