National ncd prevention and control strategy in Finland
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National ncd prevention and control strategy in Finland



Pekka Puska

Pekka Puska
Beijing 18.08.2012



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National ncd prevention and control strategy in Finland National ncd prevention and control strategy in Finland Presentation Transcript

  • 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) National NCD prevention and control strategy in Finland 2012 China Health Forum Beijing 18.8.2012 04.12.12 Pekka Puska, Director General
  • Greetings from Finland04.12.12 Pekka Puska, Director General
  • 04.12.12 Pekka Puska, Director General
  • 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 Project04.12.12 Pekka Puska, Director General
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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 of best 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 04.12.12 Pekka Puska, Director General
  • Theory + hard work• Theory: Medical Behavioural, social• Hard work: Practical and flexible work with the community04.12.12 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 action04.12.12 Pekka Puska, Director General
  • Evaluation / Monitoring • North Karelia – all Finland • Monitoring systems • health behaviour • risk factors • nutrition • diseases, mortality • Monitoring developed to a national NCD monitoring system by THL04.12.12 Pekka Puska, Director General
  • RESULTS• Big change in behavioural and biological risk factors• Big reduction in premature NCD mortality and incidence• Increesed subjective health• Healthy ageing04.12.12 Pekka Puska, Director General
  • Butter consumption per capita in Finland 20 18Consumption (kg per capita) 16 14 12 10 8 6 4 2 0 1955 1965 1975 1985 1995 2005 04.12.12 Pekka Puska, Director General
  • Salt intake in Finland 1977-2007FinnDiet Study 18 16 Calculated, men 14 Calculated, women 12 10 24 hour urine, men 8 24 hour urine, women 6 Lin. (24 hour urine, men) 4 2 Lin. (24 hour urine, women) 0 Lin. (Calculated, men) 77 82 87 92 94 02 07 79 81 91 97 98 Lin. (Calculated, women)19191919191919191920201904.12.12 Pekka Puska, Director General
  • Serum Cholesterol in Men Aged 30–59 Years mmol/l 7,5 7 North Karelia Kuopio 6,5 Turku/Loimaa Helsinki/Vantaa 6 Oulu Lapland 5,5 5 1972 1977 1982 1987 1992 1997 2002 2007FINRISK Studies 1997 & 2002 04.12.12 Pekka Puska, Director General
  • Systolic blood pressure in women (30–59 y) (30 mmHg 155 North Karelia 150 Kuopio province Southwest Finland 145 Helsinki area 140 Oulu province Lapland province 135 130 125 120 115 1972 1977 1982 1987 1992 1997 2002 2007North Karelia project evaluation and FINMONICA and the National FINRISK Studies 1972 - 2007 04.12.12 Pekka Puska, Director General
  • 04.12.12 Pekka Puska, Director General
  • Change in age-adjusted mortality ratesFinland, males aged 35–64 (per 100 000 population) Rate per 100 000 Coronary heart disease 1969- 2006 Change 1971 from 1969-1971 start of the North Karelia Project to 2006 extension of the Project All causes 1328 583 -56% nationally All 680 172 -75% North Karelia -85% cardiovascular Coronary 489 103 -79% heart disease All cancers 262 124 -53% All Finland -80% Gain of some 10 healthy years in Finnish popupaltion04.12.12 Pekka Puska, Director General
  • DISCUSSION ON NATIONAL STRATEGIES04.12.12 Pekka Puska, Director General
  • Community-based project (pilot, demonstration, model) National programme and policies04.12.12 Pekka Puska, Director General
  • Comprehensive action and partnershipfor national NCD prevention• Governments, policies (national, local)• Health services• Civil society (NGOs)• Private sector• Media• International collaboration (esp. WHO)04.12.12 Pekka Puska, Director General
  • Cornerstones of NCD preventionand 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 model04.12.12 Pekka Puska, Director General
  • 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)04.12.12 Pekka Puska, Director General
  • 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 people04.12.12 Pekka Puska, Director General
  • Examples of intersectoral work 1.Development of Finnish Change in fat contentRapeseed oil of Finnish cow milk 45 45 Fen: y = -0.16x + 362 44 44 43 g/kg Fen 43 42 Gen Gen: y = -0.16x + 358 42 41 1970 1975 1980 1985 1990 1995 2000 2005 2010 Year04.12.12 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 Salt concentration (%) Salt level in Finnish sausagesMeat product example: 2.4HK (Leading Finnish meat company) 2.2since 2007 annually: 2.0• 40.000 kg less salt• 10.000 kg less saturated 1.8 fat in their products 1.6 1975 1980 1985 1990 1995 YEAR04.12.12 Pekka Puska, Director General
  • 8th Global WHO Conference on health promotion- “Health in all policies” From Ottawa to Helsinki (June 2013)04.12.12 Pekka Puska, Director General
  • The North Karelia/Finlandexperience• 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 leadership04.12.12 Pekka Puska, Director General
  • Conclusion• 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 development04.12.12 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 area04.12.12 Pekka Puska, Director General
  • 04/12/12 Pekka Puska, Director General 31