Promoting health gently

I am in the third floor of a building that houses the Nursing school and dormitory for its students. The building itself is a section of the huge complexes that are connected to each other. Other sections include a church, municipal health care center, etc. The whole structure was built 140 years ago. The health care center serves the municipality of Frederiksberg to promote healthy life and prevent diseases. It would correspond to our county Health Department but they truly reach out and influence people’s lives in ways we don’t do in the U.S. The center staff provided a two-hour presentation about their work in English, which was their first time ever.

Frederiksberg is only 3.4 sq mi wide but has 91,855 residents as of 2006. It is the smallest and most densely populated municipality. It belongs to Region Hovedstaden that contains 29 municipalities including the Copenhagen city. Frederiksberg is a short 5-minute away by subway from downtown Copenhagen. People here say it is a very good place to live and work. There are five Regions in Denmark and the five Regions contain total of 98 municipalities. Until last year, municipalities belonged to counties and counties belonged to Regions. The nationwide Municipal Reform on 1 January 2007 has merged small municipalities into bigger ones and eliminated the county structure. The State of Denmark funds municipalities directly even if municipalities belong to a Region. The Region does not control each municipality’s health care services. Each municipality has been reporting to the county but now reports to the State directly after the Reform. Through the new system the State expects better accountability from municipalities. Frederiksberg has not merged with other municipalities by the Reform because it was big enough and had a county privilege. The reform also gave the each municipality more freedom to create its own health care programs geared to its residents.

An example of such a unique health care program is Chlamydia prevention program in Frederiksberg Health Care Center. This kind of program does not exist in other municipalities and in fact other municipalities try to learn and mimic the health programs of Frederiksberg. Starting from 2001, the Center has sent a package of mail directly to men and women of the age between 18 and 22 in Frederiksberg. The annual mail includes the information about Chlamydia, how it is transmitted, and how it can be detected. Chlamydia detection is important because persons who contract the disease do not have any symptom. A self-test kit is also included in the package, along with the information that the test is painless. The Center receives the urine sample from young men and women and sends the result to the Center doctor. The doctor contacts each individual with the result. One of the goals of the program is to encourage the young residents in the municipality to have the ownership of their own health. The decision to send the urine sample back depends on each individual’s choice. A free test kit is also available in pharmacies. It is a soft nudging rather than forcing people into something to do. This particular method of direct mailing was preferred to public campaign because it was more effective and it only cost $10,000 per year. Throughout the 5-year program period, about 7% average positive Chlamydia result was gotten from all respondents.

Other programs in the Health Care Center include obesity and smoking cessation programs. Interestingly, boys have been gaining weight while girls have not. The government has ordered to remove all soda machines from schools recently. Coca-cola company will not be silent if that happens in the U.S. A home-visiting nutritionist program will be adopted soon to educate boy’s family to cook better meal and influence boy’s lifestyle. The reason for the boys’ weight gain is that they would go out with friends more and eat junk foods. Peer pressure for boys may be higher in this country than that of girls. It will be interesting to find it out.

The Health Care Center offers smoking cessation classes regularly. Private companies offer the class for their employee at workplaces. The program is effective. But so far, I have seen many smokers in restaurants and public places. In 1970, 47% of women and 68% of men smoked. In 2006, 23% of women and 26% of men smoked. The death rate from diseases caused by cigarette smoking is seven times higher than other causes like alcohol, obesity, drug abuse, or traffic accidents. The government will prohibit smoking in public places, bars and restaurants, starting from 1 August 2007. Exception will be one-person office. If you smoke and have your own office, you can still smoke in your office even though all the smoke goes out to the hallway. Individual freedom and choice is respected and honored here. Small detail seems to be well taken care of in Denmark.