On track
Dec. 2020National prevention strategies: review and outlook
Leitartikel. Implementation of the two national strategies Prevention of Noncommunicable Diseases (NCD strategy) and Addiction began at the start of 2017. It’s now time to take stock and consider the outlook. What is the status of the two strategies? What has been achieved so far? What is yet to be achieved? And what happens next?
Cancer, diabetes, cardiovascular and chronic respiratory diseases such as asthma and COPD are the most common causes of death in Switzerland. They are known collectively as noncommunicable diseases (NCD) and are responsible for around 50 percent of deaths in men and around 60 percent in women before the age of 70 (premature death). Addictions also frequently have a fatal outcome. Every year some 1,600 people in Switzerland die as a result of alcohol abuse, and about 120 due to drug abuse. Thus it comes as no surprise that all NCDs including mental health disorders and addictions account for 80 percent of all expenditure on health in Switzerland.
Against this background, the National Strategy for the Prevention of Noncommunicable Diseases (NCD strategy) and the National Addiction Strategy were launched at the start of 2017, both with a timeframe running until 2024. The objective of the strategies is to enable the population to live for as long as possible in the best possible health.
The strategies have now reached the halfway mark, and this milestone provided an opportunity to evaluate them. The interim evaluation focused on the question: What is the implementation status of the two strategies? But it also looked at questions relating to cooperation with the various implementation partners and how the strategies are being steered.
The interim evaluation showed that both strategies are essentially on track. A number of concepts and projects have already been implemented, among them the new MonAM monitoring system that compiles figures about NCDs and addiction and makes them universally available. The FOPH and Health Promotion Switzerland have also established the prevention in healthcare provision (PHP) system to fund projects and have already completed three rounds of funding. As an intermediate year for PHP, 2021 will be used to sharpen the definition of PHP and to revise the principles for funding projects on the basis of the insights from the first three years. A new round of funding will then begin in September 2021.
The expansion of the cantonal action programmes (CAP) was a further milestone. 24 of the 26 cantons now have corresponding programmes that are receiving support in line with the strategies. “This is a major success,” says Eva Bruhin, Head of the Prevention Strategies Section at the FOPH. The cantons are implementing their programmes in line with the national principles: preventing several risk factors for a NCD at the same time or implementing cross-divisional addiction prevention measures.
Outlook for the second half
There are a number of points that need to be modified for the second half of the strategy implementation. One major new aspect will be the inclusion of dementia prevention in implementation measures, since dementia is a specific form of cardiovascular disease. Dementia causes a great deal of suffering in Switzerland, with around 30,000 people developing it every year. The vast majority of those affected live at home, but care in an inpatient setting is usually unavoidable for those who require a higher level of nursing.
Another aspect that will be important in future is communication. Here the main focus is on the partner platform, a platform that all the stakeholders can use to obtain and exchange information. The website www.prevention.ch should go online in spring of 2021 and will strengthen dialogue between the professionals and organisations involved. “This is precisely where the FOPH can achieve a great deal, in coordination and communication beyond the cantonal borders and the limits of the organisations,” Bruhin comments.
Several topics are the focus of attention with respect to addiction. One of them is the SafeZone addiction counselling service. The aim is to implement new approaches in addiction support under the heading “blended counselling”. This is the term experts use to describe a combination of online counselling and face-to-face conversations, i.e. a mix of digital and analogue communication that takes the needs of patients into account. Other topics include addictive behaviours and problematic use of psychoactive medication, and cooperation with the various implementation partners. Because this is another important finding to emerge from the first half: joint implementation of the strategies has brought the partners closer together. This will be an important factor for success over the next four years.
Ausblick auf die zweite Halbzeit
Im Hinblick auf die zweite Halbzeit gibt es verschiedene Punkte, die angepasst werden sollen. Als wichtige Neuerung wird in der Umsetzung auch die Demenzprävention mitgedacht, da gewisse Demenzformen Ähnlichkeiten mit Herz-Kreislauf-Erkrankungen aufweisen. Demenz verursacht in der Schweiz viel Leid: Jedes Jahr erkranken in der Schweiz etwa 30 000 Menschen. Der weitaus grösste Teil der Betroffenen lebt zu Hause, bei starker Pflegebedürftigkeit ist jedoch eine stationäre Behandlung meist unumgänglich.
Wichtig wird in Zukunft die Kommunikation sein. Hier steht vor allem die Partner-Plattform im Fokus, eine Informations- und Austauschplattform für alle beteiligten Akteure. Die Website www.prevention.ch wird im Frühling 2021 lanciert, um den Austausch unter den verschiedenen Fachpersonen und beteiligten Organisationen zu stärken (siehe Artikel Seite 3). «Genau hier kann das BAG viel bewirken, bei der Koordination und Kommunikation über die Kantons- und Organisationsgrenzen hinaus», so Bruhin.
Dann soll auch die Zusammenarbeit zwischen den Themenbereichen NCD, Sucht und psychische Gesundheit weiter intensiviert werden, weil da viele Schnittstellen existieren. NCDs betreffen stets den ganzen Menschen. So entwickeln zum Beispiel viele Krebspatienten Depressionen. Umgekehrt beeinflusst eine Suchterkrankung alle Lebensbereiche: Sie hat körperliche, psychische und soziale Folgen. Die Verbindungen von NCD, Sucht und psychischer Gesundheit liegen also auf der Hand und es macht daher Sinn, diese Themenbereiche in Zukunft noch stärker zu verbinden.
Im Bereich Sucht stehen verschiedene Themen im Fokus, zum Beispiel die Suchtberatung SafeZone. Es sollen neue Ansätze in der Suchthilfe implementiert werden, Stichwort «blended counseling»: Darunter verstehen Fachleute eine Verbindung von Online-Beratung und Face-to-Face-Gesprächen, also von digitaler und analoger Kommunikation, die auf die Bedürfnisse der Patientinnen und Patienten Rücksicht nimmt. Weitere Themen sind Verhaltenssüchte oder der problematische Gebrauch psychoaktiver Medikamente – und die Zusammenarbeit mit den verschiedenen Umsetzungspartnern. Denn auch das ist eine wichtige Erkenntnis in der Halbzeit: Durch die gemeinsame Umsetzung der Strategien sind die verschiedenen Partner näher zusammengerückt. Ein wichtiger Erfolgsfaktor für die nächsten vier Jahre.