THL International News

Transcription

1 THL International News

2 Pekka Puska Director General National Institute for Health and Welfare (THL) THL s challenges Public health in Finland is, on many indicators, better than ever before. But many challenges still face us - ageing, bio threats, unhealthy lifestyles and inequality. We have a high quality health and social service system underpinned by strong popular support, but it faces the challenges of rising costs, increasing demand, and the need to secure the availability of professionals and develop state-of-the-art information systems. The National Institute for Health and Welfare (THL) is well placed to meet these challenges by lending support and expertise to policy making bodies in central government and the Ministry of Health and Social Affairs through to local government and NGOs. By international standards THL has a wide remit over, and adopts an integrated approach towards, national health and welfare issues. Its breadth of expertise dates back to its predecessors, the National Public Health Institute (KTL) and the National Research and Development Centre for Welfare and Health (STAKES), both of which were responsible for a wide range of issues. THL s objective is to promote the wellbeing and health of the population, tackle diseases and social problems, and improve health and social services. THL carries out its responsibilities through research, follow-up and evaluation, and international co-operation. In addition, THL acts as the statutory statistical authority for health and welfare. Our strength lies in our 1,400 employees, backed by an annual budget of 100 million. Wide-ranging international co-operation is an important part of our remit. We participate in numerous research projects, and play an active role in many expert agencies and organisations including WHO/IHR implementation and the EU. Personally, I was delighted to participate in the international conference on prevention and control of non-communicable diseases and injuries in April in Mongolia. In a globalised world, where the challenges we face know no borders, this international dimension to our work is vital. By working with our partners, and sharing our knowledge and research, we can together find the solutions we seek. Cover photo: Mongolian young people. Photo by Markku Peltonen, Head of the Diabetes Prevention Unit at THL. He is participating also as Senior NCD Specialist in the Prevention and Control of Major Non-Communicable Diseases and Injuries Project in Mongolia.

3 Photo: Antero Aaltonen Coping with recessions Finland s experiences of population welfare from the early 1990s to now The recent global recession is by no means the worst to have hit Finland in recent decades. Between 1991 and 1993, Finland experienced its most severe financial crisis to date, with unemployment rates reaching 20%, interest rates hitting 16%, and export trade falling a massive 25% following the collapse of the Soviet Union and raised European interest rates consequent to German reunification, as explained by Dr Pasi Moisio, Head of Minimum Income Unit, recently during a THL presentation for foreign correspondents in Helsinki. The situation in Finland was compounded by several political and economic factors, including a tight fiscal policy, fixed exchange rates, financial deregulation and a property bubble and credit expansion. With the fixed exchange rate mechanism, Finnish economic planners found themselves defending the currency against international speculators, with disastrous results. Dr Moisio went on to elaborate the social consequences for Finns, which were severe. GDP fell by 14%, full employment gave way to mass unemployment, and national debt rose to 55% of GDP. A large number of young people in particular found themselves excluded from the labour market, while benefits were cut, and eligibility rules tightened, although surprisingly perhaps, no structural reforms were made in social security. Municipal budgets were targeted in a concerted clamp down on public spending. While the recovery after 1993 was very swift, some effects were more long-term: The most dramatic consequence was the growth of income inequalities and relative poverty with [Finland having] the fastest growing rates of any OECD country between 1995 and The overall effects of the 1990s recession can be seen to be the rapid structural change and the globalization of trade, from which most Finns have benefited. However, as a price, long-term unemployment was now here to stay, new categories of social exclusion and poverty emerged and Finns had to faced up to the loss of traditional job security. While the Finnish welfare state can be said to have creaked under the strain, it appears to have survived with much of its characteristics intact, reports Dr Moisio. Indeed, reforms to the work pensions system in 1996, in particular, helped to lay the foundations for a more sustainable welfare state. Nevertheless, universalism and wealth redistribution as ideas were weakened, with reductions in social transfers and decreases in taxes. Current evidence on the most recent economic recovery shows that the future prospects appear good for Finland. Dr Moisio summed it up in a conversation afterwards by saying that having eliminated the net debt up to 2004, we have put ourselves in a good position to survive the current recession, provided the Euro zone maintains itself generally in the global market. Mark Phillips, English Language Editor at THL

4 From knowledge to action: a path to meet public health threats in Finland Some 35 years after starting the well-known project to combat the high mortality of cardiovascular diseases in North Karelia, Finland is developing new strategies to meet the public health threats of today. As in the 1970s, the new methods are based on reliable, scientific information covering the aetiology and epidemiology of the health threats. Putting knowledge into action in the form of trials, intervention studies and national prevention programmes is the Finnish recipe for combating diabetes, allergies, dementia and home and leisure-time injuries, which today are growing health threats around the globe. Diabetes on focus Following the North Karelia project, it became clear that lifestyle changes had the potential to bring about tremendous improvements in public health: one of the highest mortality rates of cardiovascular diseases has fallen by 80 per cent in Finland since the 1970s. The decline was made possible by a comprehensive community action and persuasion campaign that embraced worksites, schools, health services, media, industry, legislation etc., explained Dr. Tiina Laatikainen to foreign correspondents in Helsinki in May. Today the route being taken in the fight against type II diabetes is the same. Its prevalence is extensive globally as well as in Finland: over 30 per cent of Finnish men and women respectively have impaired glucose metabolism at some stage in their lives, while some 16 and 11 per cent have diabetes though almost half of them are unfortunately undiagnosed. Once developed, diabetes is not very easy to cure, but it can be prevented through rather simple lifestyle changes. The Finnish Diabetes Prevention Study showed in the 1990s, that a moderate weight loss of five per cent through changes in diet together with increased physical activity reduced the risk of diabetes among high risk individuals by more than 50 per cent over a three-year follow-up. This internationally relevant information was put into action in a first-of-its-kind nationwide diabetes prevention program, DEHKO, which has been operating from DEHKO includes strategies for prevention, early diagnosis and treatment for the whole population as well as for high risk groups. Soon, within two years, we will have the results of DEHKO s success in our hands, when the FINRISKI national health monitoring study is completed, promises Dr. Laatikainen. last two decades: being high cholesterol and blood pressure, obesity, alcohol and physical inactivity. If the results of the prevention study are positive, it will be hopefully again followed by a national action program, foresees Laatikainen. New guidelines for treating allergy In the treatment of allergic diseases, groundbreaking new scientific information has recently been emerging. Instead of avoiding allergens the newly started National Allergy Program ( ) is directing Finns to a change of attitude: Let s strengthen our tolerance by exposing ourselves to normal environmental factors! We should teach our body to [live in] the presence, not to the absence of allergens, says Laatikainen. They should be avoided only when mandatory. Underlying the discovery has been the manifold and increasing differences between Finnish and Russian Karelia in the prevalence of allergic diseases and asthma. The reason for increasing asthma in Finland appears to be the change in environment, where we are not exposed to variety of environmental microbes and so our immune system have seemingly turned against wrong targets. The hidden problem of home and leisure time injuries Without key basic information some health threats can remain undetected. Such was the case in home and leisuretime injuries. When THL first investigated these issues some years ago, it turned out to be a much more severe problem than anticipated. The number of deaths had been increasing steadily for twenty years, numbering over 2600 fatalities in While Finland had been successfully preventing traffic and worksite accidents, injuries from leisure time activities were blind spotted. Now THL is working with a network of partners to carry out a national safety program. This includes the National Injury Prevention Programme Among Adolescents and Young Adults, which aims to prevent traffic accidents, poisonings and injuries in physical activity. Jari Kirsilä, Communications Manager, THL Lifestyle trial to prevent dementia THL is meeting other severe health threats similarly together with its partners. The Finnish Geriatric Intervention Study FINGER ( ) is the first comprehensive lifestyle trial aimed at preventing dementia. FINGER disseminates guidance on diet, physical activity, cognitive training and social activity for older people at high risk. The risk factors for dementia match those of cardiovascular diseases, as revealed by several scientific articles published by Finnish experts in

5 We need to approach health problems differently, says Mr. Paison Dakulala of the Papua New Guinea National Department of Health. A new administrative structure will be finalized this year after 18 months of comprehensive health care restructuring. Three pilot provinces have aligned curative health care with the rural public health structure. Reform in Papua New Guinea continues with preparation of a new National Health Plan starting In the new Health Plan we have to focus our action to meet the challenges, says Dakulala. The country has difficulties to overcome in meeting the Millennium Development Goals in Maternal Health and Child Health. HIV prevalence is one of the highest in the Pacific region, and health care is struggling with e.g. the increasing number of multi-resistant tuberculosis patients. Mr. Dakulala visited Helsinki for the 4th IANPHI Summer School jointly organized by IANPHI (International Association of National Public Health Institutes) and THL at beginning of June. The Summer School brought together participants from all continents with IANPHI member institutes. The aim of the Summer School course was Secretary General of IANPHI Pekka Jousilahti and Paison Dakulala. Summer School gathered IANPHI members in Helsinki to showcase THL as a comprehensive national public health institute. THL lecturers presented the course with their expertise in health policy planning, epidemiology and control of infectious and chronic diseases, environmental health, and support for health services, allowing the participants to discuss how the different public health functions are being applied in their institutes. Exchanging experience amongst participants and THL experts provoked in-depth discussion. A much-debated topic was that though the most pressing health threats in developing countries are often very different to those in developed ones, it is useful not to focus on infectious diseases alone. Developing countries are nowadays faced with a double burden as behavioral health problems have become more apparent through globalization, and thus create new challenges in public health advocacy. Even though the host institute served as an example of a national public health institute during the course, it was acknowledged that each country s own political and cultural structures must define how public Mental health collaboration between THL and the Mental Health Secretariat of Egypt health functions are best realized. Sharing knowledge enabled participants to identify similarities in their fields of work, and to create partnerships for future collaboration in both the creation and strengthening of national public health institutes worldwide. IANPHI was seen as an important organization for facilitating the exchange of expertise and experience by serving as a forum for public health leaders and providing NPHIs with tools and a framework, and by facilitating project work through grant programs. Mr. Dakulala is returning home with a greater confidence that change is possible. Valuable discussions on the importance of evidence-based research and the different means by which research can support policy formulation will be useful in his everyday work. He will also bring home ideas which are not so academic. One thing that struck me was that Finns patiently wait for the red light to turn green before crossing the street, even though there s not a car to be seen. I d like to take that behavour home with me. If we can change that, think what else might follow, laughs Dakulala. Sanna Vesikansa, International Coordinator at THL Katja Heikkiläinen, Project Manager at IANPHI/THL Finland and Egypt already have considerable experience of sharing their expertise across a range of mental health issues. They have worked together on several projects to improve mental health care and service delivery over the past few years. The financing has mainly come from the Finnish Ministry for Foreign Affairs. A new step in this collaboration was taken in 2008, when a new financing Instrument for Institutional Collaboration (ICI) was launched by the Ministry for Foreign Affairs of Finland. On 20 May 2010 THL started to implement its first ICI project in Egypt: Strengthening Mental Health Services in Egypt. The project was jointly planned by Finnish and Egyptian experts. The overall objective of the project is to improve the quality of life and health of people suffering from severe mental disorders. During the implementation the main focus will be on the development of rehabilitation services for mental health patients and nursing skills in forensic psychiatry. The Finnish experts come mainly from THL and Vanha Vaasa and Niuvanniemi Forensic Psychiatric Hospitals, which are administratively operating under THL. The local partner in Egypt is the General Mental Health Secretariat which has overall responsibility for organizing mental health care for people suffering from mental disorders. Local experts come mainly from Khanka Forensic Psychiatric Hospital and Helwan Psychiatric Hospital specialising in rehabilitation services. Anne-Marie Grouev, Project Manager at THL

6 H1N1 pandemic - the health care preparedness exercise The new influenza H1N1 epidemic resulted in nearly 100 THL experts working on prevention measures, and the Ministry of Social Welfare and Health also prioritized their manpower to deal with the threat. In addition, health care personnel at local level were tasked with the vaccination campaign. A serious H1N1 epidemic was avoided in Finland: a total of 7,669 influenza transmissions were recorded. Only four out of the total 44 deaths related to H1N1 were patients who did not have any pre-existing condition. This success was possible because preparedness plans were made early enough and were flexible, and there was good co-operation between the various actors, says Research Professor Petri Ruutu from THL. Vaccination was a key factor in preventing a more severe epidemic. Nearly 100% of health care personnel were vaccinated and over 90% of pregnant women. The most important risk groups for complications were vaccinated early in the epidemic, from late October to early December One of the challenges was that swine flu affected new groups (children and young people) and there were new risk groups for complications e.g. pregnant women and the morbidly obese. Significantly fewer pregnant women needed intensive care in Finland and other European countries than during earlier epidemics in Australia, New Zealand and USA (when vaccination was not available). Change in washing hands The exercise also brought some favorable, if unexpected, consequences. Half of the Finnish population was vaccinated, so raising awareness of the seasonal influenza vaccination programme. Improved hand hygiene may have a long-lasting impact by reducing a broad range of respiratory and gastrointestinal infections in the future. According to a European wide survey, 90% of Finns considered they had been well informed of the H1N1 epidemic, and 40% said they had changed their behavior, mostly by adopting better hand hygiene, due to the swine flu programme. The epidemic also improved preparedness for more serious bio threats. Health care professionals benefitted from a broad range of experiences, which allowed them to develop and fine-tune information material and organizational preparedness. And, according to Professor Ruutu, the exercise was also a valuable test of international co-ordination under the new WHO International Health Regulations. Early preparation When the influenza was discovered in April 2009, THL started preparedness plans for the new pandemic. The existing national pandemic preparedness plan had been well implemented following its preparation in The Avian influenza episode that began in south-east Asia in mid-2003 resulted in health care professionals being trained in the advance purchase of vaccines, the drawing up of comprehensive and transparent prioritisation schemes for high-risk groups, and the planning of mass vaccination at local level. Good stocks of personal protective equipment for health care were built up. During the H1N1 mitigation phase each imported case was identified. A wide range of guidelines were revised and implemented in a short time. Travellers and health care personnel were kept well informed. The expanding geographic spread of the pandemic led to a rapid increase in the number of travellers suspected of carrying swine flu in July, forcing a swift move to the containment phase. The experience of Australia and New Zealand showed that H1N1 required exceptional arrangements to ensure intensive care for those in need, and the burden on outpatient services and hospitals was significantly higher for swine flu than for seasonal influenza. Finland ensured early delivery of the vaccine (a total of 5.3 million doses) by being one of the first countries to enter into a purchase contract. As Professor Ruutu points out, the preparedness plans had been drawn up on the assumption that no vaccine would be available for the first wave. Communication challenges As it became clear that the pandemic would arrive later than originally forecast, the media and general public started to question the relevance of the preparedness plans. Health care professionals started to question the need for vaccination. And the media became sceptical whether the epidemic would occur at all. One piece of news, however, fundamentally altered perceptions. The death of a healthy child early in the epidemic led to lengthening queues at health centers. Learning from these dramatic changes in public and media attitudes will be an important factor in improving communication plans for future epidemics. Sanna Vesikansa, International Coordinator at THL Performance of EU healthcare systems investigated A new research project will evaluate the performance of European healthcare systems in terms of outcomes, quality, use of resources and costs. Launched in January, the EuroHOPE project will focus the evaluation on five key public health issues or diseases: acute myocardial infarction, stroke, hip fracture, breast cancer and low-birthweight infants. By using available databases as well as by collecting additional data on health-related quality of life measures (enabling Quality Adjusted Life Years as an outcome measure) and patient satisfaction (including expectations) the EuroHOPE project will perform the evaluation through a microeconomic disease-based approach. In the initial phase, the EuroHOPE project will be carried out in seven European countries: Finland, Sweden, Norway, the Netherlands, the United Kingdom (Scotland), Hungary and Italy. The four-year project is co-ordinated by the Centre for Health and Social Economics (CHESS) at THL and financed by the European Commission. EuroHOPE builds and expands on a previous CHESS-co-ordinated Finnish project called PERFECT (PERFormance, Effectiveness and Cost of Treatment Episodes). EuroHOPE on the Internet: www. EuroHOPE.info Sanna Vesikansa, International Coordinator at THL

7 New THL publication: Finnish drinking habits Alcohol consumption has tripled in Finland over the past 40 years. The old Finnish drinking pattern, with relatively infrequent but heavy drinking (compared to the European average) of mostly spirits, has at the same time undergone changes and maintained some of its characteristic features. A new THL publication, published in Finnish on June 23rd 2010, analyses the change in Finnish drinking habits from 1968 to It shows a shift to a society in which alcohol use is common and attitudes toward it are permissive. The most significant change has been the increase in women s drinking. While men drink twice as much today as they did in the 1960 s, women s consumption has increased nearly six-fold. 40 years ago, 40% of women were teetotallers; today, just 10% are. Meanwhile, the proportion drinking at least once a week has risen from under 10% to one-third. And average consumption per session has increased from two to almost four glasses at the same time as the number of heavy drinking occasions has soared. Women also report more than men that they suffer negative consequences from alcohol use. The increase in women s drinking signifies a change in alcohol culture in general. The majority of alcohol is consumed at home. Traditionally, men tended to drink with other men, but nowadays couples drink together. One consequence of the trend is that Finnish children are exposed to adults alcohol use both in good and bad: most occasions in which children are present are light drinking occasions, but approximately one in ten are occasions of heavy intoxication. The study also reveals trends in the opposite direction. Underage drinking, for instance, has been falling for the past decade. Some elements of Finnish drinking culture, are engrained. Finns mainly consume alcohol on particular occasions at weekends, late at night and on holiday. Getting drunk is still an important motivation, and heavy drinking occasions have increased amongst women, young adults and older men alike. Sanna Vesikansa, International Coordinator at THL Source: Pia Mäkelä, Heli Mustonen, Christoffer Tigerstedt (ed) Suomi juo. Suomalaisten alkoholinkäyttö ja sen muutokset [Finland drinks. Alcohol use and its changes among Finns in ] THL News from the Division of Health Protection Control and surveillance of communicable diseases learning by doing in THL The European Programme for Intervention Epidemiology Training (EPIET) provides training and practical experience in intervention epidemiology at the national centres for surveillance and control of communicable diseases in the European Union (EU). The programme is aimed at EU medical practitioners, public health nurses, microbiologists, veterinarians and other health professionals with previous experience in Public Health and a keen interest in epidemiology. The primary objective of the EPIET programme is to provide state-ofthe-art training in field epidemiology enabling its fellows to apply epidemiological methods to a wide range of public health problems in Europe. The main emphasis of the programme is on learning-by-doing activities. Finland, as one of 26 countries, provides training opportunities in this area in THL. The Department of Infectious Disease Surveillance and Control produces information on the occurrence of infectious diseases, risk factors for contracting infections, proposals for evidence-based control measures, as well as guidance to healthcare professionals. THL has national responsibility for surveillance, disease control and intervention and it collaborates actively with the European Centre for Disease Prevention and Control, ECDC. THL has hosted several EPIET fellows. The fellowships last two years. At the moment we have three EPIET fellows from Portugal, Sweden and Finland. The Department of Infectious Disease Surveillance and Control also trains physicians in the surveillance and control of infectious diseases in hospital districts and municipalities. Additional information about EPIETprogramme is available at: europa.eu/en/epiet/pages/homeepiet. aspx Terhi Hulkko Information officer THL Epidemiologic Surveillance and Response Unit

8 The National Institute for Health and Welfare (THL) THL International News Publisher The National Institute for Health and Welfare (THL) P.O. Box 30 FIN Helsinki Finland Tel Fax idc@thl.fi Editorial Staff Editor-in-Chief Jussi Simpura Research Professor Editor Sanna Vesikansa International Coordinator THL International Affairs Unit Tel sanna.vesikansa@thl.fi Layout Sisin Language editor David Borland, Mark Phillips Photos THL unless otherwise noted Printing Helsinki University Print ISSN