01.12.2014 The Swiss government is drawing up two forward-looking strategies for the prevention of addiction and non-communicable diseases
Strategies. Non-communicable diseases are currently the most common cause of deaths worldwide. According to the Swiss Federal Statistical Office, 74.6 percent of deaths among men and 75.9 percent among women in Switzerland in 2011 were due to four groups of non-communicable diseases: cardiovascular diseases, cancer, respiratory diseases and dementia. The Swiss government and the cantons are currently working together to draw up a national strategy for the prevention of non-communicable diseases. Tackling the phenomenon of addiction on a more comprehensive basis is the primary objective of the National Strategy on Addiction that is being drawn up in response to a mandate of the Swiss government, to be completed by spring 2015. The overriding goal is to secure a comprehensive and integrated package of addiction management services that includes medical care, harm reduction, counselling and treatment and promotes the social (re-)integration and health rehabilitation of addicts. The National Strategy on Addiction will guarantee continuity and also define a framework for action across all kinds of addiction. The two new strategies will replace the national programmes on alcohol, tobacco, drugs and diet & physical activity, which finish at the end of 2016.
On account of the impact on society and the economy, the increase in non-communicable diseases (NCDs) such as cancer, diabetes or cardiovascular, chronic respiratory and musculoskeletal diseases has become a major political issue. These – often prolonged – illnesses that cannot be transmitted from one person to another are now the most common causes of death in our society. They not only result in a great deal of personal suffering and reduced quality of life; they also pose major challenges to the healthcare system – at the financial, structural and human-resources level. A new study puts the consequential costs of NCDs for Switzerland at 52 billion francs a year, which means that they account for 80 percent of the country's direct healthcare costs. The Word Health Organization (WHO) assumes that the number of non-communicable diseases will continue to grow in the next few years.
Healthy lifestyle and general conditions conducive to health
We are, however, not completely powerless to address this increase in non-communicable diseases. Around half of them could be prevented, or at least delayed, by a healthy lifestyle. They are promoted by the following risk factors: an unbalanced diet, lack of physical activity, alcohol abuse and smoking. We could, therefore, do something about them. Measures that improve individual lifestyle and general social conditions can significantly reduce the burden of disease and therefore the associated economic costs as well.
Since 2008 there have been three national prevention programmes in Switzerland that target the main risk factors of non-communicable diseases: the tobacco, alcohol and diet & physical activity programmes. They each provide frameworks for the different nationwide, cantonal and municipal prevention activities in these fields. This issue of spectra contains accounts of the progress achieved in various projects in the respective programmes.
Drawing up a national NCD strategy
In November 2013, the "Dialogue on National Healthcare Policy"– a permanent platform of the Swiss government and the cantons – decided that work should start on drawing up a national strategy for the prevention of non-communicable diseases, to be completed by 2016. The aim of the strategy is to improve the health literacy of the population and create general conditions that make it easier for people to live in a healthier manner.
At the end of March 2014, around 200 players attended the first stakeholder meeting on non-communicable diseases in Berne. Since then, two working groups comprising representatives of the different stakeholder sectors have been drafting the main thrusts of the national strategy. The first group is focusing on risk factors and nationwide and cantonal prevention activities, while also exploring possible synergies with existing disease-specific strategies (such as the Swiss Cancer Strategy). The second group is concentrating on strengthening prevention in healthcare provision. The reports of the working groups on the problem analysis and the possible options for action will be available by the end of February 2015. With these reports as a basis, the extended steering committee, in which the Swiss government, the cantons, Health Promotion Switzerland, NGOs and research experts are represented, will formulate a draft strategy by the end of May 2015 and then submit it to the partners for consultation over the summer months.
National strategy for a comprehensive and coherent policy on addiction
Addiction disorders are by-products of their times. While "intemperance" was a particular cause of problems in the 19th century, heroin addiction occupied the minds of the media, society and healthcare professionals in the 1980s and 1990s. Substances such as alcohol, illegal drugs or tobacco still cause a great deal of suffering for those affected and high consequential costs for society, as well as restricting quality of life for individuals. The focus of public attention today is directed not only at "classic" forms of dependence, but also at new addictions, e.g. to prescription drugs, gambling or the Internet.
Through its "Health 2020" Agenda, the Swiss government wants in future to intensify efforts to promote health and prevent disease; addiction or problematic behaviour and forms of consumption are an important aspect of these goals. The National Strategy on Addiction will entail a realignment of the present fragmented policy on addiction. It will make it possible to bundle goals and priorities in the field of addiction on the basis of the experience gained to date and to tackle current challenges. Like the NCD strategy described above, the National Strategy on Addiction is being developed on a participatory basis, i.e. with the active involvement of the key prevention players.
The National Strategy on Addiction will provide a clear strategic direction for the cantons, municipalities, professional bodies and other partners. The strategy will ensure support for the efforts of all players to strengthen addiction prevention, secure a broadly structured treatment system and improve early identification and early intervention in cases of addiction or problematic consumption behaviour. Working together with the partners, the aim is to put in place and secure a comprehensive and integrated provision of addiction management services that includes measures for medical care, harm reduction, counselling and treatment, helps prevent the social disintegration processes associated with addiction and promotes the social reintegration and health rehabilitation of addicts. In line with its broad ambitions, the National Strategy on Addiction will formulate its goals across all forms of addiction, thereby enabling both substance-based and behavioural forms of addiction to be handled.
The Swiss government wants its National Strategy on Addiction to prevent or reduce the harm that addiction does to public health and society in general, and to mitigate the individual suffering associated with addiction.
Vision of the national NCD strategy
More people stay healthy or, despite chronic illness, are able live independently. Fewer people suffer from avoidable disabilities or die prematurely from avoidable non-communicable diseases. Regardless of socio-economic status, the population is supported in its efforts to create health-promoting environments and cultivate a healthy lifestyle.