Lessons Learned – What Works and What doesn’t Work

1. PI: LEE, Liming Department of Epidemiology & Biostatistics Peking University Health Science Center lmlee@pumc.edu.cn CIH Study Coordinator: LV, Jun Department of Epidemiology & Biostatistics Peking University Health Science Center lvjun@bjmu.edu.cn Lessons Learned – What Works and What doesn’t Work CIH in Hangzhou, China

2. Hangzhou City Beijing Hangzhou

3. Hangzhou site Intervention Site Gongshu District Population: ~162 thous Xiacheng District Population: ~258 thous Control Site Xihu District Population: ~271 thous

4. What we learn from Baseline survey results

5. Categorical physical activity levels by sex and age group %

6. Times eating out in the previous week, median times (P25, P75) by sex and age group

7. Although accompanying conditions were more prevalent among older people and self-evaluation of health worsened with advanced age, older people lived a healthier lifestyle than younger people in China.

8. How we implement Intervention activities

10. The main successes

11. A supportive environment can promote people to make healthy choices. • Hangzhou’s campaign of building a healthy city provides a good opportunity for the project. It gives a lot of policy and environmental supports to the intervention activities. The constructions of related facilities in targeted districts provide a platform for the community intervention. • Hangzhou Public Bicycle Service • Footpath along the canal, fitness paths and fitness equipment in communities, distance markers and health signs • Hangzhou Smoke Control Ordinance on March 1st2010

12. Public health system with Chinese characteristics increasing access to different settings in the community

13. Primary health care (PHC) system • A strong and cost-effective community-based PHC system is central to meet the enormous pressure from chronic conditions • Improving access and reducing inequity • Achieving better management of chronic conditions (disease management) • Increasing the focus on prevention (health management)

14. Intervention activities easily implemented inside the health system • Ideas of how to promote healthy lifestyle have been updated for our local teams. • The intervention activities are more easily understood and supported by the managers inside the health system (as workplace).

15. Community coalition for health • Make the first step to contact other non-health sectors

16. The main challenges

17. Community coalition for health • It’s hard for health sector to organize and coordinate other non-health sectors. • It needs time to realize active involvement of non-health sectors in the NCDs prevention & control • Understand the importance of NCDs prevention & control • Know what roles they should play in this process and how to integrate these into their routine functions • Action!

18. Challenges in traditional settings for intervention • Relatively long histories of collaboration between health sector and community and between health sector and education sector make the intervention activities easy to implement in the communities and schools. • Intervention activities like presenting posters on health, distributing leaflets, organizing health lectures in the community mainly attract the elderly. • The academic achievement of children is still the primary consideration of parents, teachers, and school managers.

19. Challenges in new settings for intervention • Workplaces (private enterprises and public institutions) and restaurants, usually ignored in traditional intervention programs, are new focuses in this project. • Health issue becomes a growing concern but is still not a top priority for the managers in the workplaces and restaurants. • Refuse to join in the project or not compliant with the suggested intervention activities.

20. Guidance on specific knowledges and skills required • A relatively high percentage of the people lived in urban areas has general knowledge on health but lacks of specific knowledge and skills on physical activity and diet. • There is a urgent need for qualified dietitians / nutritionists and fitness instructors / trainers . • It’s necessary to speaking with one voice and evidence-based. Now the public is confused by different voices, then does nothing (e.g., walking and climbing stairs can harm knees).

21. Lack of attraction of health goals and intervention activities • Be less: • boring, preachy, unimaginative, and not easy to follow when comparing to the opposite of healthy and commercial ads • Distant hope for better health • Intervention activities vs.

22. Bigger supportive social context has not been established completely, which becomes an obstacle to the success of single project in a limited areas • Many efforts or changes need to be achieved or can only be implemented at city-level or even nation-level • E.g., raising tax on tobacco (nation-level), regulation on smoke control in public places (at least city-level) • E.g., strengthening public transport system (city-level), reconstruction of the city environments and roads (city-level or district level) • E.g., changing cultures of smoking, drinking, diet, physical activity (city-level)

23. Conclusions • The keys to success • Building healthy city is a valuable practice and provides a good opportunity for NCDs prevention & control. • A collaboration mechanism for multi-sectors stakeholders led by government instead of health sector is necessary. • Within health system, strengthening PHC system is the key to address equity and cost-effectiveness for NCDs prevention & control.

24. Thank you