Wir setzen auf dieser Website Cookies ein. Diese dienen dazu, Ihnen Servicefunktionen anbieten zu können sowie zu Statistik- und Analysezwecken (Web-Tracking). Weitere Informationen dazu und die Widerspruchsmöglichkeit zum Web-Tracking finden Sie in unserer Datenschutzerklärung.

Alphabetical index

Foto eines Leuchtturms als Symbol für Orientierung

content

Health Promotion in Switzerland

Brigitte Ruckstuhl

(last update 08 January 2015)


Health promotion experienced a major expansion particularly during the 1990s, when the basic structures were developed that came to be employed in the following years. This development during the 1990s is all the more astonishing since up through most of the 1980s Switzerland was a veritable wasteland with respect to primary prevention measures - both at the national and at the cantonal level. In fact, what changed the dynamics of this development was the rising problem of illicit drug consumption and the outbreak of HIV/AIDS.

At the end of the 1970s the Swiss government (the Bundesrat) initiated inquiries into preparing a federal law to regulate health prevention measures, the goal being to create a nationally coordinated framework. In 1983 this suggestion was very soundly rejected in a so-called Vernehmlassung (the legislative process of consultation to the government) by the individual cantons so that the entire project was halted. At that point the Swiss Society for Social and Preventive Medicine (today´s Public Health Switzerland) prepared its “Concept for Health Promotion and Prevention 86,” the goal being to show “how prevention in Switzerland can be promoted without the enactment of a federal law” (Gutzwiller et al. 1986). This concept made the following suggestions: that a Swiss prevention fund be established for the promotion of national campaigns, that the cantons appoint representatives responsible for health prevention and promotion, and that the respective counseling and documentation departments be installed. These measures were then progressively implemented in the years that followed.

One of the first milestones in the development of health promotion in Switzerland was the establishment of a foundation in 1989 at the initiative of the individual cantons which assumed the function of the suggested prevention fund. Its goal was to launch and coordinate nationwide actions in the field of health promotion. This foundation, funded by the cantons, had only a very limited budget, but its importance lay in the fact that it was a common project supported by all the cantons. It was the first organization to popularize the notion of health promotion in Switzerland and to support and foster the respective projects.

Over time the other suggestions emerging from the “Concept 86” began to take hold. Some cantons set up special representative or delegates concerned with health promotion who then initiated, promoted and coordinated individual measures at the cantonal level. As well theme-oriented departments and documentation offices were expanded or created.

A second milestone for health promotion on the national level occurred in 1994 when the revision of the Healthcare Insurance Act was accepted in a national referendum. The Healthcare Insurance Act included the provisions of the Articles 19 and 20, which for the first time set the legal stage for health promotion in Switzerland. These articles called for the founding of a national foundation supported by the cantons and the healthcare insurance system, to be financed by levying a yearly sum of SFR 2.40 per insured individual. In 1998 the existing foundation was transferred to a new foundation, today´s “Health Promotion Switzerland” based in Bern and Lausanne. This new foundation assumed the role of representing the national interests and, together with other important stakeholders, fostering health promotion in Switzerland by initiating, coordinating and evaluating individual projects.

In 2005 the government set up an expert commission entitled “Prevention and Health Promotion” to assess the background and professional necessities as well as the plausibility of enacting a comprehensive new legal approach to prevention and health promotion. This commission came to the conclusion that the legal basis for health promotion and prevention in Switzerland would be best served by a strengthening of coordinative efforts. After 8 years of discussion the new law (PrävG) was narrowly defeated in November 2012 in the Swiss House of Parliament. In early 2013 the government adopted the “Strategy Health2020,” which regulated the health policies for Switzerland for the near future. After the failure to pass the prevention legislation, this strategy served to lay down as well the main points in the areas of health promotion and prevention.

This new legislation has the goal of better establishing prevention and health promotion within the Swiss healthcare system. A national law based on this initiative containing specific health goals is foreseen which will be assessed by a number of control and coordination instruments. The draft also contains provisions for systematically promoting self-help in Switzerland.

Over the last 20 years the cantons, which are responsible for the skills required for health promotion and prevention, have established a well-functioning infrastructure. From the beginning of the 1990s they created positions for representatives for health promotion and prevention, and from 2000 on the delegates from the then 15 cantons founded the “Federation of Cantonal Representatives for Health Promotion in Switzerland” (VBGF). Today, all cantons have such positions and are represented in this federation, which has also assumed the role of coordinating the exchange and networking of the main stakeholders involved, such as the Health Directors Conference, governmental offices as well as related NGOs. Recently, many cantons revised their healthcare laws to explicitly include health promotion and prevention. This development is all the more astonishing in light of the fact that it is generally very difficult to establish new structures in Switzerland.

The Setting Approach has since become adopted in many schools and companies. The “Healthy City Project,” on the other hand, was not successful: Geneva is the only city to become part of the WHO network.

In 1992 the Swiss Ministry of Health started a program entitled “santé jeunesse” (Youth Health) in the school system, which has since been continued under the name of “Education and Health” with a number of different partners. The Swiss health foundation Radix began parallel to this the establishment of a Swiss network for the promotion of health in schools and has represented Switzerland since 1993 in the “European Network Health Promoting Schools” (ENHPS). Radix has a mandate from the Swiss Ministry of Health and Health Promotion to coordinate the Swiss network. The organizations that work within the school system in the fields of health promotion and prevention initiated a coalition under the title of “bildung + gesundheit Netzwerk Schweiz” (Education + Health Network Switzerland).

The path to establishing health promotion in companies (corporate health promotion) was not an easy one. The Swiss foundation Health Promotion Switzerland made the theme of “Work and Health“ one of its main themes in 1993, the goal being to establish corporate health promotion in Switzerland. This foundation today represents Switzerland in the respective European network. Another program, “KMU-vital” (the abbreviation for Klein-Mittel-Unternehmen = small and middle-sized companies), was developed to assist companies that want to introduce corporate health promotion step by step. An expert office for corporate health promotion has existed since 2002 as part of the State Administrative Office for the Economy (Seco), which promotes strategies for fostering corporate health promotion. In 2003, under the auspices of this office the Swiss Federation for Corporate Health Promotion (SVBGF) was founded, which generally promotes the exchange of information and experiences and the spread of corporate health promotion. There are presently also a number of Masters courses available at the polytechnical level.

The Health Promotion Switzerland organization awards a prize for “Friendly Work Space,” a label that carries with it six main criteria and a number of subcriteria based on the quality criteria of the European Network for Corporate Health Promotion. The label is awarded to companies that fulfill most of these six criteria.

A more difficult and slow development was experienced by the Health Compatibility Test, which today is called the Health Impact Assessment (HIA). In Switzerland, the cantons of Tessin, Geneva and Jura played the major roles in spreading this theme. In 2005, they set up a platform to make HIA more widely known in Switzerland. Their website also presents Swiss guidelines for implementing HIA.

Other contributions from Switzerland, in particular from Health Promotion Switzerland, may be found in the development of instruments to foster the quality of health promotion. The past few years have seen great development in this area. The instruments presented allow knowledge-based interventions to be professionally implemented and evaluated (quality management, evaluation).
The website www.quint-essenz.ch is home to a quality system for projects which is published in all four official languages of Switzerland and is continually being updated. A new project “quint-essenz community” strives to further the exchange of information among professionals in the field. Among the instruments presented there is the so-called “impact model” for categorizing the results of health promotion activities. It is based on the assumption that the results of health promotion do not directly affect health, but rather indirectly act on the determinants of health. These various ways in which interventions influence the determinants of health have validated the “impact model.” A further cornerstone is the normative framework of action “best practice,” which is the answer to the discussions surrounding the question of evidence-based results and the demands for effectivity in projects and programs.

On the subject of capacity building, Switzerland has developed many further and continuing education courses for specialists in the field of health promotion. The first was started in 1998, and today there are Masters studies for health promotion and prevention at two polytechnics (FH Luzern and FH Nordwestschweiz) as well as at the Distance Polytechnical School, which serve the German-speaking part of Switzerland. Beginning in 2016 the FH Zurich (ZHAW), in the scope of its Health Department, will for the first time offer Bachelors studies in health promotion and prevention as an independent course of studies. Since 2009 health promotion can also be selected as a major as part of postgraduate studies in public health, which has been around since 1992, at the Universities of Zurich, Bern and Basel.

Since the 1990s Switzerland has experienced a very impressive development in these areas, though it is still far from possessing a comprehensive policy in health promotion. In addition, the position of health promotion with respect to that of healing and rehabilitation remains relatively weak - despite the developments over the past decades. This may also be seen in the fact that the sums expended for prevention and health promotion make up only 2% of the overall costs of the healthcare system in Switzerland.

References:
Ackermann G/Studer H/Ruckstuhl B, Quint-essenz: Ein Instrument zur Qualitätsentwicklung in Gesundheitsförderung und Prävention, in: Kolip P/Müller V. (Eds.), Qualität von Gesundheitsförderung und Prävention, Bern 2009, 137-156.
Broesskamp-Stone U, Gute, viel versprechende, beste Praxis? Der Best-Practice-Rahmen für Gesundheitsförderung und Prävention, in: Kolip P/Müller V. (Eds.), Qualität von Gesundheitsförderung und Prävention, Bern 2009, 115-136.
Bundesamt für Gesundheit (BAG), Prävention und Gesundheitsförderung in der Schweiz, Bern, 28. September 2007.
Cloetta B/Spencer B/Spörri A/Ruckstuhl B/Brösskamp-Stone U/Ackermann G, Ein Modell zur systematischen Kategorisierung der Ergebnisse von Gesundheitsförderungsprojekten, Prävention, 27, 2004, 67-72.
Eidgenössisches Departement des Innern EDI. Die gesundheitspolitischen Prioritäten des Bundesrates Gesundheit2010. Bern. 2013, 72.
Gutzwiller F/Abelin Th/Frey U/Martin J/van der Linde F, Gesundheitsförderung und Prävention in der Schweiz. Leitbild 86. Schweizerische Gesellschaft für Sozial- und Präventivmedizin, Bern 1986.
Kolip, P et al.. Gesundheitsförderung mit System. quint-essenz - Qualitätsentwicklung in Projekten der Gesundheitsförderung und Prävention. Bern 2012.
May, A/Castella F/Wiesli R, Die Kantonalen Beauftragten für Gesundheitsförderung. Situationsanalyse und Entwicklungspotential. Bern 2010.
Meyer K, Gesundheit in der Schweiz. Nationaler Gesundheitsbericht 2008, Bern.
Ruckstuhl B, Gesundheitsförderung. Entwicklungsgeschichte einer neuen Public Health-Perspektive. Mit Zeitzeugeninterviews, Weinheim 2011.

Internet addresses:
www.bag.admin.ch (Bundesamt für Gesundheit)
www.bildungundgesundheit.ch (Bildung und Gesundheit Netzwerk Schweiz)
www.gesunde-schulen.ch (Schweizerisches Netzwerk Gesundheitsfördernder Schulen)
www.impactsante.ch (Plattform Gesundheitsfolgenabschätzung gfa)
www.promotionsante.ch (Gesundheitsförderung Schweiz)
www.quint-essenz.ch (Qualitätssystem Gesundheitsförderung Schweiz)
www.radix.ch (Radix Schweizerische Gesundheitsstiftung)
www.bgmnetzwerk.ch (Schweizerischer Verband für betriebliche Gesundheitsförderung)
www.vbgf-arps.ch (Vereinigung der kantonalen Beauftragen für Gesundheitsförderung)

Links: Health Promotion and the Healthy / The Social City / The Perspective of Local Politics, Setting Approach


back to overview

Federal Centre for Health Education (BZgA) / Maarweg 149-161 / 50825 Köln / Tel +49 221 8992-0 / Fax +49 221 8992-300 /
E-Mail:
poststelle(at)bzga.de / E-Mail for Orders: order(at)bzga.de

The Federal Centre for Health Education (BZgA) is a specialist authority within the portfolio of the Federal Ministry of Health.