Overview of action plan

Overview of action plan accompanying the National Strategy on the Prevention of Non-Communicable Diseases (NCD strategy) 2017 2024 10 50 Joint project of: 20 Within the strategy of the Federal Council

Publication details Published by: Federal Office of Public Health (FOPH), Swiss Conference of the Cantonal Ministers of Public Health (CMPH), Health Promotion Switzerland (HPS) Publication date: November 2016 More information: Federal Office of Public Health FOPH Tel. +41 (0)58 463 88 24 E-mail: ncd-mnt@bag.admin.ch Website: www.bag.admin.ch/ncd Language versions: This publication is also available in German, French and Italian. Additional documents: Federal Council strategy Health2020 National Strategy on the Prevention of Non-Communicable Diseases (NCD strategy) Action plan accompanying the National Strategy on the Prevention of Non-Communicable Diseases (NCD strategy)

Contents INTRODUCTION 5 MEASURES 7 I. Main measures 8 1. Population-based health promotion and prevention 10 2. Prevention in healthcare 11 3. Prevention in industry and the workplace 12 II. Cross-cutting measures 13 A. Coordination and cooperation 15 B. Financing 16 C. Monitoring and research 17 D. Information and education 18 E. Framework conditions 19 FOCUS AREAS 20 Health equity 20 Childhood and adolescence 21 Old age 22 Adulthood 23 Overview of action plan accompanying the National Strategy on the Prevention of Non-Communicable Diseases (NCD strategy) 2017 2024 3

Foreword Non-communicable diseases, such as cancer, cardiovascular diseases and diabetes, are increasing rapidly in Switzerland, too. Half of these diseases can be prevented, or at least delayed, through a healthy lifestyle. This means less suffering and greater quality of life for those affected. They need less medical care and this in turn reduces healthcare costs. The National Strategy on the Prevention of Non-Communicable Diseases (NCD strategy) focuses on proven approaches. On the one hand, it draws on the experience from previous national prevention programmes on tobacco, alcohol, diet and physical activity. On the other, it incorporates elements of successful projects run by the federal government, the cantons, municipalities, Health Promotion Switzerland and many other players. This valuable work is to be continued and extended where necessary. What is new here is that these players will work together even more closely in future and will further align their activities in order to have an even greater joint impact. All measures will be geared towards the shared goals of the NCD strategy and implemented across thematic areas. We will also be adopting new and innovative approaches. We need to target people where they live, work and spend their free time. And we will focus on ensuring the information is clear and easy to understand. For example, older people use different language and favour different media to young people. The plan includes measures such as cantonal prevention programmes, which are specifically aimed at older people. We want to ensure that everyone living in Switzerland is adequately informed so they can take responsibility for their own health and live well. In addition, we are keen to better integrate disease prevention in healthcare. This should be a self-evident part of medical care in doctors surgeries, in pharmacies, in assistance and care at home, in hospitals and in nursing homes. But working and living conditions also need to be conducive to healthy lifestyles. We intend to work with industry to strengthen organisational health management and to foster partnerships, for example to develop and offer healthier products. The saying prevention is better than cure is still as relevant as ever. Alain Berset, Federal Councillor Head of the Federal Department Of Home Affairs FDHA Thomas Heiniger, Cantonal Councillor President of the Swiss Conference of the Cantonal Ministers of Public Health (CMPH) Heidi Hanselmann, Cantonal Councillor President of Health Promotion Switzerland Overview of action plan accompanying the National Strategy on the Prevention of Non-Communicable Diseases (NCD strategy) 2017 2024 4

Introduction Starting position Cancer, diabetes, cardiovascular diseases and chronic respiratory diseases are the most common causes of death in Switzerland, causing a great deal of suffering to both those affected and their loved ones. These non-communicable diseases (NCDs) are responsible for over 50% of premature mortality (deaths before the age of 70) among men, and over 60% among women. Together with musculoskeletal disorders, these five NCDs account for around 40% of total healthcare costs. The National Strategy on the Prevention of Non-Communicable Diseases (NCD strategy) 2017 2024 1 is designed to tackle the challenges associated with these diseases. The strategy s vision is as follows: More people stay healthy or enjoy a high quality of life despite chronic illness. Fewer people suffer from avoidable non-communicable diseases or die prematurely. Irrespective of their socioeconomic status, people are empowered to lead a healthy lifestyle in a health-promoting environment. The National Health Policy Dialogue, the permanent platform of the federal government and cantons, and the Federal Council, adopted the NCD strategy at the beginning of 2016. It is being implemented from January 2017. Mandate On behalf of the Federal Council and the National Health Policy Dialogue, the Federal Office of Public Health (FOPH), the Swiss Conference of Cantonal Ministers of Public Health (CMPH) and Health Promotion Switzerland (HPS) developed a set of measures to implement the NCD strategy. The federal government, cantons and Health Promotion Switzerland gear their activities to the NCD strategy in their respective areas of responsibility: existing measures will be combined and new measures will be designed to close gaps. NCD action plan The NCD action plan brings together measures of the federal government, cantons and HPS that are necessary to improve coordination between actors, improve the efficiency of prevention and health promotion and to achieve the strategy s goals. The measures were devised on the basis of past experience and evidence on the effectiveness of prevention measures. Future implementation partners and experts were consulted during the process. This action plan groups the main measures into three action fields. They are complemented and supported by cross-cutting measures. 1 See: National Strategy on the Prevention of Non-Communicable Diseases (NCD strategy) 2017 2024, Bern, Federal Office of Public Health (FOPH), Swiss Conference of the Cantonal Ministers of Public Health (CMPH), p. 5-7. Available at: http://www.bag.admin.ch/themen/medizin/00683/index.html?lang=de Overview of action plan accompanying the National Strategy on the Prevention of Non-Communicable Diseases (NCD strategy) 2017 2024 Introduction 5

Measures in three areas The main measures are split into three areas. The three areas cover the two action fields described in the NCD strategy 2017 2024, Health promotion and prevention and Prevention in healthcare. 1. Population-based health promotion and prevention addresses people in their day-to-day settings to tackle risk factors in population groups. The programmes will be primarily planned at cantonal level and implemented by NGOs, cities and municipalities (action field Health promotion and prevention ). 2. Prevention in healthcare is aimed at people who are already in contact with the health system either because they have an increased risk of disease, or because they are already sick. The measures in this area establish prevention in the medical care structure. Multipliers, in other words the medical profession, nursing staff and other specialists, have a particular role to play here (action field Prevention in healthcare ). 3. Prevention in industry and the workplace underscores the role of industry in public health, both as employers and as producers of products and providers of services. The measures in this area are voluntary and will require a commitment from industry to be implemented (action field Health promotion and prevention ). Cross-cutting measures Additional, cross-cutting measures will also help to achieve the goals of the NCD strategy. These relate to the action fields set out in the NCD strategy, coordination and cooperation, financing, research and monitoring, information and education and framework conditions. Focus areas Health equity and the life stages childhood and adolescence, adulthood and old age were adopted as focus areas that are relevant to all measures. The focus areas describe the problems and set out their relevance to the three action fields. Implementation of the NCD action plan The NCD action plan forms the basis for implementation of the goals of the NCD strategy 2017 2024. It is an orientation with links to other actors in the areas Health promotion and prevention, Healthcare and Industry. Besides the federal government, cantons and HPS, other actors will align measures to the strategy and implement them in their areas of activity and thus make a contribution to ensuring the goals of the NCD strategy are met. Overview of action plan accompanying the National Strategy on the Prevention of Non-Communicable Diseases (NCD strategy) 2017 2024 Introduction 6

1. OVERVIEW OF MEASURES Population-based health promotion and prevention Further develop cantonal programmes for health promotion and prevention Minimise risk factors (alcohol abuse and tobacco consumption); reinforce protective factors (diet and exercise) Address people based on life stages Promote health equity 2. Prevention in healthcare 3. Prevention in industry and the workplace Promote health literacy among employees (organisational health management) Improve interfaces between prevention and cure Work with industry to encourage a health-promoting environment (improve health-promoting and work offers) Minimise risk factors (alcohol abuse and tobacco consumption; reinforce protective factors (diet and exercise) Promote health equity. Cross-cutting measures A. Coordination and cooperation B. Financing C. Monitoring and research D. Information and education E. Framework conditions. Main measures

Main measures The strategy revolves around the main measures in the three measure areas (MAs): Population-based health promotion and prevention, Prevention in healthcare and Prevention in industry and the workplace. The following descriptions of the measures also illustrate the importance of cooperation between all involved to ensure the relevant activities have maximum impact. 1. Measure area Population-based health promotion and prevention 2. Measure area Prevention in healthcare 3. Measure area Prevention in industry and the workplace

. Main measures 1. Population-based health 2. Prevention in healthcare 3. Prevention in industry promotion and prevention and the workplace 1.1 Expand efforts to prevent tobacco and alcohol addiction and to promote exercise and a balanced diet. 1.2 Specifically address children and adolescents, adults and older people. 1.3 Standardise quality criteria and requirements for proposals. 1.4 Identify success factors for cantonal prevention programmes. 2.1 Develop foundations and quality criteria. 3.1 Add relevant risk and protective factors to sector- or occupation-specific stress survey 2.2 Support projects to strengthen prevention in healthcare. 2.3 Identify financing options for prevention efforts. 2.4 Provide education and training for health professionals. 2.5 Strengthen self-management among people with chronic diseases and their relatives. tool for employees. 3.2 Add relevant risk and protective factors to existing HPS tools for apprentices. 3.3 Establish institutional collaboration in the area of organisational health management. 3.4 Expand actionsanté initiative, making the healthy choice the easy choice. 2.6 Promote the use of new technologies. CMPH/cantons HPS Fed. govt. (FOPH, FSVO, FOSPO, FSIO, TCF, SAB) NGOs (associations, leagues) FUNDING BY Cantonal finances/ressources (incl. Alkoholzehntel) HPS (Art. 20 KVG) SAB (Art. 43a AlcA) TCF (Art. 28 TabTA) FOPH and FSVO (prevention budget NCD) FOPH HPS CMPH/cantons service providers insurers NGOs (associations, leagues, partner organisations) FUNDING BY HPS TCF SAB FOPH (NCD prevention budget) CHI HPS industry Fed. govt. (FOPH, FSVO, SECO) Suva FUNDING BY industry

MA 1. Measure area Population-based health promotion and prevention Derived from action field 1 Health promotion and prevention in the National Strategy on the Prevention of Non-Communicable Diseases. Existing health promotion and prevention programmes will be developed in line with the NCD strategy for more effective prevention of cancer and cardiovascular diseases, chronic respiratory diseases, diabetes and musculoskeletal disorders. Efforts will continue to be made across all life stages to control tobacco use and prevent excessive alcohol consumption, poor diet and lack of physical activity. Support will be provided to help people minimise these risk factors, build up protective factors and adopt healthy lifestyles. The aim is also to boost health literacy and individual responsibility. The life course and settings approach will be stepped up and health equity will be promoted. Experiences from previous prevention and health promotion programmes and the results of scientific studies will form a broad knowledge base to ensure the effectiveness of the measures. The measures were defined on the basis of these experiences and results. AF 2 AF 1 Measures 1.1 Expand efforts to prevent tobacco and alcohol addiction and to promote exercise and a balanced diet. 1.2 Specifically address children and adolescents, adults and older people. 1.3 Standardise quality criteria and requirements for proposals. 1.4 Identify success factors for cantonal prevention programmes. Overview of action plan accompanying the National Strategy on the Prevention of Non-Communicable Diseases (NCD strategy) 2017 2024 Measures 10

MA 2. Measure area Prevention in healthcare Derived from action field 2 Prevention in healthcare in the National Strategy on the Prevention of Non-Communicable Diseases. The prevention of cancer, cardiovascular diseases, chronic respiratory diseases, diabetes and musculoskeletal disorders is very important in healthcare: if people are already suffering from chronic diseases or have an increased risk of disease, they and their relatives can be supported through needs-based preventive and health promotion programmes to alleviate disease progression. These programmes aim to improve health status, and maintain quality of life and social participation among those who are sick. In order to lower the risk of disease, avoid complications and reduce the need for care, prevention needs to be embedded in curative care and rehabilitation across the whole healthcare structure. Training, interfaces and collaboration between different health professionals within and outside the health system will be improved. Care will be coordinated and effective preventative measures will be integrated in treatments. AF 2 AF 1 Measures 2.1 Develop foundations and quality criteria. 2.2 Support projects to strengthen prevention in healthcare. 2.3 Identify financing options for prevention efforts. 2.4 Provide education and training for health professionals. 2.5 Strengthen self-management among people with chronic diseases and their relatives. 2.6 Promote the use of new technologies. Overview of action plan accompanying the National Strategy on the Prevention of Non-Communicable Diseases (NCD strategy) 2017 2024 Measures 11

MA 3. Measure area Prevention in industry and the workplace Derived from action field 1 Health promotion and prevention in the National Strategy on the Prevention of Non-Communicable Diseases. Health-promoting working conditions are a key foundation of a healthy lifestyle. Organisational health management (OHM) approaches and instruments aim to raise awareness among apprentices and employees in their working environments. OHM has been established in many businesses in recent decades. Measures in this area help develop examples of best practice and make them accessible to more businesses. Cooperation between different OHM actors is to be improved and efforts are to be coordinated nationally. By supplying products and services, industry influences the framework conditions that allow people to lead a healthy lifestyle. In collaboration with industry, products and services in a number of areas have been designed to better promote health, for example with regard to healthy diet. This voluntary commitment of industry is to be further encouraged. AF 2 AF 1 Measures 3.1 Add relevant risk and protective factors to sector- or occupation-specific stress survey tool for employees. 3.2 Add relevant risk and protective factors to existing HPS tools for apprentices. 3.3 Establish institutional collaboration in the area of organisational health management. 3.4 Expand actionsanté initiative, making the healthy choice the easy choice. Overview of action plan accompanying the National Strategy on the Prevention of Non-Communicable Diseases (NCD strategy) 2017 2024 Measures 12

Cross-cutting measures Additional cross-cutting measures help support the main measures and achieve the goals of the NCD strategy. They are organised in the action fields Coordination and cooperation, Financing, Research and monitoring, Information and education and Framework conditions. A. Cross-cutting area Coordination and cooperation B. Cross-cutting area Financing C. Cross-cutting area Monitoring and research D. Cross-cutting area Information and education E. Cross-cutting area Framework conditions

. Cross-cutting measures AF 2 AF 1 A. Coordination and B. Financing C. Monitoring and D. Information and E. Framework cooperation research education conditions A.1 Link up NCD actors through coordination of new and existing platforms and establishment of a national NCD stakeholder conference. FOPH HPS TPS CMPH FOSOP FSVO B.1 Use financial resources strategically and facilitate financing of projects addressing all risk factors. HPS TCF SAB FOPH Cantons C.1 Observe changes and trends in NCD-relevant indicators. FOPH HPS C.2 Carry out research, monitoring and evaluations in connection with the Swiss Nutrition Policy and ensure knowledge transfer. MAIN ACTOR FSVO C.3 Evaluate funded projects. FOPH TCF HPS D.1 Inform the public and raise awareness of NCDs. FOPH HPS Cantons D.2 Raise awareness among people in vulnerable situations. FOPH HPS CMPH D.3 Increase knowledge of nutrition and healthy diet among the Swiss population. MAIN ACTOR FSVO E.1 Implement legal bases and support cantons. FOPH SAB FSVO E.2 Strengthen health-promoting environments in terms of a multisectoral health policy. FOPH SAB FSVO FOSOP E.3 Represent interests; share knowledge and experience with international partners. FOPH FSVO FOSOP FOAG E.4 Improve food composition and promote healthy meals. FSVO

CA A. Cross-cutting area Coordination and cooperation Derived from action field 3 Coordination and cooperation from the National Strategy on the Prevention of Non-Communicable Diseases. Coordination and cooperation involves linking up the various actors and developing purposeful and binding forms of cooperation. This will ensure goals and activities are coordinated, and common strategic foundations and priorities are formulated to achieve synergies and to optimise effectiveness. AF 2 AF 1 Measures A.1 Link up NCD actors through coordination of new and existing platforms and establishment of a national NCD stakeholder conference. Overview of action plan accompanying the National Strategy on the Prevention of Non-Communicable Diseases (NCD strategy) 2017 2024 Measures 15

CA B. Cross-cutting area Financing Derived from action field 4 Financing in the National Strategy on the Prevention of Non-Communicable Diseases. In order to ensure the goals set out in the NCD strategy are achieved, funding must be used strategically and resources must be deployed efficiently. Coherent and well-coordinated financing by government and the public and private sector is therefore essential. AF 2 AF 1 Measures B.1 Use financial resources strategically and facilitate financing of projects addressing all risk factors. Overview of action plan accompanying the National Strategy on the Prevention of Non-Communicable Diseases (NCD strategy) 2017 2024 Measures 16

CA C. Cross-cutting area Monitoring and research Derived from action field 5 Monitoring and research in the National Strategy on the Prevention of Non-Communicable Diseases. The evidence-based prevention policy on non-communicable diseases requires a sound scientific basis. This is to be promoted through innovation and development. For example, pilot projects can be tested regionally and/or for a limited period of time to review their effectiveness before they are rolled out nationwide or on a longerterm basis. In addition, a monitoring programme geared to the goals of the NCD strategy lays the foundations for the federal government and cantons to review their strategy and measures, to adapt them to new challenges and to develop and improve them on an ongoing basis. AF 2 AF 1 Measures C.1 Observe changes and trends in NCD-relevant indicators. C.2 Carry out research, monitoring and evaluations in connection with the Swiss Nutrition Policy and ensure knowledge transfer. C.3 Evaluate funded projects. Overview of action plan accompanying the National Strategy on the Prevention of Non-Communicable Diseases (NCD strategy) 2017 2024 Measures 17

CA D. Cross-cutting area Information and education Derived from action field 6 Information and education in the National Strategy on the Prevention of Non-Communicable Diseases. The population requires reliable information on how to stay well and on health-promoting and health-damaging behaviours in an age-appropriate and needs-based manner. It is important that the population as a whole, but people in vulnerable situations in particular, are made aware of the causes of non-communicable diseases. Only those who are well informed can effectively look after their own and others health. Multipliers, such as teachers and employers, play a key role in terms of knowledge transfer. AF 2 AF 1 Measures D.1 Inform the public and raise awareness of NCDs. D.2 Raise awareness among people in vulnerable situations. D.3 Increase knowledge of nutrition and healthy diet among the Swiss population. Overview of action plan accompanying the National Strategy on the Prevention of Non-Communicable Diseases (NCD strategy) 2017 2024 Measures 18

CA E. Cross-cutting area Framework conditions Derived from action field 7 Framework conditions in the National Strategy on the Prevention of Non-Communicable Diseases. People s living, working and environmental conditions should be shaped to help them adopt healthy behaviours ( make the healthy choice the easy choice ). There are many possible setting-based prevention measures. These include statutory regulations, such as on pricing, availability and advertising of goods and services that are damaging to health. Other potential measures could be implemented through a commitment from industry (e.g. code of conduct or voluntary commitment to healthy foods). In addition, the living environment can also promote health, e.g. through safe and well-kept cycle paths, the preservation of open spaces and recreational areas, and the provision of healthy meals in workplace and school canteens. Promoting a multisectoral health policy and health equity also helps improve living conditions. AF 2 AF 1 Measures E.1 Implement legal bases and support cantons. E.2 Strengthen health-promoting environments in terms of a multisectoral health policy. E.3 Represent interests; share knowledge and experience with international partners. E.4 Improve food composition and promote healthy meals. Overview of action plan accompanying the National Strategy on the Prevention of Non-Communicable Diseases (NCD strategy) 2017 2024 Measures 19

FOCUS Health equity 2 Social inequality, in other words unequal distribution of material and immaterial resources in a society, has a major impact on health and therefore on people s life chances. Access to resources and the way they are allocated is usually described along the lines of differences in socioeconomic status (disparities with regard to education, employment status and income). In addition, there are other determinants of social inequality, such as gender identity, age, immigration background, residence permit status, religious affiliation, language background, marital status and region of residence. One or more of these factors, as well as living, working and environmental conditions, can influence a person s state of health and bring about health inequities. Health equity means ensuring that everyone has the same opportunities to develop, preserve and if necessary restore their health. This requires the promotion of low-threshold and adequate access to health promotion, prevention, curative care and high-quality treatment and care for all if necessary by means of specific measures. In line with the WHO s Health For All strategy, the 1986 Ottawa Charter for Health Promotion, and the Federal Council s Health2020 strategy, the NCD strategy aims to reduce inequalities in access to health promotion, prevention and curative care, and to improve health equity. The principle of health equity should be considered when planning and implementing all measures in all three main areas of the NCD strategy, and is relevant for all life stages. 2 In this document the terms health equity and health equality are used synonymously. Overview of action plan accompanying the National Strategy on the Prevention of Non-Communicable Diseases (NCD strategy) 2017 2024 Focus areas 20

FOCUS Childhood and adolescence Experiences in childhood and adolescence shape development and health in adulthood. It is therefore important for every child to have a healthy start in life. On their path to adulthood, adolescents face the difficult task of coping with significant physical, emotional and social changes. This phase also involves testing boundaries. On the one hand, this should occur without causing any lasting damage; on the other, young people should be encouraged to adopt a healthy lifestyle at this stage. An environment should be created which promotes health literacy and healthy behaviour of children and adolescents. This may include ensuring safe routes to school, offering healthy school meals and organising attractive sports and exercise programmes. For the Childhood and adolescence life stage there are NCD measures in all three measure areas. The majority of children and adolescents do not have any health complaints. The focus for this life stage is therefore on the action field Population-related health promotion and prevention. The action field Prevention in industry and the workplace is also relevant with a specific measure for adolescents on the topic Young people in apprenticeships. Overview of action plan accompanying the National Strategy on the Prevention of Non-Communicable Diseases (NCD strategy) 2017 2024 Focus areas 21

FOCUS Old age The risk of suffering from one or more NCDs increases with age. In addition, more critical life events occur in old age: retirement, loss of a partner, poverty or social isolation, which may present a risk to physical and mental health. Health promotion and prevention measures in old age therefore aim to preserve health, and in the same vein, maintain independence and quality of life and prevent disability and the need for care. Good cooperation between actors is important given the healthcare challenges associated with demographic change. NCD measures related to old age feature in all three measure areas. However, as the percentage of people with an increased risk of becoming ill or suffering from an NCD is higher in the older population compared to the population as a whole, the focus is on the areas Prevention in healthcare and Population-related health promotion and prevention. These efforts aim to enhance quality of life and reduce the need for care. Overview of action plan accompanying the National Strategy on the Prevention of Non-Communicable Diseases (NCD strategy) 2017 2024 Focus areas 22

FOCUS Adulthood Social and work pressures in a complex economic and societal environment, as well as family responsibilities, are just some of the challenges of adulthood. Established behaviours, such as a sedentary lifestyle, lack of exercise, poor diet, smoking, excessive alcohol consumption or even accidents may result in non-communicable diseases. Health promotion, prevention and early detection measures aim to help people cope better with these challenges, protect them from risk and provide them with the tools they need to lead a healthy lifestyle. Adults are not only the target group for prevention and health promotion measures, they are also multipliers and role models for others. NCD measures related to adulthood feature in all three measure areas. However, the focus is on the areas Population-related prevention and health promotion and Prevention in industry and the workplace. Overview of action plan accompanying the National Strategy on the Prevention of Non-Communicable Diseases (NCD strategy) 2017 2024 Focus areas 23