In this section, we explain the risk factors and early detection measures we are focusing on and the main concepts guiding the development of interventions and measures in the “Model Region Bremen”. Specific examples of interventions and measures can be found under Current status and further plans.
Risk factors and early detection measures
Primary prevention is about avoiding the disease in the first place by addressing modifiable risk factors. In the “Model Region Bremen”, the focus is on smoking, alcohol consumption, physical inactivity, obesity and an unhealthy diet, which contribute significantly to the development of cancer and other chronic diseases. At best, it is possible to prevent the development of unhealthy behaviors, as changing habits later on is usually challenging (see below: life-course perspective). Another important topic is the HPV vaccination, which provides effective protection against cervical cancer and other HPV-associated diseases (e.g. anal cancer, genital warts). Despite a recommendation by the German Permanent Vaccination Committee (STIKO) for girls and boys, the vaccination rate remains low.
In secondary prevention, i.e. the early detection of cancer (screening), the focus is initially on the existing early detection programs for breast, colon and cervical cancer. Although their effectiveness has been proven in principle, they need to be adequately implemented in the respective healthcare system. In this respect, there is still room for improvement in Germany, particularly with regard to decentralized programs such as colorectal cancer screening. In addition, questions relating to risk-adapted (i.e. adapted to the individual risk) early detection and its acceptance will be researched in the model region.
Life-course perspective
Even if the majority of cancers do not occur until the second half of life, earlier life phases are relevant for their development. This is particularly true for unhealthy behaviors, which are often formed in childhood and adolescence. In order to develop sustainable and effective prevention concepts, it is therefore essential to include the early stages of life. Ideally, unhealthy behaviors should be prevented from the outset. However, this will not always succeed, i.e., unhealthy behaviors have typically developed in adulthood. At the same time, adults tend to be difficult to reach when it comes to prevention, because time and performance pressure determine their everyday lives. This makes it all the more important to use specific moments or occasions during this phase that can inspire a change in thinking (teachable moments). I.e., drastic changes such as pregnancy or a cancer diagnosis in a loved one, or preventative contact with a doctor. The life-course perspective is a central element in the development of prevention measures in the context of the “Model Region Bremen”.
Use of existing structures and digital possibilities
When designing prevention measures in the context of the “Model Region Bremen”, the use of existing structures is of great importance for several reasons. This approach reaches broad sections of the population and allows low-threshold access to prevention services. It is also efficient and therefore increases the chances of sustainability. This refers to structures with which people already have contact in the course of their lives, such as kindergartens, elementary schools, secondary schools, vocational schools, doctors' surgeries, occupational health offers, sports clubs, the public health service or health insurance providers. Close cooperation with politicians and other stakeholders is essential for this approach. The opportunities provided by digital offerings are also used in the design of new prevention measures, drawing on the expertise of the Leibniz ScienceCampus Digital Public Health Bremen (see also Why Bremen?).
Target group-specific approach
Even though prevention is relevant for everyone, the prevention dilemma must be taken into account: Groups that are most in need of prevention measures are often the hardest to reach. This can apply, for example, to people with a migration background or a low level of education, but also to people who consider themselves to be particularly healthy and “invulnerable”. Important aspects in the design of prevention measures are therefore comprehensibility, overcoming language barriers and conveying the appropriate messages.