mats nilsson, phd, epidemiologist february 28, 2013 · 2013-03-01 2 map with many dimensions:...

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Mats Nilsson, PhD, Epidemiologist

February 28, 2013

Futurum – the Academy for Healthcare

County Council Jönköping, Sweden

Snow’s map describing a cholera outbreak in London, September 1854

Water pumps

Cholera cases


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Map with many dimensions: Napoleons campaign against Russia 1812-1813


Public Health”Public Health – The state of health in the population.

Considers’ both the level as well as the distribution of health.”

”A good Public Health should be as good as possible and as equally distributed as possible”

Professor in Public Health Urban Janlert, Umeå University, Sweden


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Public Health

The tradition of Public health dates back more than 150 years in Sweden.

Each Swedish citizen has an unique identification, makes it possible to do longitudinal studies.



Determinants of health

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Why a public health atlas?

• Mapping geographical picture

• Basis for discussion among population, policy makers and medical profession

• Health status is affected by– Individual responsibility – life style

– Political action – government and local

– Health services


Public Health Atlas – Four steps

• 1. Is the disease a public health problem?

– More than one percent of the population is affected

• 2. Can the disease be prevented?

– Is there evidence for effective ways of health promotion and prevention?

• 3. What can be done in health care?

– Health promotion, prevention (primary and secondary), early diagnostics (screening), treatment, palliation care.

• 4. What can we learn from each other in different counties?


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• 1. Is the disease a public health problem?

– Colon cancer: No, but cancer as such is a public health problem

• 2. Can the disease be prevented?

– Primary prevention to change lifestyle. Cereals might protect, red meat might affect the development.

– Secondary prevention, part as treatment (tobacco use, alcohol, over weight, physical activity).

• 3. What can be done in health care?

– Health promotion, prevention, early diagnostics (screening), treatment, palliative care.

• 4. What can we learn from each other in different counties?

– Lifestyle factors and life style, Health curve, health promoting strategies


Public Health Atlas of Colon Cancer


The incidence of colon cancer in Sweden

Age standardized incidence females Age standardized incidence males

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In municipalities of 3 counties Colon cancer; Females

Number of new cases 2006 - 2010 Age standardized incidence 2006 – 2010

Survival in colon cancer, all causes of death

Years since diagnose

Percent

0 0 - 1 1 - 2 2 - 3 3 - 4 4 - 5 5 - 6 6 - 7 7 - 8 8 - 9 9 - 10 10 -

0

10

20

30

40

50

60

70

80

90

100

>85yrs>75yrs55 -75 yrs

<55 yrsColon cancer all ages

5 – year survival


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Futurum – akademin för hälsa och vård


Five year survival after diagnose, colon cancer

Females Males

Public Health Atlas on tobacco


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Regional dialogue and improvement work

Inquiries on tobacco habitsat doctors visit

Dental careTobacco free before surgery

Tobacco

Level 3 Help to quit tobacco use

Tobacco prevention In mothers care and children care

Level 1Smoking parents toinfants

Tobacco

Population structure

Smoking duringpregnancy

Tobacco habits among adultsSmoking / moist snuff

Tobacco habits among young people

Passive smoking

Women and childrenLevel 2 CVD Cancer Diabetes

Low birth weightTobacco habits

Tobacco policy‐Municipality County council



2,4

18,5

26,5

16,4

11,3

16,5

11,7

16,9

21,4

22,3

24,4

16,9

16,1

10,2

14,3

15,3

12,4

16

14,6

1815,8 19,2

16,7

14,1

13,2

19,1

17,2

14,2

12,8

14,1

21,7

12,4

13,6

14,3

20

18,3

16,814

20,3

18,5

0

11,1

9,3

14,3

11,7

12,6

18,4

12,1

15,8

17

13,4

13,3

14,8

11,6

12,9

10,2

10,2

129,4 14,9

17,8

7,9

10,8

18,4

15,3

11,7

12,1

9,8

8,4

11,2

9,6

13,4

14

7,5

10,14,6

Females Males

Proportion daily smokers

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Smoking habits among lung cancer patientsPercent

Females Males Females Males Females Males0

10

20

30

40

50

60

KalmarJönköpingÖstergötland

Daily smokers Stopped smoking Never smoked


When did you start smoking?

Ålder

Percent

10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

0

5

10

15

20

MalesFemales


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Number of children with low birth weight / 1 000 newborn

32,1

1639,4

34,1 28,3

50,633

31,227,2

35,6

18

31,3

20,422,8

29,9

36,2

40,6

18,3

34,7

32,5

33,6

30,6

30,2

53

27,829,5

25,2

24,1

23,6 34,1

25,1

22,3

31,5

34,1

41,6

38,5

38

31


10,5

8,5

8,2

8,1

7,3

5,5

9

12

8,7

9,1

6,3

13,7

11,5

7,6

8,1

6

12,6

9,2

12,6

9,7

11,18,8 11,6

12,2

5,7

5,2

9,7

11,9

9,4

9,5

14,1

12,9

8,9

6,3

9,8

8,7

8,2

8,6

Proportion smokersamong pregnant women

17,6

13,3

15,1

11,4

12,7

16,8

15,7

10,2

16,8

19,27,1

11,8

13,3

6,6

18

12,5

19,1

14,5

16

18,5

21,8

18,6 19,4

24,7

9,1

11

15

20,2

16,2

18,5

16,7

15,5

17,5

13,3

14,3

16

10,3

8,8

County Council Jönköping, Sweden Proportion smokers among

parents of small children

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• Tobacco free before surgery

• Support to end smoking

• Tobacco prevention in dental care

• Tobacco prevention in child health care

• Tobacco prevention in maternity welfare

• Questions about tobacco when visiting a doctor


Health care actions in the tobacco preventive area

Do You do as your neighbor?


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Fertility rate in Sweden 1970 to 2010

Fertility rate


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Child birth starts later in life

Mean age at first child


Increased no. of families with three children

Increase since end of 1990

Baby boom


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Third child fertility




Residential district outside Stockholm





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Do You do like your neighbor do?





Thank you for your attention!


mats nilsson, phd, epidemiologist february 28, 2013 · 2013-03-01 2 map with many dimensions:...

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