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of Appropriate Conditions for Behavioral Change
The five leverage points I have mentioned so far all start at one point: enabling people to change their behavior. This aspect is crucial. People are always in the focus, and it is important that they brought along. We also find that these approaches do not suffice to ensure successful prevention and health promotion. It is just as important that people can go along. The conditions they live in and which make it easier – or harder – for them to make the right decisions for themselves and for their children are of vital importance as well. This is about a real change of behavior and a change of conditions [19].
One example of good and successful prevention concerning external conditions is the so-called municipal prevention chains [20]. A chain of prevention wants to tie a comprehensive and viable network for children, young people, and parents, within their community, with the municipal authorities competent for youth, health, social, and educational matters. The aim is to merge existing networks, services, and actors so as to allow coordinated action in the sense of an overall integrated local strategy and across departmental boundaries. This creates clear framework conditions for children to grow up healthy. Also, the German prevention law, enacted in 2015, focuses on health promotion in everyday life which takes place in daycare centers, schools, municipalities, companies, and nursing homes.
Changing conditions is always a political task. Thus, the questions arise – how does policy change, and what kind of policy successfully induces a change of conditions in the way we intend it? This is exactly what the international project “Becoming Breastfeeding Friendly” deals with, involving Germany and a range of other countries. It focuses on the aspect of preventing unfavorable conditions [21]. Initiated by Yale University, the project systematically records factors which either promote or impede breastfeeding in Germany, the UK, Mexico, Ghana, Samoa, and Myanmar. It aims to initiate efficient and targeted measures to promote breastfeeding sustainably. The research project is based on the “Gear Model” [22]. It integrates all relevant fields of action that relate to breastfeeding and that mesh like gears: from a high-profile advocacy via legislative measures through to training and education for multipliers and disseminators, male and female. In Germany, a 17-member expert commission currently elaborates calls to action for key decision makers – based on the analysis of the current situation and the challenges identified in the process. At a high-profile conference on June 5, 2019, these results were presented to a broad audience. Other countries are a bit further ahead. In Mexico, for instance, the systematic analysis of the current situation states moderate improvements of conditions conducive to breastfeeding (“a moderate scaling up environment”). In Ghana, the national framework conditions are even rated as good. This example illustrates clearly – and thus refers back to my introductory remark – that, within the context of breastfeeding, we cannot think in terms of industrial versus developing or emerging nations. Factors that help or hinder breastfeeding prevail in every country, albeit in varying degrees, and they illustrate both the need for action and the need for exchange and networking.
The Importance of Networking in Other Areas of Healthy Lifestyle Promotion
A balanced diet, avoiding malnutrition, and the emergence of obesity continue to be a complex matter influenced by causes and factors at the individual, the social and the societal level. Only by combining behavioral and condition-related prevention, including the participation of all relevant actors and key decision makers, can prevention and health promotion be designed to be sustainable and successful. Networking is a key success factor in this context. For the promotion of a healthy lifestyle in the sense of a health-promoting diet and adequate exercise, it is never too early or too late. In the sense of a lifelong perspective, leverage points range from the period surrounding childbirth, to lifestyles in daycare centers, at school and at work, through to old age.
Two conclusions can be drawn from this. First, networking of activities throughout all phases of life is vital. We must strive to have meaningful structures and initiatives that continue uninterrupted in order to support people throughout their lives. Second, networking is a topic for successful prevention and health promotion even when we address people in other walks of life. The experience gathered with “Healthy Start” can be transferred. That is why, in Germany, we build networks for all stages of life. The “National Quality Center for Nutrition in Daycare Centers and Schools” (NQZ), for instance, aims to offer as many young people as possible a low-threshold access to healthy and high-quality food in daycare facilities and schools [23]. The Federal Ministry of Food and Agriculture also meets the challenge of “nutrition in old age” with an initiative for senior citizens, male and female, designed as a network.
Conclusion
Prevention and health promotion can only succeed if they focus on people who are actually concerned. “Healthy Start” focuses on pregnant and young mothers and on their families. It is essential that these people can make the right choices for themselves and for their child. This requires the proper way of addressing people while making use of existing public state structures and multipliers who actually reach people with uniform and clear calls to action. This requires conditions that allow and empower people to act accordingly. The appropriate instrument to make this possible lies in active network structures which effectively interconnect all relevant actors. The usefulness and meaningfulness of networks is revealed not just with “Healthy Start,” but in other stages of life as well. However, it is also true that the sooner we start, the better. My wish for this congress was to build such networks to fight all forms of malnutrition successfully. We are all affected and are all in the same boat.
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