Bewegungsförderung in der Schweiz

Transkript

1 Institut für Sozial- und Präventivmedizin Bewegungsförderung in der Schweiz Schlussbericht, PD Dr. med. Brian Martin, Eva Martin-Diener, Dr. Sonja Kahlmeier Arbeitsbereich Bewegung und Gesundheit

2 Inhaltsverzeichnis Bewegungsförderung in der Schweiz Inhaltsverzeichnis Bericht 1 Ausgangslage Das Projekt Bewegungsförderung in der Schweiz Zielsetzungen des vorliegenden Berichts 3 2 Entwicklung von Vorschlägen für die NGO-Allianz Situation Schweiz Situation Kantone Zusammenfassung Situation Identifikation von aktuellen Herausforderungen und mögliche Zielen Mögliche Massnahmen für die Bewegungsförderung in der Schweiz Rückmeldungen aus ausgewählten Kantonen zu den vorliegenden Massnahmenempfehlungen Vergleich mit Beurteilung und Empfehlungen des Strategieberichts 2013 des BAG 6 3 Empfehlung für das weitere Vorgehen 7 Anhänge 1 Bericht des Workshops vom Teilnehmerliste Workshop vom Porträt Fiona Bull von der Website der University of Western Australia, Handout des Workshops vom Bericht des Workshops vom HEPA PAT Schweiz, Stand August HEPA PAT, Version zur Verwendung auf kantonaler Ebene Handout des Workshops 8 3 Teilnehmerliste Workshop vom Massnahmenvorschläge samt Hintergrundargumentation 8 5 Argumentarium Bewegungsförderung, Stand Bewegungsverhalten Schweiz neue Daten Seite 2 Universität Zürich, Institut für Sozial- und Präventivmedizin,

3 Bericht Ausgangslage Bewegungsförderung in der Schweiz Bericht 1 Ausgangslage 1.1 Das Projekt Bewegungsförderung in der Schweiz Bei einem ersten Treffen zum Thema Strategie Alltagsbewegung am war in Bern festgehalten worden, dass die NGO-Allianz Ernährung, Bewegung, Körpergewicht ein Instrument möchte, um in der Bewegungsförderung mit einer gewissen Kohärenz politisch aktiv werden zu können. Im Hinblick darauf wurde am ein Workshop zum Thema Bewegungsförderung in der Schweiz durchgeführt, dessen Resultate in einem Bericht vom festgehalten worden sind (Anhang 1). In der Folge wurde ein Projekt definiert, in dem das Institut für Sozial- und Präventivmedizin der Universität Zürich zusammen mit der NGO-Allianz die wissenschaftlichen Grundlagen für eine kohärente Politik zugunsten gesundheitsförderlicher Rahmenbedingungen im Bereich Bewegungsförderung aufgearbeitet werden sollte. Dabei wurden die folgenden Ziele des Projekts vereinbart: Überblick über die Bewegungsförderung in der Schweiz sowie illustrativ in zwei Kantonen. Hierbei werden alle Altersgruppen (Kinder, Erwachsene und ältere Erwachsene) berücksichtigt. Präsentation und Kommentierung von Lösungsansätzen für identifizierte Defizite an die am Projekt beteiligten Partner. Schriftliche Vorschläge für politische Massnahmen auf nationaler und kantonaler Ebene für alle Altersgruppen (Kinder, Erwachsene und ältere Erwachsene) Schriftliches Argumentarium für Bewegung und Gesundheit welches unter anderem auch den Schweizer Kantonen mit einem Kantonalen Aktionsprogramm für ein Gesundes Körpergewicht dient und zu diesem Zweck auch die Zielgruppe Kinder und Jugendliche behandelt 1.2 Zielsetzungen des vorliegenden Berichts Der vorliegende Schlussbericht fasst das Vorgehen im Hinblick auf die Erarbeitung eines Überblick über die aktuelle Situation in der Bewegungsförderung in der Schweiz, die Definition von möglichen Zielsetzungen und Massnahmen sowie die Ausarbeitung dieser Massnahmen und eines schriftlichen Argumentariums zusammen. Im Anhang enthält er die Berichte der Workshops vom und , die auf den gleichen Workshop hin erarbeiteten und dort finalisierten Massnahmenvorschläge sowie das am Workshop vom präsentierte Argumentarium. Dieses verweist als wichtigste Hintergrundquelle auf die 2013 erschienene Version des Grundlagendokuments gesundheitswirskame Bewegung ( In diesem Dokument fehlen einzig noch die später veröffentlichten neuen Bewegungsdaten aus der Schweizerischen Gesundheitsbefragung Diese sind in einem kurzen Handout angefügt. Seite 3 Universität Zürich, Institut für Sozial- und Präventivmedizin,

4 Bericht Entwicklung von Vorschlägen für die NGO-Allianz Bewegungsförderung in der Schweiz 2 Entwicklung von Vorschlägen für die NGO-Allianz 2.1 Situation Schweiz Zur Beschreibung der aktuellen Situation bezüglich Bewegungsförderung in der Schweiz wurde das HEPA PAT (Health-Enhancing Physical Activity Policy Analysis Tool) verwendet. das gemeinsam mit der WHO entwickelt 1,2 worden ist. Das HEPA PAT erfasst die politische Struktur und historische Entwicklung der Bewegungsförderung, Inhalt und Entwicklungsprozesse der Ansätze, Erfahrungen aus der Umsetzung und schliesslich den Prozess des Ausfüllens des HEPA PAT. Im Rahmen des vorliegenden Berichts wurde eine Aktualisierung des bis Mai 2011 bereits vorliegenden HEPA PAT für die Schweiz bis und mit August 2013 durchgeführt (Anhang 2.2). 2.2 Situation Kantone Im Hinblick auf eine systematische Beschreibung der Situation in zwei Kantonen ist eine angepasste Version des HEPA PAT für Kantone entwickelt (deutsche Version in Anhang 2.3, französische erhältlich auf Verlangen) und Kontaktpersonen in St. Gallen und Waadt zugestellt worden. Aufgrund der Rückmeldungen zu dem als zu gross wahrgenommenen Aufwand vor allem aus dem Kanton Waadt wurde am Workshop vom beschlossen, diesen Ansatz nicht weiter zu verfolgen. Dafür wurden im Hinblick auf den Workshop vom von ausgewählten Kantonen Rückmeldungen zu den für die NGO-Allianz entwickelten Massnahmenvorschlägen eingeholt (siehe 2.6). 2.3 Zusammenfassung Situation Basierend auf der oben beschriebenen Beurteilung sowie der Inhalte des Evaluationsberichts NPEB 3 und des vom BAG in Auftrag gegebenen Strategieberichts wurde am Workshop vom die Situation in der Bewegungsförderung in der Schweiz auch im internationalen Vergleich wie folgt charakterisiert: durch eine gute Situation in Teilbereichen sowie durch gute und aktuelle konzeptionelle Grundlagen. Diese gesamthaft positive Beurteilung wurde unterstützt durch die Anfang Oktober 2013 erschienenen ersten Auswertungen der Schweizerischen Gesundheitsbefragung 2012, die eine Zunahme des Anteils der körperlich Aktiviten von 2002 bis 2012 von 62% auf 72% dokumentieren. Gleichzeitig ist die Bewegungsförderung auch nationaler Ebene aber auch durch eine komplexe institutionelle Situation gekennzeichnet. 1 Bull FC, Milton K, Kahlmeier S. Health-enhancing physical activity (HEPA) policy audit tool. Copenhagen, WHO Regional Office for Europe, Verfügbar unter 2 Bull FC et al. National Policy on Physical Activity: The Development of a Policy Audit Tool (PAT). J Phys Act Health, in press. 3 Von Stokar T, Stern S, Fliedner J, Dubois-Arber F, Bize R, Krafft M. Evaluation des Nationalen Programms Ernährung und Bewegung Zürich und Lausanne, 2 rbeitsgemeinschaft INFRAS, Institut universitaire de médecine sociale et préventive, Maud Krafft Consulting Stamm HP, Gebert A, Wiegand D, Lamprecht M. Die Förderung gesundheitswirksamer Bewegung und der Kampf gegen die Inaktivität. Situationsanalyse und Definition der Rolle des Bundesamtes für Gesundheit. Zürich, Lamprecht und Stamm Sozialforschung und Beratung AG Seite 4 Universität Zürich, Institut für Sozial- und Präventivmedizin,

5 Bericht Entwicklung von Vorschlägen für die NGO-Allianz Bewegungsförderung in der Schweiz 2.4 Identifikation von aktuellen Herausforderungen und mögliche Zielen In den Diskussionen am Workshop vom wurden bezüglich einer effizienteren Förderung der Bewegungsförderung auf nationaler Ebene Herausforderungen oder Defizite auf drei Ebenen identifiziert: bei der Führung, bei der Verbindlichkeit der Umsetzung sowie bei der kritischen Überprüfung des Erreichten. Anschliessend wurden aktuelle Chancen in der Bewegungsförderung und strukturelle Lösungsmöglichkeiten aus dem Ausland diskutiert. Schliesslich wurden vor diesem Hintergrund eine Reihe möglicher Ziele definiert, die sich auf die aktuellen Herausforderungen in der Schweiz beziehen, und diese zeitlich gestaffelt. Details der Diskussionen können dem Bericht des Workshops im Anhang 2 entnommen werden. Die relevanten Inhalte wurden zudem in die Hintergrundargumentation zu den drei Massnahmenvorschlägen im Anhang 4 aufgenommen. 2.5 Mögliche Massnahmen für die Bewegungsförderung in der Schweiz Schliesslich wurden am Workshop vom drei mögliche Massnahmen identifiziert, die die NGO-Allianz schon kurzfristig in Angriff nehmen kann, und die im Sinn der oben aufgeführten Ziele wirksam werden können: Aufbau eines Dialogs zu Zielen der Bewegungsförderung Entwicklung einer Allianz der Engagierten Capacity Building in der Bewegungsförderung Seite 5 Universität Zürich, Institut für Sozial- und Präventivmedizin,

6 Bericht Entwicklung von Vorschlägen für die NGO-Allianz Bewegungsförderung in der Schweiz Verschiedene Varianten für künftige Aktivitäten der NGO-Allianz im Sinne dieser Massnahmen wurden im Hinblick auf den Workshop vom entwickelt und dort diskutiert. Die definitiven Vorschläge stellen Anhang 4 dieses Berichts dar. Zusätzlich wurden folgende Bemerkungen angebracht: Allenfalls könnte es bei den Zielen der Bewegungsförderung sinnvoll sein, in einem ersten Schritt einzelne Altersgruppen in den Vordergrund zu stellen. Für ältere Personen würden beispielsweise die Häufigkeit von nicht übertragbaren Krankheiten die hohen Inaktivitätsprävalenzen dieser Altersgruppe sprechen, für Kinder die hohen Inaktivitätsprävalenzen im HBSC und die psychologische Bedeutung dieser Altersgruppe. Mögliche Schwerpunkte für die Allianz der Engagierten könnten aber auch das Capacity Building könnten sein: Sport, Nachhaltigkeit, Langsamverkehr, Raumplanung, Gesundheitsversorgung (Ärzteschaft). 2.6 Rückmeldungen aus ausgewählten Kantonen zu den vorliegenden Massnahmenempfehlungen Über informelle Kontakte zur Gesundheitsförderung in den Kantonen St. Gallen, Zürich und Fribourg wurden Rückmeldungen zu den Massnahmenvorschlägen für die NGO-Allianz eingeholt. Im Rahmen der bestehenden Ansätze wurden Anregungen für weitere Aspekte gemacht, die in der definitiven Version der Massnahmenvorschläge in Anhang 4 aufgenommen sind. Gänzlich neue Vorschläge wurden aber nicht gemacht. Eine Kontaktperson brachte eine gewisse Skepsis bezüglich der Wirksamkeit solcher Massnahmen zum Ausdruck, eine andere äusserte Vorbehalte gegenüber der Möglichkeit einer Dominanz der Bundesebene und betonte die Bedeutung des politischen Gleichgewichts mit dem Einbezug der Kantone. Aus kantonaler Sicht wurden alle drei Massnahmen (Aufbau eines Dialogs zu Zielen der Bewegungsförderung, Allianz der Engagierten, Capacity Building) grundsätzlich als sinnvoll betrachtet. 2.7 Vergleich mit Beurteilung und Empfehlungen des Strategieberichts 2013 des BAG Im unter 2.3 erwähnten Strategieberichts 2013 des BAG sind Entwicklungspotentiale in 7 Bereichen identifiziert worden: Klärung von Zuständigkeiten (vor allem BAG/BASPO) Multisektorale Koordination und Vernetzung (über NPEB und hepa.ch) Schwerpunktsetzungen (zusätzlich zu Bildung und Sport bei Kindern auch Verkehr, Planung und Umwelt sowie auch Kleinkinder, Erwachsene, unterprivilegierte Gruppen sowie Arbeit und Wohnen) Projektdokumentation und Qualitätssicherung (Best Practice, Ausbau COMPI) Datengrundlagen (SGB, Sport Schweiz Akzelerometermessungen, qualitative Studien, Evaluationen) Information und Kommunikation Zudem wurden konkret vier Empfehlungen zuhanden des BAG gemacht: Rolle des BAG in Koordination ausbauen Längerfristiges Engagement BAG sicherstellen Sammlung und Vermittlung von Know How (MOSEB, wissenschaftliche Studien) Eigene Projekte und Projektunterstützung (actionsanté, andere) Zusammenfassend können die Beurteilung und die Empfehlungen des Strategieberichts BAG als ergänzend zu denen im vorliegenden Bericht beurteilt werden. Seite 6 Universität Zürich, Institut für Sozial- und Präventivmedizin,

7 Bericht Empfehlung für das weitere Vorgehen Bewegungsförderung in der Schweiz 3 Empfehlung für das weitere Vorgehen Das Interesse der NGO-Allianz und ihrer Mitglieder, sich in der Bewegungsförderung auf nationaler Ebene weitergehen zu engagieren, wird sehr begrüsst. Für das konkrete Vorgehen empfehlen wir als ersten Schritt im Sinne des Massnahmenvorschlags Aufbau eines Dialogs zu Zielen der Bewegungsförderung, dass die NGO-Allianz die interne Diskussion zu ihren Zielen in diesem Bereich führt. Anschliessend können diese Anliegen in nationale Prozesse der Zieldefinition eingebracht werden. Parallel dazu können bereits Massnahmen im Sinne der Vorschläge 2 und 3 in Angriff genommen werden. Im Hinblick auf Beispiele für Ziele von nationalen Strategien zur Bewegungsförderung seinen folgende Länder aufgeführt: Schottland: Slowenien: Slovenia-prevod_ang.pdf Norwegen: Finnland: Western Australia: Für die Vermittlung weiterer Kontakte und Informationen stehen wir gerne zur Verfügung. Seite 7 Universität Zürich, Institut für Sozial- und Präventivmedizin,

8 Anhänge Bericht des Workshops vom Bewegungsförderung in der Schweiz Anhänge 1 Bericht des Workshops vom Teilnehmerliste Workshop vom Porträt Fiona Bull von der Website der University of Western Australia, Handout des Workshops vom Bericht des Workshops vom HEPA PAT Schweiz, Stand August HEPA PAT, Version zur Verwendung auf kantonaler Ebene 2.3 Handout des Workshops 3 Teilnehmerliste Workshop vom Massnahmenvorschläge samt Hintergrundargumentation 5 Argumentarium Bewegungsförderung, Stand Bewegungsverhalten Schweiz neue Daten Seite 8 Universität Zürich, Institut für Sozial- und Präventivmedizin,

9 Institut für Sozial- und Präventivmedizin Bewegungsförderung in der Schweiz Bericht des Workshops Physical Activity Promotion in Switzerland vom am Institut für Sozial- und Präventivmedizin der Universität Zürich PD Dr. med. Brian Martin, MPH Arbeitsbereich Bewegung und Gesundheit Bei einem ersten Treffen zum Thema Strategie Alltagsbewegung am war in Bern festgehalten worden, dass die NGO-Allianz Ernährung, Bewegung, Körpergewicht ein Instrument möchte, um in der Bewegungsförderung mit einer gewissen Kohärenz politisch aktiv werden zu können. Im Hinblick darauf wurde am ein Workshop zum Thema Bewegungsförderung in der Schweiz durchgeführt (Abbildung 1, Teilnehmerliste im Anhang 1). Dabei konnte die Teilnahme von Fiona Bull am World Economic Forum genutzt werden, wo sie als eine der weltweit profiliertesten Fachpersonen im Bereich Bewegung und Gesundheit (siehe Anhang 2) zu Ihrem Fachgebiet einen Auftritt hatte. So ergab sich die Gelegenheit, dass Fiona Bull den auf den Workshop in Zürich hin erstellten Entwurf einer Berichtsstruktur zuhanden der NGO-Allianz kommentieren und die auf Abbildung 1. Programm des Workshops Grund einer Grobanalyse internationaler Vergleiche von nationalen Bewegungsförderungsstrategien präsentierten beispielhaften ersten Lösungsansätze ergänzen konnte. Dieser Kurzbericht fasst die wichtigsten Inhalte der Diskussion des Workshops und das skizzierte weitere Vorgehen zusammen, das auf den Workshop hin erstellte Handout findet sich im Anhang 3. Inhalt der Präsentation Abbildung 2. Vorschlag für das grundsätzliche Vorgehen Nach einer Vorstellung der Teilnehmerinnen und Teilnehmer wurden der Hintergrund des Projekts und der aktuellen Stand der Diskussionen zusammengefasst. Als grundsätzlicher Ansatz wurde empfohlen, einen zweiteiligen Bericht zu erstellen, der allenfalls zu einem späteren Zeitpunkt noch mit weiteren Advocacy- Elementen ergänzt werden könnte (Abbildung 2). Anschliessend wurden die verschiedenen Elemente des vorgeschlagenen Berichts erläutert und anhand eines vorläufigen Kommentars zur nationalen Situation im Sinne einer Illustration international erfolgreiche Lösungsansätze zu relevanten Problemen aufgezeigt (Abbildung 3). Seite 1

10 Zusammenfassung der Diskussion Bewegungsförderung in der Schweiz Zusammenfassung der Diskussion Die aktuelle Situation in der Schweiz mit einer passiven Haltung der nationalen staatlichen Institutionen und gleichzeitig einer Vielzahl von Aktivitäten auf lokaler und regionaler Ebene sowie durch private Akteure ist auch im internationalen Vergleich aussergewöhnlich. Die in Abbildung 3 aufgeführten internationalen Beispiele wurden weiter erläutert, insbesondere das British Heart Foundation National Centre Physical Activity + Health, das während einer passiven Phase der staatlichen Behörden in England eine wichtige Überbrückungsfunktion hatte, und die Rolle der nationalen Gesundheitsförderungsstiftung in Thailand. Ausserdem wurden die Cross Government Task Force in Western Australia und die kanadischen Score Cards als Beispiele aufgeführt. In der weiterführenden Diskussion ohne Fiona Bull wurde auf die aktuelle Situation im Detail eingegangen und Lösungsansätze sowie mögliche Vorgehensweisen auf verschiedenen Ebene angesprochen. Es wurde deutlich, dass um mit einer gewissen Kohärenz politisch aktiv werden zu können, ein Bericht nicht nur strukturelle Lösungsvorschläge, sondern auch Optionen für ein argumentatives und taktisches Vorgehen im Sinne von Advocacy und Lobbying enthalten muss. Weiteres Vorgehen Das bereits am skizzierte und nun weiter ausgearbeitete und ergänzte Vorgehen wird grundsätzlich unterstützt. In einem nächsten Schritt ist es vorgesehen, dass der beschriebene zweiteilige Bericht in einer vorläufigen Fassung erstellt und mit der NGO-Allianz in einem Workshop vor der Finalisierung besprochen und falls nötig überarbeitet wird. Aktuell sind Finanzmittel bis und mit zur Durchführung und Nachbereitung des Workshops vom vorhanden. Die weiteren Schritte können in Angriff genommen werden, sobald die Finanzierung sicher gestellt ist. Anhänge: Abbildung 3. Aktuelle Probleme auf nationaler Ebene mit Beispielen für international erfolgreiche Lösungsansätze 1. Teilnehmerliste Workshop vom Porträt Fiona Bull von der Website der University of Western Australia, Handout des Workshops vom Seite 2 Universität Zürich, Institut für Sozial- und Präventivmedizin,

11 Anhang 1 Institut für Sozial- und Präventivmedizin Bewegungsförderung in der Schweiz Teilnehmerliste des Workshops Physical Activity Promotion in Switzerland vom am Institut für Sozial- und Präventivmedizin der Universität Zürich Andy Biedermann, CardioVasc Suisse Fiona Bull, University of Western Australia Kees de Keyzer, Bern Jürg Lüthy, idée:sport Thomas Schweizer, Fussverkehr Schweiz Heinrich von Grüningen, Schweizerische Adipositas-Stiftung SAPS Brian Martin, Institut für Sozial- und Präventivmedizin der Universität Zürich Entschuldigt: Patrick Imhof, Krebsliga Schweiz Jvo Schneider, Gesundheitsförderung Schweiz Seite 1

12 UWA Staff Profile > The University of Western Australia: The Univers of :10 Quick Links The University of Western Australia UWA Staff Profile Professor Fiona Bull Professor/Director, Centre for the Built Environment and Health School of Population Health Contact details Address Phone Fax School of Population Health The University of Western Australia (M431) 35 Stirling Highway CRAWLEY WA 6009 Australia fiona.bull@uwa.edu.au Qualifications BEd Exe., MSc Lough., PhD W.Aust. Biography Professor Fiona Bull is Director of the Centre for Built Environment and Health (CBEH), School of Population Health at The University of Western Australia and Chair of Global Advocacy for Physical Activity Council (GAPA) and President Elect of the International Society for Physical Activity and Health (ISPAH). She is also Visiting Professor at Loughborough University (UK) working with the National Centre for Physical Activity and Health and Visiting Professor at the Centre for Diet and Activity Research (CEDAR), Institute of Public Health, Cambridge University, UK and an expert Advisor to the World Health Organization. Her research focuses on furthering our understanding of the impact of the built environment on health and policy to create healthy, active and sustainable communities and cities. Her work has a specific focus on participation in physical activity, active transport, walking and cycling, measurement and monitoring of health behaviours and evaluating programs and policy across different settings (community, school, workplace, and primary health care). This work has a strong emphasis on collaboration across multiple disciplines and research translation. Fiona has over 25 years of experience and attracted research funding of more than $15 million in the field of public health and physical activity spanning research, policy and practice and has contributed to research and practice in Australia, the UK, and the USA. Outputs of research have informed local, state, national and international policy and practice. Professor Bull has led the development of the Toronto Charter on Physical Activity: A Global Call for Action (2010) and the Seven Investments that work for physical activity (2011) a supplementary document produced for the UN Meeting in Sept Professor Bull has been actively involved in the development of the Global Target and Indicators and the inclusion of physical activity in the recent Global Monitoring Framework. Key research Population based approaches to physical activity Urban design and health behaviours, particularly physical activity Research translation

13 UWA Staff Profile > The University of Western Australia: The Univers of :10 Major research interests Health benefits of physical activity (including dose response) Population health measures of physical activity international comparability Intervention research on physical activity in youth and adults Urban design impact on physical activity Global and national policy and action on physical activity Publications Summary: Over 110 publications in peer reviewed journals including 77 journal articles, 6 book chapters and 34 scientific monographs and reports. Selected publications from 2012 are listed below: Lim S, Vos T, and the Global Burden of Disease Collaboration. A Comparative Risk Assessment of Burden of Disease and Injury Attributable to 67 Risk Factors and Risk Factor Clusters in 21 Regions, : A systematic analysis for the Global Burden of Disease Study The Lancet : Hallal PC, Andersen LB, Bull FC, Guthold R, Haskell W, Ekelund U. Global physical activity levels: surveillance progress, pitfalls, and prospects. The Lancet. 2012;380(9838): Giles-Corti B, Bull F, Kuiman M, McCormack G, Van Niel K, Timperio B, Christian H, Foster S, Divitini M, Middleton N, Boruff B. The influence of urban design on neighborhood walking following residential relocation: Longitudinal results from the RESIDE study Social Science & Medicine Khan K, Thompsom A, Blaire S, Sallis J, Powell K, Bull F, et al. Physical activity, exercise and sport: their role in the health of nations. The Lancet. 2012;380: Leavy J, Rosenberg M, Bauman A, Bull F, Giles Corti B, Shilton T, et al. Effects of Find Thirty every day : Crosssectional findings from a Western Australian population-wide mass media campaign, Health Education and Behaviour October:1-13. Boyle T, Keegel T, Bull F, Heyworth J, Fritschi L. Physical Activity and Risks of Proximal and Distal Colon Cancers: A Systematic Review and Meta-analysis. J National Cancer Institute August 22, 2012 Milton K, Clemes S, Bull F. Can a single question provide an accurate measure of physical activity? British Journal of Sports Medicine April 20, Boyle T, Bull F, Fritschi L, Heyworth J. Resistance training and the risk of colon and rectal cancers. Cancer Causes and Control. 2012:1-7. Ogilvie D, Bull F, Cooper A, Rutter H, Adams E, Brand C, et al. Evaluating the travel, physical activity and carbon impacts of a natural experiment in the provision of new walking and cycling infrastructure: methods for the core module of the iconnect study. BMJ open. 2012;2(1). Kolbe-Alexander T, Lambert V, Bull F. Physical Activity Advocacy and Promotion: The South African experience. South African Journal of Sports Medicine (in press). Bull F, Milton K, Kalmyra S. National policy on physical activity: the development of a policy audit tool (PAT). Journal of Physical Activity & Health (in press). Barnes R, Giles Corti B, Bauman A, Rosenberg M, Bull FC, Leavy JE. Does Neighbourhood Walkability Moderate the Effects of Mass Media Communication Strategies to Promote Regular Physical Activity? Annals of Behavioral Medicine (in press); supplement. Shilton T, Bull F, Bauman A. Advocacy Strategies to Address NCDs: Actions to increase the profile of physical activity In: McQueen D, editor. Global Handbook on Chronic Disease: Springer publishing; 2012 (in press). Bull F, Bauman A. Physical Activity Guidelines and National population based Actions. In: Clow A, Edmunds S, editors. Physical Exercise and Mental Health: Theory and Practical Applications: Human Kinetics; 2012 Roles, responsibilities and expertise Professor Co Director BHF National Centre for Physical Activity and Health, UK Physical Activity Evaluation Health Promotion Population surveillance of risk factors Future research National policy and population monitoring of physical activity Measurement of physical activity in low and middle income countries Environmental determinants of active lifestyles Intervention trials promoting healthy lifestyles Funding received Summary Over AUS $15 million has been successfully sought from competitive research sources, industry and non-government organisations. Current grants include:

14 UWA Staff Profile > The University of Western Australia: The Univers of :10 National Heart Foundation. Healthy Active By Design (HABD) Bull, FC Hooper P and Trapp G. In collaboration with Hassell Design AUS $25,000. Australian National Data Service. POSITIVE PLACE: Spatial analysis of public open space. Bull, F. Boruff, B. Wood, L. Hooper, P AUS $250,000 Healthway (Western Australia). Long-term follow-up of Liveable Neighbourhoods: research into practice (RESIDE2). Giles-Corti, B., Knuiman, M., Van Niel, K., Bull, F., Wood, L., Zubrick, S., Hickling, S., Christian, H., Shilton, T. [#18921] AUS $750,000. Wellcome Trust, UK. Is the built environment associated with physical activity? A feasibility study for the Four Hundred Area Study (Project FAST). Hillsdon, M., Bull, F.C., Ellaway, A., Foster, C., Jones, A., Macintyre, S., Rutter, H., Wilkinson, P ,000 Engineering and Physical Science Research Council, UK. iconnect (Impact of Constructing Non-motorised Networks and Evaluating Changes in Travel). Multiple university consortium (Southampton, Bristol, Cambridge, Loughborough, Oxford, Strathclyde, UEA, UE , Memberships Member of the Australian Health Promotion Association Member of International Society of Physical Activity and Health Honours and awards 2008 Healthway Award in recognition of excellence in health promotion for the RESIDE project. Category: Research project grants targeting priority health issues or priority population groups: My role: Co Investigator Healthway Award Finalist. In recognition of excellence in health promotion for the Active Commuting Project. Category: research project grants targeting priority health issues or priority population groups. My role: co investigator Certificate of Appreciation for outstanding performance in International health, National Centre for Chronic Disease Prevention and Health Promotion, CDC, USA Excellence in Health Promotion, Finalist NHMRC Post doctoral Fellowship Previous positions Senior Lecturer, School of Human Movement and Exercise Science, University of Western Australia [Jan July 2004] World Health Organization Non communicable Disease and Mental Health Physical Activity Advisor, Cross Cluster Surveillance [Aug 2002 Dec 2002] Research Scientist Centers for Disease Control and Prevention, U.S. Federal Department of Health and Human Services, Division of Nutrition and Physical Activity [July 2000 Jan 2003] National Health and Medical Research Post Doctoral Research Fellow, Department of Public Health, University of Western Australia March [1997 July 2000] Teaching PUBH1102 Globalization and Health PUBH5754 Health promotion: Master of Public Health PUBH3302 Health Promotion PUBH8754 Health Promotion International Short Course on Physical Activity and Public Health: Mexico (January 2006); SE Asia (March 2006, August 2007); Canada (2006, 2007, 2008); South Africa (March 2007), Australia and Pacific Islands (Sydney, 2008), WPRO Region (Manilla, Philippines Dec 2008) Current external positions Chair: Global Advocacy on Physical Activity (GAPA): Council of the International Society of Physical Activity and Health ( President Elect: International Society for Physical Activity and Health (ISPAH) Member of the Expert Reference Group for NCD Surveillance, World Health Organisation Member of Evaluation and Monitoring Working Group, Western Australian Physical Activity Task Force Expert Advisor: International Union of Health Promotion and Education (IUHPE) Peer Reviewer: Landscape and Urban Planning Peer Reviewer: Medicine and Science in Sports and Exercise Peer Reviewer: Medical Journal of Australia Peer Reviewer: Journal of Epidemiology and Community Health Peer Reviewer: Active Living Policy and Environmental Studies Peer Reviewer: American Journal of Preventive Medicine Peer Reviewer: Preventive Medicine Peer Reviewer: National Health and Medical Research Council Peer Reviewer: Australian and New Zealand Journal of Public Health Peer Reviewer: British Journal of Health Psychology

15 UWA Staff Profile > The University of Western Australia: The Univers of :10 Current projects RESIDE: longitudinal natural experiment evaluating the state government's Liveable Neighbourhood Guidelines (WA LIFECOURSE: A cross sectional study utilising data from the health and wellbeing surveillance system (WA). Find 30: Evaluation of a 2 year mass media campaign to promote physical activity in Western Australia. (WA) Healthy Active by Design: with National Heart Foundation (WA) POS Tool: Australia National Data Service, spatial analysis of public open space. (Australia) National Physical Activity Policy: 7 Country Case Study Project: In collaboration with HEPA Euprope Physical Activity Network. (EU) Global Burden of Disease and Comparative Risk Assessment Project (International ) iconnect: Impact of Constructing Non-motorised Networks and Evaluating Changes in Travel (UK) Evaluation of the Living Streets active transport programme (UK) Assessment of physical activity using a single item measure (UK) Assessing levels of physical activity and related health determinants (Project ALPHA) (EU) Evaluation of the Physical Activity Care Pathway in primary care practice (UK) Research profile Research profile and publications

16 Anhang 3 Programme Institute of Social and Preventive Medicine Workshop Physical Activity Promotion in Switzerland Presentation of draft report structure and draft options for NGO alliance Discussion with Prof. Fiona Bull, GAPA/University of Western Australia Coffee break Discussion (in German) Brian Martin, MD MPH Physical Activity and Health Unit Workshop, Zurich, Programme Background Introduction of participants Background of the project Presentation of draft report structure and draft options for NGO alliance General approach Overview of elements Discussion with Prof. Fiona Bull, GAPA/University of Western Australia Coffee break Comments on general approach Comments on elements Discussion (in German) Next steps Purpose of the project Previous discussions Current planning 1

17 Purpose of the project The NGO Alliance wants to have indications where and how it can become active at the political level to make progress in physical activity promotion. ( ) There is less interest in a perfect and definite report but more interest in a tool for consistent political action. Es geht um politische Ansätze zur Förderung der Bewegung. Das Produkt soll Hinweise liefern, wo und wie die NGO-Allianz politisch aktiv werden kann, um ihre Anliegen voranzubringen. ( ) Es geht weniger darum, einen perfekten und abschliessenden Bericht zu haben als ein Instrument, um mit einer gewissen Kohärenz politisch aktiv werden zu können. HEPA PAT Case studies on the development and implementation of national policies for the promotion of physical activity Project under the lead of the British Heart Foundation National Centre Physical Activity and Health, Loughborough University Detailed analyses carried out in 7 European countries HEPA PAT Situation until May 2011 Overview of documents and developments HEPA PAT Situation until May 2011 Sustainable Development WHO Global Strategy Diet, PA and Health Sport Walk paths Health Insurance CO2 Infrastr. fund Prevention Revision NEHAP COSport Sust Dev NP DPA LeiTr Str hepa.ch/ recom. adults MissSt HPM recom. children?? Y+S Allez Hop COSport I (03-06) COSport II (07-10) Y+S Kids Agglo- Progr Health sector Sport sector Other sectors International developments Federal laws National programmes or concepts Conceptional milestones Federal level implementation NEHAP Allez Hop Fredoom to roam Federal law 2

18 Swiss National Programme Diet World Health Assembly 2004 and Physical Activity 2008 Physical activity in men of 15 years and more HEPA promotion in Switzerland Strong sports for all activities and facilities, important role of sport clubs and since 1972 of national programme Youth+Sports 2000 Concept for a national sport policy 2008 National programme Diet, Physical Activity & Health 2011 Revision of the federal law on the promotion of sports 2012 Failure of second attempt for a national prevention law no data available! Hallal PC, Andersen LB, Bull FC, Guthold R, Haskell W, Ekelund U, for the Lancet Physical Activity Series Working Group. Physical Activity 1 - Global physical activity levels: surveillance progress, pitfalls, and prospects. Lancet Jul 21;380(9838): but Successful activities in related projects, by NGOs, in cantons and communities 3

19 Topics to be covered Elements of the final product Situation for PA promotion in Switzerland at the national level Covering the sectors of sports, health, transport, spatial planning, environment (including climate) and energy Covering surveillance or monitoring Reflections on the role of cantons and communities Illustrated for two cantons (SG and probably VD) Reflection on CH in view of international recommendations and experiences Focus on policy, legislative and funding approaches Illustrative, but not systematic coverage of implementation projects What are existing advocacy approaches? What are international experiences with these advocacy approaches? Overview of the situation for PA promotion in Switzerland Including two cantons (SG and probably VD) List of measures to be taken for Switzerland Ideas for concrete political action at the national and canton level List of arguments for physical activity promotion Project steps Elements of the final product December 2012: Dec 12/Jan 13: January 2013: Preparatory meeting, Bern Funding for first phase Preliminary analyses Development of draft report structure and draft options Workshop. Zurich Decision about next steps Decision about further funding? Development of report and recommendations? Presentation and discussion with selected partners Overview of the situation for PA promotion in Switzerland Including two cantons (SG and probably VD) List of measures to be taken for Switzerland Ideas for concrete political action at the national and canton level List of arguments for physical activity promotion? Tool for continuing integration of experiences? Ongoing information about developments and opportunities 4

20 General approach HEPA PAT Update since May 2011 Physical Activity Report Update of HEPA PAT Switzerland since May 2011 Development and completion of template for two cantons Commentary based on relevant international documents Recommendations for policy solutions International developments Overview of documents and developments Sustainable WHO Global Strategy Development Diet, PA and Health Sport Walk Health CO2 Infrastr. Revisiotion Preven- paths Insurance fund Sust NP LeiTr NEHAP COSport Dev DPA Str hepa.ch/ MissSt recom.?? recom. HPM children adults Y+S Allez COSport COSport Y+S Agglo- Hop I (03-06) II (07-10) Kids Progr Advocacy Report Health sector Sport sector Other sectors International developments Federal laws National programmes or concepts Conceptional milestones Federal level implementation NEHAP Allez Hop Fredoom to roam Federal law Overview of international recommendations and experiences Recommendations for advocacy approaches UN/WHO summit on NCDs WHO Monitoring framework Advocacy Tools (optional) Swiss PAnet Swiss HEPA (NCD) policy database Others Growing interest in WEF and other international bodies Development of international tools and approaches (GAPA, ISPAH, Agita Mundo, HEPA Europe, etc) HEPA PAT Update since May 2011 HEPA PAT Update since May 2011 Overview of documents and developments Overview of documents and developments Sport sector Sustainable Development Sport Walk Health paths Insurance CO2 WHO Global Strategy Diet, PA and Health Infrastr. fund Revision Prevention Health sector Sustainable Development Sport Walk Health paths Insurance CO2 WHO Global Strategy Diet, PA and Health Infrastr. fund Revision Prevention NEHAP COSport Sust NP LeiTr Dev DPA Str NEHAP COSport Sust NP LeiTr Dev DPA Str hepa.ch/ MissSt recom.?? hepa.ch/ MissSt recom.?? recom. HPM children recom. HPM children adults adults Y+S Allez Hop COSport I (03-06) COSport Y+S Agglo- II (07-10) Kids Progr. Y+S Allez Hop COSport I (03-06) COSport Y+S Agglo- II (07-10) Kids Progr Health sector International developments Federal laws NEHAP Allez Hop Health sector International developments Federal laws NEHAP Allez Hop Sport sector Other sectors National programmes or concepts Conceptional milestones Federal level implementation Fredoom to roam Federal law Sport sector Other sectors National programmes or concepts Conceptional milestones Federal level implementation Fredoom to roam Federal law Role of national HEPA network Revision of sports law and respective ordinances Revision of national HEPA recommendations Revision of national HEPA base document (Lack of) evaluation of national Youth & Sport programme Evaluation, personnel changes and ongoing strategy discussions in national programme on diet. physical activity and health Failure of national prevention law Situation surveillance and monitoring Emerging national programme on HEPA promotion in primary care Recent announcements of health minister for 20% reduction in health costs 5

21 HEPA PAT Update since May 2011 Overview of documents and developments Other sectors Sustainable Development Sport Walk Health paths Insurance CO2 WHO Global Strategy Diet, PA and Health Infrastr. fund Revision Prevention NEHAP COSport Sust NP LeiTr Dev DPA Str hepa.ch/?? recom. adults MissSt recom. HPM children Y+S Allez Hop COSport I (03-06) COSport Y+S Agglo- II (07-10) Kids Progr Health sector International developments Federal laws NEHAP Allez Hop Sport sector National programmes or concepts Other sectors Conceptional milestones Federal level implementation Fredoom to roam Federal law Development of agglomeration programmes Energy discussions Economic estimates Evaluation project Others Preliminary commentary on the situation Decentralised consensus-based political system No culture of target setting, evaluation and accountability In federal administration, increasing emphasis on administrative expertise No strong public health tradition Strong structures and legal bases in related fields (sports, injury prevention, tobacco control, transport, environment) No stewardship for physical activity promotion at the national level No targets, no evaluation, no accountability No monitoring system meeting international standards No national centre of expertise Currently very narrow interpretation of national sport concept But: Existing structures claiming to be in charge (buzzword coordination ): national programme diet and PA, Federal Office of Sports, HEPA network 6

22 International examples for policy solutions International examples for policy solutions No stewardship for physical activity promotion at the national level No targets, no evaluation, no accountability Scotland: national programme with 20 year targets for physical activity No monitoring system meeting international standards Efforts of STEPS (GPAQ), IPAQ group, LPAS, EU developments No national centre of expertise British Heart Foundation National Centre Physical Activity + Health Currently very narrow interpretation of national sport concept National Institute for Sport and Physical Activity NISB, the Netherlands Thailand funding mechanism based on tobacco and alcohol taxes No stewardship for physical activity promotion at the national level No targets, no evaluation, no accountability Scotland: national programme with 20 year targets for physical activity No monitoring system meeting international standards Efforts of STEPS (GPAQ), IPAQ group, LPAS, EU developments No national centre of expertise British Heart Foundation National Centre Physical Activity + Health Currently very narrow interpretation of national sport concept National Institute for Sport and Physical Activity NISB, the Netherlands Thailand funding mechanism based on tobacco and alcohol taxes But: Existing structures claiming to be in charge (buzzword coordination ): national programme diet and PA, Federal Office of Sports, HEPA network Preliminary commentary on the situation Advocacy for physical activity from evidence to influence Decentralised consensus-based political system No culture of target setting, evaluation and accountability In federal administration, increasing emphasis on administrative expertise No strong public health tradition Strong structures and legal bases in related fields (sports, injury prevention, tobacco control, transport, environment) No stewardship for physical activity promotion at the national level No targets, no evaluation, no accountability No monitoring system meeting international standards No national centre of expertise Currently very narrow interpretation of national sport concept But: Existing structures claiming to be in charge (buzzword coordination ): national programme diet and PA, Federal Office of Sports, HEPA network Shilton T. Promotion and Education 2006; 8:

23 Advocacy for physical activity from evidence to influence Shilton T. Promotion and Education 2006; 8:

24 Institut für Sozial- und Präventivmedizin Bewegungsförderung in der Schweiz Bericht des Projektworkshops vom Ort: Public Health Services, Bern Dr Phil II Sonja Kahlmeier, PD Dr med. Brian Martin, MPH Arbeitsbereich Bewegung und Gesundheit , angepasst Teilnehmerliste Brian Martin, ISPM Zürich (Diskussionsleitung) Sonja Kahlmeier, ISPM Zürich (Bericht) Gaudenz Bachmann, Amt für Gesundheitsvorsorge St. Gallen Andreas Biedermann, CardioVascSuisse Patrick Imhof, Krebsliga Jürg Lüthy, Stiftung idée:sport Robert Schmuki, Stiftung idée:sport Jvo Schneider, Gesundheitsförderung Schweiz Heinrich von Grünigen, Schweizerische Adipositas-Stiftung Entschuldigt: Kees de Keyzer, PGF health promotion & public health Thomas Schweizer, Fussverkehr Schweiz Eva Martin-Diener, ISPM Zürich Einleitung Das Institut für Sozial- und Präventivmedizin der Universität Zürich hat von der NGO-Allianz ein Mandat erhalten, um die wissenschaftlichen Grundlagen für eine kohärente Politik zugunsten gesundheitsförderlicher Rahmenbedingungen im Bereich Bewegungsförderung aufzuarbeiten. Auf dieser Basis sollen zusammen mit der NGO-Allianz insbesondere Massnahmen zur Stärkung der Rahmenbedingungen erarbeitet werden. Im Rahmen dieses Projektes fand im September 2013 ein Projektworkshop statt, an dem einerseits der Stand des Projektes anhand eines provisorischen Zwischenberichtes präsentiert wurde. Andererseits wurden mit den Teilnehmenden inhaltliche Schwerpunkte definiert, die bis zum Projektabschluss vertieft ausgearbeitet werden sollen. Es wurden noch keine konkreten Handlungsvorschläge für die NGO-Allianz behandelt. Am Workshop nahmen 8 Personen von 7 Institutionen teil (Teilnehmerliste im Anhang 1). Stand der Arbeiten Zum Stand der Arbeiten wurde den Teilnehmenden vorgängig ein provisorischer Zwischenbericht zugestellt. Dieser enthält: Seite 1

25 Übersicht und Beurteilung der aktuellen Schweizer Situation Bewegungsförderung in der Schweiz Health-Enhancing Physical Activity Policy Audit Tool (HEPA PAT) zur Beschreibung der aktuellen Situation bezüglich Bewegungsförderung in der Schweiz, aufdatiert für die Situation bis August 2013 (Entwurf); eine angepasste Version des HEPA PAT für Kantone; mögliche Lösungsansätze und Massnahmen im Hinblick auf die nationale Ebene. Bezüglich der für Kantone angepassten Version des HEPA PAT haben erste Kontakte mit den Kantonen Waadt (Alexia Fournier) und St. Gallen (Karin von Vacano) gezeigt, dass das vorliegende Format als zu umfangreich und komplex empfunden wird und zudem gewisse Überlappungen mit den kantonalen Autoevaluationsberichten für Gesundheitsförderung Schweiz bestehen. Die weiteren Schritte auf kantonaler Ebene wurden deshalb im weiteren Verlauf des Workshops angepasst (siehe Abschnitt Weiteres Vorgehen ). Übersicht und Beurteilung der aktuellen Schweizer Situation Anhand der vorgenommenen Analyse der Situation in der Schweiz wurde festgestellt, dass die Ausgangslage in verschiedenen Teilbereichen durchaus als gut bezeichnet werden kann (siehe Abbildung 1), auch wenn es in verschiedenen Bereichen weiterhin Verbesserungspotentiale gibt. Auch stehen verschiedene gute konzeptionelle Grundlagen zur Verfügung und hepa.ch kann als Austauschgefäss genutzt werden. Abbildung 1. Zusammenfassende Beurteilung der Situation in der Schweiz bezüglich Bewegungsförderung Abbildung 2. Herausforderungen für die Bewegungsförderung in der Schweiz Andererseits stellt sich die institutionelle Situation relativ komplex dar. Die identifizierten Punkte decken sich auch mit Schlussfolgerungen der Evaluation des Nationalen Programms Bewegung und Ernährung (2011) und der Situationsanalyse zur Förderung gesundheitswirksamer Bewegung von Lamprecht und Stamm (2013). Aufgrund dieser Situation ergeben sich auf nationaler Ebene Herausforderungen in 3 Bereichen (Abbildung 2): bei der Führung auf nationaler Ebene, in der verbindlichen Umsetzung und bei der kritischen Überprüfung des Erreichten. Seite 2 Universität Zürich, Institut für Sozial- und Präventivmedizin,

26 Strukturelle Lösungsmöglichkeiten im Ausland Bewegungsförderung in der Schweiz Die Herausforderungen wurden anhand verschiedener Beispiele erläutert. Beispielsweise wurden bei der Revision der Sportförderungsverordnung von von einer ganzen Reihe von Public Health Organisationen insgesamt fünf Anliegen konsistent in Abbildung 3.Anliegen Public Health Organisationen für Revision Sportförderungsverordnung den Vernehmlassungsprozess ein- gebracht. Die Eingaben wurden jedoch nicht beantwortet, die Anliegen wurden nicht aufgenommen und dies wurde auch erst nach der Verabschiedung festgestellt (Abbildung 3). Als weiteres Beispiel wurden die nur sehr allgemein formulierten Ziele des NPEB angeführt, welche sich dementsprechend auch nicht überprüfen lassen und eine Programmkonzeption mit sich bringen, die insgesamt noch zu wenig konsistent und wirkungsorientiert ist. Auch die noch ausbaufähige Einbindung der Projekte des BASPO im Bewegungsbereich in den NPEB wurde aufgeführt; hier wurde jedoch darauf hingewiesen, dass auf kantonaler Ebene die Einbindung des Sportbereiches oft gut funktioniert. Als Beispiel bezüglich der Herausforderungen im Bereich der Datenqualität wurde die Ergebnisse zum Bewegungsverhalten aus dem Omnibus-Bericht von 2011 verwendet, welche im inzwischen vorliegenden internationalen Vergleich sehr tiefe Inaktivitätsraten ausweist. Insgesamt wurde die präsentierte Situationsanalyse von den Teilnehmenden geteilt. Gleichzeitig bieten sich jedoch auch eine Reihe von Chancen (Abbildung 4). Diese liegen einerseits in der internationalen Entwicklung, wo bei verschiedenen internationalen Institutionen das Interesse an der Bewegungsförderung zunimmt. Auch auf nationaler Ebene gibt es positive Entwicklungen, etwa im Rahmen der neuen Gesamtschau Gesundheit Abbildung 4. Chancen für die Bewegungsförderung in der Schweiz 2020 des Bundesrates, im zunehmenden Interesse an der Rolle der Ärzteschaft und nicht zuletzt bei den stark steigenden Investitionen in den Langsamverkehr. Strukturelle Lösungsmöglichkeiten im Ausland Auf der Basis der Situationsanalyse, der identifizierten Chancen und Herausforderungen wurden verschiedene strukturelle Lösungsmöglichkeiten präsentiert. Solche gibt es im internationalen Vergleich. So hat das breit abgestützte nationale Bewegungsförderungsprogramm in Schottland ( let s make Scotland more active ) eine starke Führung auf nationaler Ebene, mit einen Horizont von Seite 3 Universität Zürich, Institut für Sozial- und Präventivmedizin,

27 Mögliche Ziele und ausgewählte Massnahmen für die Schweiz Bewegungsförderung in der Schweiz 20 Jahren angelegte quantifizierte nationale Bewegungsziele, eine gute Einbindung der verschiedenen Partner und auch nationale Finanzierungsmechanismen. Das Programm wird kritisch überprüft, ein Evaluationsbericht nach 5 Jahren ist kürzlich erschienen 1, und das Programm wird in einem Plenarvortrag an der 5. Konferenz von HEPA Europe an der Universität Zürich am 28. August 2014 vorgestellt werden. In England hat das British Heart Foundation National Centre Physical Activity and Health an der University of Loughborough eine wichtige Rolle bei der fachtechnischen Unterstützung von nationalen Institutionen, aber auch bei der kritischen Überprüfung des Erreichten auf Programm- wie auf Projektebene. Einen radikalen Weg bezüglich der als ungenügend wahrgenommenen Einbindung der Sportstrukturen in die Bewegungsförderung haben die Niederlande genommen. Nachdem noch in den 90er Jahren das nationale Bewegungsförderungsnetzwerk geleitet wurde, wurde 10 Jahre später das Neederlands Instituut voor Sport & Bewegen neu gegründet, dem die Aufgabe und die Mittel für Bewegungs- und Breitensportförderung zugeteilt wurden. Mögliche Ziele und ausgewählte Massnahmen für die Schweiz Solche internationale Ansätze und Erfahrungen können für die Diskussion in unserem Land befruchtend und anregend wirken. Trotzdem ist es in der Regel ist es weder möglich noch sinnvoll, Lösungen aus einem anderen historischen und kulturellen Hintergrund als solche importieren zu wollen. Als realistische erste Schritte hin zu Lösungen für die Schweiz wurden Zwischenziele zur Diskussion gestellt, welche in kurz-, mittel- und langfristige Ziele unterschieden wurden (Abbildung 5). Auf der Basis dieser Vorschläge brachten die Teilnehmenden verschiedene Ideen und Anliegen ein. Die Diskussion fokussierte sich dabei vor allem Abbildung 5. Mögliche Ziele für die Bewegungsförderung mit zeitlicher Staffelung auf mögliche Mechanismen für ein wirksameres Lobbying, die Möglichkeiten und Grenzen der Einbindung des Sportbereiches und Möglichkeiten zur weiteren Verbreitung wissenschaftlicher Erkenntnisse und Grundlagen. Anschliessend wurden aus den eingebrachten Vorschlägen drei mögliche Massnahmen identifiziert: Aufbau eines Dialogs zu den Zielen der Bewegungsförderung o Aufbauend auf der kommenden Welle der nichtübertragbaren Krankheiten und dem absehbaren Druck auf das Gesundheitswesen o Optimalere Nutzung der vorhandenen Ressourcen 1 Halliday E, Mutrie N, Bull F. Getting Scotland on the move? Reflections on a 5-year review of Scotland's national physical activity strategy. Br J Sports Med Nov;47(17): doi: /bjsports Epub 2013 Jul 23. Seite 4 Universität Zürich, Institut für Sozial- und Präventivmedizin,

28 Weiteres Vorgehen Bewegungsförderung in der Schweiz o Optimalere Erreichung aller Zielgruppen Entwicklung einer Allianz der Engagierten o Stärkung der Kerninstitutionen o Einbindung aller wichtigen Partner o Aufbau von Champions o Weitere Optionen Stärkung der Professionalität (Capacity Building) in der Bewegungsförderung o Argumentarium o Internationale Anlässe o Weitere Optionen Weiteres Vorgehen Zu den drei ausgewählten Massnahmen werden vertiefte Handlungsvorschläge ausgearbeitet. Zusätzlich werden Rückmeldungen von ausgewählten Kantonen eingeholt. Die Ergebnisse werden an einem abschliessenden Workshop am mit den eingeladenen Institutionen diskutiert. Zudem wird ein Schlussbericht und ein Argumentarium zuhanden der NGO Allianz erstellt. Anhänge: 1. HEPA PAT Schweiz, Stand August HEPA PAT, Version zur Verwendung auf kantonaler Ebene 3. Handout Präsentation Workshop vom Seite 5 Universität Zürich, Institut für Sozial- und Präventivmedizin,

29 Health-enhancing physical activity (HEPA) Policy Audit Tool (PAT) <Switzerland> Draft number: <1> Date: <23 August 2013 covering situation until August 2013> Draft version for the workshop of the NGO Alliance 0n The previous version until May 2011 is available at Completed by: Brian Martin, MD MPH, Institute of Social and Preventive Medicine, University of Zurich Eva Martin, MPH, Institute of Social and Preventive Medicine, University of Zurich Sonja Kahlmeier, PhD, Institute of Social and Preventive Medicine, University of Zurich Lead author Brian Martin Contact details 4

30 This tool is divided into four sections: Overview of the HEPA PAT Section A Section B Section C Section D aims to capture an overview of the government structure and history of physical activity policy in your country; is concerned with the content of relevant policy and the development process of identified HEPA policy; is focused on the experience of implementation of the HEPA policy; presents a short summary of the process undertaken to complete the HEPA Policy Audit Tool and who was involved in the process SECTION A Background information and context 1. Please provide an overview of the institutional structure in your country. Provide enough detail to assist the reader in understanding the government / organisational system in your country and where physical activity policy and action has previously been addressed. Include details of whether your country has a centralised or federal structure, as well as which level of government is responsible for health, physical activity, sports and recreation. Switzerland has a federalistic structure where most political responsibilities lie with the communities and with the cantons and the federal administration has a mainly subsidiary role, except for some specifically defined topics such as defense or external policy. The responsibility for both health and education lies primarily with the cantons. In health, there are exceptions such as the fight against infectious diseases. A stronger national role in health promotion through a national prevention law has been rejected by parliament in In sports (and as interpreted by the Strategy of the Federal Council for a Sports Policy in Switzerland from 2000 also in physical activity promotion) there is a federal responsibility because of its historical association with defense and with the army. In physical activity promotion, there are many activities at the local and the regional level, often not based on any national action plans and often neither based on evidence nor contributing to the body of evidence and experience. There are some very successful private initiatives that are often not based on national policies, but that are contributing to their development and that often integrate public partners only at a later stage: The offer of the sport clubs and sport associations, the SlowUp events ( Switzerland Mobility ( Allez Hop (see point 10), bike to work ( bike 2 school ( and Midnight Projects ( 2. a. Please provide details (title, publication date, issuing body) of the key policy documents in your country which outline the government's (and where applicable nongovernmental organizations (NGO)) intention and/or strategy to increase national levels of physical activity. Include in this section current documents and key past documents, preferably structured by sector (including health, sport, transport and environment, as applicable). Please provide any web-links to policy documents which can be downloaded and specify if the full or summary version of documents 5

31 are available in English. In addition, please indicate which documents are considered to be the most important ones for guiding current physical activity actions in your country, and explain the links or relationships between the listed documents, where they exist. Also mention if a policy document includes or is accompanied by an action plan on how to implement the policy. However please provide the specific details on actions plans in question 8. Environment Freedom to roam (Freies Betretungsrecht von Wald und Weide), 1907 The freedom to roam, or everyman's right is the general public's right to access certain public or privately owned land for recreation and exercise. This right is guaranteed by the Swiss civil code. It states that forest and pasture are accessible freely for everyone, as long as there is no excessive usage. Except in special cases like the protection of young forest or biotopes it is not allowed to fence in forest areas. This also applies to private property. Similar regulations are in place for land which is not usable (e.g. stretches of water, rock, snow and ice), regardless of the land being under the control of the canton and not claimed as private property or being in private hand. Local or cantonal authorities can define restrictions to this right to roam in order to protect specific areas. Federal CO2 Law (Bundesgesetz über die Reduktion der CO2-Emissionen, CO2- Gesetz), 1999 The CO2 Law defines Switzerland s obligation to reduce CO2 emissions. Compared with the 2010 targets, the surplus in traffic was about 2.6 million tons per year. While the overall targets (re-formulated for 2012) will probably be reached, the traffic emission target will not be met. Nevertheless, the introduction of a CO2 tax on fuels has so far been rejected in parliament. Instead, a climate cent for fuels was introduced. In the revised law of 2013, a total emission reduction of 20% until 2020 (compared to 1990) has been adopted. In addition to the proposed principle measures of CO2 tax for combustibles and climate cent for fuels, significant reductions could also be expected from the promotion of physically active transport. First estimates indicate that in the long term 17 to 20% of all trips and 3 to 4% of all kilometers in motorized individual transport could be shifted to physically active transport, resulting in savings of 0.4 to 0.5 million tons of CO2 and about 2-5 billion in savings through health benefits from physical activity through cycling and walking. German document ( CO2-Potenzial des Langsamverkehrs ) with extensive summary in English at German document ( Ökonomische Abschätzung der volkswirtschaftlichen Gesundheitsnutzen des Langsamverkehrs in der Schweiz ) with English summary at National environment and health action plan (Aktionsplan Umwelt und Gesundheit), The national environment and health action plan was run by the Federal Offices of Public Health, therefore it is listed below in the health sector. Sport/education Federal Law on the Promotion of Gymnastics and Sport (Bundesgesetz über die Förderung von Turnen und Sport, Sportförderungsgesetz), 1972 Based on a constitutional vote in 1970, a federal law has been introduced in It covers physical education to be provided in schools by the cantons and the communities and the activities of the federal administration in the promotion of sports, particularly the Youth and Sport programme open to boys and girls of 14 to 20 and since to 20 years of age. A revision of the law in 2012 included among other 6

32 things an extension of the age range for Youth and Sport to 5 to 20 years. The Federal Law is the basis of the annual budget of the Swiss Federal Office of Sport and of the Youth and Sport programme. It is also the basis of the estimated 500 million Swiss Francs that the communities and cantons invest each year into physical education. Documentation at but only in German, French and Italian Transport Federal Law on Walking and Hiking Paths (Bundesgesetz über Fuss- und Wanderwege), 1985 The law and the respective ordinance define walking and hiking paths and the responsibility of the cantons to create and maintain them, to verify and if necessary improve the path networks, and to have an administrative structure in charge of them. It also defines the supportive role of the federal administration, in particular with respect to subsidising the private organisation Swiss Hiking (Schweizer Wanderwege) which has the overall task of maintaining the national hiking network of kilometers. Documentation at but only in German, French and Italian Federal law on the Infrastructure Fund (Bundesgesetz über den Infrastrukturfonds für den Agglomerationsverkehr, das Nationalstrassennetz, sowie Hauptstrassen in Berggebieten und Randregionen Infrastrukturfondsgesetz IFG), 2006 Increases in mobility and related problems in urban and suburban areas (Agglomerationen) and on the national motorways shall be dealt with and the main roads in mountain areas and border regions shall be maintained. For this purpose, the Infrastrucuture Fund (alimented by petrol taxes and by motorway fees (Autobahnvignette) will provide 20.8 billion Swiss Francs (about 13.5 billion Euro) over the next 20 years including 6 billion Swiss Francs for public and private transport infrastructure in agglomerations of which 2.56 billion Swiss Francs is earmarked for urgent projects and 3.44 billion Swiss Francs for agglomeration programmes. It is foreseen to spend about 3 billion already between 2011 and The Swiss Federal Government stated that non-motorised transport should take on a central role in urban and suburban areas and that a relevant proportion of the means available should be used for improving the quality in non-motorised transport (funding details see question 17). Documentation at in English and at in German, French and Italian Sustainable Development Strategy Guideline and Action Plan Extract Human Powered Mobility (Strategie Nachhaltige Entwicklung: Leitlinien und Aktionsplan Auszug Langsamverkehr) The Action Plan included a goal to increase the proportion of physically active transport stages with the overall modal split, and the federal administration was called upon to develop an Action Plan on Human Powered Mobility (Massnahmenplan Langsamverkehr) until the end of The evaluation report stated that physically active transport could be introduced as 3rd pillar of the transport system and that several implementation aids had been published. The publication of the new Action Plan was postponed to The new Action Plan foresees the full establishment of physically active transport as 3rd pillar of the transport system and the implementation of the Action Plan Human Powered Mobility. Documentation at in English Federal Leisure Transport Strategy (Strategie Freizeitverkehr),

33 Health In Switzerland, the largest share of the total traffic volume is caused by trips during leisure time. Therefore, a strategy was developed as a response to an intervention (Postulat) of the federal parliament (2002), asking for a sustainable transport policy also for leisure time trips. Overall, the strategy pursues a reduction of individual motorized transport in favor of public transport and non-motorized transport, focusing on leisure time trips within and between adjacent urban areas. On the one hand, leisure time walking and cycling are recognized as a particularly sustainable transport activity as such; on the other hand, trips to sporting activities are identified as an important field of action, because of a high number of trips and a high share of motorized transport. The strategy suggests incentives and attractive offers rather than regulations. Furthermore, collaboration between sectors and an active role for the Confederation in a network of key players from cantons and towns/cities, associations, pressure groups and private industry are suggested. Documentation at but only in German, French and Italian Federal Health Insurance Law (Bundesgesetz über die Krankenversicherung (KVG), 1996 Among many other aspects, the Health Insurance Law covers health promotion in its articles 19 and 20. The (private) health insurance companies are required to collect a contribution from every insured person (which is by law everybody in the country) and together with the cantons to have an institution using these funds (currently about 18 million Swiss Francs per year) for health promotion and prevention of diseases. The foundation Health Promotion Switzerland has taken over this task. It has currently three core issues: the strengthening of health promotion and prevention, the promotion of a healthy body weight and on worksite health promotion (with focus on mental health/stress and generation change management). Within the promotion of healthy body weight, Health Promotion Switzerland supports the national programme Suisse Balance on diet, nutrition and body weight. Another contributor to Suisse Balance, though on a different basis (see NPDPA below) is the Federal Office for Public Health. In addition, Health Promotion Switzerland now supports Programmes on Nutrition and Physical Activity in almost all cantons. Documentation at in German, French and Italian and for the main contents also in English National Programme on Diet and Physical Activity (Nationales Programm Ernährung und Bewegung), Already included at The National Programme on Diet and Physical Activity (NPDPA) was developed based on a mandate been given by the Swiss Federal Council in It aims at facilitating the making of health promoting choices in order to prevent non-communicable disease more efficiently and to lead to a more effective counteraction of, among others, overweight and obesity among the population in general, and especially among children and young people. In May 2012, the project has been extended for 4 years. Documentation available only in German, French and Italian at Evaluation report (including executive English summary) at Health 2020 (Gesundheit2020), 2013 This new strategy outlines the priorities of the federal council for the next 8 years, including 36 measures across all areas of the health system. Within the area improve quality of life, one goal is to intensify health promotion and disease prevention. Public and private actors are called upon to further coordinate and increase activities to prevent chronic diseases and in particular NCDs, also mentioning physical activity as 8

34 an important determinant. It is also stated that sufficient financial resources shall be put in place for health promotion, prevention and early diagnosis. No specific budget or action plan for the implementation is included in the strategy. Documentation available in English National strategy against cancer (nationale Strategie gegen Krebs) In 2013, the national strategy against cancer was endorsed by the Federal Governemnt. It had been developed since 2001 by Oncosuisse, an umbrella organisation of institutions active in the fight against cancer, the federal administration and the cantons. Physical activity is mentioned in the context of the National Programme on Diet and Physical Activity as well as in the context of empowering particularly exposed population groups to using protective behavioural strategies. Historical documents Strategy of the Federal Council for a Sports Policy in Switzerland (Konzept des Bundesrates für eine Sportpolitik in der Schweiz), Already included at Summary from there: The strategy was issued by the Swiss Federal Office of Sport in Within the area of sports and health, it was stated that the Federal Government aims at increasing the number of people in all age groups who are physically active. The type of sport and physical activity promoted and the intensity and the level at which they are pursued should be adapted to individual interests, abilities, motives and other personal and environmental factors. A list of priority activities was given. The Government also mandated the Swiss Federal Department of Defense, Civil Protection and Sport in cooperation with the cantons, municipalities and a number of other agencies to submit a national action plan on physical activity. Special emphasis should be placed on health promotion, accident prevention, sustainable development and sport for young people, senior citizens and the disabled. No specified budget or timeframe for the policy was mentioned. The strategy was the basis of comparable developments in many cantons. At the national level, it was phased out in 2012 with the adoption of the updated Law on the Promotion of Gymnastics and Sport. Documentation at but only in German and French. Document available in English at National environment and health action plan (Aktionsplan Umwelt und Gesundheit), According to the Final Report 10 Jahre Umwelt und Gesundheit. Erfahrungen at the Website indicated below, the Swiss National Environment and Health Action Plan was implemented from 2001on (page 6), According to other sources it begun already in It had three priority areas: nature and wellbeing, mobility and wellbeing, housing and wellbeing. The action plan had development projects in three pilot regions, project support possibilities through an innovation pool, coordination and networking elements as well as communication elements, but not a budget for large scale implementation. The action plan was discontinued in Documentation at but only in German and French. Document available in English at Mission statement on human powered mobility, draft (Leitbild Langsamverkehr, Entwurf), 2002 Already included at Summary from there: Human powered mobility (HPM) includes pedestrian traffic, hiking, cycling and other forms of non-motorized mobility such as inline-skating or kickboard scooters. This document, issued by the Swiss Federal Departments of the Environment, Transport, Energy and Communications in 2002 provides the national mission statement for the promotion of HPM which stems from the recognition of its potential to reduce traffic in 9

35 urban areas at only modest infrastructural costs. It is also recognized that HPM has positive effects on the quality of life, on political targets related to energy and the environment, on the costs of health care for a large segment of population, and on economic impulses for the leisure and tourism sector. As the only explicit federal responsibility in the field of HPM in Switzerland is the promotion of hiking and pedestrian traffic through the Footpaths Act, the mission statement aims at extending this law to include the whole range of HPM. The document states a vision and formulates a strategy, to be implemented in 13 groups of measures. One of the targets was to increase HPM from 47% to 54% of all travel episodes within 10 years, representing a 15% increase with regard to the baseline level but this target has not been formally adopted and is not used officially (see also additional comment below). In order to improve the transport system, to reduce stresses on the environment, to promote health and also to promote soft tourism and reduce mobility costs, the proportion of physically active transport ( slow transport) shall be increased in comparison with individual motorized transport and with public transport. For this purpose, the Federal Roads Authority ASTRA tries to improve the conditions for promoting physically active transport, for example by providing the cantons with: financial contributions to respective structures in the context of the programmes in urban and suburban areas (Agglomerationsprogramme, see above); guidance and materials; basic research and support for pilot projects; adaptations in transport law; evaluation and monitoring. Additional comment: The mission statement only exists as a draft and has never been finalised. However, it has been very important in guiding the development and its contents will be taken up in the Action Plan on Human Powered Mobility (Massnahmenplan Langsamverkehr) to be finalized in 2014 as a measure of the Sustainable Development Strategy (see below). Documentation at but only in German, French and Italian Health objectives for Switzerland (Gesundheitsziele für die Schweiz), 2002 Within the context of the Health for All strategy of WHO, Public Health Switzerland (then the Swiss Society for Public Health) has published 21 health objectives for Switzerland in 2002, in a process supported by the Federal Office of Public Health, the project for a national health policy in Switzerland, the conference of the health directors of the cantons, and the foundation Health Promotion Switzerland. The benefits of physical activity are mentioned particularly under objective 11 (living a healthier life), but also under objectives 8 (reduction of non-communicable diseases) and 13 (settings for the promotion of health). The document does not refer to the national recommendations for health-enhancing physical activity in adults issued in Its objectives are not legally binding and there is no budget. Documentation at only in German and French Main documents It was not possible to select a few documents as the most important documents as such because there are documents in different sectors as well as historic documents and current developments (which cannot yet be judged regarding their impact). In conclusion: Environment: The Freedom to roam (1907) is a very important historic key element both for the environment and for transport. The impact of the Federal CO2 Law (1999) still remains to be seen. Sport/education: The Federal Law on the Promotion of Gymnastics and Sport (revised in 2012) is the most important basis. Transport: The Freedom to roam (1907) and the Federal Law on Walking and Hiking Paths (1985) are very important historic key elements. Even though the Mission 10

36 statement on human powered mobility (2002) has not been finalized officially, it has guided strongly further developments in this area. The impact of the most recent laws (Federal CO2, law 1999, Federal law on the Infrastructure Fund 2006) and strategies (Federal Leisure Transport Strategy, 2009) is to be seen. Health: The Federal Health Insurance Law (1996) was an important step, defining among other things the role of the foundation Health Promotion Switzerland. The National Programme on Diet and Physical Activity ( ) is the latest development in this sector and will be continued for 4 years. Interlinkages between the documents are illustrated in the below graph 11

37 2. b. Please also outline any international documents which may have guided the development of physical activity policy in your country, if applicable. Supportive for the development of Swiss documents were the following international processes: The Rio Conference on Sustainable Development (1992) for policy and activities on sustainable transport, including cycling and walking The Global Strategy on Diet, Physical Activity and Health (2004) and the European WHO Ministerial Conference on Counteracting Obesity (2006) for policy and activities on diet and physical activity. Currently, there is discussion about the integration and application of the WHO s recent policy documents on the control and prevention of non-communicable diseases NCC (Omnibus resolution at the 2013 World Health Assembly, Vienna Declaration 2013 fpr Europe) SECTION B Content and development of national policy 3. During the development of the policies/action plans mentioned in question 2 was a consultative process used involving relevant stakeholders? If yes, please list the organizations that have been involved in the development of the policies, and briefly comment on their role and any challenges to engaging other agencies in the development of policy related to physical activity in your country (if known). Strategy of the Federal Council for a Sports Policy in Switzerland, 2000: Broad consultation of all releveant partners during development of policy document. No more involvement of partners in definition of measures. National Programme on Diet and Physical Activity (Nationales Programm Ernährung und Bewegung ): A first development phase took part with the main national partners and representatives of the cantons, in addition three workshops were carried out with more than 100 participants from different interested circle. The actual programme was developed in a following phase by the Federal Office of Public Health in cooperation with the Federal Office of Sport, the foundation Health Promotion Switzerland and the Coordinating Conference of the Health Directors of the Cantons. Before being agreed on by the Federal Council, the programme had the usual consultation round by the involved units of the federal administration. ((What was the development process for the next phase beyond the evaluation report?)) Federal laws: there are well established processes for consultation with all relevant public and private partners during the preparation and establishment of federal laws in Switzerland. 4. In the documents introduced in question 2, are there indications of integration of physical activity with other related sectors (e.g. with health such as links to obesity strategies, with transport such as links to walking and cycling agendas)? Please provide details and examples. Many of the policy documents mentioned under point 2 are examples of inter-sectoral approaches. The National Programme on Diet and Physical Activity has a strategic steering group including both the health and the sport sector. Health Promotion Switzerland combines in its long-term strategy for a healthy body weight ( ) the two main action fields nutrition and physical activity. Based on the Federal Law on Walking and Hiking Paths, the Federal law on the Infrastructure Fund and the Sustainable Development Strategy, the Federal Roads 12

38 Authority has a coordinating group within the federal administration on physically active transport (Bundeskoordination Langsamverkehr) which includes the sectors of transport, environment, spatial development, energy, economy, sport and health. There are similar groups on leisure time traffic (Kompetenzzentrum und Koordinationsgruppe Freizeitverkehr) and development of suburban open spaces (suburbane Freiraumentwicklung), both organised by the Federal Office for Spatial Development. The network HEPA Switzerland is supported by the Federal Offices of Sport and Public Health, by the Foundation Health Promotion Switzerland and the Swiss Council for Accident Prevention and has more than 100 member institutions from different sectors. The Swiss Council for Accident Prevention bfu is one of the institutions supporting the network HEPA Switzerland (see point 25), the Swiss Accident Insurance Fund SUVA is one of its members. In 2011/2012, the Swiss Council for Accident Prevention bfu had funded a project to explore and define possibilities for improving collaboration between physical activity promotion and accident prevention but is no longer active in this area. 5. a) Does your country have national recommendations on physical activity levels? National recommendations refer to consensus statements on how much activity is required for health benefits. If your country has established recommendations, please state who issued them and what is the recommended level of physical activity. Please also specify any variation in the recommendations on physical activity levels for different population subgroups, for example for children or older adults. Please also state in which document and year these recommendations were announced. b) Please state if the national government has endorsed these recommendations, or if recommendations by another nationally recognized body or international institution have been officially adopted. c) If your country has no recommendations on physical activity, please state if there are any plans to develop them. If recommendations on physical activity have been issued at sub-national level (e.g. in case of countries with a federal structure), please state so. The first national HEPA recommendations have been issued by the Federal Offices of Sport and Public Health, Health Promotion Switzerland and the Network HEPA Switzerland, for adults in 1999 and for children in Updated recommendations have been issued in summer 2012 by the same institutions with some more partners. The new recommendations follow the Global Recommendations of WHO in recommending for adults and older adults 150 minutes of moderate intensity or 75 minutes of vigorous intensity activity per week, or an equivalent combination, in bouts of at least 10 minutes. Older adults should be as active as possible even if they cannot reach the minimum recommendations. At least 60 minutes of moderate- to vigorous intensity daily are recommended for children and adolescents, no minimum bouts are necessary. Strength training is recommended for all age groups, bone health training for children and adolescents and balance training for older adults, as well as to limit extended periods of sitting. References for recommendations Recommendations in German, French and Italian for all age groups: Swiss Federal Office of Sports, Swiss Federal Office of Public Health, Health Promotion Switzerland, Network HEPA Switzerland: Health-Enhancing Physical Activity. Core Document. Magglingen: Swiss Federal Office of Sports, 2013, at or Article describing the basis for the revision of the recommendations: Kahlmeier S, Alpiger P, Martin B. National recommendations for health-enhancing physical activity: the situation for Switzerland in 2011 and options for further developments. Schweiz Zeitschrift Sportmed Sporttraumat 60 (3), , 2012, available at 6. Does your country have any clear national goals (targets) and performance 13

39 indicators for population prevalence of physical activity for a specific time period i.e. a statement of what level of population change in physical activity is desired across a timeframe? If yes, please provide details and specify in which policy document(s) these goals are stated. Please start with the most specific and measurable targets, followed by a listing or summary statement of any more general targets and goals for physical activity related behaviours. The Strategy of the Federal Council for a Sports Policy in Switzerland has defined the increase of physically active people in Switzerland as the first goal of the Swiss Sports Policy. The strategy has had two packages of measures (Massnahmenpakete) so far, one from 2003 to 2006 and one from 2007 to The package of measures 2003 to 2006 had stated the target of first stabilizing and then increasing by one percent per year the proportion of physically active people in Switzerland. Analyses of physical activity behaviour have shown an increase in the proportion of the adult population meeting current HEPA recommendations by 4% between 2002 and The package of measures 2007 to 2010 did not state specific targets anymore. The National Programme on Diet and Physical Activity stateds as its third goal the promotion of physical activity and sport. No specific targets were defined, which was mentioned as one of the weaknesses of the programme in the evaluation report. 7. Does your country have any other related goals and performance indicators formulated in the policy document(s)? For example, there may be goals for health professionals to screen more patients for physical activity, or for a reduction in car trips. If so, please give examples and indicate the time period for the desired change, if available. In the first packages of measures of the Strategy of the Federal Council for a Sports Policy in Switzerland from 2003 to 2006 specific targets were defined for the measure of the local physical activity networks: by the end of % of all communities with 5000 to inhabitants and 50% of all communities with 2000 to 5000 communities should have a functioning physical activity and sport network with a coordinator. 75% of all communities with more than inhabitants should have a sport vision statement and strategy. Overall, Switzerland has some communities. In the report on the success of the measures it is stated that 20 local networks have participated in the programme. The Sustainable Development Strategy stated as one of its goals the increase of the proportion of physically active transport stages within the modal split of overall mobility. The goals of the new strategy are more general. The Federal Leisure Transport Strategy pursues a reduction of individual motorized transport in favor of public transport and non-motorized transport. No specific targets are defined. The Federal Law on the Promotion of Gymnastics and Sport states the obligation of the cantons and communities to provide three lessons of physical education per week in their schools. Analyses have shown that by 2009, the law was implemented in the vast majority of cantons ( The observatory sport and physical activity Switzerland ( contains a whole series of indicators which are being used to follow the development and the success of the Swiss Sport Policy. 14

40 The next few questions explore the contents of physical activity related action plans and whether your country has a detailed plan of what will be implemented and who has responsibility. 8. Do the relevant documents (as listed in question 2) have any related action plan(s) which outline an implementation strategy? This might ideally outline: specific actions and timelines; assignment of responsibilities; an indication about available resources; indicators and milestones. If yes, please provide a brief description (or if there is too much, please summarize the main groups of actions). The National Programme on Diet and Physical Activity (Nationales Programm Ernährung und Bewegung ) did not have an action plan. The federal administration is called upon to develop an action plan on Human Powered Mobility, foreseen to be available by The Federal Leisure Transport Strategy does not have a specific related action plan; however, suggested measures are implemented continuously. The federal laws mentioned under point 2 do not necessarily have corresponding action plans, but ordinances defining the ways in which the corresponding financial means are being used. The Health 2020 document does not have an action plan but identified selected measures for priority implementation by the end of They do not include activities on NCDs, physical activity or health promotion. 9. Looking across the relevant physical activity policy documents in your country, please indicate which settings, if any, are identified for the delivery of the physical activity action plans. Please tick all that apply. Kindergarten x Sport and leisure x Primary schools x Transport High schools x Tourism Colleges/universities x Environment Primary health care Urban design and planning x Clinical health care (e.g. hospitals) Other (please specify) Workplace Senior/ older adult services ((To be discussed on : are further settings explicitly mentioned in policy documents?)) 10. Which population groups are targeted by specific actions or activities stated in the policy/action plans? Please tick all that apply. Early years Sedentary/ the most inactive Children / Young people x People from low socio-economic groups Older adults x Families Workforce / employees Indigenous people Women General population x People with disabilities Other (please specify) Clinical populations/ chronic disease patients 15

41 11. To illustrate the approaches being used to promote physical activity in your country, please provide up to 3 examples of interventions included in your policy/action plans which reflect the diversity of the plans across different population groups and settings. Please link your examples to the relevant documents as listed in question 2. Youth and Sports -> Youth and Sports is the national sports promotion programme for 5-20 year olds. It reaches more than half a million children and adolescents every year and now also has offers for 5 to 10 year old children. Youth and Sports is based on the Federal Law on the Promotion of Gymnastics and Sport. See also points 2 and 16. More detailed information: Kelly P, Cavill N, Foster C. An Analysis of National Approaches to Promoting Physical Activity and Sports in Children and Adolescents. Report. Oxford, British Heart Foundation Health Promotion Research Group, University of Oxford Report and summary report available at Allez Hop -> For about a decade, Allez Hop offered weekly activity sessions (e. g. Nordic walking) for middle age adults. In the best years, more than individuals were reached. Allez Hop started as a private inititiative, but became part of a measure in the Strategy of the Federal Council for a Sports Policy in Switzerland. See also points 2 and 21. More detailed information: Wanner M, Martin-Diener E, Bauer G, Stamm HP, Martin BW. Allez Hop, a nation-wide programme for the promotion of physical activity in Switzerland: what is the evidence for a population impact after one decade of implementation? Brit J Sport Med, 2011 December; 45(15): Document available at Primary care interventions -> A number of approaches for physical activity promotion have been developed in Switzerland. They have been coordinated and were part of a measure in the Strategy of the Federal Council for a Sports Policy in Switzerland. More detailed information: Bize R, Surbeck R, Padlina O, Peduzzi F, Cornuz J, Martin B. Promotion of physical activity in the primary care setting: The situation in Switzerland. Schweiz Z Sportmed Sporttraumatol 2008, 56 (3), Document available at -> Ausgabe /3 or at Please comment on how well you think the interventions outlined in the policy documents(s) (question 2) and/or action plan(s) (question 8) reflect current scientific knowledge on effective interventions. When working on this question, you may be interested in discussing how well evidence is informing practice. The Youth and Sport programme is once more announcing an evaluation of its activities. Currently, information is available on the reach of the programme (documentation available in German and French), on the acceptance of instructors training (documentation available in German and French), but not yet on the programme s effect on children s physical activity behaviour. The evaluation of the National Programme on Diet and Physical Activity stated that from a health promotion point of view the programme was relevant and that it was taking into account international experiences and recommendations. The monitoring systems described in question 15 aims at providing an accurate picture of the situation in Switzerland, which is essential for the development of coherent strategies. 13. Are there recommendations of how agencies/ institutions/ stakeholders should be working together to deliver the policy / action plan(s)? This can be through partnerships and/or alliances and within or between sectors. General recommendations are included in several of the documents. The National Programme on Diet and Physical Activity has stated the intention and the general principles. New developments have been the programme s strategic steering group 16

42 including both the health and the sport sector and the initiative actionsanté for voluntary collaboration from the industry. The evaluation report stated that the programme has contributed to increasing exchange among partners but is not yet able to fully serve as steering- and coordination instrument across all partners and activities. 14. Does your country have a specific plan for the evaluation of the policy implementation? If yes, please provide a brief overview of the extent of the evaluation activities and identify who is responsible for coordinating and/or undertaking the evaluation. The observatory sport and physical activity Switzerland ( contains a whole series of indicators which are also being used to follow the development and the success of the Swiss Sport Policy. An evaluation of the National Programme on Diet and Physical Activity was carried out in 2011 by an external consortium of institutions, including a university institute and a policy consultancy firm. Methodologies included interviews, document analysis and an online survey with relevant stakeholders, and interviews with international experts and programme leaders. The evaluation had 3 main goals: 1) to give an account of programme implementation, activities and achievements, 2) to provide a basis for the proposal to the Federal Council to extend the programme, and 3) to develop proposals to improve the strategic direction and implementation of the programme. The evaluation concluded that the programme has contributed to a better overview of activities and to clarifying roles and responsibilities of the actors involved. It also had first successes in some areas, including for example the MOSEB system (see question 15) and in promoting multisectoral exchange. However, it was also stated that in particular regarding physical activity promotion, the implementation needed to be specified further. It was also recommended to develop specific and measureable goals and an action plan for implementation as well as an interagency steering mechanism and a joint communication strategy to create a common programme identity across all involved partners and activities. The overall strategy of Health Promotion Switzerland for a healthy body weight is being evaluated by different monitoring and evaluation projects. For example, the cantonal programmes for a healthy body weight are accompanied by a formative evaluation. 15. a. Does your country have an established surveillance or health monitoring system, which includes suitable population-based measures of physical activity? If so, for how many years has this surveillance system been in place, who coordinates the system, which target groups are surveyed, which indicators are monitored, and how often? Is this conducted and reported on a regular basis? The Swiss Health Survey provides the best estimates of overall physical activity behaviour in adults. Questions on high-intensity leisure time physical activity are included since 1992 and were repeated every 5 years, which allows trend analysis but not the complete assessment of the national PA recommendations. The best survey for overall physical activity behaviour in adolescents is the Health Behaviour in School Children HBSC, in which Switzerland participates since Data from both surveys rely on standardised, nationally representative samples providing robust estimates, but they are based on self-report instruments of untested, poor or questionable validity against objective measurements of physical activity. No nationally representative data is available on compliance of children with HEPA recommendations. A concept for a Monitoring System on Nutrition and Physical Activity ( has been developed in the context of the National Programme on Diet and Physical Activity and a collection of indicators has been published, currently including 6 17

43 indicators on physical activity behaviour from the two sources mentioned above, the Microcensus Transport on cycling and walking, the Swiss Sport Survey, an Omnibus Survey of the Federal Statistical Office, and two studies using accelerometers in children. The MOSEB also contains information on existence and participation in offers for physical activity. The most recent report of MOSEB is from January The observatory sport and physical activity Switzerland ( contains a whole series of indicators that are being used to follow the development and the results of the Swiss Sport Policy. Currently, none of the above monitoring systems addresses the question of the measurement properties of the physical activity questionnaires used in Switzerland and further methodological developments are mentioned only for nutrition. Overview: Martin BW, Mäder U, Stamm HP, Braun-Fahrländer C. Physical activity and health what are the recommendations and where do we find the Swiss population? Schweiz Z Sportmed Sporttraumatol 2009, 57 (2), ( -> Ausgabe /2). References for monitoring systems: Observatory sport and physical activity Switzerland: Overview in English at detailed reports in German MOSEB: In English at including the an outline of the concept (Federal Office of Public Health. Monitoring System for Nutrition and Physical Activity (MOSEB). Outline. Final version of 11 February Federal Office of Public Health, 2009.), reports and information brochures. 15. b. Please comment on the extent to which the national surveillance system in your country provides policy-relevant data and is therefore useful for assessing progress towards national goals (if stated in question 6) and the effectiveness of national policy and implementation. The data provided through the national surveillance system is regularly taken up in the public and the political debate. However, as stated in question 6 there are only few examples of quantified objectives for national policy which limits the possibilities for judging the effectiveness of national policy and implementation. 15. c. Please comment on how well you think surveillance data has helped progress the agenda on physical activity in your country. Monitoring data has been a basis for the development of the Sport Strategy and the National Programme on Diet and Physical Activity. According to the evaluation report of the national programme, the MOSEB also is a useful source of information for the relevant stakeholders. A decline in cycling among children and adolescents documented in the Microcensus Transport 2010 has helped to sensitize different stakeholders and to initiate a discussion on how this negative trend could be addressed. 16. What evidence is there of current political commitment to the physical activity agenda and the development and/or implementation of national policies and action plans? Examples of political commitment might include: the inclusion of physical activity in official speeches; political discussions about physical activity promotion in parliament; visible engagement by politicians in HEPA related events; personal participation in 18

44 HEPA. In Switzerland, there have been different historical phases and events: Youth and Sport has had very strong political support on different political levels (cantons and national) since the 1970s. So against the explicit will of the respective minister, the parliament has agreed on full federal funding for the Youth and Sport Kids extension of the programme (covering not only 10 to 20, but also 5 to 10 year olds) in The Strategy of the Federal Council for a Sports Policy in Switzerland has had strong political support during its development in the late 1990s, but only limited additional resources (about 3% of the overall budget of the Federal Office of Sport) have materialised for the concrete measures. There was some political support for the (first ever) proposed national prevention law but the discussions of the law in the federal parliament showed that in some political parties and also in some cantons there is opposition to more federal responsibility in this field even when no additional funding was foreseen. The law was not supported by federal parliament in At the same time, there is growing interest and growing support for all aspects of physical activity promotion at the level of cities and cantons. For example, 22 of 26 Swiss cantons have politically committed on a cantonal programme for a healthy body weight, combining nutrition and physical activity. For each of the 22 cantonal programmes the signature of the responsible member of the cantonal government was required. After a decline after the late 1990s, there is again growing interest and political support for the promotion of walking and cycling also under the aspects of transport and spatial planning (agglomeration programs) as well as environmental protection (C02 reduction). Many figures of public life like to present themselves as physically active or active in sports. However, this does not imply any particular position towards physical activity promotion as a public task. 17. Is the funding for the delivery and implementation of interventions listed in the policy / action plan(s)? If yes, please provide details of the level of funding commitment, any increases/ decreases, and from what sources (if available). Strategy of the Federal Council for a Sports Policy in Switzerland : The first package of measures (2003 to 2006) had an annual budget of about EUR 3 million, the second one ( ) of about EUR 2.6 million, corresponding to about 3% of the annual budget of the Swiss Federal Office of Sport. About EUR were spent on health-related measures, corresponding to less than 1% of the annual budget of the Swiss Federal Office of Sport. The National Programme on Diet and Physical Activity had an annual budget of EUR 1.9 million. This covered project staff, administration and selected network and project support. ((The BAG website still indicates an annual budget of CHF 3 million)) The Foundation Health Promotion Switzerland has an overall annual budget of about EUR 13 million. A growing proportion of this budget (ca EUR 3 mio/year) goes into the financial support of the Nutrition and Physical Activity programmes in the cantons. The agglomeration programmes have started two waves of implementation. The first wave ( ) included about EUR 375 Mio for pure cycling and walking infrastructure measures, representing about 12% of total spending. The second wave ( ) included EUR 575 Mio. or 17% of total spending. This does not include measures to improve general traffic safety or intermodal nodes which also benefit cycling and walking. The relative increase also demonstrates the foreseen focus on human powered mobility with the programs (see also question 2). The Sustainable Development Strategy, the Federal Leisure Transport Strategy and 19

45 the draft of the Mission Statement on Human Powered Mobility do not state mechanisms or sources for funding. The federal laws mentioned under point 1 have specific funding mechanisms (see there). Section C Implementation of the physical activity policy/action plan This section aims to capture details on the experiences of actually implementing physical activity policies and actions. The reality can be very different from the theory and it is of interest to learn about the process and impact that national policy has had in terms of what is actually underway to promote physical activity in your country. 18. a. Is there a designated government department, nongovernment group or individual providing overall stewardship (i.e. a combination of leadership, coordination and advocacy with other sectors) for HEPA promotion in your country? Does their role include stewardship of the implementation of the policy and/or action plan(s)? If yes, please describe their role. There is not one single institution providing overall stewardship. However, there are different bodies responsible for partial aspects, including: Strategy of the Federal Council for a Sports Policy in Switzerland, 2000 Federal Office of Sport National Programme on Diet and Physical Activity (Nationales Programm Ernährung und Bewegung ): Overall: Federal Office of Public Health Physical activity in everyday life: Federal Office of Public Health Sport: Federal Office of Sport Promotion of healthy body weight: Foundation Health Promotion Switzerland See also question 2. Federal laws: see point 1 18 b. If responsibility for the leadership and coordination of the action plan implementation has been delegated outside of government, what is the role of government (if any), and what level of government support is evident towards the implementation of the action plans in your country? There is not one overall action plan funded for physical activity promotion. However, some activities have been delegated outside of government. One example is the Foundation Health Promotion Switzerland as described in questions 2, 4 and 17. The federal administration is represented (together with representatives of cantonal governments, of health insurances and with other partners) in the foundation board of Health Promotion Switzerland. There is no clear mechanism for government support to the foundation s activities. 20

46 19. Please outline the extent to which the national level policy documents and leadership (if present) guides the implementation of policy and other physical activity promotion actions at a sub-national or local level. When working on this question, you may be interested in discussing whether there is synergy and coherence between these levels of implementation and action. Examples for good synergies and coherence: 1. Development of programmes on Nutrition and Physical Activity in cantons, supported by the non-ministerial structure Health Promotion Switzerland (see point 17). In the case of the integrated projects of Suisse Balance combining physical activity and nutrition ( the activities are supported by both Health Promotion Switzerland and the Federal Office of Public Health. 2. Development of sport strategies of cantons, following the initiative of the Federal Office of Sport but funded by their own resources 3. Initiatives of several cantons in Youth and Sport Kids and related offers since 2008.(see point 11) 20. Please identify who provides leadership and coordination of physical activity related activities at the sub-national and local level? Health promotion authorities in cantons and cities Sport promotion authorities in cantons and cities Urban planning authorities in cantons and cities Transport planning authorities in cantons and cities Education authorities in cantons and cities Network HEPA Switzerland as a voluntary exchange platform for actors at the canton and community level Institutionalised coordinating mechanisms (so-called coordination conferences) for the members of governments of the cantons (so-called councillors) in the respective sectors (e.g. public transport, health etc.) 21. Please provide brief details on up to three examples of interventions which have been successfully implemented following the development of the policy and action plan. Please also give 3 examples of any less successful interventions, as these often provide important lessons. Successful interventions Good examples for the sub-national level were described in question 19; there is currently no particular national example that has been successfully implemented as the consequence of a policy or action plan. ((Are there any projects that have made it to a national level? Actionsanté is mentioned in several of the BAG s projects, but its physical activity projects don t have much visibility yet)). Less successful interventions 1. Discontinuation of Allez Hop at the national level. Despite its obvious success, the programme was discontinued in 2008 without consideration of evaluation results (see point 11) 2. Failure to reach objectives in local sport networks and absence of consideration of respective evaluation results in second package of measures of the Strategy of the Federal Council for a Sports Policy in Switzerland (see points 6 and 12) 3. Discontinuation of HPM (physically active transport) activities at Federal Office of Sport. Despite reaching all of its objectives in the first package of measures of the Strategy of the Federal Council for a Sports Policy in Switzerland, it was discontinued in the second package of measures without consideration of evaluation results. 21

47 22. Is there any evaluation of physical activity interventions at the sub-national and/or local level? Please give a general overview of the role of evidence and evaluation of practice undertaken in your country in relation to HEPA promotion. Independent evaluation of selected approaches The cantonal programmes of nutrition and physical activity are currently being evaluated (information available in German and French). Link: /index.php 23. Does your country have a national level communication or mass media strategy aimed at raising awareness and promoting the benefits of physical activity? Please provide details of the communication activities (if any). Health promotion Switzerland has had different campaigns also addressing physical activity ( The Schweiz bewegt campaign (Switzerland on the move) tries to encourage communities every spring to organize events for WHO s Physical Activity Day or the week around it ( It was originally an initiative of the Federal Office of Sport, but now a separate organisation with a number of private and public partners including the Federal Office of Sport and Health Promotion Switzerland. The lack of a communication strategy has been mentioned in the evaluation as one of the main weaknesses of the National Programme on Diet and Physical Activity (see page 11). 24. In your country are the physical activity interventions linked together by the use of any common branding/ logo/ slogan? Examples of this in other countries include Agita Sao Paulo and Find 30. If yes, please describe. The Youth+Sport brand is known by the vast majority of the Swiss population and has an excellent reputation. The Programme Nutrition and Physical Activity has established the initiative actionsanté for coordinating voluntary action of the private industry. The private sector can use the actionsanté logo for the communication when it is partner of actionsanté but it has not been used yet for physical activity promotion. The Schweiz bewegt brand (see qu. 23) 22

48 25. Does your country have any network or communication system linking and/or supporting professionals who have an interest in physical activity and/or are working on the promotion of physical activity or related areas? If yes, please describe, providing a web-link and contact person, if available. Network HEPA Switzerland National network with more than 100 member institutions, website at see Promotion of Health-Enhancing Physical Activity HEPA in Switzerland in report of 2004 expert meeting at Health Promotion Switzerland is the responsible institution for the network of the 22 cantonal programmes on nutrition and physical activity. The Youth and Sport programme has together with the cantons and the sports federations an extensive system for training and continuing education of sport instructors. The above questions have sought information to capture both the what and the how of your country s policy development and implementation around physical activity. What do you think are the 2 to 3 examples of greatest progress and also what you think have been the 2 to 3 biggest challenges faced by your country in commencing or continuing a national level approach to the promotion of HEPA. 26. a. Please list up to three examples of an area or issue where the greatest progress has been made in your country in recent years. 1. Extension of the Youth and Sport programme to 5 to 10 year olds in (see points 11 and Consensus on recommendations and principles of physical activity and health (see points 2 and 23); growing interest in the topic in the media and in the public. 3. Growing involvement and number of actions by other sectors, in particular increased investments in cycling and walking infrastructure 26.b. Please list up to three areas or issues that remain as more difficult challenges to address. 1. Clarification of roles and joint actions by national institutions 2. Better mechanisms (funding, structures) for supporting action and change 3. Monitoring system on physical activity for all age groups 27. Please use this space to provide any further details which you were not able to provide in other sections of the tool. It has to be noted that there were diverging numbers available for some of the budgetary information reported in question 17. So the Federal Office for Public Health has confirmed repeatedly that the annual budget of the National Programme on Diet and Physical Activity is EUR 1.9 million (2.3 million Swiss Francs). At the same time, the official website of the Office has kept indicating until that the Office spends about EUR 2.5 million (3 million Swiss Francs) for the programme. This discrepancy was pointed out in early December 2011, but no explanation 23

49 was given for it and the information on the website remained unchanged ( ((Discrepancy continues to exist)) Section D A summary of how the HEPA PAT was completed It will be of interest to those who read this audit of HEPA policy to know how this review was undertaken and who was involved in the process. Please outline in brief the process used. This should include details of who initiated the process, who led the process, who was involved and how they were identified or selected as well as the timelines of the consultation process. In addition, please include details of consultation steps that were undertaken and a list of individuals and organisations that were contacted and from whom feedback were received. Overview of process and timelines The current draft of the HEPA PAT has been updated by the Institute of Social and Preventive Medicine for the meeting of the NGO Alliance on 18 September The updated version has not yet been reviewed by anybody else. List of experts who were consulted for input Contact person Organisation Input received 24

50 Health-enhancing physical activity (HEPA) Policy Audit Tool (PAT) Angepasste Version zur Verwendung auf kantonaler Ebene Institut für Sozial- und Präventivmedizin Universität Zürich September 2013 Basierend auf: Bull FC, Milton K, Kahlmeier S. Health-enhancing physical activity (HEPA) policy audit tool. Copenhagen, WHO Regional Office for Europe, 2011 Version