Community & Healthy City 6 Years Experience

Transcription

1 Community Engagement for Health The Kwai Tsing Safe Community & Healthy City 6 Years Experience C B Chow Cluster Clinical Coordinator (Community Health) KWC YH Chow, Adela Lai, Alan Lee, Alan Chow, et al Kwai Tsing Safe Communty and Healthy City Association

2 Kwai Tsing District

3 Kwai Tsing District 3.20% 8.10% 8.60% 9.70% 24% % % No Schooling Primary Secondary Matriculation Non-degree course Degree Cours 75% living in public housing estate 21 housing estates 35 secondary schools 41 primary schools 67 kindergartens 1 higher education institute 1 acute general hospital 1 psychiatric hospital 43 nursing homes 22 sq km Population: 490,000

4 Kwai Tsing District Divided into 5 districts 6 th densely populated (21800 persons per km 2 )

5 Kwai Tsing - Industry Contains almost 2/3 of Hong Kong s heavy industries Container terminals Cement industry Chemical industry Ship repair and construction Oil tanks

6 System & Surveillance for a Safe Community Evidence of Program Indicators for International Safe Communities Indicators for International Safe Communities Infrastructure: Based on partnership and collaborations, governed by a crosssectional group that is responsible for safety promotion in their community Injury Surveillance: Document the frequency and causes of injuries Programs: Long-term, sustainable, covering both genders and all ages, environments, and situations Targeted at high-risk groups and environments Promote safety for vulnerable groups Evaluation: Assess programs, processes and the effects of change Networks: Ongoing participation in national and international Safe Cmmunities networks (WHO Collaborating Centre on Community Safety Promotion, May 2002)

7 Objectives To promote a safety culture through partnerships and integration of resources To coordinate resources in Kwai Tsing District to implement comprehensive and systematic safety promotion, education and researches To share experience and contribute to International Safe Community network under World Health Organization

8 Kwai Tsing Safe Community Inaugurated in October 2000

9 15 major government departments, 4 education institutes and 8 private organizations

10 Targets To reduce injuries by 30% in 5 years To be accredited by WHO as Safe Community in 2 years

11 Database AEIS Accident & Emergency Information System CDARS Hospital admissions Child abuse registry of SWD Traffic accident database Police Crime rate Police Fire outbreaks Fire Services Department Ad hoc surveys

12 Pilot Study on Fall Injuries Survey was conducted at AED of PMH July 2000 To investigate incident rate, causes and characteristics 107 cases were interviewed in four weeks 24 student volunteers recruited for data collection. Pamphlets, questionnaires were designed and issued % Percentage Age Distribution of Fall Injuries Age

13 8 6 Public Attitudes towards Health and Safety Survey on awareness on occupational safety and health in May respondents were interviewed by telephone Score Air Quality Cancers Traffi c Accidents Heart Attacks Occup. Accident Average Score Health and Safety Issues Home Accidents Me ntal Illne ss Food Poisoning

14 Survey on Hospital Staff s s Attitude towards Health and Safety To explore the attitude of hospital staff towards work safety and its relationship Self- administered questionnaires on April 01 Response rate was 48% (1448 staff)

15 Survey on Hospital Staff s s Attitude towards Health and Safety 70% 60% 50% 40% 30% 20% 10% 0% Arthri tis/lb P Stres s /head GI probl em Resp. probl em Skin Visio n Heari ng Other s Administrative 40% 40% 20% 30% % 0 Medical 41% 41% 18% 45% 18% 9% 2% 5% Nursing 60% 60% 38% 41% 16% 6% 3% 3% Allied Health 47% 47% 26% 23% 16% 11% 4% 2% Clerical 41% 41% 28% 30% 9% 24% 10% 8% Supporting 58% 58% 22% 16% 10% 12% 10% 7%

16 Survey on Teenagers Attitude towards Safety and Risk Taking Behaviour Survey to find out prevalence of risk behaviours and health status of youth 6147 schoolchildren participated (1026 primary and 5121 secondary school students) Questionnaire based on Youth Risk Behaviour Surveillance and Wessex Healthy Schools Award Scheme Students evaluation Questionnaire

17 Survey on Teenagers Attitude towards Safety and Risk Taking Behaviour Primary students 6% carried weapons to school and being threatened 25% reported property being stolen or damaged 13% complained being sexually harassed 25% found to have depressive symptoms 9.8% had suicidal thoughts 3% tried cough syrup and 2% sniffing organic solvent Secondary students 7% carried weapons to school and 4% being threatened 25% reported property being stolen or damaged 17% complained being sexually harassed 40% found to have depressive symptoms 18.9% had suicidal thoughts 1% tried cough syrup and 2% sniffing organic solvent

18 Central Hub for Community Health Resources with funding from Yuen Yuen Institute Co-ordinating Office Venues for meeting, education talks, activities Models, facilities and equipment to demonstrate safety

19 Central Hub for Community Health Resources Models, facilities and equipment to demonstrate safety

20 Kwai Tsing Safe Community and Health City Association Made up of key members from Steering and Working Committees To initiate changes by pooling community resources and efforts To identify major health and safety issues To collect and raise funds

21 Setting - Home - School -Road Age Child - Youth - Elderly - Elderly home - Work place School 2003 Estate 2002 Safe & Healthy Means -Safety education -Safety promotion -Skill training Emergency, CPR -Ambassador Mechanism -Fall -Fire -Traffic -Crime -Violence Workplace 2004

22 600 Hospitalized Child and Youth Injuries in Kwai Tsing Number Year 0-4 yr 5-9 yr yr yr yr

23 Hospitalized Adult Injuries in Kwai Tsing Number Year yr yr yr yr yr yr yr yr

24 No of episodes Hospitalized Elderly Injuries in Kwai Tsing Year yr yr yr yr 85+ yr

25 Kwai Tsing Healthy City Inaugurated in January 2002

26 Steering & Working Committees 葵青安全社區及健康城市協會董事會 Board of Directors 葵青安全社區及健康城市協會督導委員會 Steering Committee 行政會 Executive Committee 安健屋邨委員會 Safe & Healthy Estate Subcommittee 葵青區傷害監察專責委員會 KT Injury Surveillance Subcommittee 安健學校委員會 Safe & Healthy School Subcommittee CIIF 及青衣健康中心委員會 CIIF & TY Community Health Centre Subcommittee 安健約章委員會 Safety & Health Charter Subcommittee 葵青社區照顧互動網委員會 KT Community Care Network Subcommittee

27 Kwai Tsing Safe Community & Healthy City Association Founded in August 2002 To sustain the work of Healthy City & Safe Community As a NGO and not for profit Accept Donation Apply for research & development funds Reduce red tapes and procedures Work according to Memorandum & Articles

28 Designated to be the 73 rd Safe Community on 18 March 2003

29 New Collective Identity A common bond was forged between the hospital staff and society at large This new communal spirit was further promoted by the mass media which for once began to serve a constructive purpose by informing the public of the methods of coping with it in everyday living. (Leo Ou-Fan Lee,2003).

30 Spiritual Appreciation Solidarity, resilience Open expressions of appreciation to the frontline healthcare workers, family members. Tributes to the heroic professionalism of the frontline health care workers Mutual support, peace of mind Setting up hotlines and emergency services Mobilizing volunteers to distribute facemasks and disinfectants, measure body temperature for the public in MTR Helping underprivileged people to clean up their homes Serving single elderly persons in the community of homes for the elderly

31 認識及預防流感

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33 Community Diagnosis Conducted by the Chinese University of Hong Kong during 10/03 3/04 Interviewed 685 residents Conducted 5 Focus Group meetings Overall satisfied with the facilities Concerns on night drifters, neighborhood, environmental hygiene, exercise and health information

34 Safe and Healthy Estate Safe and Healthy homes Safe and Healthy Community Safe and Healthy Workplaces Safe and Healthy Elderly homes Safe and Healthy Schools

35 Founding Member of the Alliance For Healthy Cities, West Pacific Region on 15 June 2004

36 6 Years Experience The Setting Approach Setting up the Community Health Centre Safety & Health Charter Project Safe & Healthy Estate Project Safe & Healthy School Project Safe & Healthy Elderly Home Project Medical & Health Record Fall Prevention for the Elderly Injury Surveillance System Diabetes Retinopathy Screening Program Sharing and Learning Accreditation Schemes

37 Community Health Centre

38 Community Health Centre in Housing Estate Established Nov 2004 in a Public Housing Estate Funded by Community Investment Inclusion Fund Establish networks of community resources Enforce individual, family & community health Pilot of Family Nurse Practitioner

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40 The Family Nurse Practitioner Designated community nurse Responsible for all patients discharged Review cases from GOPC Resource person for health problems / issues Establish service networks Reduce health risks, improve population health Empower individual / groups for health The Nurse of Cheung Ching

41 Safety & Health Charter 28 Organizations - 13 major government departments, 3 Public Utilities, 3 education institutes and 5 private organizations, 2 NGOs, 2 Hospitals

42 Safety & Health Charter 45 Safety & Health Information Stations

43 Health Galas for 24 Estates Safety & Health Charter

44 Health Assessment & Counseling

45 Safety & Health Charter Health Check Results Health Screening in Kwai Tsing % 90.00% 80.00% 40.95% 17.85% 30.90% 38.70% 10.35% Abnormal Population Normal Population 70.00% 64.92% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% BMI > 25 Body Fat >27% Blood Sugar >7.8mmol/L Cholesterol >5.2mmol/L Syst olic BP >140mmHg Diastolic BP >90mmHg

46 祖堯 荔景 長亨 石籬 長青 青衣 大窩 青衣 總數 口 No >60 53% 46% 50% 81% 72% 49% 77% 30% BMI 40% 31% 33% 41% 27% 53% 45% 38% Sys 38% 41% 42% 52% 42% 44% 43% 26% Dia 11% 11% 15% 17% 7% 13% 13% 11% Sugar 14% 14% 17% 17% 12% 16% 23% 15% Lipid 43% 36% 30% 24% 24% 27% 26% 31% 58% 39% 41% 13% 16% 31%

47 長發 葵芳 葵涌 葵興 安蔭 石蔭 葵芳 大白田 總數 No >60 46% 77% 46% 72% 85% 85% 79% 69% BMI 37% 55% 38% 44% 44% 38% 44% 50% Sys 20% 37% 22% 34% 34% 54% 50% 41% Dia 4% 6% 5% 9% 9% 15% 5% 10% Sugar 15% 30% 23% 10% 28% 13% 21% 18% Lipid 37% 32% 22% 21% 26% 35% 41% 38% 70% 44% 36% 8% 20% 32%

48 Results of Health Assessment Obesity Hi Systolic Hi Diastolic Hi Blood Sugar Hi Blood Choles. Total 41% 39% 11% 18% 31% >60 47% 50% 11% 21% 33% >75 41% 50% 7% 22% 29%

49 Safety & Health Charter Prevention of 3 Highs

50 Diabetes Retinopathy Screening Collaborated with HK Poly U School of Optometry Provided at Integrated Community Health Centre Referred by the GOPC / FM Clinics Retinal photos for DM patients Service at cost of HK$80 Early detection of Retinopathy Early referral to Ophthalmologist Target for all DM patients in Kwai Tsing District

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55 Website

56 5 Star Health & 5 Star Home Project in KT Organized by the HK Red Cross To promote healthy lifestyle 1/4/ /3/ Star Health Ambassadors 5-Star Home 5-Star Health Garden Declaration Health Kits Newsletter 五星健康五星家

57 Analysis and way forward

58 Community engagement for safety and health Active involvement of people (as lay people, as service users or as residents) in any decisions that may affect the safety and health of them, their families and the communities they are linked to. Process community development Public education and awareness Consultation Community Participation integral part of decision making and action Identify and/or define issues / problems Identify and/or developing solutions Managing and/or delivering solutions Monitoring and evaluating services Effectiveness depend on both community and organisational capacity to engage

59 Factors on success of community engagement Environment History of collaboration Political and social climate Membership Mutual respect, understanding and trust Appropriate cross-section section of members Members see engagement in their self-interest Ability to compromise Purpose Goals clear and realistic to all partners Shared vision Unique to the effort Mattessich and Monsey 1992 Process/Structure Members feel ownership Every level in each organisation in collaborating groups participate in decision-making Flexibility of collaborating group Clarity of roles and guidelines Ability to sustain itself in midst of changing conditions Communication Open and frequent interaction, information and discussion Informal and formal channel of communications Resources Sufficient fund Skilled convenor

60 Before Principles of community Be clear about the purposes or goals of engagement effort, and the population and/or communities you want to engage Become knowledgeable about the community For engagement to occur Go into community, establish relationships, build trust, work with the formal and informal leadership, seek commitment from community to create processes for mobilization Community self- determination is the responsibility and right of all people engagement For engagement to succeed Partnering with community to create change and improve health Must recognize and respect community diversity Sustain engagement by identifying and mobilizing community assets,, and by developing capacities and resources for community health decisions and actions Be prepare to release control of actions or interventions to community and be flexible enough to meet the changing needs of community Requires long-term commitmnet by the engaging organisations and its partners

61 System & Surveillance for a Safe Community Evidence of Program Indicators for International Safe Communities Infrastructure: Based on partnership and collaborations, governed by a crosssectional group that is responsible for safety promotion in their community Injury Surveillance: Document the frequency and causes of injuries Programs: Long-term, sustainable, covering both genders and all ages, environments, and situations Targeted at high-risk groups and environments Promote safety for vulnerable groups Evaluation: Assess programs, processes and the effects of change Networks: Ongoing participation in national and international Safe Cmmunities networks (WHO Collaborating Centre on Community Safety Promotion, May 2002)

62 Main strategies Development of local networking and coalition Mobilizing local community to local networking, arranging personal appointments and discussing aims & objectives of the programme and thereby securing commitment of cooperation. The sectors covered are: Existing Health system, Public Administration, other relevant Govt. Departments like Police (including village police, Elected public representatives, Municipal Chairman, UP Chairmen, Various Association leaders Local elite,, Local NGO s Developing Injury surveillance system

63 Tuen Mun Kwai Tsing Tai Po Tsuen Wan Sham Shui Po Tung Chung Data source AED Hospital Inpatients Police crime, drugs & traffic SWD abuse Labour occupational injuries AED Hospital Inpatients Police crime, drugs & traffic SWD abuse Labour occupational injuries AED Hospital Inpatients Police crime, drugs & traffic SWD abuse Labour occupational injuries AED Hospital Inpatients Police crime, drugs & traffic SWD abuse Labour occupational injuries AED Hospital Inpatients Police crime, drugs & traffic SWD abuse Labour occupational injuries AED Hospital Inpatients Police crime, drugs & traffic SWD abuse Labour occupational injuries Special groups Worker Elderly Children Worker Elderly Children Elderly Children Worker Elderly Workers Children Poor family New arrivals Elderly Children Elderly Workers Top nonintentional injuries Occupation Domestic Sports Occupation Domestic Traffic Domestic Occupation Sports Domestic Occupation Sports Domestic Occupation Sports Domestic Occupation Sports Top Intentional injuries Assault Abuse Self harm Assault Abuse Self-harm Assault Self harm Abuse Assault Abuse Self harm Assaults Abuse Self harm Assaults Abuse Top places of injuries Work place Home Workplace Street Home Home Workplace Home Workplace Home Home Workplace Home Workplace Total injury reduction - Intention al Non- 3 yr 22% 10% 20% 3 yr 24% 5% 25% 3 yr 25% 5% 30% 3 yr 34% 2% 30% 3 yr 14% 30% 16% 3 yr 30% (increase in population by 50%)

64 Partners Tuen Mun Kwai Tsing Tai Po Tsuen Wan Sham Shui Po Tung Chung Populatoin 500, , , , , ,000 Lead local organization Tuen Mun Hospital (Medical) KT Safe Community Association AHMLN Hospital (Medical) Yuen Yuen Institute (Religious NGO) Caritas Med Centre (Medical) TC Safe Community Association Political body District Council District Council District Council District Council District Council District Council Local community organisations Association of Heads of Schools SKH Lady McLehose Centre Liaison Committee of Tai Po Schools Tsuen Wan Rural Committee Local Schools SKH Lady McLehose Centre SSP School Liaison Committee SSP Commercial & Industrial Liaison NT Ass. of Societies Island Youth Ass HK Island Women Ass. North Lantau Citizen Ass Govt Departments TM District Office Fire service Dept Police Force Labour Department HK Housing Authority KT District Office Fire Services Dept HK Police Force Labour Dept HK Housing Authority Food & Environmental Hygiene Dept Dept of Health Electrical Mechanical Service Dept Leisure Cultural Sports Dept Social Welfare Dept Environmental Protection Dept District Office Fire Services Dept Police Force Labour Dept HK Housing Authority Food & Environmental Hygiene Dept Dept of Health Leisure Cultural Sports Dept Social Welfare Dept Transport Dept Environmental Protection Dept Transport Dept Education & Manpower District Office Fire Services Dept Police Force Labour Dept HK Housing Authority Food & Environmental Hygiene Dept Dept of Health Leisure Cultural Sports Dept Social Welfare Dept Transport Dept Environmental Protection Dept Education & Manpower District Office Labour Dept Food & Environmental Hygiene Dept Dept of Health Leisure Cultural Sports Dept District Office Fire Service Police Force Housing Authority Social Welfare Dept Public utilities CLP Power KCRC Light Rail TM Hospital China Gas CLP Power PM General Hospital KC Mental Hospital Tai Po Hospital Nethersole Hospital Kowloon Motor Bus KC Railway China Gas Yan Chai Hospital Caritas Medical Centre China Gas MTR Airport Authority NGOs Occupation Safety & Health Council (OSHC) OSHC OSHC Red Cross Salvation Army UCN Community Health Service OSHC Independent Commissoin Against Corruption Jockey Club Youth Centre OSHC Neighbourhood Adviceaction Council SKH Tung Chung Integrated Service Youth outreach team, YWCA HK Federation of Trade Union

65 Commercial & business Academic Institutions Structure Working Groups ( ) regular program at District Councils Tuen Mun Kwai Tsing Tai Po Tsuen Wan Sham Shui Po YKK HK Ltd Vogue Laundry Green Island Cement River Trade Terminal Co Sino properties Ltd Shiu Wing Steel Ltd Lignan University Steering Committee Executive Committee Injury Surveillance Occupational Safety Home Safety School Safety Road Safety Estate Safety Environmental Safety HK Container Terminal Operators Association Fat Kei Transport Dow Chemical (HK) Ltd Kowloon Motor Bus Oil & Chemical Industry Safety Com Chinese University of Hong Kong HK Polytechnic U HK Institute of Vocational Education Steering Committee Working Committee Injury Statistics Occupational Safety Home Electrical Safety Student Safety Road Safety OSH Carnival (Crime prevention) (Fire prevention) Chinese University of Hong Kong HK Science & Technology Park Steering and Working Committee Community Diagnosis Safety and Healthy Promotion Safe and Healthy Neighbourhood Safety and Health Promotion Accreditation (Agriculture, fisheries, commerce & industry) Adventist Hospital Chinese University of Hong Kong Executive Committee Injury Surveillance Safe School Safe Estate Safe Aged Home Occupational Safety Finance (Crime prevention) (Road Safety) (Fire prevention) Kowloon Labour Union Federation of Trade & Union Steering Committee (Crime prevention) (Road Safety) Tung Chung China National Aviation Co Ltd Chinese University of Hong Kong Steering Committee Working committee Injury Surveillance Safe School Safe Family Safe Workplace Safe Environment (Crime prevention) (Fire prevention) (Road safety)

66 Injury surveillance information 1. Relevance of injury statistics Tuen Mun Kwai Tsing Tai Po Tsuen Wan Sham Shui Po Yes but lack socio-economic data Yes, but lack demographic, place, activity and nature 2. Dissemination strategy Not structural Mainly to District Council, local media Community involvement 1. All relevant organisation involved 2. Structure & organisation conducive to leadership building and ownership 3. Are targets and solutions developed locally Legitimisation Yes but no local agencies & NGOs Yes but weak in business sector Yes but lack demographics, place, activity Yes, but no data on ethnic minorities Yes but no data on poor families & new arrivals Tung Chung Yes but no data on new move in families Not structural Not structural Not structural Not structural Yes but no business sector Yes but no public utilities Poor involvement of SWD & NGO & Academic Yes Yes Yes Yes No formal structure established yet Partly, lack local initiatives on non-intentional injury; mainly on environmental improvement Partly, lack local initiatives on non-intentional injury; mainly on environmental improvement Partly, lack local initiatives on non-intentional injury Partly, lack local initiatives on non-intentional injury; mainly on environmental improvement Partly, lack local initiatives on non-intentional injury Yes but Yes Partly, lack local initiatives on non-intentional injury; mainly on environmental improvement 1. Are programmes linked with credible authorities Yes with Hospital Yes with Hospital & University Yes with Hospital & University Yes with Hospital & University Yes with Hospital Yes with Hospital & University 2. Are public services involved in projects Yes but not systematic Yes but not systematic Yes but not systematic Yes but not systematic Yes but not systematic Yes but not systematic

67 The Way Ahead new injury surveillance system New GIS injury prevention system Prioritized by volume and severity Identified high risk group by injury map Analysis the mechanism, activity, place of injury of the identified ied group Recruited stake holders Targeted for a regionalize surveillance system OSH injuries from Labor department Intentional and traffic injuries from police Fire related injuries from Fire department 個案數字 < 家中工廠 / 工場辦公室 / 公司地盤 ( 年齡組別 System enhancement for Data integration and report generation To prepare for data upload/download from various stakeholders Design process of data integration Report plan in the future; aim at epidemiological monitoring Sharing of data to the public and stakeholders Identify source of data distribution e.g. web / journal Educational activities Linking data to action

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69 20 critical steps to healthy city Getting started 1. Building a support group Yes 2. Understand healthy city Yes concepts 3. Getting to know your city Yes 4. Finding project funds Project based 5. Deciding organisation location CHRC 6. Preparing project proposal Yes 7. Obtaining project proposal Getting organized 8. Appointing the steering committee 9. Analyzing the project environment Yes Yes but 10. Defining project work Yes but 11. Setting up the project office Yes but 12. Planning project strategy Not quite 13. Building project capacity No 14. Establishing accountability mechanisms Taking action No 15. Increasing health awareness Yes 16. Advocating strategic planning Yes/No 17. Mobilizing intersectoral action Yes but 18. Encouraging community participation Yes but 19. Promoting innovation Yes but 20. Securing healthy public policy No

70 Advantages of community engagement A health care system that reflects the specific needs, values, culture and attitudes of the community; A more efficient use of resources +++ Not studied An enhanced sense of control and empowerment Increased support for resulting programs and services Greater access to local skills and resources ++++ Increased community awareness of health issues +++++

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72 Community-level work Networking Organisational development

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74 Level of community engagement Public education and awareness +++ safety & health problems + service provision Consultation + via district council limited Community Participation integral part of decision making and action Identify and/or define issues / problems Identify and/or developing solutions Managing and/or delivering solutions Monitoring and evaluating services ++ safety & 三高, mainly via professionals community diagnosis and service data + mainly via professional input and service provides + via District Councilors, HGC + via District Councilors, HGC, complaints

75 Resource limitations Barriers Lack of representativeness +++ Conflicting vested interests +++ Time constraints No designated unit Lack of knowledge and training for both citizens and health planners +++++

76 Conclusion Community Engagement for Health can be achieved through Safe Community & Healthy City Key to Success Innovation for all new ideas Collaboration with all partners Participation at all levels Networking with all organizations Bottom Up Approach Data and Measurement BUT will need formal legimatization and funding for organisation development

77 Partnership Participation Sharing Challenges

78 Building of a Safe & Healthy City in HK

79 Thanks 謝謝!

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