Empowering persons suffering from chronic disease Workshop to consider “Tackling the Societal Challenges of Horizon 2020” UASnet Conference 2014 in Copenhagen on October 23rd and 24th Aileen Robertson PhD Public Health Nutritionist & Anne-Le Morville, OT, Ph.D. Metropolitan University College Copenhagen Denmark
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Empowering persons suffering from chronic disease Workshop to consider “Tackling the Societal Challenges of Horizon 2020” UASnet Conference 2014 in Copenhagen.
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Empowering persons suffering from chronic disease
Workshop to consider
“Tackling the Societal Challenges of Horizon 2020” UASnet Conference 2014 in Copenhagen on October 23rd and 24th
Aileen Robertson PhDPublic Health Nutritionist
&Anne-Le Morville, OT, Ph.D.
Metropolitan University College Copenhagen
Denmark
Horizon 2020 Health Demographic Change and Wellbeing Work Programme
•Improve understanding of determinants of inequalities in obesity;•Indentify initiatives that can impact positively on determinants;•Develop & pilot tools to assess impact of policies on determinants;•Develop, disseminate guides & recommendations for best practice
Sustainable Prevention of Obesity through Integrated Strategies
WHO Collaborating Centre for Global Nutrition & Health
Copenhagen
EU DG SANCO
1 Inequities in obesity
Overweight & obesity in women, by educational status (2009)
Finland
Finland: women's mean BMI by education status, 1982-2002
23
24
25
26
27
28
1982 1987 1992 1997 2002
BM
I
Lowest
Medium
Highest
No differences in men
Portugal
Portugal: obesity prevalence trends by gender and educational level
02
46
810
1214
1618
1995-6 1998-9 1995-6 1998-9
men women
Pre
va
len
ce
(%
)
under 6 yrs school
6 - 12 yrs school
over 12 yrs school
In general, obesity is rising most in the lowest socioeconomic groups , especially women & children.
Adult obesity prevalence in France by household income
Interventions have different impacts across social groups
Few obesity interventions have been evaluated for their effectiveness in low socioeconomic groups.
Education campaigns alone are less effective in low socioeconomic groups and make inequities worse.
People from low income groups do not engage well with interventions, and high numbers drop-out.
Population-based policies, such as restrictions on marketing to children, likely to have greater impact on inequalities than interventions targeted at individuals.
“First do no harm” –
well-intentioned interventions can make inequities worse
How inequities compound over lifecourse
Pregnancy Adulthood Health problemsChildhood
More likely to have high
or low birthweight
Less likely to be
breastfed
Poor housing, unreliable means for cooking/
refrigeration
More likely to suffer financial hardship
from consequences of illness
More likely to gain weight
during pregnancy & less likely to
breast-feed
More likely to experience
chronic stress
More likely to have difficulty affording
health care
Less likely to be able to get time off work or
afford transport to health services
More likely to have other health
problems made worse by obesity
More likely to experience
discrimination in health services
Low paid, repetitive jobs with inflexible opportunities for physical activityLess likely to be
exposed to & develop tastes for variety of foods
More likely to live near
outlets selling cheap, high
energy dense food
Less encouragement & social support
More likely to experience
food insecurity
Fewer options for safe outdoor
play or active transport
Conceived by a woman with
poor nutritional status
More time spent watching TV &
exposure to advertising
Mother without
access to paid maternity
leave
Socioeconomic context and position
(society)
Differential exposures
(social and physical environment)
Differential health outcomes
(individual)
Differential vulnerabilities
(population group)
Differential consequences
(individual)
Example:
Barriers in access to PHC
Intervention:
Improving uptake of services within
primary health care
Levels at which health inequities can be addressed within primary health care services
Socioeconomic context and position
(society)
Differential exposures
(social and physical environment)
Differential health outcomes
(individual)
Differential vulnerabilities
(population group)
Differential consequences
(individual)
Social stigma can disempower
& compound marginalisation
Intervention:
Anti-discrimination
policies that are non-judgemental
or patronising where
professionals demonstrate
empathy
Levels at which health inequities can be addressed within primary health care services
Sustainable Prevention of Obesity through Integrated Strategies
WP 1 Coordination of SPOTLIGHT WP 2 Individual-level self-regulation determinants WP 3 Obesogenicity of environments WP 4 RE-AIM of multi-level interventions WP 5 Inventory of European community based interventions WP 6 Success- and failure factors for implementation WP 7 Dissemination and take-up of findings WP 8 Data management and data storage
Workpackages
Work Package 6
OBJECTIVES:
1. To identify determinants of successful adoption and implementation of multilevel intervention approaches in 3 different European countries
WHAT WORKS? (Or DOES NOT WORK??)
2. To translate these findings to recommendations for effective public health interventions and ”Best Practice” and DISSEMINATE.
Project, provincial town, Denmark
Some initial findings
Timing of the project clashed with renovation causing half the citizen/target group to move
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One aim of the project was to find out whether such a huge renovation project can be actively used in a local community project. Whether it was a way to get people to stick together and come up with some common statements and preferences about what they want for the area. This did not happen. (Project Manager)
We drowned in the [huge overarching] area renovation project of half a billion kroner. (approx 1 billion Euros)(Project staff )
Lack of Needs Assessment & Common Vision
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What are the needs? We really didn’t know when we started. (Project staff)
We cartwheel around the place, because as project manager and staff we really do not know what we want and which goals we are aiming for (Manager)
It is a little like "now we work a little here, and then we work a little here" and there are no goals or vision, no overview of what we’re doing (Close partner)
Poor Communication and Cooperation
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We‘ve been talking for half-a-year now and the great directors ………….have not even been able to figure out how to work together yet! (Project staff) For cooperation to function, that's a challenge! And... Had it been two other personalities, it might have gone differently, but our close partner and project manager have had difficulty working with each other (Project staff)
... what exactly went wrong...? Something in relation to project management.... There is constantly some 'twist' between our close partner and project manager (Project staff) No money has been allocated.., that is, we are dependent on others without offering anything in return…………. (Project manager)
Unable to Reach those most difficult to reach (and those most in need)
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[the citizens] have not asked us to come. It's not their desire. It is a project by the authorities for politicians ..who thought it was a really good idea, and something they wanted …. (Project Manager)
In relation to the families I work with, they have other issues to deal with and these are so overwhelming and take up so much time and energy that [project activities] are of no interest. [...] The most affected families are not reached (External Partner) When some resident join activities others deliberately stay away:The problem is that the same 8-10 people take part in all the activities! This should never have been ! (Close partner)
Interesting statement
’They have other issues to deal with and these
are so overwhelming and take up so much time
and energy that [project activities] are of no
interest.’
Daily life includes all the activities and
’issues that one has to deal with’
The ’issues’ structures use of time and space
- And makes it difficult to participate in our intervention
’other issues to deal with and these are so overwhelming’
Lack of accessibility
Limitations due to illness, disease or legal/structural factors
Problems with friends or family
What happens when there is an overwhelming amout of issues to be dealt with and maybe even a lack of activities in daily life?
Quality of life decreases
Physical activities decreases
Social activities decreases
Passive activities increases
- boredom, lack of control and subsequent increase in disease
How do we prevent this?
What are the daily issues that are of importance to the user?
Only the user knows …
The aim of an intervention
To enhance wellbeing, empowerment and self-management
Find durable solutions to ’issues’ in everyday life Use welfare technology Focus on self-management and patient engagement Manage the symptoms, treatment, physical and
psychosocial consequences and lifestyle
A technical solution: An app
Engagement and self management through peer-groups:
Peer to peer discussions and ideas for managing disease in daily life
Taking part in peer-groups without the need for physical presence
Independent from health care professionals Independent interaction Follows the needs of the group members Easier access to health care providers
Our assumptions
Empowerment through experiencing personal growth as a result of developing skills and abilities
The peer-to-peer relation has a positive influence on how to handle and structure daily life (self-management)
Mutually committing peer setting will increase the possibility for sustainable outcomes
Enhanced well-being, empowerment and self-management will result in a better and timelier use of the health care services
Daily life issues
More satisfying activities = ideas for how to structure daily life, including health enhancing activities
Social activities increases = ideas/solutions to get outdoors and participate in social activities
Passive activities decreases = More satisfying activities enhances motivation for new activities
Appoint Group Leader to manage discussion & time and Rapportuer to report back
Task………. Basis for 2020 Horizon Call 2016/2017 –
Reduce Inequalities within EU: Design & test novel approaches to better empower clients & reach difficult-to-reach
(e.g. avoid ”blaming the victim”, being judgemental, exacerbating stigma)
Consider changes in current approaches to reach H2020 demand for ”Excellence, Impact & Implementation”
- Working environment – (e.g. Not accessible; or available when needed; friendly & inviting?) 6 minutes
- Approach as professionals (e.g. too ”professsional”; dispower by being ”judgemental”, not empathetic) 6 minutes
- Professional tools – (e.g. change out-dated technology?) 6 minutes