[Cardiovascular disease prevention and health promotion in the French speaking community of Belgium]. / Le cadre de la prévention et de la promotion de la santé cardiovasculaire en communauté française de Belgique.

Cardiovascular diseases remain the first cause of mortality in Belgium and are a priority for the Five-year program of health promotion in the French speaking Community. It is declined in operational programs by priority thematics, including the heart health. With this framework, it appeared necessary to operationalize cardiovascular priorities. A process of systemic and participative planning was set up in order to seek operational strategies and actions, and to cover the whole population and actors concerned with these health problems. The various cardiovascular risk factors, which potentiate one another, are approached together and in a global way. Upstream to the risk factors, social health determinants play an important role in cardiovascular diseases and others diseases like cancers. Tracking cardiovascular risk factors among people 30 to 75 years is also proposed. It makes it possible to identify people at risk and to put forward individual and adapted measures. The plan integrates actions of health promotion (acting on the health determinants and factors which influence them) as well as actions aiming at improving tracking and the accompaniment of the patients in secondary and tertiary prevention. Actions on health determinants and the factors influencing them present moreover the advantage of being often common to many chronic diseases.

[Promoting health in health care organizations and hospitals? A survey of the French community in Belgium]. / Promouvoir la santé dans les milieux de soins et les hôpitaux? Une enquête en communauté française de Belgique.

Health promotion concept and practices have brought many significant changes even in disease management and care settings. In the Ottawa charter, health promotion is defined as "the process of enabling people to increase control over, and to improve, their health". However, care settings are in contradiction with this process on several levels (focus on disease and not enough on health, concern more on cure than on care, etc.). The emergence of health promotion practices has been deeply questioning these features. Care institutions start to reconsider their role and missions. However, changes are slow and there has been much resistance. What is the current situation of health promotion in French speaking Belgian care institutions in 1998? The WHO EUROPE HEALTH PROMOTING HOSPITALS' (HPH) project, which officially started in 1991, aims at "promoting positive health and well-being in hospitals and beyond that, in the community". For each participating hospital, the implications of membership have an important influence on the institution and care project, because it implies adherence to the principles of the Ottawa charter on health promotion, and to the philosophy and objectives of HPH. Belgium joined the WHO project and the HPH network in 1996. It was necessary to review the situation of health care institutions in the French speaking community of Belgium in order to understand the evolution over the last years, to assess health professionals expectations and the feasibility of some actions, and to provide political decision makers with information likely to influence future decisions and choices in a positive way. This article presents the descriptive results of a survey carried out on nursing and patient education departments in health care institutions. Half of 105 hospitals answered the questionnaires sent. Out of these answers, 150 projects and actions were identified and briefly described by the institutions, which had the possibility to present a maximum of five actions. The main topics addressed were chronic diseases, psychology (conflict management, aggressiveness, ill-treatment), maternity, screening, prevention and vaccination. Regarding perspectives, 78% of actions concern disease and/or risks of disease (therapeutic or preventive perspectives) and 22% concern the maintenance or improvement of health. 90% of listed and described actions are permanent, and only 10% are selective (limited), which suggests an evolution of projects and their integration in practices. Concerning the number of projects, two aspects were analysed: the number by institution and the evolution over the last twenty years. On average, there are 3.2 actions per institution. As for the evolution, 7% of hospitals said they had at least one education action/project in 1980, 60% in 1990 and 98% in 1998. This amazing and remarkable evolution occurred simultaneously to the development of education committees, of patient education co-ordinators and/or resource persons. In this field, there was also a remarkable evolution since the creation of the first committees in 1983. Amongst the elements encouraging the development of information and health education initiatives and actions mentioned by hospital managers, the first one is a demand from the public (and patients). It is the first time, since the existence of such surveys that this factor is mentioned as the most important.