“One Good Year Added” for every citizen within a community: Joachim Fischer

Enhancing and maintaining population health and well-being across the life-span is the ultimate goal of Public Health and preventive efforts. Achieving this goal has two key aspects: risk reduction, which involves ameliorating the health and economic impact of chronic and preventable diseases from earliest childhood on and resource strengthening, which focuses on raising healthy children and enabling them to participate as active citizens leading full and productive lives through adulthood and old age.

The reality, however, is that fragmented support systems work against this goal: in childhood, many are left behind or remain at risk, disparities in health develop and increase within the population, chronic disease prevalence is changing due to a growing epidemic of obesity, and productivity in the workplace suffers due to mental health issues, particularly depression.

While individual behavior choices may compound the effects of these fragmented systems, it has become increasingly clear that interventions to change behavior at the individual level are insufficient to promote population health and well-being across the life span.

Growing evidence from diverse settings (e.g., Perry Preschool Project, North Karelia Study or Five Cities Study) demonstrates the effectiveness of community-based approaches aimed at improving population health and well-being by addressing the dysfunctional structures and support mechanisms that exist beyond the individual level.

The “One Good Year Added” project establishes a community-based participatory initiative that engages citizens of Gaggenau (population 30.000) alongside a network of national and international experts. The challenge is to balance true participatory vertical approaches (citizens across all ages within neighborhoods) with horizontal more paternalistic approaches (e.g. communal occupational health management for small enterprises) and to align this with an overarching health in all politics communal strategy.

Key messages:

• By leveraging the settings (e.g. kindergartens, schools, neighborhoods, work places) through a community approach, “One Good Year Added” aims at increasing health and well-being across the life-span.

• The contextual diversity requires combining participatory “vertical” approaches (e.g. all ages within neighborhoods) and horizontal “nudging” approaches (e.g. health management for small enterprises).