Policies of Community Health Building and Future Direction

in Taiwan

Bureau of Health Promotion,

Dept. of Health, Taiwan

Shio-Jean Lin, MD

Outline

• Background

• Current status

• International interaction

• Future direction

• Conclusion

Top 10 Causes of Death in 2003No. Cause of Death

Mortality Rate(per 100,000)

% of Death

1 Cancer 156.01 27.10

2 Cerebrovascular Disease 54.98 9.55

3 Cardiopathy 52.23 9.07

4 Diabetes 44.38 7.71

5 Accident 36.30 6.31

6Chronic liver disease and cirrhosis

22.98 3.99

7 Pneumonia 22.60 3.93

8 Nephritis and nephrosis 19.08 3.32

9 Suicide 14.16 2.46

10 Hypertension 8.17 1.42

Top 10 Causes of Death 1993-2003 7-8 causes in chronic disease 1951 3 causes in chronic disease

Prevalence in 2003 ： (age 40 years old and above)

Hyperglycemia 12.7% Hypertension 35.0% Hyperlipidemia 16.5%

One death in cancer per 15mins in 2003

Human Ecosystem（ Hancock & Perkins,1985）

SpiritSpirit

BodyBody MindMind

FamilyFamilyPersonal Personal BehaviorBehavior

Human Human BiologyBiology

Phycho-SocioPhycho-SocioEconomicEconomic

EnvironmentEnvironment

PhysicalPhysicalEnvironmentEnvironment

CultureCulture

Sick Sick Care Care

SystemSystemWorkWork

Human-Made Human-Made EnvironmentEnvironment

Lifestyle

BiosphereBiosphere

Unhealthy Behaviors

Diet Exercise Stress Alcohol Tobacco Betel nut

Not knowing the Importance

Lower motivation

Rely on automation equipmet

Genetic,PersonalityTraumaEnvironmentSocial normSupport network

Characteristics

Family influences

Social Pressure

Biochemistry Problems

Risk of Alcoholism

Trauma

Connect sentimentBuild Socio-statusTeenagers show their independence

Accepted by peer group

Freshen up

Stress release

KnowledgeTraditional DietaryExterior DietaryFamily and

EnvironmentHabit and

persistenceConsideration for

Health

Health Promotion Strategy

Environment changeEnvironment change

Enhance health and life Enhance health and life qualityquality

Behavior changeBehavior change

1.Build Healthy Public Policy

2.Create Supportive Environments

3.Strengthen Community Action

4.Develope Personal Skills

5.Reorient Health Services

Ottawa Charter,1986

Challenge 2008 --National Development Plan

The 10th Plan: New Home Town Development Plan 10.7.2. Assists Community to Initiative Healthy Lifestyles

1999 Projects of Community Health Building (PCHB)

Dec, 2002 PCHB has been included into the

New Home Town Development Plan Apr, 2004 “Smoke Free Environments” has been

included into this plan.

Administration: Bureau of Health Promotion, DOH Period of Administered: 2002-2007

Objectives : 2004-2007 Establish spontaneous health care organizations in t

he community Assist community health centers to become professi

onal promoting centers within the county. 2-3 Centers per county At least 65 promoting centers nationwide

Develop model of healthy cities Facilitate center of community health consultation an

d help local health department to promote community health activites

Cumulatively promote 80 Healthy places

Strategies

Establish networks and Technical supports

Guidance

Consultant

Health Develop Centers

The Public,Professionals,& Government

Bureau of Health Promotion

LocalHealth Departments

unite

Entrust assisted projects

Professional assistance

Technical Supports Community and Society

GovernmentalHealth

PromotionDepartments

Professionals

Current status of Community Health Building (1)

In August, 2003:302 Community Health Building Centers

In 921 disastrous areas: 22 centers In tribes and remote islands : 46 centers

Categories Number

Hospital Based 85

Health Departments Based 111

NGO/NPO Based 86

School Based 20

Total 302

Promoted Health Issues

23%

21%

17%

13%

11%

8%

2% 1% 2%

2%

Health Fitness

Health Dietary

Chronic Disease Prevention

Quit Smoking

Safty Drug Usage

Circuit Medical Services

Deliver Meals to the Elders

International SpousesEducationHealth Management to Elderswho Live AloneOther

bhp

www.bhp.doh.gov.tw/hpnet/

Current status of Community Health Building (2)

Education and Training: Local health department executive workshop Volunteers training by Ping-Tong Technology University Guildance of volunteers training by Fu-Zen University

Consultation and Guidance ： Establish 4 centers (east, west, north, south) of community

consultation and management by the Community Building Association, ROC

Using narrative method to probe into community building strategies by Yang-Ming University

Evaluation Establishing a system to monitor and evaluate people participating

community health building Studying different models of community health building

Advocacy ： Slogan ：「 Health needs you to intervene 」 Film of 13 centers of community health building Film of healthy places

International interaction: 2001-2002 Taiwan-Japan community health building symposium 2002 Taiwan-Australia community health building symposium

Current status of Community Health

Building (3)

Japan experiences – " Health Promotion Act "

1. From administrative notice move to legislation

2. Reform medical insurance

3. Clearly indicate the articles of planning local program

4. Stipulate duty of county and city governments

5. Stipulate mutual responsibility and obligation

　 (publish ：２００２ / ８ / ２ No. １０３ law ）

Chapter ： Public health ˙ Nutrition Investigation Health care instruction Specific diet supplying facility (nutrition management, prevents two toba

ccos) Regulations of nutrition labeling

Healthy Japan 21 Using health promotion to practice an bright elderly s

ociety Goal: reduce premature deaths, prolong life, and enh

ance quality of life Basic Policy: Focus on prevention Support environments for health building Set goals and evaluation Promote cooperation Topics: nutrition, physical fitness, mental health, alco

hol drinking, smoking cessation, oral health, diabetes, heart disease, stroke, cancer

健康日本２１「健康管理」之思維演變

取自 :2002 台日社區健康營造研討會資料

社區動力

Experience in Australia--Healthy City Illawarra

Including possible determinants of health Framework based on Ottawa Chatter Suitable for requirement for policy, social and o

rganizational change Good partnership Steady expenditure support is important Community is a powerful and vigorous source Is practical and useful Focus on process and outcomes Importance of accepting outcome (ex. policy ch

ange)

取自 :2003 台澳社區健康營造研討會資料

Characteristics and Concepts of Healthy Japan 21

1. Focus on building health habits as a whole2. Setting goals & Evaluating the target of indicators3. Not only for comprehensive community health buildi

ng plan

4. Plan the implementation procedure in order to promote residents to participate 　

　

ConceptsConcepts ①Residents participation

　　　　 ② Residents to be the first position

　　　　 ③ Provide information to choice and decide

　　　　 ④ Enhancing self-care ability

取自 :2002 台日社區健康營造研討會資料

Current status of Community Health Building (3)

To implement healthy environment & spaces in 31 communities（ until 31 Dec.2003）

Assist the exemplary community to build healthy and safe places based on WHO 6 indicators of safe community guidelines

To coordinate intersectoral collaboration for smoke free environment (restaurant, workplace, schools)

Call for healthy place proposals to facilitate community participation mechanism

P

M

G

G

SF

F

F

PS

PPS

G S

G P

GF

HP

G

S FH

SP

S

F F GHealthy Space and Environment BuildingF: Friendly and Caring SpaceG: Greener LandscapeH: Healthier Farming M: MarketP: Pavement S: Sport Space

BeforeBefore

Before

After

After

After

Six Indicators of WHO Safe Communities

1.An infrastructure based on partnership and collaborations, governed by a cross-sectional group that is responsible for safety promotion in their community;

2.Long-term, sustainable programs covering both genders and all ages, environments, and situations;

3.Programs that target high-risk groups and environments, and programs that promote safety for vulnerable groups;

4.Programs that document the frequency and causes of injuries; 5.Evaluation measures to assess their programs, processes and

the effects of change; 6.Ongoing participation in national and international Safe

Communities networks.

Safe Communities Project

The Safe Communities concept began its formal existence at the First World Conference on Accident and Injury Prevention held in Stockholm, Sweden in September 1989.

The Manifesto for Safe Communities, the resolution of the conference, states that "All human beings have an equal right to health and safety."

This is a fundamental aspect of the World Health Organization (WHO) Health for All strategy and for the WHO Global Program on Accident Prevention and Injury Control.

This premise has led to community action around the world ; actions leading to safe communities.

Safe Community in Taiwan

July, 2002

Bureau of Health Promotion and Defense Medical college began it collaboration for safe communities. Types of safe communities

Urban: Nei-Hu, Taipei Rural: Tong-Shi, Taichung County Aboriginal (mountain): Mountain Ali, Cha-I County Aboriginal (coastal): Fon-Bin, Hwu-Lian County

Vision:• To create healthy places constantly• To strengthen and enlarge community resources • To promote healthy life and action • To build healthy public policies

Methods• Facilitating intersecteral collaboration• Coordinating departments of Tainan city government • Assessing city health problems and collecting healthy

city indicators• Publishing Journal of healthy cities• Establishing city health profile

Healthy City-Tainan

Future Directions

Providing health information and issues Creating supportive environment to help implement

healthy life Emphasizing on voluntary community health care and

cooperation Integrating health-care resource and services Implementing healthy city/community programs Reinforcing international cooperation

『 Health is not only a single target ; it is the process to lead human to go to advanced development. Healthy people have work ability and they engage in activities in community. And healthy system means in family, educational institution, working location, public place, community and other healthy institutions all lie in the healthy condition. 』

~WHO(1981)

There are three types of people: A person who can foresee a thing A person who knows things afterward A person who is not aware of anything

To intermediate these three kinds of people, it needs to use services as a purpose

Dr. Sun, Yersen

老有所終，壯有所用，幼有所長 禮記，禮運篇

Thanks for your

attention