Dr. Jürgen Wuthe Ministry of Labour und Social Affairs Baden-Württemberg, Germany

1. Chronic illness prevention and management - Public Health Strategy for Baden-Württemberg - Joint Seminar between EHESP & NPHSW 11th and 12th March 2009, Rennes Dr. Jürgen Wuthe Ministry of Labour und Social Affairs Baden-Württemberg, Germany

2. Challenges for a Public Health Strategy Change of disease pattern Change of lifestyle Public Health Strategy Baden-Württemberg Demographic change Health as a factor in the competitiveness of regional and national economies Ministry of Labour and Social Affairs

3. Design Public Health Strategy Baden-Württemberg Approach Analysis Principles Objectives Action areas Implementation Focus of action Measures Ministry of Labour and Social Affairs

4. The 10 most frequent causes of death in Baden-Württemberg in the year 2005 Source: StaLa B.W., personell communicatio, 2007 Ministry of Labour and Social Affairs

5. Total cases of death in Baden-Württemberg 2007 - Causes of death (percentage of total cases) Source: personell communication Statistisches Landesamt Baden-Württemberg, 2009 Ministry of Labour and Social Affairs

6. Almost 60% of the disease burden in Europe measured by DALY* is accounted for by 7 leading risk factors Risik factor Part in % • high blood pressure 12,8% • tabacco 12,3% • alcohol 10,1% • high blood cholesterol 8,7% • overweight 7,8% • low fruit and vegetable intake 4,4% • physical inactivity 3,5% *disability adjusted life years (DALYs) Source: WHO, Regionalkomitee for Europe 2006 Ministry of Labour and Social Affairs

7. Lifestyle • Risik factor tobacco • In Baden-Württemberg men start smoking at 16.6 years, women at 17.5 on an average • 15 - 20 year old smokers started smoking already at 14.4 years • 78% of smokers fume approx. 5 – 20 cigarettes per day Source: Statist. Monatsheft Ba-Wü 10/2006, S. 6-9 Ministry of Labour and Social Affairs

8. The demographic change 8 % 31 % 0,1 % 9 % 46 % 48 % 43 % 15 % Source: Bevölkerungsstatistik, Landesvorausrechnung Baden-Württemberg, Statistisches Landesamt Baden-Württemberg 2007 Ministry of Labour and Social Affairs

9. Disease frequencies 2005 in Baden-Württemberg according to age groups – Sick persons and accident victims on 1000 persons of the same age – Source: Mikrozensus, Statistisches Landesamt Baden-Württemberg 2007 Ministry of Labour and Social Affairs

10. The contribution of health to the economy Labour productivity Labour supply Health Economic output Education Savings Source: M. Suhrcke et al, The contribution of Health to the Economy in the EU, 2006 Ministry of Labour and Social Affairs

11. Health as an important factor in the competitiveness of regional and national economies „The population of western Europe is aging steadily, and the region`s birthrate is well below the replacement level, but Europe`s elderly are exceptionally healthy. That means they could be more productive for longer than their predecessors were. If western Europe governments learn to tap this potential, healthy aging could become the region`s next great economic asset.“ Source: Foreign Affairs (86) 55 – 68, 2007 Ministry of Labour and Social Affairs

12. Results • The disease pattern of the population has changed due to the • changes in society during the 20th century. • The main group of diseases today are noncommunicable (chronic) • diseases. • The demographic development of our society will aggravate this • situation in the future. • Our lifestyle – in addition to individual characteristics – is responsible • for the development of these diseases. • According to general opinion risk factors due to our lifestyle can be • avoided by prevention and health promotion. • More and more importance is attached to the health of the population • as an important location factor. Ministry of Labour and Social Affairs

13. Public health strategy Baden-Württemberg • Account • - high quality of life • - enhanced labour force participation rate • new markets for health and wellness • - high competetiveness • Risks • - tobacco • - high blood pressure • - physical inactivity • - poor diet and nutrition • - overweight • - alcohol • risiks at workplace • - social gradient Chronic diseases - cardiovascular diseases - neoplasams - diabetes - mental disorders - musculoskeletal diseases - chronic repiratory diseases • Health promotion • Prevention • physical activity • no tobacco • - healthy diet • - no risky and low alcohol use • - healthy childhood • - social paticipation • healthy surroundings in • workplaces, day-care centers, • schools etc. • Results • early incidence of chronic disease • rising costs for social systems • early retirement due to illness • reduction of competitiveness Ministry of Labour and Social Affairs

14. Estimated proportion of diseases potentially avoidable by changing lifestyle avoidable cases (Procent) 100 80 60 40 20 0 stroke colonic cancer Coronary disease diabetes mellitus Typ II Ministry of Labour and Social Affairs Source: Weiland et al., Deut. Ärzteblatt, 2006

15. Life expectancy and compression of the diseases‘ onset disease death present 55 years 80 years Expansion of diseases 55 years 85 years Compression of diseases 70 years 85 years Source: Fries, JF; 2003 Ann. Intern. Med. 139: 455-459 Ministry of Labour and Social Affairs

16. Objectives of the Public health strategy • Avoiding or compression of morbidity of chronic diseases • Promoting health in all phases of life and life worlds • Ensuring the competitiveness of Baden-Württemberg • by prevention and health promotion Ministry of Labour and Social Affairs

17. Action areas • Starting healthy – childhood and youth • Keeping well and fit – adulthood • Healthy ageing • Further fields of operation embracing the whole span of life: • Early diagnosis and care in the case of illness • Education and research • Utilization of the innovation potential of the health market Ministry of Labour and Social Affairs

18. Key directions • establishing healthy surrounding • starting early and integrally – decisive for success • reducing health disadvantages • early detection of chronic diseases • better handling of chronic diseases • better care for people with chronic diseases • supporting patients‘ rights and the ability of self-management • integrating self-help groups Ministry of Labour and Social Affairs

19. Implementation Actions • Developing strategic partnerships • The developement of strategic patrnerships will be done in the „Health • Forum Baden-Württemberg“ which includes all partners of health care • and health market in Baden-Württemberg. • Prevention, health promoting and health reporting as task of the State • Health Office and the Public Health Service Baden-Württemberg will be • strengthened. • Prevention and health promotion should be supported by all political • departments (health in all policis). • On the regional/local level health conferences should be established to • realise objectives of the strategy. • The Public Health Strategy will start in July with a great symposium. Ministry of Labour and Social Affairs

20. Thank you for your attention ! Ministry of Labour and Social Affairs

21. Phases of life and life world/life style? • Life world is a definable social system of high importance for health: • Habitation • Living/life style?? • Working and • Recreational activity including sports and playing such as: • - kindergarden • - schools • - clubs • - institutions for elderly and companies Ministry of Labour and Social Affairs

22. Erkrankungszahlen und Kosten für Diabetes mellitus in den Jahren 2000, 2020 und 2050 Klammern: prozentuale Veränderung gegenüber 2000 Quelle: F. Beske, Gesundheitsversorgung 2050, igsf, Band 108 diem carpe