Problem: Rising lifestyle-related risk factors for chronic disease; growing burden of chronicity, notably cardiovascular disease, type 2 diabetes and cancer; rising economic pressures linked to increasing burden of complex chronic conditions.
Solution highlights: Municipally-managed Healthy Life Centres staffed by multidisciplinary public health teams were established across Norway to advance local health promotion; government commitment to addressing chronic disease through strengthening health promotion provided a platform for change and fostered widespread scale-up of activities; the Healthy Life Centre concept was invented locally and continues to depend on locally-driven efforts, with municipalities given significant autonomy over activities; a structured approach to the rollout of Healthy Life Centres from the outset (including research, piloting and creation of national guidelines) ensured accountability and systematic evaluation; collaborative partnerships between primary care providers, Centre staff and patients proved integral to successfully running activities.
Description of practice
Increasing prevalence of lifestyle-related risk factors contributed to adverse trends relating to chronic conditions such as cardiovascular disease, type 2 diabetes and cancer. Rising chronicity and multimorbidity strained health system budgets, but economic pressures were also felt in other sectors. For example, work absences for full-time employees, with almost 7% of the workforce on sick leave at any given time, ranked highest among OECD countries and were nearly double that of other Nordic countries. Several strategies to curb rising chronicity had been experimented with nationally, but had achieved only marginal success.
In the early 2000s, taking direction from the locally-designed Healthy Life Centre Model implemented in Modum Kommune, the Norwegian Directorate of Health launched a strategic plan to advance municipal health promotion and disease prevention efforts. Following review and successful piloting of the Model, the Directorate issued a recommendation advising municipalities to increase health promotion efforts, endorsing Healthy Life Centres as the recommended approach. Healthy Life Centres are municipally-managed facilities offering a wide range of interventions, including smoking and alcohol cessation programmes, cooking classes and nutrition counselling, courses for coping with mental health challenges and diabetes management support. Healthy Life Centres network a variety of health professionals, including physiotherapists, psychologists and nutritionists, who work in close coordination with primary care providers to facilitate referrals. Individuals can access Healthy Life Centres directly or through referral from primary care and must have sufficient motivation to opt-in to the service. Once enrolled, participants meet with a counsellor to review medical history, discuss desired behaviour changes and develop a personalized 12-week care plan. Basic principles of motivational interviewing are used to establish goals with the active involvement of participants. Participants typically complete two or three programme cycles before fully establishing desired changes and being referred back to primary care. Healthy Life Centres are funded primarily through municipal health budgets and, in many cases, partnerships with other public facilities, such as schools and community centres, have helped minimize costs. To support implementation of Centres across the country, the Directorate subsidized start-up costs and developed implementation guidelines. By 2014, over 180 Healthy Life Centres were operational, servicing approximately half of all municipalities. The high implementation rate reflects the benefits of technical and financial resources invested nationally, as well as regional motivation and capacity to adapt the initiative to local needs.
Implementation of practice
What stage is the practice currently in?
Fully implemented and scaled up
Who was/is responsible for the implementation of the practice?
While the concept of Healthy Life Centres derived from local action in the Municipality of Modum Kommune, scaling up and embedding the initiative within the health system was largely a result of macro-level efforts led by the Directorate of Health. Leveraging this supportive national context, municipal actors across the country have replicated the Model with local adaptations. A distributed leadership approach helped engaged local leaders in the design process and create local ownership by allowing municipalities autonomy to implement their own initiatives. Team-working between health professionals, collaborative partnerships with participants and connections to the community contribute to successful running of Centres.
Improved health outcomes and reductions in health expenditures were demonstrated in the Healthy Life Centre pilot study. A large-scale formal evaluation of the approach led by the Directorate of Health is currently underway.
This case was prepared as part of a larger effort by the WHO Regional Office for Europe and published (2016) in the document, "Lessons from transforming health services delivery: Compendium of initiatives in the WHO European Region".
© Copyright World Health Organization (WHO), 2016
The methodology used for the development of this case is slightly different from the templates used on the IntegratedCare4People web platform, in particular in the analysis of enabling factors and barriers to change.
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- Inger Merete Skarpaas and Turid Sundar
- Norwegian Directorate of Health