they identified the key individuals who are in close contact with young families. Then they invited relevant organizations, institutions, and professional associations to actively design the network, and the initiative attracted increasing attention. Today, the network is supported by professional associations, scientific organizations and institutions, the Federal Ministry of Food and Agriculture, and by the National Breastfeeding Commission. Through multipliers, male and female, whom young families trust, the network seeks access to pregnant women and young families.
This is where I see a fourth leverage point for successful prevention and health promotion. Multipliers, mainly doctors and midwives, but also the “early helpers,” such as family midwives, youth and health departments of local authorities with their “welcome visits,” social workers, male and female, and baby pilots – must be interconnected in a network structure [15]. The network thus uses existing structures of healthcare and counselling and places messages for health-promoting diets and sufficient physical exercise. In Germany, statutory screening and early detection examinations for pregnant women, infants, and children (“U-tests”) count among them. Here, disseminators and multipliers meet the target group face-to-face. This approach works well for families of low socioeconomic status and families with a migration background who, compared to their use of other prevention offers, can be addressed quite effectively this way. At any rate, they have been making more frequent use of these offers in recent years.
The important fifth leverage point for a successful strategy leads back to the initial impulse for the network in 2008. The participants in the workshop at that time were interested in uniform recommendations for action. Successful messages require a uniform common language. The message must be clear and it must be communicated consistently, otherwise the effect fizzles out. Translated into a successful strategy to combat malnutrition, it means we need recommendations and calls to action. The network has developed these, regarding diet and lifestyle before and during pregnancy, diet and physical exercise of infants and breastfeeding women, as well as diet and physical exercise in early childhood [16–18]. These recommendations for action are based on the current state of scientific knowledge. They are the central focus of training efforts for disseminators and multipliers in classroom events and in webinars by advisors trained to advise and support young families.
The network has also developed appropriate materials. They enable all participants to cooperate. In addition, there are low-threshold media for parents like apps, flyers, posters, and stickers, some of them available in foreign languages. They translate the recommendations into simple messages, relevant for people’s behavior in everyday life. These media support multipliers during their consultations [14].
Importance of Appropriate Conditions for Behavioral Change
The five leverage points I have mentioned so far all start at one point: enabling people to change their behavior. This aspect is crucial. People are always in the focus, and it is important that they brought along. We also find that these approaches do not suffice to ensure successful prevention and health promotion. It is just as important that people can go along. The conditions they live in and which make it easier – or harder – for them to make the right decisions for themselves and for their children are of vital importance as well. This is about a real change of behavior and a change of conditions [19].
One example of good and successful prevention concerning external conditions is the so-called municipal prevention chains [20]. A chain of prevention wants to tie a comprehensive and viable network for children, young people, and parents, within their community, with the municipal authorities competent for youth, health, social, and educational matters. The aim is to merge existing networks, services, and actors so as to allow coordinated action in the sense of an overall integrated local strategy and across departmental boundaries. This creates clear framework conditions for children to grow up healthy. Also, the German prevention law, enacted in 2015, focuses on health promotion in everyday life which takes place in daycare centers, schools, municipalities, companies, and nursing homes.
Changing conditions is always a political task. Thus, the questions arise – how does policy change, and what kind of policy successfully induces a change of conditions in the way we intend it? This is exactly what the international project “Becoming Breastfeeding Friendly” deals with, involving Germany and a range of other countries. It focuses on the aspect of preventing unfavorable conditions [21]. Initiated by Yale University, the project systematically records factors which either promote or impede breastfeeding in Germany, the UK, Mexico, Ghana, Samoa, and Myanmar. It aims to initiate efficient and targeted measures to promote breastfeeding sustainably. The research project is based on the “Gear Model” [22]. It integrates all relevant fields of action that relate to breastfeeding and that mesh like gears: from a high-profile advocacy via legislative measures through to training and education for multipliers and disseminators, male and female. In Germany, a 17-member expert commission currently elaborates calls to action for key decision makers – based on the analysis of the current situation and the challenges identified in the process. At a high-profile conference on June 5, 2019, these results were presented to a broad audience. Other countries are a bit further ahead. In Mexico, for instance, the systematic analysis of the current situation states moderate improvements of conditions conducive to breastfeeding (“a moderate scaling up environment”). In Ghana, the national framework conditions are even rated as good. This example illustrates clearly – and thus refers back to my introductory remark – that, within the context of breastfeeding, we cannot think in terms of industrial versus developing or emerging nations. Factors that help or hinder breastfeeding prevail in every country, albeit in varying degrees, and they illustrate both the need for action and the need for exchange and networking.
The Importance of Networking in Other Areas of Healthy Lifestyle Promotion
A balanced diet, avoiding malnutrition, and the emergence of obesity continue to be a complex matter influenced by causes and factors at the individual, the social and the societal level. Only by combining behavioral and condition-related prevention, including the participation of all relevant actors and key decision makers, can prevention and health promotion be designed to be sustainable and successful. Networking is a key success factor in this context. For the promotion of a healthy lifestyle in the sense of a health-promoting diet and adequate exercise, it is never too early or too late. In the sense of a lifelong perspective, leverage points range from the period surrounding childbirth, to lifestyles in daycare centers, at school and at work, through to old age.
Two conclusions can be drawn from this. First, networking of activities throughout all phases of life is vital. We must strive to have meaningful structures and initiatives that continue uninterrupted in order to support people throughout their lives. Second, networking is a topic for successful prevention and health promotion even when we address people in other walks of life. The experience gathered with “Healthy Start” can be transferred. That is why, in Germany, we build networks for all stages of life. The “National Quality Center for Nutrition in Daycare Centers and Schools” (NQZ), for instance, aims to offer as many young people as possible a low-threshold access to healthy and high-quality food in daycare facilities and schools [23]. The Federal Ministry of Food and Agriculture also meets the challenge of “nutrition in old age” with an initiative for senior citizens, male and female, designed as a network.
Conclusion
