Introduction to Finnish NCD Prevention. PREVENTION OF NONCOMMUNICABLE DISEASES SEMINAR, Helsinki

Transcription

1 Introduction to Finnish NCD Prevention PREVENTION OF NONCOMMUNICABLE DISEASES SEMINAR, Helsinki

2 28/03/2011 Pekka Puska, Director General 2

3 Global Health Burden Estimated global deaths by cause, all ages, C ardio vascular diseases C ancer H IV/ A ID S C hro nic respirato ry diseases T uberculo sis M alaria D iabetes 0 Source : WHO 2005: «Preventing Chronic Diseases: A Vital Investment» 28/03/2011 Pekka Puska, Director General 3 3

4 Global Public Health in Transition Chronic diseases especially cardio-vascular diseases Leading health problem in industrialized countries Main killers and rapidly growing problem in developing countries 28/03/2011 Pekka Puska, Director General 4

5 Lifestyle Transition Emerging global epidemic of NCDs is to a great extent a consequence of changes in the diets, of declining physical activity and of increase of tobacco use The determinants of these changes are urbanisation, changes in occupations, population ageing and many global influences Risks are increasingly accumulating in lower socio-economic groups of the population 28/03/2011 Pekka Puska, Director General 5

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7 North Karelia Project Principles 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 of best available knowledge: - previous studies - collective international recommendations - epidemiological situation in North Karelia Chosen risk factors: - smoking - elevated serum cholesterol (diet) - elevated blood pressure 28/03/2011 Pekka Puska, Director General 7

8 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 28/03/2011 Pekka Puska, Director General 8

9 From Karelia to National Action First province of North Karelia as a pilot (5 years), then national action ( ) Continuation is North Karelia as national demonstration ( ) Good scientific evaluation to learn of the experience Comprehensive national action 28/03/2011 Pekka Puska, Director General 9

10 Evaluation/Monitoring - North Karelia all Finland - Monitoring systems health behaviour risk factors nutrition diseases, mortality 28/03/2011 Pekka Puska, Director General 10

11 Intervention Principles Restricted risk factor targets, based on epidemiological knowledge Sound behavioural & social science principles for planning, implementation and evaluation Intervention flexible to respond to the naturally occurring opportunities and feedback (monitoring) Key principles: Community organization (working with the community to change physical and social environment conducive to target behavioural changes) = To make the healthy lifestyles the easy ones. 28/03/2011 Pekka Puska, Director General 11

12 Use of Butter on Bread (men age 30 59) Kg/m North Karelia Kuopio province Southwest Finland Helsinki area Oulu province Lapland province 28/03/2011 Pekka Puska, Director General 12

13 Consumption (kg per capita) Butter consumption per capita in Finland /03/2011 Pekka Puska, Director General 13

14 Milk Consumption in Finland in 1970 and 2006 (kg per capita) kg Whole milk Whole form milk Low fat milk 20 Skim milk /03/2011 Pekka Puska, Director General 14

15 Use of Vegetable Oil for Cooking (men age 30 59) % North Karelia Kuopio province Southwest Finland Helsinki area Oulu province Lapland province 28/03/2011 Pekka Puska, Director General 15

16 Fruits and Vegetables Supermarkets 28/03/2011 Pekka Puska, Director General 16

17 g/day Salt Intake in Finland Year Sources: Karvonen et al. 1977, Nissinen et al. 1982, Pietinen et al. 1981, Pietinen et al. 1990, Valsta 1992, KTL/Nutrition Report 1995, KTL/ FINDIET 1997 and FINDIET2002 Studies, KTL/unpublished information Per capita statistics Dietary surveys, men Dietary surveys, women Sodium excretion, men Sodium excretion, women Lin. (Sodium 28/03/2011 Pekka Puska, Director General 17

18 Fat intake in Finland Recommendations EN% Total fat (~ 30 EN%) SFA (~10 EN%) MUFA (10-15 EN%) PUFA (5-10 EN%) Year Sources:Uusitalo et al Kleemola et al Findiet Study Group 1998 Männistö et al Paturi et al /03/2011 Pekka Puska, Director General 18

19 7,5 Serum Cholesterol in Men Aged Years mmol/l 7 6,5 6 North Karelia Kuopio Turku/Loimaa Helsinki/Vantaa Oulu Lapland 5, FINRISK Studies 1997 & /03/2011 Pekka Puska, Director General 19

20 mmhg Systolic Blood Pressure in Men Aged Years North Karelia Kuopio province Southwest Finland Helsinki area Oulu province Lapland province /03/2011 Pekka Puska, Director General 20

21 Smoking in men (30 59 y) % North Karelia Kuopio province Southwest Finland Helsinki area Oulu province Lapland province North Karelia project evaluation and FINMONICA and the National FINRISK Studies /03/2011 Pekka Puska, Director General 21

22 Age-adjusted mortality rates of coronary heart disease in North Karelia and the whole of Finland among males aged years from 1969 to start of the North Karelia Project extension of the Project nationally North Karelia Mortality per population Age-standadized to European population All Finland - 80% - 85% 28/03/2011 Pekka Puska, Director General 22

23 Observed and Predicted Declines in Coronary Mortality in Eastern Finland, Men % Year Observed Predicted Cholesterol Blood pressure Smoking 28/03/2011 Pekka Puska, Director General 23

24 Mortality Changes in Finland from to 2006 (Men Years, Age Adjusted) Rate (per ) Change from to 2006 All causes % All cardiovascular % Coronary heart disease % All cancers % 28/03/2011 Pekka Puska, Director General 24

25 CONCLUSIONS A comprehensive, determined and theory-based community program can have a meaningful positive effect on risk factors and life styles Such changes are associated with respective favourable changes in chronic disease ratesand health of the population A major national demonstration program can be a strong tool for favourable national development in chronic disease prevention and health promotion 28/03/2011 Pekka Puska, Director General 25

26 Why success in North Karelia Appropriate epidemiological and behavioural framework Restricted, well defined targets Good monitoring of immediate targets (behaviours, process) Flexible intervention Emphasis in changing environment and social norms Working closely with the community Positive feedback, work with media International collaboration, support from WHO Close interaction with national health policy, integration with National Public Health Institute Long term, dedicated leadership 28/03/2011 Pekka Puska, Director General 26

27 From Karelia to National Action Major Elements of Finnish National Action 1. Research & international research collaboration Health services (especially primary health care) North Karelia Project, other demonstration programmes Health Promotion Programmes (coalitions, NGO s, collaboration with media etc.) Schools, educational institutions 28/03/2011 Pekka Puska, Director General 27

28 Major Elements of Finnish National Action 2. Industry, business collaboration Policy decisions, intersectoral collaboration, legislation Monitoring system: health behaviours, risk factors, nutrition, diseases, mortality International collaboration 28/03/2011 Pekka Puska, Director General 28

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30 WHO S NCD STRATEGY 2000 NCD s a priority Prevention key Integrated approach, targeting main behavioural factors: diet, physical activity and tobacco WHO NCD ACTION PLAN (WHA 2008) 28/03/2011 Pekka Puska, Director General 30

31 Prevention targets the population levels of most important risk factors. 28/03/2011 Pekka Puska, Director General 31

32 WORLD DEATHS IN 2000 ATTRIBUTABLE TO SELECTED LEADING RISK FACTORS Blood pressure Tobacco Cholesterol Underweight Unsafe sex Fruit and vegetable intake High Body Mass Index Physical inactivity Alcohol Unsafe water, sanitation, and hygiene Indoor smoke from solid fuels Iron deficiency Urban air pollution Zinc deficiency Vitamin A deficiency Unsafe health care injections Occupational risk factors for injury Number of deaths (000s) Source: WHR /03/2011 Pekka Puska, Director General 32

33 SIX OF THE SEVEN TOP DETERMINANTS OF MORTALITY IN DEVELOPED COUNTRIES RELATE TO HOW WE EAT, DRINK AND MOVE DIET AND PHYSICAL ACTIVITY, TOGETHER WITH TOBACCO AND ALCOHO, ARE KEY DETERMINANTS OF CONTEMPORARY PUBLIC HEALTH 28/03/2011 Pekka Puska, Director General 33

34 RISK FACTORS Tobacco: FCTC (2003) Diet & Physical activity: global strategy (2004) Alcohol: global strategy under preparation (2010) 28/03/2011 Pekka Puska, Director General 34

35 Sound Combination of Population Strategy With High Risk Strategy 1. Population strategy: - Greatest public health gains - Cost effective - Results also in other health benefits 2. High risk strategy: - Great benefits to the persons concerned - Effective use of health services 28/03/2011 Pekka Puska, Director General 35

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37 Theory and Action for Effective Programmes and Policies MEDICAL KNOWLEDGE SOCIAL & BEHAVIORAL THEORY EFFECTIVE PROGRAMS POLICIES STRONG SUSTAINED IMPLEMENTATION 28/03/2011 Pekka Puska, Director General 37

38 During the last few years a great number of strategies and plans for evidence based, effective prevention and health promotion have been produced Many important priorities have been identified. 28/03/2011 Pekka Puska, Director General 38

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40 FROM PRIORITIES TO IMPLEMENTATION IDENTIFYING PRIORITIES IMPLEMENTING THEM 28/03/2011 Pekka Puska, Director General 40

41 PUBLIC POLICY POPULATION PRIVATE SECTOR HEALTH PROGRAMME 28/03/2011 Pekka Puska, Director General 41

42 CVDs are to a Great Extent Preventable Diseases Medical evidence for prevention exists. Population-based prevention is the most costeffective and the only affordable option for major public health improvement in NCD rates. Major changes in population rates can take place in a surprisingly short time. 28/03/2011 Pekka Puska, Director General 42

43 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 28/03/2011 Pekka Puska, Director General 43

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45 THANK YOU