national ncd prevention and control strategy in finland

2012 China Health Forum

Beijing 18.8.2012

National NCD prevention and control strategy in Finland

Pekka Puska, MD, PhD, MPolScDirector General, National Institute for Health and Welfare (THL), FinlandVice President, Int. Association of National Public Health Institutes (IANPHI)Past President, World Health Federation (WHF)

13.04.23 Pekka Puska, Director General

Greetings from Finland

Pekka Puska, Director General13.04.23

History in Finland

• Hardships of war and postwar years

• Relative increase in standard of livingGreat increase in CVD

• Attention to extremely high CVD mortality

• Determined action: North Karelia Project


1010Pekka Puska, Director General13.04.23

North Karelia ProjectPrinciples

• Due to the chronic nature of CVD, the potential for the control of the problemlies 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


Theory + hard work

• Theory:MedicalBehavioural, social

• Hard work: Practical and flexible work with

the community


From Karelia to National Action

• First province of North Karelia as a pilot (5

years), then national action (1972–77)

• Continuation is North Karelia as national

demonstration (1977–97)

• Good scientific evaluation to learn of the

experience

• Comprehensive national action


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


RESULTS• Big change in behavioural and

biological risk factors

• Big reduction in premature NCD mortality and incidence

• Increesed subjective health

• Healthy ageing


Butter consumption per capita in Finland

0

2

4

6

8

10

12

14

16

18

20

1955 1965 1975 1985 1995 2005

Co

nsu

mp

tio

n (

kg p

er c

apit

a)


Salt intake in Finland 1977-2007FinnDiet Study


0

2

4

6

8

10

12

14

16

18

197719791981198219871991199219941997199820022007

Calculated, men

Calculated, women

24 hour urine, men

24 hour urine, women

Lin. (24 hour urine, men)

Lin. (24 hour urine, women)

Lin. (Calculated, men)

Lin. (Calculated, women)

Serum Cholesterol in Men Aged 30–59 Serum Cholesterol in Men Aged 30–59 YearsYears

FINRISK Studies 1997 & 2002

mmol/l

5

5,5

6

6,5

7

7,5

1972 1977 1982 1987 1992 1997 2002 2007

North Karelia

Kuopio

Turku/Loimaa

Helsinki/Vantaa

Oulu

Lapland


13.04.23

Systolic blood pressure in Systolic blood pressure in women (30women (30–59 y)59 y)

115

120

125

130

135

140

145

150

155

1972 1977 1982 1987 1992 1997 2002 2007

North Karelia

Kuopio province

Southwest Finland

Helsinki area

Oulu province

Lapland province

North Karelia project evaluation and FINMONICA and the National FINRISK Studies 1972 - 2007

mmHg

Pekka Puska, Director General

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 diseaseCoronary heart disease

Gain of some 10 healthy years in Finnish popupaltion

Gain of some 10 healthy years in Finnish popupaltion



DISCUSSION ON

NATIONAL STRATEGIES

Community-based project

(pilot, demonstration, model)

National programme and policies


Comprehensive action and partnership for national NCD prevention

• Governments, policies

(national, local)

• Health services

• Civil society (NGOs)

• Private sector

• Media

• International collaboration

(esp. WHO)


Cornerstones of NCD prevention and control (WHO global strategy)• Attention to behavioural 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


Pekka Puska, Director General

Integrated PreventionCommon Risk Factors

TOBACCO USETOBACCO USE

UNHEALTHY DIETUNHEALTHY DIET

PHYSICAL PHYSICAL INACTIVITYINACTIVITY

ALCOHOLALCOHOL

CVD

DIABETES

CANCER

COPD

MUSCULOSCELETAL

ORAL HEALTH

13.04.23

Role of health monitoring

• Comprehensive NCD monitoring

• Emphasis on monitoring of main risk factors and related behaviours (also in population subgroups)

• Rapid feed-back to policy makers and the public

• National institutional base (THL)


Intersectoral work towards 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)

• Social change process combining government policies, expert guidance, broad health promotion and mobilization of people


Examples of intersectoral work 1.

Development of Finnish Rapeseed oil

Fen: y = -0.16x + 362

Gen: y = -0.16x + 358

41

42

42

43

43

44

44

45

45

1970 1975 1980 1985 1990 1995 2000 2005 2010

Year

g/kg

Fen

Gen

Change in fat content of Finnish cow milk

Change in fat content of Finnish cow milk


Examples of intersectoral work 2.

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

• 10.000 kg less saturated

fat in their products 1975 1980 1985 1990 1995

YEAR

1.6

1.8

2.0

2.2

2.4

Salt

co

ncen

tratio

n (

%)

Salt level in Finnish sausages


8th Global WHO Conference on health promotion - “Health in all policies”

From Ottawa to Helsinki (June 2013)


The North Karelia/Finland experience• Supports and has interacted much with

the WHO NCD strategy:– Integrated prevention–FCTC, Diet & physical activity strategy

• Happy about the recent political support to upgrading of NCD prevention–UN NCD Summit in September 2011

in New York–Follow up work under WHO leadership


• NCD prevention and control is possible and pays off

• Population based NCD prevention by appropriate policies and health promotion activities is the most effective way to improve public health

• Influencing NCD related lifestyles is also the way to support sustainable social and economic development


Conclusion


Best wishes to the public health work in China

and many thanks for the good

collaboration between China and Finland in this area

13/04/23 Pekka Puska, Director General 31

national ncd prevention and control strategy in finland

Health & Medicine

pekka puska

mpolscdirector general

prevention health

province of north karelia

north karelia kuopio

north karelia projectto

beyondthe health

national ncd monitoring