Policies of Community Health Building and Future Direction in Taiwan

1. Policies of Community Health Building and Future Direction in Taiwan Bureau of Health Promotion, Dept. of Health, Taiwan Shio-Jean Lin, MD

2. Outline • Background • Current status • International interaction • Future direction • Conclusion

3. Top 10 Causes of Death in 2003

4. 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

5. Culture Lifestyle Personal Behavior Phycho-Socio Economic Environment Family Spirit Sick Care System Work Body Mind Human Biology Physical Environment Human-Made Environment Biosphere Human Ecosystem （Hancock & Perkins,1985）

6. Unhealthy Behaviors Diet Exercise Stress Alcohol Tobacco Betel nut Knowledge Traditional Dietary Exterior Dietary Family and Environment Habit and persistence Consideration for Health 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 Genetic,PersonalityTraumaEnvironment Social normSupport network Not knowing the Importance Lower motivation Rely on automation equipmet

7. Environment change 1.Build Healthy Public Policy 2.Create Supportive Environments 3.Strengthen Community Action 4.Develope Personal Skills 5.Reorient Health Services Enhance health and life quality Behavior change Health Promotion Strategy Ottawa Charter,1986

8. 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

9. Objectives : 2004-2007 • Establish spontaneous health care organizations in the community • Assist community health centers to become professional 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 and help local health department to promote community health activites • Cumulatively promote 80 Healthy places

10. Strategies Healthy and sustainable community NETWORK INFORMATION RESOURCES DECISION MAKING Empowerment

11. Governmental Health Promotion Departments Bureau of Health Promotion Guidance Entrust assisted projects unite Professionals Local Health Departments Consultant Professional assistance Health Develop Centers The Public, Professionals, & Government TechnicalSupports Community and Society Establish networks and Technical supports

12. 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

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

16. 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

18. Current status of Community Health Building (3) • 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

19. Japan experiences – " Health Promotion Act " • From administrative notice move to legislation • Reform medical insurance • Clearly indicate the articles of planning local program • Stipulate duty of county and city governments • 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 tobaccos) • Regulations of nutrition labeling

20. Healthy Japan 21 • Using health promotion to practice an bright elderly society • Goal: reduce premature deaths, prolong life, and enhance 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, alcohol drinking, smoking cessation, oral health, diabetes, heart disease, stroke, cancer

21. 健康日本２１ 「健康管理」之思維演變 社區動力 取自:2002台日社區健康營造研討會資料

22. Experience in Australia--Healthy City Illawarra • Including possible determinants of health • Framework based on Ottawa Chatter • Suitable for requirement for policy, social and organizational 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 change) 取自:2003台澳社區健康營造研討會資料

23. Characteristics and Concepts of Healthy Japan 21 1.Focus on building health habits as a whole 2. Setting goals & Evaluating the target of indicators 3.Not only for comprehensive community health building plan 4. Plan the implementation procedure in order to promote residents to participate Concepts①Residents participation ②Residents to be the first position ③Provide information to choice and decide ④Enhancing self-care ability 取自:2002台日社區健康營造研討會資料

24. 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

25. F F G F S S P H S F F S G G H P M G F G P G P S P P GS P S F Healthy Space and Environment Building F: Friendly and Caring Space G: Greener Landscape H: Healthier Farming M: Market P: Pavement S: Sport Space Before Before Before After After After

26. An infrastructure based on partnership and collaborations, governed by a cross-sectional group that is responsible for safety promotion in their community; • Long-term, sustainable programs covering both genders and all ages, environments, and situations; • Programs that target high-risk groups and environments, and programs that promote safety for vulnerable groups; • Programs that document the frequency and causes of injuries; • Evaluation measures to assess their programs, processes and the effects of change; • Ongoing participation in national and international Safe Communities networks. Six Indicators of WHO Safe Communities

27. 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.

28. 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

29. Healthy City-Tainan • 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

30. 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

31. 『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)

32. 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

33. Thanks for your attention