Bewegungsförderung in der Schweiz

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1 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

2 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,

3 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

4 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

5 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:

6 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

7 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

8 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

9 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 Sust Dev NP DPA LeiTr Str hepa.ch/ adults MissSt HPM children Y+S Hop I (03-06) 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 Hop Fredoom to roam Federal law 2

10 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

11 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

12 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 Dev DPA Str hepa.ch/ MissSt HPM children adults Y+S 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 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 Sust NP LeiTr Dev DPA Str NEHAP Sust NP LeiTr Dev DPA Str hepa.ch/ MissSt hepa.ch/ MissSt HPM children HPM children adults adults Y+S Hop I (03-06) Y+S Agglo- II (07-10) Kids Progr. Y+S Hop I (03-06) Y+S Agglo- II (07-10) Kids Progr Health sector International developments Federal laws NEHAP Hop Health sector International developments Federal laws NEHAP 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

13 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 Sust NP LeiTr Dev DPA Str hepa.ch/ adults MissSt HPM children Y+S Hop I (03-06) Y+S Agglo- II (07-10) Kids Progr Health sector International developments Federal laws NEHAP 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

14 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:

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