Policies of Community Health Building and Future Direction in Taiwan
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Transcript of Policies of Community Health Building and Future Direction in Taiwan
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