Stratégie nationale Prévention des maladies non transmissibles (stratégie MNT) 2017–2024, prolongée jusqu’en 2028

Objectives

Switzerland’s National Strategy for the Prevention of Non-Communicable Diseases provides an orientation framework for governmental and non-governmental action during 2017 to 2024. It seeks to prevent or delay disease, detect it early, mitigate its consequences, reduce avoidable illness and premature deaths, improve quality of life and autonomy, preserve social participation and productive capacity, and contain growth in health and care costs.[1][2][3][4]The vision is that more people remain healthy or live well with chronic illness, supported by health-promoting environments and equitable opportunities regardless of socioeconomic status.[5][3]

• Address five priority disease groups: cardiovascular diseases, cancer, diabetes, chronic respiratory diseases and musculoskeletal disorders.[1][6][7]
• Reduce shared behavioural risks, notably tobacco use, harmful alcohol consumption, unhealthy diet, physical inactivity and overweight, while recognising related physiological risks such as hypertension, high cholesterol and raised blood glucose.[7][8][9]
• Improve health literacy, health-promoting behaviour, protective factors, quality of life and self-management, while reducing care needs among people living with chronic disease.[2][3][10]
• Strengthen equality of access and tailor prevention to people in vulnerable situations, including groups facing socioeconomic, cultural or linguistic barriers.[2][11][12]
• Develop health-promoting living, working and environmental conditions through a broad determinants approach that incorporates social environments, education, transport, spatial planning, economic circumstances and access to services.[9][13]

The strategy combines behavioural prevention, which supports individual knowledge, skills and lifestyle change, with structural prevention, which creates conditions that make healthy choices feasible.[3][14]It applies primary prevention to avoid disease onset, secondary prevention for screening and early intervention among people at risk, and tertiary prevention to prevent progression and complications and improve quality of life.[15][16][14]

Its seven action areas are health promotion and prevention; prevention in healthcare; coordination and cooperation; financing; monitoring and research; information and training; and health-promoting framework conditions.[2][17]Health promotion and prevention, alongside prevention within healthcare, are central areas; the remaining areas support integrated implementation.[2][17]

Implementation

Implementation is designed as a coordinated, life-course and settings-based model that builds on existing prevention programmes, cantonal action, disease-specific strategies and healthcare services.[18][11][4]It combines population-wide measures with targeted support for people at greater risk or already affected by non-communicable diseases, and links prevention, treatment, rehabilitation, long-term care and self-management.[19][20][21]

• Design interventions for life stages and settings such as families, schools, workplaces, municipalities, neighbourhoods and social housing, addressing multiple risk factors in relation to people’s needs and living circumstances.[22][23][11]
• Continue and align established programmes on alcohol, tobacco, nutrition, physical activity, healthy body weight, migration and health, while developing measures for emerging needs.[1][6][24][4]
• Embed evidence-based prevention in healthcare through screening, smoking cessation, weight management, physical-activity support, health counselling, health pathways, coordinated care and practical guidelines or standards.[20][21][25]
• Develop accessible, low-threshold and culturally appropriate support for vulnerable groups, including multilingual services, intercultural interpretation and outreach through professionals, employers and associations.[11]
• Strengthen patient participation, health literacy, self-management education and support for relatives, including through patient organisations and appropriate new technologies.[10][26]

The Federal Office of Public Health, the Swiss Conference of the Cantonal Ministers of Public Health and Health Promotion Switzerland jointly developed the strategy in partnership with stakeholder groups.[5][27]The Swiss Health Policy Dialogue, the Confederation-canton platform, requested the strategy and provides a route for approving measures and coordinating implementation.[5][4]Federal measures are adopted by the Federal Council, while cantonal programmes continue and are progressively aligned with the strategy.[4][28]

Delivery relies on public authorities, insurers, health professionals, healthcare institutions, non-governmental and non-profit organisations, health leagues, researchers, employers, schools and community actors.[24][29][30][26]Primary-care doctors, pharmacists and other health professionals have roles in counselling, chronic-disease management, referral, preventive care and interprofessional collaboration.[30][15][21]A stakeholder conference is intended to enable regular implementation review, experience-sharing, networking and knowledge transfer, supported by a strategic implementation committee involving the principal national partners and other stakeholders.[31][28]

Monitoring is intended to use existing data and build on the Nutrition and Physical Activity Monitoring System, Federal Statistical Office sources and other national evidence.[18][32]It should track disease burden, risk factors, social determinants, at-risk groups and costs, identify data gaps, inform research and innovation priorities, and support revision of measures.[32]The responsible national partners are to report progress regularly to the Swiss Health Policy Dialogue, with an interim implementation report to the Federal Council in 2020 and a subsequent detailed evaluation covering relevance, effectiveness, economic efficiency and sustainability.[33][28]

Implementation is to draw principally on participating organisations’ own resources and existing funding sources, including Health Promotion Switzerland and the Tobacco Prevention Fund.[34]The strategy also identifies a need for additional resources for prevention in healthcare, prevention among older people and sustainable innovative projects, but the supplied material does not specify an approved overall budget or quantified allocation.[18][35][36]

Monitoring & Evaluation

The strategy establishes monitoring and research as a supporting action area and links performance oversight to its objectives, implementation priorities and evidence base. It envisages a national non-communicable disease monitoring system drawing on existing sources, regular implementation reporting to the Swiss Health Policy Dialogue, an interim report to the Federal Council in 2020, and a final evaluation covering relevance, effectiveness, economic efficiency and sustainability.[32][28]

• Establish monitoring linked to strategic objectives and priorities, enabling the Confederation and cantons to review and adapt the strategy and its measures.[32]
• Build the system on the Nutrition and Physical Activity Monitoring System and integrate national data, including Federal Statistical Office sources.[32][37]
• Track disease burden, behavioural and physiological risk factors, social determinants, at-risk groups and costs.[32]
• Use epidemiological surveillance as a preventive intervention and support monitoring with research, innovation and knowledge transfer.[16][10]
• Address evidence gaps, notably the lack of nationally representative data and limited evidence on the quality and effectiveness of projects at the interface between prevention and curative care.[32]
• Quantify strategic objectives from 2016 onwards, with at least one target value and timeframe for each objective, to support priority-setting and assessment of effectiveness.[28]
• Collect relevant indicators through the monitoring system and report regularly on progress towards the objectives.[28]
• Report regularly from the Federal Office of Public Health, the Swiss Conference of the Cantonal Ministers of Public Health and Health Promotion Switzerland to the Swiss Health Policy Dialogue on implementation stages and stakeholder-conference conclusions.[28]
• Submit an interim implementation report to the Federal Council in 2020 and a detailed evaluation in 2023 assessing relevance, effectiveness, economic efficiency and sustainability; earlier planning material refers to an evaluation report in 2024 covering relevance, effectiveness and sustainability.[28][33]
• Use a stakeholder conference to review implementation regularly and an independent expert group on prevention in healthcare to evaluate services and assess implementation and financing options.[18][38]

Existing evidence sources include the Swiss Health Survey, Swiss Addiction Monitoring, the Nutrition and Physical Activity Monitoring System, Federal Statistical Office data, cancer-registry data and other health-observatory publications.[39][32][40]The extracts provide baseline indicators on mortality, premature mortality, prevalence, hospitalisation and risk-factor trends, but do not provide a complete final indicator set or a detailed methodology for every evaluation component.[6][41][42][43][44]

Costing & Financing

The strategy recognises that non-communicable diseases impose a substantial health-system and wider economic burden, while seeking to contain future cost growth associated with population ageing and increasing chronic illness.[45][46]It identifies financing as an action area but does not specify an approved overall strategy budget, detailed funding envelope or quantified funding gap.[17][35]

• Align public financing instruments with the strategy’s objectives and intervention areas, while allowing flexible priorities and support for innovative multi-risk-factor measures.[35]
• Simplify and harmonise project-funding applications, improve transparency, and develop shared quality standards and allocation criteria across funders.[35]
• Explore partnership financing involving federal offices and other organisations, and use programme agreements, service contracts or memoranda of understanding where appropriate.[35][37]
• Finance implementation through participating actors’ own resources and existing contributions available from Health Promotion Switzerland and the Tobacco Prevention Fund.[34]
• Provide additional resources for prevention in healthcare, prevention for older people, unmet prevention needs and the development and sustainable adoption of innovative projects.[35]
• Clarify transparent remuneration and financing for coordinated prevention services, counselling and preventive services under compulsory health insurance and other insurance arrangements.[38][36]
• Address funding gaps through joint financing of multisectoral health-policy projects and examine increased support for innovation, self-management and autonomy-support offers.[37][10][26]

Health Promotion Switzerland is financed through annual prevention contributions collected through health-insurance premiums and is supported by cantons and insurers.[29][30]The Tobacco Prevention Fund is financed through a special tobacco tax.[29]Economic evidence indicates that chronic diseases account for about 80% of health expenditure, while the five priority disease groups account for about 40% of total health expenditure.[45][1]In 2011, direct treatment costs for all non-communicable diseases were reported at 51.7 billion Swiss francs, including 25.6 billion Swiss francs for the five strategy diseases.[46]

Prevention is presented as economically beneficial: Swiss analyses reported benefits of 23 Swiss francs per franc invested in alcohol prevention and 41 Swiss francs per franc invested in tobacco prevention, while tobacco-prevention activity was associated with an estimated annual reduction in social costs of nearly 800 million Swiss francs.[47][19]These estimates provide an economic rationale rather than a costed financing plan.[47][19]