Stratégie nationale Prévention des maladies non transmissibles (stratégie MNT) 2017–2024

Objectives

Switzerland’s National Strategy for the Prevention of Non-Communicable Diseases (NCD Strategy) covers 2017–2024 and provides a common framework for governmental and non-governmental prevention actors. Its overarching aim is to prevent or delay NCD onset, detect disease early where possible, mitigate consequences, reduce avoidable illness and premature mortality, and enable people to remain healthy or maintain quality of life despite chronic illness.[1][2][3][4]The strategy seeks to contain the rising disease and cost burden, improve social participation and productive capacity, reduce care needs, and promote health regardless of socioeconomic status.[5][3][6]

• Focus on cardiovascular diseases, cancer, diabetes, chronic respiratory diseases and musculoskeletal disorders, while recognising that action on shared lifestyle risks may also benefit other conditions.[2][7][8]
• Reduce tobacco use, harmful alcohol consumption, unhealthy diet, physical inactivity and overweight, while strengthening protective factors, health literacy and individual capacity for informed health choices.[9][10][6][11]
• Apply primary prevention to build health-promoting conditions and reduce risks, secondary prevention to identify elevated risk and early disease, and tertiary prevention to limit progression, complications and loss of quality of life.[12][13][14]
• Use life-course, living-environment and multi-risk-factor approaches, addressing childhood and adolescence, adulthood and older age through settings such as schools, workplaces, municipalities and neighbourhoods.[13][15][11][16]
• Improve equitable access to prevention and health promotion, with needs-based and accessible support for people in vulnerable situations, including people facing socioeconomic, cultural or linguistic barriers and migrants.[9][6][17][18]
• Organise action across seven areas: health promotion and prevention; prevention in healthcare; coordination and cooperation; financing; monitoring and research; information and training; and health-supporting framework conditions. Health promotion and prevention, alongside prevention in healthcare, are the central delivery areas.[5][19][6]
• Strengthen health-supporting living, working and environmental conditions so that healthy choices are attractive and practical, including through multisectoral policies that address social determinants and health inequalities.[20][6][21]

Implementation

Implementation combines structural prevention with behavioural prevention, building on existing federal, cantonal and non-governmental programmes, legislation, funding streams and professional networks.[22][4]The Confederation, cantons and Health Promotion Switzerland jointly develop and coordinate measures, while a wider partnership of health professionals, insurers, patient and specialist organisations, civil-society groups, employers, educational bodies and affected people contributes to delivery.[20][23][24][25]

• Coordinate national implementation through the Federal Office of Public Health, cantons and Health Promotion Switzerland, with measures approved through the Swiss Health Policy Dialogue and federal measures adopted by the Federal Council.[4][26]
• Align federal, cantonal and local programmes with the strategy while respecting Switzerland’s federal allocation of responsibilities, under which cantons and municipalities lead much health promotion and prevention activity.[23][27][4]
• Maintain and align existing platforms, establish an NCD stakeholder conference under the Swiss Health Policy Dialogue, and create an expert group on prevention in healthcare to support coordination, practical exchange, knowledge transfer and advice on implementation issues.[28][29][26]
• Embed evidence-based prevention in healthcare, rehabilitation and counselling through coordinated health pathways, health counselling, patient education, early detection, self-management support and improved interfaces between healthcare, prevention and social services.[30][18][31]
• Develop guidelines, standards and practical tools for prevention and care, based on scientific evidence, the needs of affected people and regular review of jointly agreed goals and measures.[31]
• Deliver tailored services through primary-care doctors, pharmacists, hospitals, long-term-care settings, municipalities, patient organisations and health leagues, using community partners such as midwives, employers, schools and associations where relevant.[32][13][17]
• Establish a national NCD monitoring system using existing databases and monitoring arrangements, including Federal Statistical Office data, to track disease burden, risk factors, social determinants, vulnerable groups and costs, identify data gaps and support adaptation of the strategy.[33][34]
• Set quantified targets for strategic objectives, collect corresponding indicators, report regularly to the Swiss Health Policy Dialogue, submit an interim report to the Federal Council in 2020, and undertake a detailed evaluation in 2023 covering relevance, effectiveness, efficiency and sustainability.[26]
• Finance implementation through participating actors’ own resources and existing funding sources, including Health Promotion Switzerland and the Tobacco Prevention Fund; prioritise clarification of financing for preventive services, particularly prevention in healthcare and for older people.[26][35][36]
• Support research, pilot projects and innovation where evidence is limited, especially multisectoral interventions, multi-risk-factor projects and initiatives linking prevention with curative care; disseminate successful approaches and support their transition into sustained services.[33][34]

Monitoring & Evaluation

The strategy establishes monitoring and research as a dedicated area of action, intended to provide the evidence base for reviewing, adapting and continuously developing non-communicable disease prevention measures. A national monitoring system is to be built from existing databases and arrangements, including Federal Statistical Office data, and is intended to replace the Monitoring System for Food and Physical Activity (MOSEB).[33][34]

• Collect data on disease burden, behavioural and physiological risk factors, social determinants, vulnerable groups and economic costs, while addressing important data gaps, particularly for children under 15.[34]
• Use monitoring findings to assess progress against quantified strategic objectives, each of which is to have at least one target value and an achievement period defined in consultation with participating actors.[26]
• Review existing research priorities, identify knowledge gaps, support pilot projects where evidence is insufficient, and promote applied innovation, particularly multisectoral and multi-risk-factor initiatives and projects linking prevention with healthcare.[33][34]
• Apply health-pathway and counselling approaches that include an initial assessment, jointly agreed objectives, co-developed measures and regular review for people at increased risk or living with chronic disease.[31]
• Inform partners and the public regularly about principal research and knowledge-transfer findings, while disseminating evidence on successful pilot projects and conditions for their sustainable integration into routine services.[34]
• Report regularly to the Swiss Health Policy Dialogue on implementation stages, including findings from the non-communicable disease stakeholder conference.[26]
• Submit an interim implementation report to the Federal Council in 2020, conduct a detailed evaluation in 2023 covering relevance, effectiveness, efficiency and sustainability, and subsequently report the conclusions to the Swiss Health Policy Dialogue and Federal Council.[26]

Existing surveillance sources include the Swiss Health Survey, Swiss Addiction Monitoring System, MOSEB, cancer statistics and mortality statistics, which provide baseline information across major non-communicable diseases and risk factors.[37][38]Epidemiological surveillance is also recognised as an intervention level in prevention.[12]The supplied material does not set out a complete indicator set, reporting format, detailed evaluation methodology or a fully specified allocation of formal accountability responsibilities beyond the Confederation, cantons, Health Promotion Switzerland, the Swiss Health Policy Dialogue and the Federal Council.[33][34][26]

Costing & Financing

Financing is a distinct area of action, with implementation to be funded through participating actors’ own resources and existing funding streams.[26]The strategy seeks more coherent, efficient allocation of public and private resources, but identifies fragmentation, earmarked funding, limited transparency and uncertainty about sustained funding for innovative and cross-cutting projects.[29][39]

• Allocate resources strategically to prevention in healthcare, prevention for older people, health promotion and prevention in areas of greatest need, and innovation projects capable of sustained implementation.[39][36]
• Clarify remuneration for preventive services in healthcare, including counselling and coordination functions and non-medical services, in collaboration with public authorities, insurers and employers.[36]
• Align public funding instruments with strategy objectives, harmonise application and allocation processes, and apply common quality standards and funding criteria.[39]
• Address funding gaps affecting prevention services and successful pilot projects, including by examining stronger innovation financing through Health Promotion Switzerland and the Tobacco Prevention Fund.[33][34][40]
• Use earmarked financing sources, including Health Promotion Switzerland’s insured-person contribution and the Tobacco Prevention Fund’s special tobacco tax.[24]

The economic burden is substantial. In 2011, direct treatment costs of non-communicable diseases were 51.7 billion Swiss francs, more than 80% of total health expenditure of 64.6 billion Swiss francs.[41]The five priority disease groups accounted for 25.6 billion Swiss francs, or 39.7% of total health costs, with indirect costs estimated at 15.4 to 29.5 billion Swiss francs depending on the calculation basis.[41][42]In 2013, Switzerland spent 1.54 billion Swiss francs on prevention, equal to 2.2% of total health expenditure, compared with an Organisation for Economic Co-operation and Development average of 3.1%.[43]

Specified funding includes 4.5 million Swiss francs available jointly to the Federal Office of Public Health and Federal Food Safety and Veterinary Office for future strategy implementation, and approximately 18 million Swiss francs generated in 2015 through a 2.40 Swiss franc annual prevention contribution per insured person.[44]Tobacco prevention receives approximately 12.5 million Swiss francs annually from a levy, while cantons receive about 26 million Swiss francs from their share of net spirits-tax revenue.[3]The material provides no consolidated strategy budget, quantified funding gap, total allocation by action area or binding resource-mobilisation target.[29][39][26]