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Lessons Learnt from Finnish Experiences on NCD Prevention and Control

Lessons Learnt from Finnish Experiences on NCD Prevention and Control. Erkki Vartiainen, MD, Professor, Assistant Director General. 2. Start of the North Karelia project (1). Seven countries study in North Karelia since 1955

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Lessons Learnt from Finnish Experiences on NCD Prevention and Control

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  1. Lessons Learnt from Finnish Experiences on NCD Prevention and Control Erkki Vartiainen, MD, Professor, Assistant Director General Erkki Vartiainen

  2. 2

  3. Start of the North Karelia project (1) • Seven countries study in North Karelia since 1955 • Public attention to the high CVD mortality and to the statistics that the province of North Karelia is in the worse situation • Petition by the representatives of people in North Karelia for national assistance to cope with the problem (January 1971) • Delegation led by the Governor to Helsinki, the petition was handed to the Prime Minister and other decision makers • Involvement of Finnish experts and WHO

  4. Two main questions in 1970’s • Can risk factors and behaviors be changed on population level ? • If risk factors will reduce what will happen to the mortality?

  5. Aims of the North Karelia Project North Karelia Project MAIN OBJECTIVE: • Initially: To reduce the CVD mortality • Later: To reduce major chronic disease mortality and promote health INTERMEDIATE OBJECTIVES: • To reduce the population levels of main risk factors, emphasizing lifestyle changes and to promote secondary prevention NATIONAL OBJECTIVE: • Initially: To be pilot for all Finland • Later: To be demonstration and model program

  6. North Karelia Project Hierarchy of objectives GENERAL GOAL:Improved health MAIN OBJECTIVES:Prevention of chronicdiseases & promotion of health Medical / Epidemiologicalframework:- earlier research- local prevalence INTERMEDIATE OBJECTIVES: Risk factors, life-styles and treatment Social / Behavioural framework:- theory- community analysis PRACTICAL OBJECTIVES: Intervention programme

  7. From Karelia to national action • First province of North Karelia as a pilot (5 years), then national action • Good scientific evaluation to learn of the experience

  8. 25 % 5 % 70 % People with average risk factor level People with clinically high risk factor level People with low risk factor level Individual risk of CHD Distribution of people according to risk factor level Theoretical presentation of the difference between individual risk and the proportional attributable risk

  9. Community intervention model of the North Karelia Project

  10. II. BEHAVIOUR MODIFICATION (Puska and McAlister)

  11. Theoretical principles of the interventions North Karelia Project • Medical framework: • Primary prevention • Main targets: smoking, diet, cholesterol, blood pressure • Population approach, general risk factor reduction emphasizing lifestyle changes • Social / Behavioural framework • Social marketing • Behaviour modification • Communication • Innovation – diffusion • Community organization

  12. Practical intervention North Karelia Project • Emphasis on persuasion, practical skills, social & environmental support for change • Research team & local project office with comprehensive community involvement • Main areas: 1. Media activities (materials, massmedia, campaigns) 2. Preventive services (primary health care etc.) 3. Training of professional and other workers 4. Environmental changes (smokefree areas, supermarkets, food industry etc.) 5. Monitoring and feed-back

  13. Evaluation North Karelia Project Evaluation tasks • Feasibility, performance • Effects: risk factors, lifestyles,disease rates, mortality • Change process • Costs • Other consequencies Evaluation types • summative: 5-year periods • formative, internal evaluation

  14. Smoking control programmes • Voluntary restrictions of smoking in public places • Mass media • Voluntary restrictions in advertising • Use of opinion leaders • Training of health care personnel • Cessation services in health centres

  15. Hypertension register • Computer based • Hypertension clinic • Nurses in a key position • Invitation letter once a year

  16. NSO’s role • Heart Association • Martta (house wife’s) association

  17. Setting strategy • Schools • Work site • Media • Family • Health centers/hospitals • Villages

  18. Use of lay opinion leaders to promote health innovations in community • Innovation-diffusion theory • Training seminars in municipalities • Discuss health issues in normal life • 805 persons participated • Recruiting by local people and Heart Association • 1975-1982 • Evaluation in 1982: 399 (50%) still active

  19. Discussions with target groups

  20. A comprehensive television smoking cessation programme in Finland • Voluntary smokers in TV studio tried to stop smoking • 6 sessions + 2 follow-up sessions • Intensified filed activity in North Karelia • 250 000 at least 4 sessions • 30 000 attempt to quit • 20 000 quit • 10 000 remained non-smokers

  21. Berry program • From dairy industry to berry production • Helping in marketing and product development • Funding from ministry

  22. Smoking control programmes • Work side programmes • School programmes • TV programmes • Radio programmes • Quit and Win Competition • Smoke Free Class Competition • Quit and Win-Do Not Start and Win for Young People

  23. Village competition to lower cholesterol • 1991 7 villages, population 105-210 • 1997 16 villages, population 85-420 • Village committees organized • 2 months competition • Baseline and follow-up cholesterol measurement • Best village win 2000 €

  24. Cholesterol changes in 1991 competition

  25. Cholesterol change in 1997 competition

  26. Change (%) in cholesterol by number of dietary changes

  27. Change in cholesterol value by village activity

  28. Percentage of weekly smokers (Baseline smokers excluded) Program effect1 8th OR = 0.47 (0.30-0.71) 51% 9th OR = 0.68 (0.51-0.89) 28% The OR for weekly smoking for experimental school compared to control school pupils

  29. Erkki Vartiainen

  30. Serum cholesterol in men aged 30-59 years mmol/L

  31. Serum cholesterol in women aged 30-59 years mmol/L

  32. Serum cholesterol distribution in North Karelia in 1972 and 2007

  33. Use of butter for cooking %

  34. Use of vegetable oil for cooking(men age 30-59)

  35. Use of butter on bread(men age 30-59) %

  36. Milk Consumption in Finland in 1970 and 2006 (kg per capita) kg 140 Whole milk 120 100 Low fat milk 80 Whole form milk 60 40 20 Skimmilk 0 1960 1970 1980 1990 2000 2010

  37. Examples of intersectoral work 1. Change in fat content of Finnish cow milk

  38. 1982, 1992, 1997, 2002, 2007 • FINMONICA/FINRISK surveys • Age and sex-stratified random sample, 25-64-years, in 3-5 study areas • Diet subsample 3000-4000 • Response rates, 60-70% • 3-day food record, 1982, 1992 • 24 h recall, 1997 • 48 h recall, 2002 and 2007

  39. Fat intake Recommendations EN% Year

  40. Estimated effects on serum cholesterol

  41. Estimated effects on serum cholesterol

  42. Estimated effect of statins on population cholesterol 4%

  43. Serum cholesterol level by myocardial infarction and statins

  44. Systolic blood pressure in men aged 30-59 mmHg

  45. Systolic blood pressure in women aged 30-59 years mmHg

  46. Diastolic blood pressure in men aged 30-59 years mmHg

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