01.12.2014 For a society in which a balanced diet and sufficient physical activity are taken for granted

National Nutrition and Physical Activity Programme. The Swiss government, the cantons and Health Promotion Switzerland are cooperating in a broadly based national programme to promote a balanced diet and sufficient level of physical activity. The long-term aim is to prevent chronic illnesses such as cancer, cardiovascular diseases and diabetes. Interim report on progress at the half-way point.

Pictures For a society in which a balanced diet and sufficient physical activity are taken for granted

TODO CHRISTIAN

In May 2012, the Swiss government extended the National Programme on Nutrition and Physical Activity (NPEB) by a further four years to the end of 2016. This measure ensures that prevention activities already launched have a long-term effect. Since January 2014, the implementation of the NPEB goal "Promotion of a balanced diet" has been the responsibility of the Federal Food Safety and Veterinary Office FSVO. This new federal office brings together the responsibilities of the former Federal Veterinary Office (FVO) and the Food Safety Division of the Federal Office of Public Health (FOPH) under one roof. The NPEB's strategic management team consists of representatives of the four previous partners – FOPH, Federal Office for Sport (FOSPO), Swiss Conference of Cantonal Health Directors and Health Promotion Switzerland – and the new FSVO. It has evolved into an important strategic body that contributes to implementation of the NPEB's goals, particularly main goal no. 1, "Securing nationwide coordination". It raises the visibility of the programme through joint activities organised under the aegis of the NPEB; in this it is a major success and a good example of cooperation at the national level.

Environment conducive to physical activity
In January 2013 the Swiss government approved the global "Health 2020" strategy, which emphasises that people's health is determined by up to 60 percent by factors not related to health policy.
In its NPEB-related work, the FOPH employs a multisectoral approach, focusing for instance on specific cooperative projects with other federal agencies in order to create general conditions that are conducive to the promotion of physical activity. Some examples:
Federal Coordination of Non-motorised Traffic: This working group is based on a mandate awarded by the Swiss government to increase the proportion of traffic that is non-motorised, i.e. walking and cycling. Under the leadership of the Federal Roads Office, the group discusses relevant projects and changes to the law that might promote non-motorised traffic.
Development of Guidelines on Suburban Open Spaces: An attractive network of small and large urban spaces is particularly important for the public's quality of life, particularly in densely populated urban agglomerations. These spaces are used for recreation, exercise, leisure activities, sport or the enjoyment of nature. In order to raise awareness of this topic among the different players at the municipal, urban agglomeration, cantonal and federal levels and to broker practical approaches to action, seven federal offices (including the NPEB partner FOSPO) cooperated in drawing up a set of guidelines which can be accessed on the FOPH website.
DZM Service Centre for Innovative and Sustainable Mobility: In the framework of the DZM the FOPH cooperates with the Federal Offices for Spatial Development (lead manager), Roads, Traffic, Environment and Energy in supporting sustainable and innovative mobility projects. The FOPH is thus promoting innovative non-motorised traffic projects.
Model Project – Sustainable Spatial Development 2014–2018: Thanks to the involvement of eight federal offices (including the NPEB partner FOSPO) and with a focus on the development of open spaces in agglomerations, the Model Project – Sustainable Spatial Development promotes, for instance, pilot projects that encourage physical activity in Switzerland's largest built-up areas. Nine open-space projects are currently being supported.  

Promoting Physical Activity at the Workplace
At the end of 2012 Suva (Swiss Accident Insurance Fund), Health Promotion Switzerland and the FOPH undertook to work more closely together and develop innovative approaches in the field of workplace health promotion. This involves bundling the skills and resources of these organisations so as to be able to coordinate activities and offer standardised tools, support and methods to companies that wish to make a comprehensive commitment to improving the health of their workforces. The proposed procedure is to develop an innovative, modern and reliable intervention model that is based on an integrated approach. Specialists in ergonomics, physical activity, nutrition and mental health will offer their services to employees at the workplace. A first pilot project, "Nestmove", which focused exclusively on physical activity, was launched in collaboration with Nestlé in 2013. A second pilot project drawn up in cooperation with Migros-Vaud has been in development since 2014; it includes mental health and nutrition as well as physical activity.

actionsanté
Since 2009, the FOPH's "actionsanté" initiative has provided support for companies that actively encourage employees to adopt a healthy lifestyle. Private-sector partners can get involved in this initiative by voluntarily pledging to take action. The aim is to provide attractive and readily accessible products and offerings that make it as easy as possible for the public to choose the healthy option as regards diet and physical activity. A total of 19 private-sector partners are now participating with 32 different activities in the four action areas: 1) information for consumers, 2) marketing and advertising, 3) food formulations and provision, and 4) promotion of an environment that encourages physical activity. Extending the initiative to 2016 gives the partners of actionsanté time to plan the pledged activities more comprehensively and integrate them more effectively into the companies' everyday processes, thereby making them more effective. In compliance with the new thematic responsibilities, the FOPH and the FSVO have been implementing actionsanté jointly since January 2014. Both offices are represented on the management board of actionsanté. The actionsanté office continues to be the point of contact for companies and to coordinate the activities.
This initiative has also been attracting the interest of specialists in other countries. A wide-ranging study by the Bertelsmann Foundation has called actionsanté a model initiative for interaction between the private and public sectors.
 
MOSEB Monitoring System
The MOSEB Nutrition and Physical Activity Monitoring System refers to the continuous, systematic collection of comparable, representative data on specific indicators that reflect the nutritional and physical activity situation in Switzerland. Wherever possible, MOSEB draws on established data sources. Its purpose is to describe developments and identify changes. MOSEB therefore provides an important basis for initiating or reviewing and, if necessary, modifying preventive measures and also for ensuring food safety.
In April 2014 the poster "Nutrition and physical activity in Switzerland", including eleven selected indicators that convey the current situation, was published for the first time (see also p. 4–5). The second edition of the brochure "Nutrition and physical activity in Switzerland" followed in October 2014. It explains 21 selected MOSEB indicators in a clear, understandable fashion. In addition, the 5th, 6th and 7th updates of the MOSEB indicator collection were concluded in 2013 and 2014. The latest findings show that the proportion of obese persons in the population has grown in the last five years. At the same time, more people are engaging in sufficient physical activity than previously. However, the vast majority of people have not been achieving the nutritional recommendations on the consumption of fruit and vegetables. The costs generated by lack of physical activity are now also illustrated.

Treatment and counselling
With the aim of reducing the frequency of non-communicable diseases caused by lack of physical activity, the FOPH wants to upgrade the role, skills and presence of family doctors who wish to support a change in their patients' behaviour by offering information, awareness-raising and counselling. Among people with whom they are in regular contact, family doctors tick all the boxes necessary for acting as catalysts of the process of assuming more responsibility. The FOPH is cooperating with the Canton of Ticino in developing a pilot project designed to achieve these goals. The underlying objective is to create a prevention and health promotion network that is based on the dynamic relationship between doctor and patient and to introduce new channels of communication between them. The network will consist, on the one hand, of the patient and his or her environment (as owner of the personal resources) and, on the other, of the family doctor who is helping the patient achieve his or her behavioural change. It will enable the route taken by the patient to be defined and it can be expanded to include other professionals from the fields of healthcare or physical activity.
Since the end of 2013 – based on the findings of an FOPH-backed investigation of the pilot project "Kidsstep" over a period of six years – the new Federal Ordinance governing statutory health insurance benefits has enabled overweight or obese children (who suffer from a disease arising from this condition) to be given all-round care, both in group and individual treatment settings.
In 2014, the FOPH mandated the Forum Obesity Switzerland (FOS) to perform a situation analysis of the care and treatment of overweight or obese adults. The aim of this study is to identify existing gaps and thereby improve coordination at the national level. When this report becomes available, a meeting will be organised in 2015 to define the action that needs to be taken.

International action in the physical activity field
At the international level, there has been a growing focus on the promotion of physical activity. In 2011, the United Nations approved a global goal of a 10-percent reduction in the prevalence of physical inactivity within ten years. At the European level the EU Member States approved the Council's first recommendation on cross-sector support for health-enhancing physical activity in December 2013.
European strategy on the promotion of physical activity: The European Member States of the World Health Organization (WHO) have also focused increasingly on the topic: in connection with the Vienna Declaration on Nutrition and Noncommunicable Diseases in the Context of Health 2020 in July 2013, the WHO was mandated with the task of drawing up a European strategy for the promotion of physical activity, to be presented at the 65th Session of the Regional Committee for Europe in September 2015. The FOPH has declared its willingness to play an active part in drawing up this strategy, for instance by organising the meeting of the WHO European Member States to streamline the European strategy on the promotion of physical activity, which is scheduled to take place in Zurich in late January 2015.
THE PEP (Transport, Health and Environment Pan-European Programme): The pan-European exchange platform "THE PEP" was launched by the UN Economic Commission for Europe and the WHO in 2002. It aims to increase networking between the transport, health and environment sectors and to promote the exchange of experience at the international level. A total of 56 countries from Europe, the Caucasus, Central Asia and North America are currently participating in the programme. When the THE PEP exchange platform was being set up, the FOPH played an active role in steering the activities and priorities and invested both human and financial resources in the project. The lead role for Switzerland is taken by the Federal Department of the Environment, Transport, Energy and Communications.
Physical activity promotion in the health care setting and the 10th Annual Meeting and 5th Conference of HEPA Europe: The FOPH supported and took part in the WHO Meeting of Experts to discuss "Physical activity promotion in the health care setting" and in the 10th Annual Meeting and 5th Conference of HEPA Europe, organised by the University of Zurich's Epidemiology, Biostatistics and Prevention Institute.

The partners' contributions
The Federal Food Safety and Veterinary Office (FSVO) established early in 2014 is tasked with implementing and further developing the Swiss Nutrition Strategy and, in the context of the NPEB, is therefore responsible for promoting a balanced diet. The Swiss Nutrition Strategy is derived from data generated by the 6th Swiss Nutrition Report from 2012. These data will be supplemented by the findings of the first National Nutrition Survey "menuCH". The survey will, for the first time, supply data on the dietary and physical activity habits of the Swiss population. The study began in January 2014, and 2000 people are to be interviewed by the spring of 2015. The FSVO is involved in the following NPEB-related projects:
Salt Strategy: People in Switzerland eat too much fat, too much sugar and too much salt. A high-salt diet can, however, cause hypertension and hence increase the risk of cardiovascular disease. The Swiss population's average daily salt intake of about 9 grams per person exceeds the 5 grams per person per day recommended by the WHO. In 2008, the Swiss government and other stakeholders therefore developed a strategy designed to lower salt intake in Switzerland and reduce the risk of cardiovascular disease. Processed foodstuffs account for the bulk, i.e. 70 to 80 percent, of daily salt intake. Various producers have voluntarily undertaken to reduce salt levels in bread, meat, cheese, finished products, etc. (see actionsanté).
Community catering: As the federal office responsible for promoting a balanced diet, the FSVO supports the "Quality Standards in Community Catering" project. With more than a million people taking meals every day in nurseries, schools, canteens, hospitals and retirement homes, community catering plays an important role in feeding the population.
The activities of the Federal Office for Sport are an important contribution towards achieving goal no. 3 of the NPEB, "Promotion of sport and physical activity". The principal tool used is the Youth+Sport (Y+S) programme, which provides courses and camps for children and adolescents in more than 70 sports and disciplines. Every year, around 700,000 five to twenty year olds take part in over 55,000 sports courses or camps. The Y+S School Sports programme, currently in the development phase, will supplement compulsory sports teaching and build a bridge to voluntary club-based sports.
With the establishment of the Swiss adult sport programme (esa) in 2009 the federal authorities created a sports promotion programme geared to grass-root and recreational sports. Working in collaboration with partner organisations (cantons, associations and commercial suppliers), esa aims to establish a uniform quality standard in the basic and advanced training of sports leaders. The focus is on thorough training of sports leaders, enabling them to cope skilfully with adults' diverse expectations of sport.
The Health and Physical Activity Network Switzerland hepa.ch is a merger of organisations, institutions and enterprises that support health-enhancing physical activities (HEPA) at the national, cantonal or local levels. The focus of the hepa.ch network's activities in 2013 was the publication of a new set of recommendations on physical activity, which was the product of intensive dialogue with various partner organisations.
The Health Promotion Switzerland foundation is active in the following three domains in the framework of the NPEB: 1. As part of its public relations activities, Health Promotion Switzerland raises awareness of the importance of a healthy bodyweight among the general population. 2. Soft drinks are a major cause of overweight and obesity. 3. The current public campaign therefore advocates water as a healthy, calorie-free alternative.
The Outcome Management – Healthy Bodyweight system summarises the different evaluation and monitoring activities in this field, places them in a logical context and thus provides the foundation and its partners with an important basis for measuring and steering their actions in this thematic domain.
The long-term collaboration with 20 cantons in the framework of the cantonal action plans for a healthy bodyweight, targeting primary prevention in children and adolescents, was continued in 2013. Health Promotion Switzerland supports the cantons by providing funding, coordination, advice, exchange of information, and evaluations.

National Nutrition and Physical Activity Programme – five main goals:

1. Securing national coordination
2. Promotion of a balanced diet
3. Promotion of physical activity and sport
4. Integrated approaches to promoting a healthy bodyweight
5. Improvement of counselling and treatment provision

Contact

Alberto Marcacci, Head of the Nutrition and Physical Activity Section, alberto.marcacci@bag.admin.ch

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