Are French local health contracts promising in addressing determinants of diet and physical activity?

Abstract Background There is a consensus on the need to transform the built, economic and socio-cultural environments to promote healthy eating (HE) and physical activity (PA). Yet, limited capacity and the biomedicalisation of public health are often blamed for steering investments towards individual risk factors. In France, local health contracts (LHCs) agreed between a regional health agency (RHA) and a local government could improve health promotion strategies. We examined how LHCs take into account the environmental determinants of HE and PA. Methods Using the CLoterreS national census, we analysed a stratified random sample of 53 LHCs with a view to identify if actions target individual (knowledge, skills, etc.) or environmental (interpersonal, organisational, community or political) determinants. To this end, we developed an instrument drawing from different typologies of action and consensus documents to assess the integration of the socioecological approach in programmes. We ran a series of interviews with RHA staff (n = 39) and local actors (n = 23) to put into context our results. Results Out of 53 LHCs, 42 included at least one action on HE or PA. For these topics, there was a higher proportion of actions targeting individuals (83% and 76% per contract, respectively) than environments (51% and 58%). For the latter, actions on interpersonal determinants (e.g. family) were the most common. However, we also found instances of actions on more distal ones (e.g. to improve nutrition standards in school canteens and walkability). Contextual factors such as local priorities, past experience with health promotion and the involvement of local actors in needs assessment and action planning may influence such orientations. Conclusions LHCs constitute a promising avenue to address the environmental determinants of health-related behaviours. A key feature of this instrument is its capacity to develop intersectoral strategies. Further research will show if LHCs deliver on their action plan. Key messages • Local health contracts facilitate the mobilisation of a broad diversity of NGOs and agencies. • This makes it a promising device for addressing the environmental determinants of HE and PA, provided adequate resources are devoted to stakeholder engagement and local government capacity-building.


Background:
There is a consensus on the need to transform the built, economic and socio-cultural environments to promote healthy eating (HE) and physical activity (PA).Yet, limited capacity and the biomedicalisation of public health are often blamed for steering investments towards individual risk factors.In France, local health contracts (LHCs) agreed between a regional health agency (RHA) and a local government could improve health promotion strategies.We examined how LHCs take into account the environmental determinants of HE and PA.

Methods:
Using the CLoterreS national census, we analysed a stratified random sample of 53 LHCs with a view to identify if actions target individual (knowledge, skills, etc.) or environmental (interpersonal, organisational, community or political) determinants.To this end, we developed an instrument drawing from different typologies of action and consensus documents to assess the integration of the socioecological approach in programmes.We ran a series of interviews with RHA staff (n = 39) and local actors (n = 23) to put into context our results.

Results:
Out of 53 LHCs, 42 included at least one action on HE or PA.For these topics, there was a higher proportion of actions targeting individuals (83% and 76% per contract, respectively) than environments (51% and 58%).For the latter, actions on interpersonal determinants (e.g.family) were the most common.However, we also found instances of actions on more distal ones (e.g. to improve nutrition standards in school canteens and walkability).Contextual factors such as local priorities, past experience with health promotion and the involvement of local actors in needs assessment and action planning may influence such orientations.

Conclusions:
LHCs constitute a promising avenue to address the environmental determinants of health-related behaviours.A key feature of this instrument is its capacity to develop intersectoral strategies.Further research will show if LHCs deliver on their action plan.

Background:
Hospitals and their health care staff were severely impacted by the Covid-19 pandemic.Many health professionals faced high levels of stress and burn-out due to unfavorable work environments, limited staffing and highly pressured workloads.Yet, even prior to the pandemic, health professionals in many countries faced challenging work environments with often limited resources and support.At the same time, the roles of health professionals are changing across Europe, with new roles, task-shifting and sharing happening in teams, also driven by the Covid-19 pandemic.From a health system and management perspective, recruitment and retention is critical to ensure that there is a sufficient and well-educated health workforce capable to perform high-quality care.Multiple innovations have been implemented across Europe, these will be presented and discussed with a view towards evaluating complex interventions, sustaining innovations, ensuring the scalability and transferability of proven interventions for the benefit of health professionals and wider society.Objectives: This workshop will address innovative strategies at the micro (team level), meso (healthcare setting) and macro level (policy) to ensure that health professionals are motivated, perform high-quality care in teams and are sufficiently supported by enabling work environments and recruitment and retention policies.Innovations to improve work environments, task-shifting as well as recruitment and retention will be discussed, based on the findings from four EU-funded research projects: Magnet4Europe, H-Work, TASHI and METEOR.The format is a 'round table' with 5 panel discussants.The Magnet4Europe project focuses on the reorganization of hospital work environments for nurses and physicians in hospitals in five European countries.Innovative elements include a system-, inter-professional, organization-wide change management, structural empowerment of clinical staff and one-on-one twinning of European hospitals with U.S. twinning partners.

Innovations in the EU projects:
The H-WORK project aims to design, implement and validate psychosocial interventions to promote mental health and wellbeing in SMEs and the public sector.Innovative elements are the evaluation of interventions at multiple levels (individual, team, manager and organisational level) and the development of the H-Work innovation platform with toolkits, policy briefs and novel digital solutions.The TaSHI project provides a novel and up-to-date knowledge on task shifting and transferability of good practices in implementation.Through a cross-national and -sectoral perspective, the focus is on task shifting as an innovation towards more effective organisation of care and workforce, to improve efficient and sustainable systems.METEOR aims to enhance scientific knowledge on the predictors of job retention for healthcare workers and develops iii240 European Journal of Public Health, Volume 32 Supplement 3, 2022