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GLOBAL PUBLIC HEALTH IN TRANSITION

Community-based NCD prevention - 40 years experience in Finland Pekka Jousilahti, Research Professor National Institute for Health and Welfare. GLOBAL PUBLIC HEALTH IN TRANSITION. Chronic diseases – especially cardiovascular diseases Leading health problem in industrialized countries

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GLOBAL PUBLIC HEALTH IN TRANSITION

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  1. Community-based NCD prevention- 40 years experience in FinlandPekka Jousilahti, Research ProfessorNational Institute for Health and Welfare

  2. GLOBAL PUBLIC HEALTH IN TRANSITION Chronic diseases – especially cardiovascular diseases Leading health problem in industrialized countries Main killers and rapidly growing problem in developing countries 04/01/2020 2

  3. Projected Main Causes of Death, Worldwide, All Ages, 2005 04/01/2020 3

  4. 04/01/2020 4

  5. Global Health Burden Estimated global deaths by cause, all ages, 2005 Source : WHO 2005: «Preventing Chronic Diseases: A Vital Investment» 3 04/01/2020 5

  6. CVDS ARE TO A GREAT EXTENT PREVENTABLE DISEASES Medical evidence for prevention exists. Population-based prevention is the most cost-effective and the only affordable option for major public health improvement in CVD rates. Major changes in population rates can take place in a surprisingly short time. 04/01/2020 6

  7. CHD mortality in 25 countries in the late 60s- men and women aged 35 to 64 years Source: Thom et al. 1992

  8. 5

  9. Preventiontargets the populationlevels of mostimportantriskfactors. 04/01/2020 9

  10. DIFFERENT LEVELS OF PREVENTION TARGETS POPULATION HIGH RISK PATIENTS • Determinants • social • economical • cultural • political Risk factors behavioural biological CVD/NCD Consequencies PREVENTION HEALTH PROMOTION TREATMENT, REHABILITATION, SEC. PREVENTION 04/01/2020 10

  11. WORLD DEATHS IN 2000 ATTRIBUTABLE TO SELECTED LEADING RISK FACTORS Number of deaths (000s) Source: WHR 2002 04/01/2020 11

  12. North Karelia ProjectPrinciples for Defining the Intermediate Objectives • Due to the chronic nature of CVD, the potential for the control of the problem lies in primary prevention• The risk factors were chosen on the basis ofbest available knowledge: - previous studies - collective international recommendations - epidemiological situation in North Karelia• Chosen risk factors: - smoking - elevated serum cholesterol (diet) - elevated blood pressure

  13. Serum cholesterol distribution in Finland and Japan in 1970’s Frequency % mmol/l

  14. Main Principles of the North Karelia Project • Prevention is the only sustainable public health approach • Risk factors identified by prospective studies, closely linked with certain behaviours - deeply enrooted in the community • Community based preventive programme 1 Target: the community (not individuals) 2 Intervention: through community structures (not external intervention) • Emphasis on community organization, general community changes

  15. Personal Responsibility ”Nobody can take better care of your health than yourself” Public Responsibility ”Make the healthy choices the easy ones” (Ottawa declaration) COMBING PERSONAL AND PUBLIC RESPONSIBILITIES 04/01/2020 15

  16. - Individual behaviour - Clinical interventions RISK FACTORS • - • Public Health policy • Other government • sectors (HiAP)

  17. North Karelia Project PRACTICAL INTERVENTION • 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, mass media, campaigns2. Preventive services: new public health law3. Training: health professionals and other workers4. Environmental changes: smoke-free areas, supermarkets, food industry etc.5. Monitoring and feed-back: risk factors, morbidity, mortality

  18. Cardiovascular disease Action Plan for Promoting Finnish Heart Health

  19. Major Elements of Finnish National Action • Health services: primary and secondary • North Karelia Project, other demonstration programmes • Health Promotion Programmes: coalitions, NGO’s, collaboration with media, etc. • Schools, educational institutions, working places • Industry, trade, marketing: business and private sector collaboration • Policy decisions, inter-sectoral collaboration, legislation: HiAP (Health in All Policies) • Monitoring system: health behaviours, risk factors, nutrition • Research • International collaboration

  20. Finnish Heart Health Programme In twenty years the cardiovascular diseases are not anymore a public health problem among working aged population and healthy years in life will increase. • Promotion of heart health and prevention of cardiovascular disease • health in all policies • socioeconomic differences • adequate national and regional resources • Early diagnosis and treatment • correct treatment in correct timing • differences in care between sosioeconomic groups • Rehabilitation and prevention of recurrent disease cases • more resources to outpatient rehabilitation • Population strategy • arterial diseases and lifestyles • CVD among women • High risk strategy • prevention and treatment guidelines • prevention of type 2 diabetes • European recommendations

  21. SOUND COMBINATION OF POPULATION STRATEGY WITH HIGH RISK STRATEGY POPULATION STRATEGY: - Greatest public health gains - Cost effective - Results also in other health benefits HIGH RISK STRATEGY: - Great benefits to the persons concerned - Effective use of health services 04/01/2020 21

  22. Population-based and high risk strategies 5 % 70 % 25 % People with low risk factor level People with average risk factor level People with clinically high risk factor level Individual risk of CHD Distribution of people according to risk factor level

  23. LIFESTYLES AND RISK FACTORS CAN CHANGE! 04/01/2020 23

  24. Smoking in men (30–59 y) % North Karelia project evaluation and FINMONICA and the National FINRISK Studies 1972 - 2007

  25. ANTISMOKING LEGISLATIONIN FINLAND IN 1977: Prohibition of all forms of advertising Restrictions in smoking in public places Health warnings etc. 1/2% level of tobacco tax for antismoking activities Prohibition of sale to under 16 years old

  26. ANTISMOKING LEGISLATIONIN FINLAND IN 1995, 2000 AND 2007: Worksite smoking policy Sales to persons under 18 years of age prohibited Restaurant, bar smoking policy

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

  28. Fruits And Vegetables – Supermarkets

  29. www.sydanmerkki.fi

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

  31. % Use of butter for cooking

  32. % Use of vegetable oil for cooking(men aged 30-59)

  33. Fat intake Recommendations EN% Year • The FINDIET Study

  34. Systolic blood pressure in men (30–59 y) mmHg North Karelia project evaluation and FINMONICA and the National FINRISK Studies 1972 - 2007

  35. Saltintake in Finland 1977-2007 g/day The FINDIET Study

  36. Morbidity and mortality changes follow risk factor change! 04/01/2020 38

  37. 69 72 75 78 81 84 87 90 93 96 99 2002 Age-adjusted mortality rates of coronary heart disease in North Kareliaand the whole of Finland among males aged 35-64 years from 1969 to 2002 700 start of the North Karelia Project 600 extension of the Project nationally 500 North Karelia 400 300 - 82 % All Finland Mortality per 100 000 population 200 - 75% 100 Year

  38. Observed and Predicted Decline in CHD mortality 35-64 year old men

  39. TOBACCO USE UNHEALTHY DIET PHYSICAL INACTIVITY ALCOHOL Common Risk Factors CVD DIABETES CANCER COPD MUSCULOSCELETAL ORAL HEALTH

  40. Age adjusted mortality rate of lung cancer in North Karelia and in all Finland in male population aged 35-64 years in 1969-1995

  41. MORTALITY CHANGES IN NORTH KARELIA from 1969–71 to 2006(Men 35–64 Years, Age Adjusted) Rate (per 100.000) Change from1969–71 2006 1969–71 to 2006All causes 1509 572- 62%All cardiovascular 855 182- 79%Coronary heart disease 672 103- 85%All cancers 271 96- 65%Lung cancers 147 30- 80% 04/01/2020 Pekka Puska, Director General 43

  42. Changes in perceived health(self-reported very good/good)

  43. Life expectancy at birth in Finland in 1941–2004 Source: Statistics Finland. Koskinen S, Aromaa A, Huttunen J, Teperi J. Health in Finland. Helsinki 2006. www.ktl.fi/hif

  44. Finland Has Shown • Prevention of major chronic diseases is possible and pays off • Population based prevention is the only cost effective and sustainable public health approach to chronic disease control • Prevention calls for simple changes in some lifestyles (individual, family, community, national and global level action) • Influencing lifestyles is a key issue • Many results of prevention occur surprisingly quickly (CVD, diabetes) and also at relatively late age • Comprehensive action, broad collaboration with dedicated leadership and strong government policy support are crucial

  45. THE MAIN CHALLENGE IS NOT WHAT TO DO, BUT HOW TO DO! 04/01/2020 47

  46. FOR SUCCESSFUL PREVENTION Strong leadership combined with Good partnership Do the right things Do enough 04/01/2020 48

  47. STRONGER SUPPORT FOR IMPLEMENTATION • Stronger public health infrastructures • Stronger health surveillance/monitoring • Innovative financial support mechanisms 04/01/2020 49

  48. CIVIL SOCIETY The role of civil society is increasing in most countries NGO’s: mobilize people, serve people, watchdogs, etc. Push for childhood obesity to public / political agenda 04/01/2020 50

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