national ncd prevention and control strategy in finland
DESCRIPTION
Pekka Puska Beijing 18.08.2012TRANSCRIPT
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
13.04.23 Pekka Puska, Director General
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
Pekka Puska, Director General13.04.23
699
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
Pekka Puska, Director General13.04.23
Theory + hard work
• Theory:MedicalBehavioural, social
• Hard work: Practical and flexible work with
the community
13.04.23 Pekka Puska, Director General
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
Pekka Puska, Director General13.04.23
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
Pekka Puska, Director General13.04.23
RESULTS• Big change in behavioural and
biological risk factors
• Big reduction in premature NCD mortality and incidence
• Increesed subjective health
• Healthy ageing
13.04.23 Pekka Puska, Director General
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)
Pekka Puska, Director General13.04.23
Salt intake in Finland 1977-2007FinnDiet Study
13.04.23 Pekka Puska, Director General
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
Pekka Puska, Director General13.04.23
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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
13.04.23 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
13.04.23 Pekka Puska, Director General
13.04.23 Pekka Puska, Director General
DISCUSSION ON
NATIONAL STRATEGIES
Community-based project
(pilot, demonstration, model)
National programme and policies
Pekka Puska, Director General13.04.23
Comprehensive action and partnership for national NCD prevention
• Governments, policies
(national, local)
• Health services
• Civil society (NGOs)
• Private sector
• Media
• International collaboration
(esp. WHO)
13.04.23 Pekka Puska, Director General
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 General13.04.23
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
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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)
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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
Pekka Puska, Director General13.04.23
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
13.04.23 Pekka Puska, Director General
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
13.04.23 Pekka Puska, Director General
8th Global WHO Conference on health promotion - “Health in all policies”
From Ottawa to Helsinki (June 2013)
13.04.23 Pekka Puska, Director General
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
13.04.23 Pekka Puska, Director General
• 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
13.04.23 Pekka Puska, Director General
Conclusion
13.04.23 Pekka Puska, Director General
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