SITUATION BEFORE THE INITIATIVE BEGAN
Cardiovascular diseases are the leading cause of death worldwide. Because of our ageing population the number of cardiovascular diseases will continue to rise in absolute figures. The share of these diseases in overall mortality in Austria is well above 50%. In Vienna that share is even higher, with 56%. Most at risk are elderly people, socially disadvantaged persons and migrants. The situation definitely calls for action.
ESTABLISHMENT OF PRIORITIES
“A Heart for Vienna”, the Cardiovascular Preventive Care Programme for People in Vienna, was adopted by the Vienna City Council as part of the Vienna Health Promotion Programme 2000. Main priority was to lower the incidence and prevalence of avoidable cardiovascular diseases. The project was officially launched in 2001, with the municipality of Vienna, and since 2006 the WGKK as well, acting as project sponsor. The “Fund for Social Affairs in Vienna“ has been in charge of implementation since 2002. Univ. Prov. Dr. Anita Rieder from the Institute for Social Medicine at the Medical University Vienna, supported by an experts’ committee, was responsible for scientific consulting and development of the concept.
Diagram: organisation chart “A Heart for Vienna“
Expertinnenbeirat experts advisory council
Steuergruppe steering group
Programmleitung programme management
Veranstaltungen events
Öffentlichkeitsarbeit public relations activities
The following target groups were identified:
general population
groups specially at risk
socially disadvantaged
elderly people
women/men – gender-specific aspects
migrants
people in the workplace, especially blue-collar workers
FORMULATION OF OBJECTIVES AND STRATEGIES
General objectives:
reducing the incidence and prevalence of avoidable cardiovascular diseases
containing morbidity
reducing mortality
Special short-term objectives:
reducing risk factors: lack of physical activity, unhealthy diets, obesity, hypertension, smoking, excessive alcohol consumption, psycho-social factors (stress) in the target groups addressed
high participation of people with above-average risk
raising people’s willingness to at least choose a healthier life style
improving quality of life in the target groups
The measures identified to achieve these objectives are aimed at behaviour prevention on the one hand and prevention in the context of circumstances on the other hand.
Ad behaviour prevention: we provide information on risk factors through personal counselling, lectures and workshops, as well as information brochures (in several languages) in public institutions.
Ad prevention in the context of circumstances: we create options for metropolitan settings, such as healthy meals at bakeries, restaurants and company restaurants, free multi-cultural leisure-time and physical activities to allow people, and our target groups in particular, to adopt a healthy life style.
All of the activities covered by the programme “A Heart for Vienna“ are developed with the different socio-economic groups in mind. During implementation of the projects consideration may also be given to the four health Influencing factors defined by Dahlgren & Whitehead.
Quelle: Dahlgren G and Whitehead M (1991) Policies and strategies to promote social equity in health. Stockholm, Institute for Futures Studies
MOBILISATION OF RESOURCES
Between 2001 and 2005 funding for the project was provided by the City of Vienna and since 2006 has been split between the City and the Vienna Regional Health Insurance Company WGKK in equal shares.
Programme management for “A Heart for Vienna” was delegated to the department for health promotion within the Fund for Social Affairs in Vienna to better utilise all available synergies and optimise the programme structure and organisation. Operation of the programme is in the hands of a core team of five which is the equivalent of 3.5 full time employees. Their task is to implement internal projects, including organisation of events and public relations activities, but also to coordinate existing and future cooperation.
The Vienna Food and Nutrition Institute is our partner at public events.
We run projects especially for women in cooperation with the Vienna Office for Women’s Health.
The Guild of Vienna Bakers provides financial support and personal contacts to enhance our cooperation with bakers.
Successful cooperation with 160 bakers (Mann, Ströck and Geier branches) has made possible city-wide implementation of the project “Herz Weckerl“.
The scientific advisory council under Prof. Rieder provides the scientific/technical background we need to keep up with state-of-the-art science.
In cooperating with the Austrian Society for Nutrition we can draw on a source of expertise and support to effectively handle public relations.
The Vienna Press and Information Services support our public relations activities
The Women’s Health Centre FEM Süd and the Men’s Health Centre – both located within the Vienna Socio-Medical Centre South – are our partners in implementing projects at the setting, i.e. with the relevant target groups.
The Fund for A Healthy Austria provides additional funding for projects carried out in the context of “A Heart for Vienna“.
Channelling health-promoting resources since 2001 to reach the target group of “A Heart for Vienna“ has proved effective:
Citywide 15 projects have been realised at the settings – with the target groups concerned.
30,000 individuals have been reached (through one-to-one counselling for a heart-healthy lifestyle.
Level of awareness in Vienna for the programme “A Heart for Vienna“ is 28% (according to telephone survey carried out in December 2006, NPO-Institute at the Vienna University of Economics)
PROCESS
Strategic decisions for the programme are taken by the steering group which the Vienna Regional Health Insurance Company, the City of Vienna, the department for health promotion at the Fund for Social Affairs in Vienna, as well as programme management at “A Heart for Vienna“ are participants in. Since 2006 the programme has been evaluated comprehensively by the NPO-Institute at the Vienna University of Economics. These accompanying research activities include, amongst others, regular surveys such as interviews and questionnaires. Their evaluation and public opinion become an integral part of decision-making processes. Progress of the project is also made possible by technical inputs from cooperation partners.
Diverging needs of the stakeholders and sponsors involved naturally create tension which the programme has to be capable of handling in the interest and to the benefit of the target group. Process evaluation helps to analyse procedures, develop structures and monitor their implementation.
“A Heart for Vienna”, in its activities for the people of Vienna, provides information on risk factors by distributing brochures (in several languages) and offering one-to-one counselling at public events, presentations and workshops. Thus, the module “information“ is complemented by the module “interaction“. This means creating clear options to help people in Vienna, and in particular the target group of the programme, to actually live a healthier life.
RESULTS ACHIEVED
Activities and results of the programme are documented regularly by programme management and published in semi-annual reports.The level of awareness for the programme in 2004 was at about 20% of all people, by 2006 28% were aware of the programme. Approximately 89% believe activities for the prevention of cardiovascular diseases are essential. The level of awareness for risk factors for cardiovascular diseases, based on the factors we put forward, was between 87% and 90%.
Events
Anticipated change of behaviour following visits to the programme’s measuring and information booth (Basis: 10 events in the first half of 2007)
Since 2001, “A Heart for Vienna“ has held an average of fifteen events annually to accomplish its mandate for cardiovascular health. These include both large-scale events and small street and district festivals where target persons are addressed directly. The measuring and information booth is staffed by specially trained medical experts and medical students only. Their task is to take people’s blood pressure, measure their abdominal girth, calculate their body-mass index and give advice on how to change their lifestyle. By October 2007 the number of blood-pressure measurements had reached the 30,000 mark.
2001 to 2005 | 2006 | 2007 |
13,523 | 8,226 | 8,251 |
Persons contacted at events by 2007
Public Relations Activities
Public relations activities, since 2006, are no longer handled externally but by a member of the programme team appointed for the purpose. This enables us to better utilise synergies with our clients and establish personal contacts with media representatives.
We want to ensure consistent development of media relations so we define one theme per month which we then distribute to relevant media. The theme is also covered by a monthly newsletter and sent out to decision makers in politics and the economy, to our partners and the public. Additional newsworthy themes are taken up and edited for the public as they occur.
In 2007 the team at “A Heart for Vienna“ also published a monthly “heart tip“ in the “Wiener Bezirksjournal” (district journal delivered to every household in Vienna free of charge). In autumn 2007 a mass media nutrition campaign was launched at selected City Light billboards and trams in Vienna.
Launch of the nutrition campaign with City Councillor Maga Sonja Wehsely Viennese bakers
Internet
At the relaunch of our website www.einherzfuerwien.at in mid 2007 special care was taken to deliver a clear structure and transparency of content. Information and offers are updated daily. The website includes an event calendar, as well as features such as “good-for-your-heart recipes“ and “heart tip of the month “. We know from the rising number of accesses that our services are well accepted by users and our website is a perfect backup for public relations activities in the media.
Diagram: number of accesses www.einherzfuerwien.at 2006 and 2007
Overview of current projects
Project “Herz-Weckerl“ – Heart Buns
Since 2005, approximately 160 bakery branches citywide have been selling good-for-your-heart snacks which because of their ingredients easily pass as full meals. Recipes were developed in cooperation with experts from the Austrian Society for Nutrition to ensure every “Herz-Weckerl“ variety meets the scientific criteria defined for cardiovascular health. Cooperation with bakeries is currently being extended to include confectionary, bread and other baked goods.
2005 | 2006 | 2007 | Total |
409,136 | 558,160 | 584,088 | 1,551,384 |
sales figures
Project “In Shape Without Dieting“ (Schlank ohne Diät)
The standard programme for sustainable weight loss was optimised for the target group of “A Heart for Vienna“. It also covers fitness classes and special cooking courses. First courses at the Vienna Women’s Health and Men’s Health Centres started in October 2007, by early November all of the 270 places available until July 2008 were already booked out.
Project “Strong and Fit“ (Stark und Fit)
This “Programme for 50 plus Men’s Hearts“ – made possible at the Vienna Men’s Health Centre with kind support from the Fund for A Healthy Austria – , since October 2007, has been offering special lifestyle counselling for men in combination with fitness classes which their female partners may join in.
Project “The Pleasures of Favoriten“ (Genuss in Favoriten)
Staff at small and medium-sized enterprises are sensitised to the topic of food at the workplace, a project which is also to achieve sustainable changes in eating habits at home. Currently four enterprises with a total of more than 350 employees are participating in the project.
Project “Walk Yourself Healthy” (Geh! Sund)
As little as one hour of extra walking per week reduces the risk of cardiovascular complications by approximately 5%. The project wants to make walking as a daily habit more palatable to people while raising their awareness for its health-promoting effect. To spread this message which everyone in Vienna is to receive we have taken the parapluie approach. Individual target groups are reached through subprojects and multipliers.
Project “Laugh and relax” (Lach dich entspannt)
There is scientific evidence that laughing and a good sense of humour have positive effects on people’s psycho-social health. The project is geared towards the target groups of “A Heart for Vienna“, especially those living in socially disadvantaged settings. The project is to be extended to include cooperation with pharmacies in Vienna.
Project “Your Job and Your Heart” (Herzjobben)
Health promotion ideally starts out where people spend most of their time – at work. Very small enterprises (up to 9 employees) and small enterprises (up to 49 employees) in particular – not least because of their scarce resources – rarely address the issue of health promotion at the workplace. Fifteen of them, in the 15th, 16th and 20th districts, are now participating in a BGF cycle to be completed by mid 2009.
Projects in the Planning Stage
Patient Training
At the Vienna General Hospital patients diagnosed with acute cardiologic problems and their relatives are taught about therapies options and changes in lifestyle as part of a project entitled „Herzensbildung“ (training for your heart ). The project is to be extended to include all hospitals in Vienna with cardiology departments.
SUSTAINABILITY
“A Heart for Vienna“ places special emphasis on the sustainability of the strategies chosen to achieve improvement at all relevant levels, i.e. with people’s behaviour and their relation to their environment. To ensure sustainability the programme has been embedded in political, economic and communal settings.
The programme is established through image – Information – interaction.
· Image – concentrates on opinion leaders and the media, as well as politics and the economy
·
Information – for the relevant public and individuals
· Interaction – through specific participation in project activities
At the programme level sustainability is achieved through partnership, cooperation and networking.
· Successful cooperation between the City of Vienna and the Vienna Regional Insurance Company reflects increasing awareness for the need and efficiency of prevention programmes.
· The network of partners from different areas is kept in working order and is expanded at regular intervals. Resulting synergies facilitate implementation of the strategies.
· Politics and the economy are showing a keen interest in cooperation.
At the project level emphasis at all times is placed on empowering the target group, equipping it to implement changes independently. This is the common goal of all our projects!
· Project “Walk Yourself Healthy“: trains association members to act as multipliers and pass on knowledge
· Project “Heart Bun“: introduces and establishes the healthy snack as an independent product regardless of other developments
· Project “The Pleasures of Favoriten“: networks restaurants and enterprises
· Project “In Shape Without Dieting“: creates a community right at the setting
LESSONS LEARNED
Objectives
While the individual objectives defined at the programme outset proved successful each on its own, they did not create any synergies. This is why increasing emphasis is now placed on linking the various activities (projects, events, presentations, etc.) to reach the overall goal and generate greater success and progress.
Public Relations Activities
The first stage of the programme was characterized primarily by spreading information on the risk factors for cardiovascular diseases. Now that public relations activities have been relocated within the programme proper, relevant projects are also increasingly incorporated to achieve a noticeably higher impact. One-to-one interviews with journalists are sought wherever possible.
Results
The programme has attracted so much public attention that potential partners in business and the economy are now also taking an interest in establishing cooperation and participation. We are currently negotiating with companies in medicine technology, food industry and groceries.
TRANSFERS
The programme, in principle, is easily transferable to other cities with similar structures.
“A Heart for Vienna“, during its initial stage, also sought good and successful examples the structures and approaches of which were subsequently optimised for Vienna. We are now streamlining our experience and expertise in a separate networking project to support active transfer.
Thus, we established contact with the initiative “Salzburg 2010“, offering expertise, analyses and consulting services.
