+ Lessons Learned – What Works and What doesn’t Work CIH in Hangzhou, China PI: LEE, Liming Department of Epidemiology & Biostatistics Peking University Health Science Center CIH Study Coordinator: LV, Jun Department of Epidemiology & Biostatistics Peking University Health Science Center

+ Hangzhou City Hangzhou Beijing 2

+ Hangzhou site Control Site Intervention Site Gongshu District Population: ~162 thous Xiacheng District Population: ~258 thous Xihu District Population: ~271 thous 3

+ What we learn from Baseline survey results 4

+ Categorical physical activity levels by sex and age group 5 %

+ Times eating out in the previous week, median times (P 25, P 75 ) by sex and age group 6

+ Although accompanying conditions were more prevalent among older people and self-evaluation of health worsened with advanced age, older people lived a healthier lifestyle than younger people in China. 7

+ How we implement Intervention activities 8

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+ The main successes 10

A supportive environment can promote people to make healthy choices. Hangzhou’s campaign of building a healthy city provides a good opportunity for the project. It gives a lot of policy and environmental supports to the intervention activities. The constructions of related facilities in targeted districts provide a platform for the community intervention. Hangzhou Public Bicycle Service Footpath along the canal, fitness paths and fitness equipment in communities, distance markers and health signs Hangzhou Smoke Control Ordinance on March 1 st

+ Public health system with Chinese characteristics increasing access to different settings in the community 12

+ Primary health care (PHC) system A strong and cost-effective community-based PHC system is central to meet the enormous pressure from chronic conditions Improving access and reducing inequity Achieving better management of chronic conditions (disease management) Increasing the focus on prevention (health management) 13

+ Intervention activities easily implemented inside the health system Ideas of how to promote healthy lifestyle have been updated for our local teams. The intervention activities are more easily understood and supported by the managers inside the health system (as workplace). 14

+ Community coalition for health Make the first step to contact other non-health sectors 15

+ The main challenges 16

+ Community coalition for health It’s hard for health sector to organize and coordinate other non-health sectors. It needs time to realize active involvement of non- health sectors in the NCDs prevention & control Understand the importance of NCDs prevention & control Know what roles they should play in this process and how to integrate these into their routine functions Action! 17

+ Challenges in traditional settings for intervention Relatively long histories of collaboration between health sector and community and between health sector and education sector make the intervention activities easy to implement in the communities and schools. Intervention activities like presenting posters on health, distributing leaflets, organizing health lectures in the community mainly attract the elderly. The academic achievement of children is still the primary consideration of parents, teachers, and school managers. 18

+ Challenges in new settings for intervention Workplaces (private enterprises and public institutions) and restaurants, usually ignored in traditional intervention programs, are new focuses in this project. Health issue becomes a growing concern but is still not a top priority for the managers in the workplaces and restaurants. Refuse to join in the project or not compliant with the suggested intervention activities. 19

+ Guidance on specific knowledges and skills required A relatively high percentage of the people lived in urban areas has general knowledge on health but lacks of specific knowledge and skills on physical activity and diet. There is a urgent need for qualified dietitians / nutritionists and fitness instructors / trainers. It’s necessary to speaking with one voice and evidence-based. Now the public is confused by different voices, then does nothing (e.g., walking and climbing stairs can harm knees). 20

+ Lack of attraction of health goals and intervention activities 21 Be less: boring, preachy, unimaginative, and not easy to follow when comparing to the opposite of healthy and commercial ads Distant hope for better health Intervention activities

+ Bigger supportive social context has not been established completely, which becomes an obstacle to the success of single project in a limited areas Many efforts or changes need to be achieved or can only be implemented at city-level or even nation-level E.g., raising tax on tobacco (nation-level), regulation on smoke control in public places (at least city-level) E.g., strengthening public transport system (city-level), reconstruction of the city environments and roads (city-level or district level) E.g., changing cultures of smoking, drinking, diet, physical activity (city-level) 22

+ Conclusions The keys to success Building healthy city is a valuable practice and provides a good opportunity for NCDs prevention & control. A collaboration mechanism for multi-sectors stakeholders led by government instead of health sector is necessary. Within health system, strengthening PHC system is the key to address equity and cost-effectiveness for NCDs prevention & control. 23

+ Thank you 24