Gaps in policy based evidence – NIPH Slovenia

Gaps in policy based evidence – NIPH Slovenia

Dr. Mojca Gabrijelčič Blenkuš

The future of research on obesitogenic environments SPOTLIGHT meeting

Brussels, 19th November 2015

Interlinks of policy and expert cycle

SCIENCE POLICY

Analysis and interpretation of the relevant knowledge in the field Defining priorities

Definition of goals and target groups Definition of indictors

Definition of relevant policies/sectors Definition of measures Interactive communication strategies

Implementation Providing resources, Definition of channels Evaluation

Defining and testing theories Methodology development Interpretation of scientific results

Negotiations where different interests are existing Preparation and enforcement in implementation of regulation and soft legislation

PARTICIPATIVITY (including stakeholders, citizens)

LAYER 1 LAYER 2 LAYER 3

Source: Gabrijelčič Blenkuš et all, NIPH, 2012 HTTP://WWW.NIJZ.SI/SL/PUBLIKACIJE/VSEVLADNI-PRISTOP-ZA-ZDRAVJE-IN-BLAGINJO-PREBIVALCEV-IN-ZMANJSANJE-NEENAKOSTI-V-ZDRAVJU

Breastfeeding, SES and suportive environment

Country % of mothers who were

breastfeeding after 6

months

Maternaty leave, in

weeks, (paid fully or

partialy)

Sweden 53 9.6

Norway 50 9.0

Poland 10 18.0

Canada 24 8.4

Netherlands 25 16.0

Great Britain 21 9.3

USA 20 0.0

Slovenia 65 52

Source: HRAST project, Slovenia, 2012

Breastfeeding duration in relation to the education level of the mother

Participatory research Focus groups with future mothers: Maternity “schools”

Disaggregation (target population and data) – definitely needed

Lowest Education

Technical secondary education

Bologna I

University degree and

more

Bre

astf

eed

ing

in m

on

ths

Percentage of overveight or obese primary and secondary school children 6 – 19 y, SLOFIT database

EU AP on childhood obesity, DG EAC Eurydis database

North-West/East-South differences Relevant for SPOTLIGHT case-studies?

Percentils of physical fitness index 6 – 19 y, SLOFIT database

Intention of „Together for Health“ project – to develop the approach and implement the same P fitness protocols in 19 + age groups In primary health care

Obesity? Sarcopenic obesity? Lean body mass? Frailty? At what age? Longevity societies Demographic revolution Life long approach Sustainability

Take action to reduce sedentary behaviours and promote physical activity in children and adolescents

Promotion of physical activity should be complemented with promotion of physical fitness. Physical fitness should be promoted along with physical activity.

Promoting only physical activity will not give the best results simply because the existing recommendations for physical activity are too loose, too general and too moderate, especially for children.

Physical fitness should be linked to the importance of the lean body mass (potential for good functioning of the immune system, prevention of frailty with all its consequences in later life, ...).

SLOFIT system in Slovenia – influence of SES on physical fitness exists (University of Ljubljana, Faculty of Sport – contact person: Dr. Gregor Starc, funding: MoE)

WHO Commission on Ending Childhood Obesity: European Regional Consultation

DRAFT FINAL REPORT

Malta, 29 October, 2015

DRUŽBENA

RAVEN 2,02 p<0,001

Tradicionalni

brezskrbneži

Osveščeni

intelektualci

Tradicionalni

skeptiki

… sadje in zelenjava nista dovolj, če želiš DOBRO DELATI

... sadja in zelenajve nimam vedno PRI ROKI

… sadje in zelenjava se hitro POKVARITA in moti me, če

ju mečem stran

… sadje in zelenjava, ki ju imam rada, sta PREDRAGA

… ne verjamem, da sta sadje in zelenjava zares zdrava,

ker vsebujeta ostanke PESTICIDOV

… STROKOVNJAKI nenehno spreminjajo mnenje, kaj od

sadja in zelenjave je zdravo, in kaj ne

… v našem gospodinjstvu vsi NE MARAJO jesti sadja in

zelenjave

… priprava obroka iz zelenjave zahteva veliko ČASA

INDIVIDUALNA

RAVEN1,77 p<0,001

Tradicionalni

brezskrbneži

Osveščeni

intelektualci

Tradicionalni

skeptiki

… sadje in zelenjava me ne NASITITA dovolj

… že od nekdaj NE JEM veliko sadja in zelenjave

… ne dovolim, da mi kdorkoli soli PAMET o tem, kaj je

zdravo in kaj ne

… poznam bolj malo RECEPTOV za pripravo zelenjave

… eni zelo pazijo na zdravo prehrano z veliko sadja in

zelenjave, pa vseeno HUDO ZBOLIJO

… ne vem točno, kolikšne KOLIČINE sadja in zelenjave

moram pojesti na dan

… sadje in zelenjava mi povzročata PREBAVNE TEŽAVE

… OKUS zelenjave se mi zdi slab

p<0,001 p<0,05 p<0,001Primerjava znotraj skupin

2,2 1,34 3,18

1,91 1,25 2,63

Structure influence level

Individual agency influence level

Inhibitory factors for healthy nutrition in adult population in Slovenia, NIPH 2012

Group with LOWEST SES and education

Group with HIGHEST SES and education

Structural inhibitory factors as: - I don‘t have time to prepare due to the daily obligations - I don‘t trust experts, they change opinions to often - It‘s to expensive - …

Individual inhibitory factors as: - I don‘t know the recipies to prepare - I don‘t want others to tell me what to do - I don‘t like the taste - I …

Inhibitory factors were identified in focus groups first.

0

10

20

30

40

50

60

70

80

90

ČE BI … KER SEM …

ČE - OTROK

KER - OTROK

ČE - ZDRAVNIK

KER - ZDRAVNIK

ČE - UPORABNA RAZLAGA

KER - UPORABNA RAZLAGA

ČE - PRAKTIČEN NASVET

KER - PRAKTIČEN NASVET

ČE - PARTNER/KA

KER - PARTNER/KA

0

10

20

30

40

50

60

70

ČE BI … KER SEM …

ČE - OTROK

KER - OTROK

ČE - ZDRAVNIK

KER - ZDRAVNIK

ČE - UPORABNA RAZLAGA

KER - UPORABNA RAZLAGA

ČE - PRAKTIČEN NASVET

KER - PRAKTIČEN NASVET

ČE - PARTNER/KA

KER - PARTNER/KA

0

10

20

30

40

50

60

70

80

ČE BI … KER SEM …

ČE - OTROK

KER - OTROK

ČE - ZDRAVNIK

KER - ZDRAVNIK

ČE - UPORABNA RAZLAGA

KER - UPORABNA RAZLAGA

ČE - PRAKTIČEN NASVET

KER - PRAKTIČEN NASVET

ČE - PARTNER/KA

KER - PARTNER/KA

Low education, Low SES group: … če bi, …ker sem, % … if , … because of

Inhibitory factors for healthy nutrition in adult population in Slovenia, NIPH 2012

Motivation factors for changing behaviour, identified in focus groups:

Če bi … - if I would … Ker sem … - because I have /did …

… got a child

… doctor‘s advice

… got a practical explanation

…my partner has changed behaviour

… got a practical advice

Situation

analysis,

priorities

set

Q1

Measures

were

defined

Q2

Measures

were

adopted

Q3

Measures

were implemented

Q4

Health

inequalities

considered

Q5

Measure

reached

>50% target

population

Q6

Adequate

funding

available

Q7

Goal in line

with

strategic

aims

Q8

Implemente

d activities

in line with

goals

Q9

Food

safety 4,3 4,5 4,3 3,5 NA 4,5 4,0 5,0 5,0 substanti

al/moder

ate

Healthy

nutrition 4,1 4,1 3,1 2,8 3,2 2,4 2,4 4,6 3,7 moderate

/little

Pregnant &

lactating

women,

infants

3,8 3,8 2,6 2,2 3,0 3,8 2,2 5,0 4,2 moderate/

little

Children &

adolescents 4,4 4,5 4,0 3,3 4,5 3,4 2,8 5,0 3,5 moderate

Active

population 4,1 4,3 2,9 2,6 3,3 1,9 2,9 4,1 3,7 moderate/

little

Healthy food

offer 4,0 3,0 3,0 3,0 1,0 1,0 1,0 3,0 3,0 little/

minimal

Nutrition

education 3,3 3,7 3,0 2,0 1,7 2,3 2,3 4,0 3,0 little

Local

sustainable

food

supply

4,3 3,7 3,5 3,2 2,8 3,3 2,3 4,7 4,2 Moderate

Slovene FNAP 2005-10 evaluation

Level of

success

Lowest level of implementation: Health sector! New FN&PA AP 2015- 2015: Whole chapter dedicated to health sector

Siloses – doesn‘t work communication

2. PHC community intervention, from 2003 on Dr. Milena Kovač Blaž, Primary health centre, Ljubljana, 2015

11 Values of BMI in participants at the beginning and after 6, 12, 18 and 24 months p<0,05

Screening – overweight&obesity and malnutrition at the same time SAME INTERVENTION

1.Response in Health Sector: “Together for health” project 2014-16, NFM Comprehensive primary health care intervention, for all population gropus, strong low SES focus

Life Expectancy at age 65 and expected years Without activity limitation With moderate activity limitation With severe activity limitation Life Expectancy at age 65 and expected years Without chronic morbidity With chronic morbidity Life Expectancy at age 65 and expected years In very good or good perceived health In fair perceived health In bad or very bad perceived health

P = provisional values

4.6

4.8

5.2

6.9

6.6

7.2

6.8

8.5

5.9

7.6

5.4

7.7

11.6

14.1

4.3

6.1

0 2 4 6 8 10 12 14 16 18 20 22 24

Expected years

Women

Men

Women

Men

Women

Men

Health data source: SILCP), Source: EHLEIS Country reports, Issue 6, Januar 2013

Life and health expectancies at age 65 based on activity limitation (Healthy Life Years), chronic morbidity and perceived health for Slovenia

European Semester - NRP Country Specific Recommendations – CRS Operatonal programs – regular funding (infrastructure, pilot interventions, ...) SUSTAINABILITY - INSTITUTIONALIZATION

CSR for Slovenia, regarding measures to increase HLY

Join forces (smaller countries)

EC

Invest at your national level, influence decisions (example – SFS)

DG SANTE: EU AP on childhood obesity, HLG, Platform – work with multinationals, link to JRC, link to other DGs (example - TTIP presentation, Oct 2015)

WHO

FNAPs, EPAS,

WHO NP, ...

Commission on Ending Childhood obesity is the window of opportunity to establish the

Framework convention to protect and promote sustainable and diverse food suplies, diets and physical activity – FC-NPAC.

Comments about the draft final report from Slovenia

WHO Commission on Ending Childhood Obesity: European Regional Consultation

DRAFT FINAL REPORT

Malta, 29 October, 2015

Interlinks of policy and expert cycle – specific know-how area (HiAP, multidisciplinary competence, KB/KT, ... ; prevention versus promotion

SCIENCE POLICY

Analysis and interpretation of the relevant knowledge in the field Defining priorities

Definition of goals and target groups Definition of indictors

Definition of relevant policies/sectors Definition of measures Interactive communication strategies

Implementation Providing resources, Definition of channels Evaluation

Defining and testing theories Methodology development Interpretation of scientific results

Negotiations where different interests are existing Preparation and enforcement in implementation of regulation and soft legislation

PARTICIPATIVITY (including stakeholders, citizens)

LAYER 1 LAYER 2 LAYER 3

Source: Gabrijelčič Blenkuš et all, NIPH, 2012 HTTP://WWW.NIJZ.SI/SL/PUBLIKACIJE/VSEVLADNI-PRISTOP-ZA-ZDRAVJE-IN-BLAGINJO-PREBIVALCEV-IN-ZMANJSANJE-NEENAKOSTI-V-ZDRAVJU