achievements and challenges in ncd prevention in … and challenges in ncd... · berry project in...
TRANSCRIPT
ACHIEVEMENTS AND
CHALLENGES IN NCD
PREVENTION IN
FINLAND
Northern Dimension Partnership in Public Health meeting
Helsinki 11.10.2018
Pekka Puska
Professor, Member of Parliament
Past Director General, National Institute for Health and Welfare (THL), Finland
Past President, International Association of National Public Health Institutes
(IANPHI)
HISTORY IN FINLAND
• Hardships of war and postwar years
• Relative increase in standard of living
Great increase in CVD
• Attention to extremely high CVD mortality
• Determined action: North Karelia Project
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NORTH KARELIA PROJECT
PRINCIPLES
• 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 (diet & treatment
• Community based approach to change lifestyles
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EVALUATION / MONITORING
• North Karelia – all Finland
• Monitoring systems
health behaviour
risk factors
nutrition
diseases, mortality
Monitoring developed to a national NCD monitoring system by THL
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RESULTS
Lifestyles and publichealth can change!
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USE OF BUTTER SERUM
ON BREAD CHOLESTEROL
(MEN 30-59) (MEN30-59)
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mmol/L
Laboratory bias corrected
SALT INTAKE IN SYSTOLIC BLOOD
FINLAND 1977-2007 PRESSURE
FINNDIET STUDY (MEN 30-59)
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Now official aim: Smokefree Finland
CHANGE IN AGE-ADJUSTED MORTALITY RATES
FINLAND, MALES AGED 35–64 (PER 100 000 POPULATION)
extension of the Project
nationally
start of the North Karelia Project
North Karelia -85%
All Finland -80%
Rate per 100 000
1969-1971
2006 Change from 1969-1971 to 2006
All causes 1328 583 -56%
All cardiovascular 680 172 -75%
Coronary heart disease
489 103 -79%
All cancers 262 124 -53%
Coronary heart disease
Gain of some 10 healthy years
in Finnish population
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SIHVONEN YM. 2003
Healthy and sick years of life expectancy of 65 yearold Finns in 1980 and in 2000
Subjective health
0
5
10
15
20
1980 2000 1980 2000
ye
ars
Managing basic functions
0
5
10
15
20
1980 2000 1980 2000
ye
ars
men women men women
Healthy/no disability
Sick/disability
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RESULTS: SUMMARY
Big change in lifestyles and biological risk factors
Big reduction in premature NCD mortality and incidence
Increased subjective health
Healthy ageing
x x x
NCD changes explained to great
extent by risk factor changes
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MAJOR ELEMENTS OF FINNISH MAJOR ELEMENTS OF
NATIONAL ACTION 1. FINNISH NATIONAL ACTION 2.
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
Industry, business – collaboration Policy decisions, intersectional
collaboration, legislation
Monitoring system: health behaviours, risk factors, nutrition, diseases, mortality
International collaboration
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INTERSECTORAL WORK FOR NCD
PREVENTION
- ”HEALTH IN ALL POLICIES”
People’s lifestyles are influenced by decisions in different sectors of society (much of them beyond the health sector)
Health in general and NCD prevention in particular should be taken into account in decisions made by different sectors (health impact assessment)
Ultimately success calls for a social change process, combining government policies, expert guidance, broad health promotion and mobilization of people
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8th Global WHO Conference on health promotion - “Health in all policies”
From Ottawa to Helsinki (June 2013)
HELSINKI STATEMENT
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EXAMPLES OF INTERSECTORAL WORK (1/3)
Development of Finnish Rapeseed oil
Fen: y = -0.16x + 362
Gen: y = -0.16x + 358
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1970 1975 1980 1985 1990 1995 2000 2005 2010
Year
g/k
g
Fen
Gen
Change in fat content
of Finnish cow milk
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EXAMPLES OF INTERSECTORAL WORK
(2/3)
Biscuit example:
Leading Finnish biscuit manufacturer (LU Finland Ltd) has removed some 80.000 kg of SAFA by changing the fats used
All trans fats removed and major transfer to rapeseed oil
Meat product example:
HK (Leading Finnish meat company)
since 2007 annually:
40.000 kg less salt
100.000 kg less saturated fat in their products 1975 1980 1985 1990 1995
YEAR
1. 6
1. 8
2. 0
2. 2
2. 4
Salt
con
cent
rati
on (
%)
Sal t l evel i n Fi nni sh sausages
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Berry project in North Karelia
•To promote berry farming, product development and
consumption
•Dairy farmers could switch over to berry farming
•Financing from Ministries of Agriculture and Commerce
Finnish Heart Symbol
EXAMPLES OF INTERSECTORAL WORK (3/3)
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REDIRECTION OF HEALTH SERVICES
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• Reorientation and strengthening of health systems
•Primary health care:
”Now more than ever”
(WHR 2008)
• Special emphasis for NCDs
• Chronic care model
• Preventive practices
REFORM OF SOCIAL AND HEALTH CARE
IN FINLAND (SOTE)
Background:
Changing needs
Changing possibilities
Ageing of population
Increasing costs
Objectives:
Larger population base
Integration (primary sectorcare, social services)
Wider choice of services
Equal acces to services
Control of increasing costs
Greater emphasis on primary care and prevention
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SOLUTION
Regions (maakunnat) to be responsible
Integration
Additional contribution of private services to public primary care
Strenghtened ICT systems
Digitalization
Strengthened prevention & health promotion (regions, municipalities, NGO’s – incentives)
The reform will create 18 autonomous regions with elected councils
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CORNERSTONES OF NCD PREVENTION
AND CONTROL (WHO GLOBAL
STRATEGY)
Attention to behavioral risk factors
– Tobacco use
– Unhealthy diet
– Physical inactivity
– Harmful use of alcohol
Monitoring and surveillance of
– Risk factors and diseases
– Preventive actions
Redirection of health services
– Prevention
– Chronic care model
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GLOBAL TARGETS (WHO NCD ACTION PLAN)
1. 25 % reduction of avoidable mortality
2. 10 % reduction in harmful use of alcohol
3. 10 % reduction in insufficient physical activity
4. 30 % reduction in mean population salt intake
5. 30 % reduction in tobacco use
6. 25 % reduction in raised blood pressure
7. Halt the raise in diabetes and obesity
8. At least 50 % of eligible (=high risk) people receive drug treatment and councelling to preventheart attack and stroke
9. In 80 % availability of affordable basic technologies and essential medicines for NCD
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INTEGRATED PREVENTION
COMMON RISK FACTORS
TOBACCO USE
UNHEALTHY DIET
PHYSICAL INACTIVITY
ALCOHOL
CVD
DIABETES
CANCER
COPD
MUSCULOSCELETAL
ORAL HEALTH
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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
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PUBLIC RESPONSIBILITY
POLICY INTERVENTIONS
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DURING THE LAST FEW YEARS A GREAT
NUMBER OF STRATEGIES AND PLANS FOR
EVIDENCE-BASED, EFFECTIVE PREVENTION OF
NCD’S AND HEART HEALTH PROMOTION HAVE
BEEN PRODUCED
Many important
priorities have been
identified
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IDENTIFYING IMPLEMENTING
PRIORITIES THEM
FROM PRIORITIES TO IMPLEMENTATION
Implementation gap
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From strategies to effectiveaction
IDENTIFYINGPRIORITIES
“Less is more”
IMPLEMENTING
THEM
• Policy support
• Institutional
base
• Media support
• Resources
• Monitoring
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MAIN CAUSES OF MORTALITY
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COMPREHENSIVE ACTION AND
PARTNERSHIP FOR NATIONAL NCD
PREVENTION
Governments, policies
(national, local)
Health services
Civil society (NGOs)
Private sector
Media
International collaboration
(esp. WHO)
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MOBILIZATION OF PEOPLE IS THE KEY
CHANGES IN PEOPLE’S LIFESTYLES
POLICY DECISIONS
SOCIAL CHANGE PROCESS!
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SUCCESFUL PREVENTION OF NCD’S IS
NOT ONE TIME DECISION
It is an incremental process, applying- Health promotion- Series of policy decisions Policies (laws) influence people and people influence policy
(example: tobacco control process) Monitoring of changes crucial, for both the policy makers and
the public Strong public health institutional base + strong NGO’s Leadership – focal point(s) - collaboration
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Sustained changes in population health canonly take place with permanent changes in people’s lifestyles and environments, and
represent a long term social change process!
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Thank you
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