Ncd prevention global and finnish perspectives

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Pekka Puska
Seoul, 15.11.2012

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  • World Health Organization December 4, 2012 And what's drastic here – 90% of the premature death from NCDs occur in developing countries – countries that are already vulnerable and will also been hit heavily by global economic crisis and negative effects of climate changes. (Over the next decades, it is predicted that billions of people, particularly those in developing countries, face shortages of water and food and greater risks to health and life as a result of climate change 1 ) 1 Climate Change: Impacts, Vulnerabilities and adaptation in Developing Countries (2007) United Nations Framework Convention on Climate Change (UNFCCC).
  • Ncd prevention global and finnish perspectives

    1. 1. Pekka Puska, MD, PhD, MPolScDirector General, National Institute for Health and Welfare (THL),FinlandPresident, Int. Association of National Public Health Institutes(IANPHI)Past President, World Health Federation (WHF) NCD prevention – Global and Finnish perspectives Seoul 15.11.2012 04.12.12 Pekka Puska, Director General
    2. 2. Greetings from Finland04.12.12 Pekka Puska, Director General
    3. 3. GLOBAL PUBLIC HEALTHIN TRANSITION Chronic non-communicable diseases – especially cardiovascular diseases Leading health problem in industrialized countries Main killers and rapidly growing problem in developing countries12/04/12 Pekka Puska, Director General
    4. 4. :Sourceof premature deaths from NCDs occur in developing countries 90% Total number of deaths in the world million 25 2.3M M 6 .. 8 M 68 million 20 2.3M million 15 3.7M 10.2M 10.2M 13.6M 13.6M million 10 0.5M 5.9M 5.9M 0.6M 3.3M3.0M 3.0M M 3 .. 3 M 33 3.0M 0.9M 1.1M 3.0M High-income Upper Lower Low-income countries middle-income middle-income countries Group III - Injuries Low-income countries Group II – Other deaths from noncommunicable diseases Group II – Premature deaths from noncommunicable diseases (below the age of 60), which are preventable Group I – Communicable diseases, maternal, perinatal and nutritional conditions 04.12.12 Pekka Puska, Director General 4
    5. 5. 8
    6. 6. 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
    7. 7. 69
    8. 8. 1004.12.12 Pekka Puska, Director General
    9. 9. 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
    10. 10. Theory + hard work• Theory: Medical Behavioural, social• Hard work: Practical and flexible work with the community04.12.12 Pekka Puska, Director General
    11. 11. From Karelia to National Action• First province of North Karelia as a pilot (5 years), then national action (1972–97)• 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
    12. 12. Major Elements of FinnishNational 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 institutions12/04/12
    13. 13. Major Elements of FinnishNational Action 2. • Industry, business – collaboration • Policy decisions, intersectoral collaboration, legislation • Monitoring system: health behaviours, risk factors, nutrition, diseases, mortality • International collaboration12/04/12
    14. 14. 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
    15. 15. RESULTS Lifestyles and public health can change04.12.12 Pekka Puska, Director General
    16. 16. 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
    17. 17. Use of Vegetable Oil for Cooking (men age 30–59) %70 North Karelia60 Kuopio province Southwest Finland50 Helsinki area Oulu province40 Lapland province3020100 1972 1977 1982 1987 1992 1997 2002 2007 12/04/12 WHO meeting, Helsinki 6 - 7 September 2010
    18. 18. 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
    19. 19. 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
    20. 20. 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
    21. 21. 04.12.12 Pekka Puska, Director General
    22. 22. 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
    23. 23. Observed and Predicted Declines inCoronary Mortality in Eastern Finland,Men % 0-10 Observed-20 Predicted-30 Cholesterol-40 Blood pressure Smoking-50-60-70-80-90 1972 1977 1982 1987 1992 1997 2002 2007 Year 12/04/12 Pekka Puska, Director General
    24. 24. RESULTS: SUMMARY• Big change in lifestyles and biological risk factors• Big reduction in premature NCD mortality and incidence• Increased subjective health• Healthy ageing xxx NCD changes explained to great extent by risk factor changes04.12.12 Pekka Puska, Director General
    25. 25. 04/12/12 Pekka Puska, Director General 25
    26. 26. DISCUSSION ON STRATEGIES (Finland and WHO)04.12.12 Pekka Puska, Director General
    27. 27. Community-based project (pilot, demonstration, model) National programme and policies04.12.12 Pekka Puska, Director General
    28. 28. Sound Combination of PopulationStrategy With High Risk Strategy1. Population strategy: - Greatest public health gains - Cost effective - Results also in other health benefits1. High risk strategy: - Great benefits to the persons concerned - Effective use of health services
    29. 29. 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
    30. 30. 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
    31. 31. Integrated PreventionCommon Risk Factors TOBACCO USE CVD DIABETES UNHEALTHY DIET CANCER PHYSICAL INACTIVITY COPD ALCOHOL MUSCULOSCELETAL ORAL HEALTH 04.12.12 Pekka Puska, Director General
    32. 32. Redirection of health services• Reorientation and strengthening of health systems• Primary health care: ”Now more than ever” (WHR 2008)• Special emphasis for NCDs • Chronic care model • Preventive practices04.12.12 Pekka Puska, Director General 32
    33. 33. Surveillance/monitoring• Monitoring of • ”Best buys”: NCD mortality trend  Diseases Risk factor trends  Risk factors/behaviours  Determinants  Prevention & control process (health service response)• National institutional base for surveillance and links with national health monitoring• International standardization and collaboration• Active use of surveillance results: Feed-back, communication 04.12.12 Pekka Puska, Director General 33
    34. 34. During the last few years a greatnumber of strategies and plans forevidence-based, effective preventionand health promotion have beenproducedMany important priorities havebeen identified04.12.12 Pekka Puska, Director General 34
    35. 35. FROM PRIORITIES TO IMPLEMENTATIONIDENTIFYING IMPLEMENTINGPRIORITIES THEM Implementation gap12/04/12 Pekka Puska, Director General
    36. 36. 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
    37. 37. 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
    38. 38. 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• 100.000 kg less saturated 1.8 fat in their products 1.6 1975 1980 1985 1990 1995 YEAR04.12.12 Pekka Puska, Director General
    39. 39. BERRY PROJECT IN NORTH KARELIA • To promote berry farming, product development and consumption • Dairy farmers could switch over to berry farming • Financing from Ministries of Agriculture and Commerce12/04/12
    40. 40. The Finnish Heart Symbol www.sydanmerkki.fi
    41. 41. Fruits and Vegetables – Supermarkets12/04/12
    42. 42. WORLD Deaths in 2000 Attributable to Selected Leading Risk Factors Blood pressure Tobacco Cholesterol Underweight Unsafe sex Fruit and vegetable intake High Body Mass Index Physical inactivity Alcohol Unsafe water, sanitation, and hygiene Indoor smoke from solid fuels Iron deficiency Urban air pollution Zinc deficiency Vitamin A deficiency Unsafe health care injections Occupational risk factors for injury Number of deaths (000s) 0 1000 2000 3000 4000 5000 6000 7000 8000 Source: WHR 200212/04/12 Pekka Puska, Director General
    43. 43. Seven of the Nine Top Determinants ofMortality in the World Relate to HowWe Eat, Drink and Move Diet and physical activity, together with tobacco and alcohol, are key determinants of contemporary public health12/04/12 Pekka Puska, Director General
    44. 44. RECENT POLITICAL SUPPORT UN high-level summit on NCDs New York Sept 2011 • Preceeded by Ministerial Conference in Moscow (April 2011). • Political declaration • Action on global NCD prevention and control” • WHO’s leadership, intersectoral support04.12.12 Pekka Puska, Director General 44
    45. 45. The journey to scale up global action Global Strategy for the Prevention and 2000 Control of Noncommunicable Diseases 2003 Global Strategy on Diet, Physical Activity and Health Action Plan on the Global Strategy for the 2004 Prevention and Control of NCDs 2008 Global Strategy to Reduce the Harmful Use of Alcohol 2009 WHO Global Status Report on NCDs 2010 2011 UN Political Declaration on NCDs04.12.12 Pekka Puska, Director General 45
    46. 46. 8th Global WHO Conference on health promotion- “Health in all policies” From Ottawa to Helsinki (June 2013)04.12.12 Pekka Puska, Director General
    47. 47. 3147
    48. 48. Finland Has Shown• Prevention of cardiovascular diseases is possible and pays off• Population based prevention is the most cost effective and sustainable public health approach to CVD control• Prevention calls for simple changes in some lifestyles (individual, family, community, national and global level action)• Influencing diet and especially quality of fat 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 12/04/12
    49. 49. 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
    50. 50. Conclusion• Chronic disease (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
    51. 51. Thank you04.12.12 Pekka Puska, Director General

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