The Amsterdam approach to healthy weight Jaap Seidell Vrije Universiteit Amsterdam
Greetings from Amsterdam
Many sectors were involved in the country case stories with the health sector taking the lead in most cases, coordinating action and engaging other players. The other main sectors involved were agriculture, education, family affairs, interior, labour, justice, sports and tourism. The case stories reveal a number of mechanisms that facilitated intersectoral action with lessons learnt focusing on the importance of establishing common goals, engaging sectors and implementing mechanisms for intersectoral work.
Behaviour change wheel
Amsterdam Healthy Weight Programme 15-5-2017
The numbers (2014) In the Netherlands, 13,2% of children were overweight or obese In Amsterdam, it was 19% (almost one in five) That s over 25.000 children between 2 and 18 years of age Trend of improvement: in 2012, 27.000 children (21%) were overweight or obese
Risk factors limited education migrant background poverty problems accumulate in lower-class suburban areas
A healthy future Mission: a healthy weight for all children in Amsterdam in 2033 Vision: healthy weight is a collective responsibility and a healthy choice is the easy choice Strategy: healthier behavior in a healthier environment
Approach long-term sustainable inclusive (of people and domains) sharing responsibility (everyone is needed) learning by doing
Action Healthy parenting Healthy schools Healthy neighbourhoods (volunteers, shop owners, neighbours) Designing a moving city Comprehensive care of children already overweight or obese Lobbying the food industry
Aims for 2015-2018 1. Amsterdam must demonstrably become a more healthily organized city 2. Significant reduction in the number of children who are overweight and obese in the five heaviest neighbourhoods 3. Neighbourhood approach must be extended to cover five other too heavy neighbourhoods 4. Fewer primary schools with more than 25% of pupils overweight or obese 5. All children who are obese or morbidly obese must be given appropriate care
Aims for 2015-2018 6. No attrition in the chain: right type of care at the right time 7. Demand driven service package, with scope for one s own responsibility and empowerment 8. BMI of five-year-olds in Amsterdam no higher than 5% above national average 9. Higher number of children classified as being of healthy weight than in 2013
Youth on a healthy weight The Dutch JOGG approach is based on the successful French project EPODE and consists of five pillars: Political and governmental support Cooperation between the private and public sector (public private partnership) Social marketing Scientific coaching and evaluation Linking prevention and health care
Activities at the national level Advice on creating political and managerial support Training in the JOGG approach for locally involved parties Information on successful interventions and best practices Designing and providing municipalities with communication and information materials Directions on how to implement the JOGG approach Scientific research how to measure the effects of the approach
National reach (2016): 832.000 children Number of towns/cities: 119 In 12 cities a redcution on overweight was demonstrated (2010-2014).
JOGG Logic model
Evaluation
Urban agriculture, schoolgardens, farm-education influence food choice & preferences
WHO on PPP Encourage industry health-for-all principles Facilitatie universal access to drugs and health services Accelerate R and D Acquire knowledge and expertise from the commercial sector
Pro s Pro s and Con s of PPE Access to financial resources Con s fading of responsibilities and accountability Access to knowledge and expertise Creative and innovative solutions Marketing- en communication skills Complexity formation and management Differences in partners (objectives, cultures etc) Uncertain results Legitimacy Integrated approach to problem Reputation damage Limits of publication Compromising academic freedom (gebaseerd op Van Huijstee, Francken, & Leroy 2007)
PPP (PPE): in public health Donations, funding, sponsoring salesagreement Licence or franchise Fusion or take-over PPS: Alliance model: Complex projects Equal relations; governance (triple helix etc) Joint plan and partnerselection. PPP: Concession model - Well-ordered clear project - Public party develops policy and looks for partners for execution/implementation - Public party is directing is and is mandator
Innovative interdisciplinary research for for effective and sustainable prevention of chronic non-communicable diseases Jaap Seidell VU/VUMC/AMC/UvA/HvA WORK IN PROGRESS DRAFT November 2016
Samuel Sarphati Samuel Sarphati (1813-1866) Amsterdams physician, entrepreneur and visionary Combination of research, policy and practice Tackling upstream determinants of d
Times have changed Goudsbloemgracht, 2e helft 19e eeuw Goudsbloemgracht: Willemsstraat, 2011 New epidemics: obesity and noncommunicable diseases Strongly determined by biological and environmental determinants. Highly prevalent in deprived areas
Sarphati Amsterdam: a key health initiative of the city Amsterdam The City of Amsterdam has provided Sarphati Amsterdam with initial funding as well as access to relevant anonymized data and infrastructure in order to carry out a research agenda focused on promoting a healthy growth and development and on the prevention of chronic non-communicable diseases. The initial focus is on childhood overweight and obesity and the impact of the environment. Five major Research Institutions in Amsterdam and the Public Health Service of the City of Amsterdam (GGD) have committed to facilitating the execution of the Sarphati Research Agenda, bringing in dedicated Researchers as well as supplemental data [VU, VUMC, AMC, UvA, HvA] Sarphati Amsterdam s business model relies on the investments of the City as well as Research Institutions, where engagement with private parties is essential for long-term sustainability and effectiveness WORK IN PROGRESS DRAFT November 2016
Sarphati Amsterdam s Mission & Vision Mission Conduct innovative interdisciplinary research beneficial to effective and sustainable prevention of non-communicable diseases. Vision Sarphati Amsterdam provides a unique and high-quality research infrastructure that combines excellent scientific expertise from several disciplines. Sarphati Amsterdam contributes to the ambitious goal of the city of Amsterdam to improve the health behaviour and quality of life of its residents. Sarphati s knowledge and infrastructure are of high interest to students, researchers, policy makers and companies globally, which further strengthens Amsterdam s profile as a knowledge city. WORK IN PROGRESS DRAFT November 2016
What s in it for me? Engaging with Sarphati Amsterdam......access to a unique research infrastructure and data sets Research infrastructure that entails a unique and dynamic data collection approach with the addition of 11.000 newborns in Amsterdam every year via the Youth Health Care (i.e. the Sarphati cohort) Participation of the citizens of Amsterdam guarantees a collection of unique, long-term data of a highly diverse population...knowledge exchange and innovative research Multidisciplinary collaboration within and among all research institutes of Amsterdam (i.e. VU, VUmc, AMC, UvA, HvA) and GGD Anticipation of the need to find solutions for the global epidemic of life-threatening conditions such as obesity opportunities for grant applications Prestigious researchers in combination with access to a unique data base, as well as a unique research infrastructure ensure increased opportunities of successful grants and collaboration with private parties...impactful solutions The Sarphati Amsterdam network combines research with daily practice WORK IN PROGRESS DRAFT November 2016 An approach that results in practical solutions, such as information supply, tools, education and supervision
Does your research fit Sarphati Amsterdam s research agenda? Your research potentially fits the research agenda of Sarphati Amsterdam if A. You are working with data of Cohorts part of Sarphati Amsterdam Your research involves data concerning one of the cohorts that are part of Sarphati Amsterdam, or other data that is collected among Amsterdam residents, with initial focus on children and their environment. AND B. The content of research meets 1 out of the 2 following criteria Your research contributes to better insights in the complex working mechanisms that lead to a healthy growth and development and the prevention of chronic non-communicable diseases among Amsterdam residents, with initial focus on children and their environment. AND/OR Your research generates knowledge that can be applied for the development and evaluation of interventions promoting healthy growth and development and preventing and treating chronic non-communicable diseases, such as overweight and obesity in the Amsterdam child population. WORK IN PROGRESS DRAFT November 2016
Sarphati Cohort: general information A large-scale, multi-ethnic cohort study for long-term monitoring of the development of all children in Amsterdam (0 19 years) dynamic: ~11,000 children born in Amsterdam annually are added to the cohort Innovative data collection through youth health care registration Nested intervention study possibilities WORK IN PROGRESS DRAFT November 2016
Data collection Sarphati Cohort through Youth Health Care collected during consultation registered in digital patient file by YHC physicians and nurses standardised measurements and observations core set-plus c o r e s e t collected after consultation questionnaires linked to core set consultation collected prior to consultation questionnaires linked to digital patient file linked to care questionnaire subcohort collected after consultation questionnaires and interviews observations and measurements, i.a. biosamples linked to core set and core set-plus WORK IN PROGRESS DRAFT November 2016
Sarphati Cohort Data collection during & aroundyhc consultations core set-consultation growth (perception parent, BMI) motoric skills (perception parent, Van Wiechen) nutrition (perception parent, breast fed/formula, introduction solid food) sleep (perception parent, quality & pattern) demographics 2 wks 1 mo 2 mo 3 mo 4 mo 6 mo 11 mo 14 mo 18 mo 2 yrs 3 yrs 3,9 yrs 5 yrs 7 yrs 10 yrs additional questionnaires core set-questionnaire physical activity & sedentary behaviour nutrition (eating behaviour & feeding styles) sleep demographics WORK IN PROGRESS DRAFT November 2016
Conclusions Effective local integrated approaches to prevent childhood obesity are possible, affordable and scalable. These requires intersectoral collaboration and cocreation of outcomes of activities. Ans it requires a long-term vision to create health promoting environments.