Local prevention agreement West Maas and Waal

The collaboration between all parties is brought to life in the local prevention agreement West Maas en Waal Vitaal (hereinafter: LPA). The preventive approach to health problems (physical, mental, and social) is central, because prevention is better than cure. 

In addition, we work together based on the idea that we would rather do four things well than ten things halfway. We therefore pay attention to the actions that are already taking place and the collaborations that already exist. We incorporate the positive points into the basis for the LPA. 

To realize the agreements made, organizations in the social domain, entrepreneurs, and residents of WMW are working together. Health is not only the responsibility of healthcare professionals, but of all of us. In light of the coronavirus pandemic, this is very relevant. The ambition is therefore to involve (even) more organizations, companies, associations, and others in the LPA in the future.

We use the concept of positive health. This focuses on stimulating people's ability to cope with physical, mental, and social challenges. People take control of this themselves as much as possible.

On the following pages, you can read how and with whom we will be working to achieve all our ambitions.

In healthcare, there is a visible shift from treating symptoms (curative approach) to addressing causes (preventive approach). Reinforced by the coronavirus pandemic, prevention is receiving increasing attention. This includes developing and maintaining a healthy lifestyle.
In recent years, the municipality has been working with various parties on prevention. The support, input, and commitment of our partners are very important in this regard. We do this, for example, through the circle consultation with senior citizens' associations, contact with village platforms, the approach to substance use, and the 'Samen Beter 2017-2022' policy. The LPA is a collaboration in which we can exchange ideas and make agreements on these issues. 

At the beginning of 2021, 37 partners signed the West Maas en Waal local sports agreement. The local sports agreement and the prevention agreement have many similarities, including in the area of prevention. In 2022, we want to merge the two agreements. The merged documents will form the basis for a single, powerful West Maas en Waal Vitaal sports and prevention agreement that will be continued in the long term. 

Prevention and achieving the associated objectives takes time. The national prevention agreement has made more than 200 agreements with various partners. At the local level, we translate these agreements into local, tailor-made solutions. The national and local ambitions therefore require the LPA to be secured in the long term. We currently define the long term as 2040. The LPA is continuously monitored, evaluated, and adjusted in order to implement the best possible policy for the long term. 

A core team of leaders has been put together to manage the LPA. The core team meets regularly, assesses subsidy/project applications, discusses feedback from other participants and ongoing activities, and organizes meetings for all participants. The core team takes the initiative to keep other participants involved and enthusiastic. 

The LPA is a living document. More organizations may join in the future. Other partners also have the opportunity to register with the core team. In addition, we want to start working with working groups for each priority area in the future. This will allow organizations to discuss specific issues with other stakeholders. Someone from the core team will always be present. This allows the core team to maintain an overview of all initiatives within the LPA. 

The core teams of the local sports agreement and the local prevention agreement will be merged in 2022. We see a lot of overlap between the two agreements and want to make efficient use of this.

In the municipality of WMW, prevention is already a topic in, among other things, the local sports agreement West Maas en Waal and the policy framework 'Samen Beter 2017-2022' (Better Together 2017-2022). We are following up on this in the LPA. The key features, partly from the above documents, are listed below. Furthermore, the implementation document is concrete and practical. 

During the open afternoons at the town hall in week 38, potential partners were invited to contribute their ideas to the local prevention agreement. This took place in person, digitally, and by telephone, and was energetic every time. The frameworks and frequently mentioned points from these discussions are listed below.
 
Appendix 2 lists the invited and potential partners. These are the opportunities for growth that the core team currently sees.

Furthermore, we would like to frame the LPA with the following rules.
The local prevention agreement West Maas en Waal Vitaal:

1. Encourages and supports the acquisition/maintenance of a healthy lifestyle for all age groups;
2. Focuses on the themes of smoking, substance use, and problematic alcohol consumption among young people;
3. Focuses on the themes of healthy weight and mental well-being throughout society;
4. Provides a comprehensive approach;
5. Is a collaboration between public and private partners;
6. Involves residents in the development and implementation of the agreement;
7. Is linked to the local West Maas en Waal sports agreement and local health policy;
8. Ensures lasting effects of the efforts by securing them beyond 2023;
9. It is not a 'paper tiger'; it contains concrete actions, whereby we would rather do four things well than ten things half-heartedly.
10. Where possible, establishes connections between the various organizations and themes.

A great deal of input was provided during the brainstorming sessions held during the open afternoons. Sometimes organizations were able to exchange ideas with each other, and sometimes the project leader brought initiatives together afterwards. The input from those involved has been funneled into concrete agreements, abstract ambitions, and existing policy. We have listed this overview for each priority area:

Priority 1. Healthy weight

• Ambition to become a JOGG municipality;
• We offer Bendefit@work to companies to work on and raise awareness of employee vitality;
• We are merging the sports and prevention agreements;
• Encouraging more exercise in education through the use of, for example, the neighborhood sports coach, Gym je slim (Exercise Smart) or Bewegen met Nijntje (Exercising with Miffy).

Priority 2. Reducing smoking

• We are making various areas smoke-free, such as playgrounds, public spaces, and sports facilities.
• We provide promotional materials for a smoke-free generation;
• We are participating in the regional theme table on reducing smoking among young people with the municipalities of Beuningen, Druten, and Wijchen.
• We make young people aware of the consequences of smoking through the use of Helder op School (by Iriszorg, Pro Persona Connect, and the VO, among others).

Priority 3. Reduced alcohol consumption and substance abuse

• In 2022, we will draw up a new policy for Responsible Alcohol Serving together with partners. We will involve Iriszorg and associations, for example.
• We organize an information meeting in every village about substance use for parents, volunteers at associations, and other interested parties.
• We raise awareness of the consequences of alcohol and substance use and involve parents in identifying these issues. Depending on the choice of the parties involved, programs such as Get2KnowU can be used. The Helder op School (Clear at School) program is already in use.

Priority 4. Mental well-being

• We are committed to making mental well-being a topic of discussion and involving parents in identifying issues. Depending on the choice of the parties involved, programs such as Get2KnowU can be used.
• Youth workers are present at the secondary school during breaks and can be called upon by teachers for a series of lessons, support in case of escalation, and as consultation hours for young people.

The core team meets periodically. At least twice a year, all affiliated partners meet to discuss the progress of agreements made. We also jointly monitor whether the LPA remains up to date. We do this by discussing the results of studies, experiments, or other experiences with each other and adjusting the LPA where necessary. 

The following principles have been established for requesting project budgets and evaluating projects.

The assessment of a grant application is based on the following points:

• Area(s) of overlap with priority area(s)
• Collaboration (minimum of 3 parties)
• Budget
• Continuity
• Planning

Projects are evaluated on:

• Target audience reached
• Target group experience (Effectiveness/satisfaction)
• Project results
• Learning from the process
• Participation of partners from the local prevention agreement
• New connections (cross-pollination, new collaborations)
• Efficient use of the budget

The government makes an annual implementation budget of €10,000 available. The municipality of West Maas en Waal submits an annual application for this to the Ministry of Health, Welfare and Sport. The financial reach can be extended by combining activities with activities from the local sports agreement West Maas en Waal in Beweging (West Maas en Waal in Motion) or by using and seeking other sources of funding (such as the government support program 'Support package for social and mental well-being and lifestyle' or support from the business community). The LPA does not act as a subsidy desk for individual activities of a solitary organization. It is about supporting activities that, in line with the LPA, are developed and/or carried out by at least three collaborating organizations (private and public). As indicated earlier, the core team decides whether a contribution from the implementation budget will be allocated to an activity. The core team is responsible for the financial processing and final responsibility.

Of course, we want the activities in the LPA to help and support the right residents. To be effective, supply and demand must be well aligned. This requires coordination between those who identify needs (schools, youth/parent workers, general practitioners, etc.) and those who provide activities (municipalities, social organizations, entrepreneurs, etc.). To achieve this, the LPA supports those who identify needs in mapping out demand. On the other hand, it encourages activity providers to bundle their activity offerings. A themed meeting (e.g., a prevention afternoon at the town hall) brings identifiers and providers together to exchange information about supply and demand. This facilitates referrals from identifiers to providers and vice versa.

The core team provides updates via email newsletters and the municipality's communication channels. This information can of course also be shared via the communication channels of all participating parties (digital and printed). 

West Maas en Waal Vitaal was established in a very short period of time, despite time constraints and coronavirus restrictions, with various physical meetings, numerous telephone calls, and digital consultations. We are proud of the ambitions we have set, the agreements we have made, and the new collaborations we have planned. This makes it possible to apply for the 2021 implementation budget via VNG and VWS with the local prevention agreement Maas en Waal Vitaal and to start implementation immediately. In the coming months, the core team will provide further details and depth. 

The aim is to achieve broader support, more partners, and more activities. In addition, there is considerable overlap with the local prevention agreement for West Maas en Waal. We are taking the opportunity to merge both agreements, in consultation with all partners. The local sports and prevention agreement Maas en Waal Vitaal is expected to be merged in the first quarter of 2022. To continue working hard for a more vital society!

Specifically: youth

The GGD Youth Health Monitor has provided insight into the health, well-being, and lifestyle of secondary school students in WMW. The survey is conducted every four years among students in grades 2 and 4 of secondary education. The students complete a digital questionnaire about their health, mental well-being, lifestyle (such as nutrition, exercise, alcohol, and smoking), enjoyment of school, school absenteeism, and sexuality.
In summary, the most important findings of the WMW monitor are:

• Very high percentage of alcohol consumption among young people (43%) and high acceptance of alcohol consumption by parents (34%). In the Gelderland-Zuid region, there has been a downward trend in alcohol consumption among young people over the years, but this decline has stagnated in the municipality of WMW.
• Smoking and the use of soft and hard drugs do not emerge from the monitor as a cause for concern, but are average in comparison with the Gelderland-Zuid region. What is striking is that 0% of young people indicate that they have used hard drugs in the last four weeks and 1% indicate that they have used drugs at some point.
• Attention needed for slow increase in psychosocial problems among young people;
• Stress and performance pressure among young people is evident in the figures. 38% indicate that they feel stressed (very) often. This is more favorable compared to the Gelderland-Zuid region (41%), but still a fairly high percentage. The vast majority of these young people feel stressed by 'school or homework'. Stress at home affects a small percentage, but is often more serious and combined with psychosocial problems.
• (Many) more young people in WMW indicate that they dislike or hate school (15%), which is a significant difference compared to the region (10%).
• Resilience is a major protective factor in preventing problems. 13% of young people in WMW indicate that they feel insufficiently resilient. 

Coronavirus is affecting the health and resilience of young people. This group therefore needs extra attention, especially now. Activities in the LPA help to mitigate the effects of coronavirus and enable a good restart after the coronavirus period. 

Specifically: elderly people and neighborhoods

The GGD Health Monitor 2020-2021 shows that adults in WMW are doing quite well. There has been a decline in unhealthy lifestyle habits such as alcohol consumption and smoking. And physical activity is increasing among the over-65s. Fruit consumption among 18-65 year olds is also increasing. Fewer people report having difficulty making ends meet. They report having €1,000 available for unforeseen expenses. The social environment is also portrayed positively. The sense of security is increasing. In addition, the LGBTQ+ group reports experiencing less discrimination. Mental well-being among people aged 65 and older is also developing positively. Anxiety and depression symptoms are showing a downward trend.

However, there are also areas of concern. Overweight among 18-65 year olds has been on an upward trend for years, and this trend shows no sign of slowing down. Physical activity among 18-65 year olds is also on a downward trend. Vegetable consumption among the over-65s is also declining. Another worrying development is that more and more people are reporting feelings of loneliness.

• Municipality of West Maas and Waal
• Sociom
• GGD Gelderland-South
• Trivium
• Maas and Waal in motion
• Active Maas and Waal
• Pro Persona Connect
• Stronger/ Question Guide West Maas and Waal
• IrisCare
• KoppieOp Children's Coaching