introduction to finnish ncd prevention - thl to... · 2014-05-02 · lifestyle transition ......

Introduction to Finnish NCD Prevention

PREVENTION OF NONCOMMUNICABLE DISEASES SEMINAR, Helsinki 14.3.2011

28/03/2011 Pekka Puska, Director General 2

Global Health Burden

Estimated global deaths by cause, all ages, 2005

H IV/ A ID S

T uberculo sis

M alaria

C ardio vascular

diseases

C ancer

C hro nic respirato ry

diseases

D iabetes

0

2000000

4000000

6000000

8000000

10000000

12000000

14000000

16000000

18000000

20000000

Source : WHO 2005: «Preventing Chronic Diseases: A Vital Investment»

328/03/2011 3Pekka Puska, Director General

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


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



3


North Karelia ProjectPrinciples for Defining the Intermediate Objectives

• 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


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


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 (1977–95)

• 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


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.


Use of Butter on Bread (men age 30–59)

0

10

20

30

40

50

60

70

80

90

100

1972 1977 1982 1987 1992 1997 2002

North Karelia

Kuopio province

Southwest Finland

Helsinki area

Oulu province

Lapland province

Kg/m2


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

per

cap

ita)


Milk Consumption in Finland in 1970 and 2006 (kg per capita)

0

20

40

60

80

100

120

140

kg

1960 1970 1980 1990 2000 2010

Whole milk

Whole form milk

Low fat milk

Skim milk


Use of Vegetable Oil for Cooking (men age 30–59)

0

10

20

30

40

50

60

70

1972 1977 1982 1987 1992 1997 2002 2007

North Karelia

Kuopio province

Southwest Finland

Helsinki area

Oulu province

Lapland province

%


Fruits and Vegetables – Supermarkets


Salt Intake in Finland 1977–2002

0

2

4

6

8

10

12

14

16

1977

1979

1981

1982

1987

1991

1992

1994

1997

1998

2002

Per capita

statistics

Dietary surveys,

men

Dietary surveys,

women

Sodium excretion,

men

Sodium excretion,

women

Lin. (Sodium

excretion, men)

Lin. (Per capita

statistics)

g/d

ay

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


18

Fat intake in Finland 1982-2007

EN%

Year

Recommendations

0

10

20

30

40

1982 1987 1992 1997 2002 2007

Total fat (~ 30 EN%)

SFA (~10 EN%)

MUFA (10-15 EN%)

PUFA (5-10 EN%)

Sources:Uusitalo et al. 1986

Kleemola et al. 1994

Findiet Study Group 1998

Männistö et al. 2003

Paturi et al. 2008


Serum Cholesterol in Men Aged30–59 Years

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


Systolic Blood Pressure in Men Aged 30–59 Years

120

130

140

150

160

1972 1977 1982 1987 1992 1997 2002

North Karelia

Kuopio province

Southwest Finland

Helsinki area

Oulu province

Lapland province

mmHg

28/03/2011 21

Smoking in men (30–59 y)

0

10

20

30

40

50

60

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

%

Pekka Puska, Director General

28/03/2011 Pekka Puska, Director General

Age-adjusted mortality rates of coronary

heart disease in North Karelia

and the whole of

Finland among

males aged

35–64 years

from 1969

to 2006.

Mortality per

100 000

populationAge-standadized to European population

start of the North Karelia Project

extension of the Project nationally

North Karelia

All Finland

- 85%

- 80%

22


Observed and Predicted Declines in Coronary Mortality in Eastern Finland, Men

-90

-80

-70

-60

-50

-40

-30

-20

-10

0

1972 1977 1982 1987 1992 1997 2002 2007Year

%

Observed

Predicted

Cholesterol

Blood pressure

Smoking


Mortality Changes in Finland from 1969–71 to 2006 (Men 35–64 Years, Age Adjusted)

Rate (per 100.000) Change from

1969–71 2006 1969–71 to 2006

All causes 1328 583 - 56%

All cardiovascular 680 172 - 75%

Coronary heart disease 489 103 - 79%

All cancers 262 124 - 53%


• A comprehensive, determined and theory-based community program can have a meaningful positive effect on riskfactors 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

CONCLUSIONS


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


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


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

Pekka Puska, Director General 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


Prevention targetsthe population levelsof most importantrisk factors.

28/03/2011


0 1000 2000 3000 4000 5000 6000 7000 8000

Occupational risk factors for injury

Unsafe health care injections

Vitamin A deficiency

Zinc deficiency

Urban air pollution

Iron deficiency

Indoor smoke from solid fuels

Unsafe water, sanitation, and hygiene

Alcohol

Physical inactivity

High Body Mass Index

Fruit and vegetable intake

Unsafe sex

Underweight

Cholesterol

Tobacco

Blood pressure

WORLDDEATHS IN 2000 ATTRIBUTABLE TO SELECTED LEADING RISK FACTORS

Number of deaths (000s)

Source: WHR 2002

28/03/2011

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


RISK FACTORS

─Tobacco: FCTC (2003)

─Diet & Physical activity: global strategy (2004)

─Alcohol: global strategy under preparation (2010)



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


24


Theory and Action for Effective

Programmes and Policies

MEDICAL

KNOWLEDGE

SOCIAL & EFFECTIVE

BEHAVIORAL PROGRAMS

THEORY POLICIES

STRONG

SUSTAINED

IMPLEMENTATION

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.



43

28/03/2011


IDENTIFYING IMPLEMENTING

PRIORITIES THEM

FROM PRIORITIES TO IMPLEMENTATION

28/03/2011


PUBLIC

POLICY

HEALTH PROGRAMME

POPULATIONPRIVATE

SECTOR


CVDs are to a Great Extent Preventable Diseases

• Medical evidence for prevention exists.

• Population-based prevention is the most cost-

effective 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.


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

THANK YOU

introduction to finnish ncd prevention - thl to... · 2014-05-02 · lifestyle transition ......

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