Policies of Community Health Building and Future Direction in Taiwan

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Policies of Community Health Building and Future
Direction in Taiwan

• Bureau of Health Promotion,
• Dept. of Health, Taiwan
• Shio-Jean Lin, MD

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Outline

• Background
• Current status
• International interaction
• Future direction
• Conclusion

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Top 10 Causes of Death in 2003
No. 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
6 Chronic 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
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• 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

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Human Ecosystem (Hancock Perkins,1985)
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Unhealthy Behaviors
Diet
Exercise
Stress
Alcohol
Tobacco
Betel nut

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

• Knowledge
• Traditional Dietary
• Exterior Dietary
• Family and Environment
• Habit and persistence
• Consideration for Health

Genetic,PersonalityTraumaEnvironment Social
normSupport network
Not knowing the Importance Lower motivation Rely
on automation equipmet
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Health Promotion Strategy
Ottawa Charter,1986
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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

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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

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Strategies
Healthy and sustainable community
NETWORK
INFORMATION
RESOURCES
DECISION MAKING
Empowerment
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Establish networks and Technical supports
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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
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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

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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

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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
• (publish2002/8/2 No.103 law)
• ChapterPublic health ? Nutrition Investigation
• Health care instruction
• Specific diet supplying facility (nutrition
  management, prevents two tobaccos)
• Regulations of nutrition labeling

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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

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??2002?????????????
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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)

??2003?????????????
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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
Concepts ?Residents participation
?Residents to be the first position
?Provide information to choice and decide
?Enhancing self-care ability
??2002?????????????
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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

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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
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Six Indicators of WHO Safe Communities
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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.

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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

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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

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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

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• ?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)

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• 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

• ????,????,????
  ??,???

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Thanks for your attention