Plan de mesures 2021–2024 de la Stratégie nationale Prévention des maladies non transmissibles (stratégie MNT) 2017–2024

Objectives

Switzerland’s 2021–2024 action plan operationalises the National Strategy for the Prevention of Non-Communicable Diseases for 2017–2024. It seeks to enable more people to remain healthy or live well with chronic illness, reduce preventable non-communicable diseases and premature deaths, and improve the coordination and effectiveness of prevention and health-promotion activity.[1][2]The strategy covers cancer, cardiovascular disease, chronic respiratory disease, diabetes, dementia and musculoskeletal disorders, while linking action with national work on addictions, mental health and suicide prevention.[3][2]

• Promote population health and prevention by reducing tobacco and alcohol-related risks, encouraging physical activity and balanced diets, strengthening health literacy, and supporting people to establish health-promoting lifestyles.[4][5]
• Embed prevention in healthcare by integrating risk-factor reduction, counselling, coordinated care and self-management throughout care pathways for people at increased risk and those already living with illness.[6][7]
• Improve workplace and economic conditions by supporting occupational health management, healthy lifestyles, health-supportive goods and services, and easier healthy choices.[8][9]
• Strengthen cross-cutting functions in coordination and cooperation, financing, monitoring and research, information and training, and health-supportive framework conditions.[10][11]

Health equity and a life-course perspective are overarching principles. Measures are intended to address childhood and adolescence, adulthood and older age, with particular attention to socially disadvantaged groups and settings, vulnerable migrant groups, people receiving social assistance, unemployed people, and older people at risk of isolation or reduced autonomy.[10][12][13][8]For children and adolescents, priorities include healthy living conditions, health literacy and early intervention; for adults, health promotion, prevention and early detection; and for older people, autonomy, quality of life, healthy ageing and prevention of disability and care dependency.[14][11][15]

The plan also seeks to shape living, working and environmental conditions so healthy choices are easier. This includes regulatory and voluntary approaches concerning price, availability and advertising; healthier food composition and balanced meals; healthy built environments and active mobility; multisectoral policy; and international cooperation on non-communicable disease commitments and food reformulation.[16][17]

Implementation

Implementation is based on coordinated action by the Confederation, cantons and Health Promotion Switzerland, using the plan as a common framework for public authorities, healthcare and social-care professionals, non-governmental organisations, patient organisations, insurers, educational bodies, employers and other economic actors.[2][3][18]Existing activity is consolidated and gaps are addressed through new measures, with prevention delivered in population settings, healthcare and workplaces.[2][10]

• Deliver population prevention primarily through cantonal programmes and local implementation by non-governmental organisations, cities and municipalities, adapting priorities on risk factors and life stages to local needs.[10][12]
• Integrate multiple risk factors, addiction-related issues and mental health into cantonal programmes rather than treating them as isolated issues, and apply common quality, reporting and evaluation requirements where feasible.[12][19]
• Prioritise equitable programme design by incorporating the circumstances of disadvantaged groups, using evidence-based success factors, and providing cantons with tools, guidance and support.[12][20]
• Develop prevention in healthcare through quality principles, project support, professional education, self-management support, new technologies and personalised interdisciplinary care pathways.[6][7]
• Strengthen workplace health through sector-specific adaptation of the Friendly Work Space Job-Stress-Analysis, the Friendly Work Space Apprentice offer, institutional cooperation and voluntary collaboration with business.[9][21][22]

Governance is led through the National Health Policy Dialogue and a cooperation agreement between the Federal Department of Home Affairs and Health Promotion Switzerland. A steering committee comprising the Federal Office of Public Health, the Swiss Conference of Cantonal Health Directors and Health Promotion Switzerland coordinates activities, communication, mandates and annual and multiannual priorities, while aligning relevant non-communicable disease, mental-health and suicide-prevention measures.[18]Responsibility is distributed across the three principal delivery areas: the Swiss Conference of Cantonal Health Directors oversees population health promotion and prevention, the Federal Office of Public Health oversees prevention in healthcare, and Health Promotion Switzerland oversees prevention in the economy and workplace.[18]

Operational coordination uses annual national stakeholder conferences, cantonal exchange meetings, specialist networks and continuing forums to share experience, disseminate good practice, address interfaces between non-communicable diseases, addictions and mental health, and support implementation learning.[23]The plan also envisages whole-of-government working across social policy, education, environment, labour, transport, spatial planning and the economy, alongside cooperation with international organisations including the United Nations, World Health Organization, Organisation for Economic Co-operation and Development, European Union and Council of Europe.[24][25]

Monitoring is undertaken through the Swiss Monitoring System for Addictions and Non-Communicable Diseases, managed by the Federal Office of Public Health with the Swiss Health Observatory. Indicators are reviewed with partner organisations, draw on national data sources and support international comparison and assessment of progress towards strategic objectives.[26][27]Funded and implemented projects may be assessed for suitability, effectiveness and economic efficiency, and the overall strategy is subject to interim and final evaluation reporting.[28][27]

Financing combines cantonal resources, Health Promotion Switzerland, the Tobacco Prevention Fund, alcohol-levy revenue, federal allocations and, where appropriate, insurers, employers and private-sector partners.[29][30][27]The approach includes harmonising applications, quality criteria, resource allocation, reporting and evaluation across funders, while pursuing sustainable financing options for preventive services in healthcare, particularly non-medical advice and coordination.[31][30][32]

Monitoring & Evaluation

Monitoring and evaluation combine national surveillance, periodic indicator review, project-level assessment and formal reporting to guide implementation of Switzerland’s non-communicable disease strategy. The Swiss Monitoring System for Addictions and Non-Communicable Diseases, managed by the Federal Office of Public Health in cooperation with the Swiss Health Observatory, is the central mechanism for objective monitoring and international comparison.[32][26]

• Monitor strategy progress through indicators drawing on national data and systems operated by federal offices and other institutions, including the Federal Statistical Office, Health Promotion Switzerland, the National Institute for Cancer Epidemiology and Registration, and the Health Behaviour in School-aged Children study.[26][27]
• Review indicators regularly with partner organisations and use the evidence base to assess progress towards strategic objectives, prioritise measures and support their development during 2017–2024.[26][27]
• Evaluate the strategy’s appropriateness, effectiveness, economic efficiency, sustainability and implementation; provide an interim report to the Federal Council in 2020 and an evaluation report by 2024 at the latest, with measures adapted for the second phase where necessary.[27]
• Report implementation progress to the National Health Policy Dialogue, the Federal Council and the foundation board of Health Promotion Switzerland, and conduct specific project evaluations where required.[18]
• Assess projects implemented or funded under the strategy for suitability, effectiveness and economic efficiency, including alcohol-misuse prevention projects, Health Promotion Switzerland measures and tobacco-prevention projects.[28]
• Review the progress, effects and quality of Health Promotion Switzerland measures; collect cantonal action-programme data with cantons; support project evaluations; and incorporate findings into subsequent programme and project development.[28]
• Apply appropriate evaluation to Tobacco Prevention Fund projects, including under the relevant fund ordinance, while the fund also supports applied research and evaluations.[28][33][34]
• Evaluate the Swiss Nutrition Strategy for suitability, effectiveness and economic efficiency, supported by continuing monitoring, commissioned research and representative data from the menuCH national food survey.[28]
• Use common quality criteria, shared reporting requirements and shared evaluation criteria for applications and funded projects, particularly where programmes address multiple risk and protective factors.[12][19][31]
• Monitor cantonal alcohol and tobacco legislation, document good and innovative cantonal practices, and provide cantons with knowledge-management and communication support.[19]
• Support prevention and self-management planning, coordination, analysis and evaluation through structured prevention data in electronic patient records; examine the behavioural effects of mobile health applications and other new technologies.[35][8]
• Test, validate and evaluate workplace-health tools and the Friendly Work Space Apprentice offer before national dissemination.[21][36]

Several action areas identify evidence use, consultation, implementation learning and stakeholder exchange, including annual national and cantonal platforms, but do not provide quantified targets or reporting frequencies for every individual measure.[37][23]

Costing & Financing

Financing seeks to align public, public-law and private resources with strategy priorities, coordinate funders and create sustainable support for preventive services, particularly for people at increased risk or living with illness.[29][31][30]

• Coordinate application, award and financing processes among Health Promotion Switzerland, the Tobacco Prevention Fund, the Federal Office of Public Health and the Swiss Conference of Cantonal Health Directors; use harmonised applications, common quality criteria and shared reporting and evaluation requirements.[31]
• Fund prevention through cantonal ordinary budgets, alcohol-tithe revenue, Health Promotion Switzerland contributions, the Tobacco Prevention Fund and federal allocations.[34][38]
• Provide fixed contributions for cantonal tobacco-prevention programmes, grants for designated non-governmental organisations conducting alcohol-misuse prevention, and contractual support to cantonal health departments for nutrition, physical activity and mental-health programmes for children, adolescents and older people.[31][30]
• Develop partnership-based and potentially shared sustainable financing models for preventive healthcare services involving public authorities, insurers, employers and other funding sources. A funding gap is identified for non-medical advice and coordination for people at increased risk and people who are ill.[30]
• Use Health Promotion Switzerland resources to support preventive healthcare projects, with a financial-allocation concept used to assess applications and allocate resources to projects and mandates.[13][7]
• Finance non-communicable disease prevention projects through Health Promotion Switzerland, the Tobacco Prevention Fund and the alcohol levy; some funding is earmarked for particular substances and may also support addiction-strategy and mental-health projects.[27]
• Maintain an annual disease-prevention contribution under the Health Insurance Act. It was 2.40 Swiss francs per insured person in 2016 and generated about 18 million Swiss francs; it rose to 3.60 Swiss francs in early 2017 and 4.80 Swiss francs in early 2018, generating an additional 18 million Swiss francs for Health Promotion Switzerland, with no further increase planned at least until the end of 2024.[27]
• Finance the Tobacco Prevention Fund through a levy on cigarette packets and fine-cut tobacco. Its receipts were approximately 12.5 million Swiss francs in 2020.[34]
• Allocate 10% of net spirits-tax revenue to cantons for addressing the causes and effects of substance abuse, while 90% is allocated to old-age and survivors’ insurance and disability insurance. The cantonal share was approximately 26 million Swiss francs.[34]
• Provide annual federal implementation resources of 3.0 million Swiss francs for the Federal Office of Public Health, including 1.0 million Swiss francs for personnel, and 0.95 million Swiss francs for the Federal Food Safety and Veterinary Office, including 0.35 million Swiss francs for personnel. The Federal Customs Administration additionally provides 1.0 million Swiss francs to the Federal Office of Public Health for the national addiction strategy and action on problematic alcohol consumption.[38]

Most action-specific excerpts do not specify total programme budgets, cost estimates, resource requirements or wider economic assumptions.[21][22][32][16]