DEVELOPMENT AND DELIVERY OF EFFECTIVE PUBLIC HEALTH ACTIONS IN FINLAND – WE CAN SUCCESSFUL WITH NEW CHALLENGES ALSO<br />A...
Non-communicable diseases are preventable – in Finland and globally<br />Lifestyle related NCD’s are largely preventable u...
North Karelia Project as demonstration project started NCD prevention work in Finland<br />In early 1970’s North Karelian ...
Basis and activities of the North Karelia project<br />Public petition to the Parliament, which through state budget commi...
30/05/2011<br />5<br />Ensuing national NCD prevention proved  successful <br />(Age-adjusted annual mortality rates / 100...
SOME OLD PROBLEMS REMAIN WHILE NEW ONES ALSO EMERGE<br />major Finnish Health challenges are still lifestyle related<br />...
Current health challenges<br />CVD and cancer are responsible for more than 60% of the population’s mortality<br />Mental ...
2.6.2011<br />THL<br />8<br />kg/m2<br />Average BMI of Finnish men 25-64 years 1997-2007 (Vartiainen THL 2010)<br />
9<br />Total consumption of absolute alcohol per capita in litres 1965-2009, Finland (Karlsson THL 2010)<br />10.2 l<br />...
Average 24 h energy intake (kcal) of adult Finns 1982-2007, 48h or 24 h recall<br />Energy intake		1982			2009<br />Men 25...
Health enhancing physical activity in Finland (Husu et al. UKK-Institute 2011)<br />Half of adults meet current guidelines...
2.6.2011<br />THL<br />12<br />19-34<br />35-49<br />50-64<br />25-49<br />25-49<br />19-34<br />35-49<br />50-64<br />25-...
WELFARE STATE responds to new health challenges also<br />30/05/2011<br />13<br />
GDP per capitain Finland 1975-2010, e<br />14<br />30/05/2011<br />
15<br />Characteristics of Finnish public sector <br /><ul><li>Large & strong public sector
public expenditures 56.3% of GDP in 2009</li></ul>Universal rights<br />social protection / services (23.9% of GDP) not ta...
The Ministry of Social Affairs and Health<br />Legislation<br />Funding and directing activities<br />Coordinates producti...
Ministry of Social Affairs and Health and related national authorities<br />30/05/2011<br />17<br />
2.6.2011<br />18<br />THL promotes nation’s health and welfare <br />THL monitors the state of health and welfare, and stu...
The basis of THL’s work<br />Strong basic and applied research – from societal level to the level of cells<br />Long-stand...
National programmes and recommendations for health promotion<br />Government Resolution on Health 2015 Public Health Progr...
Promoting health-enhancing physical activity and nutrition: resolution and implementation document (2008)<br />Objectives:...
Methods<br />Influencing culture, living environments, circumstances, products, and societal structures<br />Ensuring enou...
Main alcohol policy implementation measures<br />Early intervention model in primary and occupational health care settings...
Main activities to reduce tobacco use (based on FCTC)<br />Keep prices of tobacco products as high as possible<br />Promot...
Tobacco act came into force on October 1, 2010<br />As the first country in the world: aims at gradual elimination of cons...
Some current THL’s programs to develop and implement instruments for local use<br />Local programs (ATH) to increase welfa...
GOAL model<br />GOAL group<br />Municipal <br />administration<br />Community-based interventions/specific target programm...
National strengths <br />Efficient public health system including planning, reporting and evaluation<br />Covering regular...
More national strengths <br />Strong focus on primary health care development and Health in All Policies principle<br />Go...
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Plenary1 a uutela

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Plenary1 a uutela

  1. 1. DEVELOPMENT AND DELIVERY OF EFFECTIVE PUBLIC HEALTH ACTIONS IN FINLAND – WE CAN SUCCESSFUL WITH NEW CHALLENGES ALSO<br />Antti Uutela, PhD, Research professor, Director<br />National Institute for Health and Welfare THL, Department of Lifestyle and Participation, Finland<br />Professor, University of Tampere, Finland<br />President, Finnish Society of Sport Sciences<br />
  2. 2. Non-communicable diseases are preventable – in Finland and globally<br />Lifestyle related NCD’s are largely preventable until old age<br />Smoking, diet/alcohol use, and physical activity are relevant lifestyles<br />Lifestyle is greatly influenced industrial structure, culture, and social and physical environments, and well as psychosocial characteristics of individuals<br />Therefore, lifestyle is also apt to respond to interventions, including policies and programs<br />All policies may have health impacts – and all agencies involved with them form therefore the public health system, and, that<br />Implementation partnerships are needed for good results<br />30/05/2011<br />2<br />
  3. 3. North Karelia Project as demonstration project started NCD prevention work in Finland<br />In early 1970’s North Karelian men of 35-64 years had annual coronary heart disease mortality of 700/100,000 <br />Relevant factors contributing to this were identified as:<br />too high saturated fat intake<br />high prevalence of daily smoking<br />untreated high blood pressure<br />After careful planning and implementation of policies and programs successful change in NCD’s has been achieved <br />30/05/2011<br />3<br />
  4. 4. Basis and activities of the North Karelia project<br />Public petition to the Parliament, which through state budget committed the region to following activities (state governance):<br />Screening of risk factors and when necessary treatment (hospital districts)<br />Courses for general population on healthy lifestyle(NGO’s)<br />Partnership with industry for healthier foods (less fat, more fiber - business)<br />Use of national media to support the change in diet and regarding smoking (public service)<br />A formative and evaluative study was also initiated<br />
  5. 5. 30/05/2011<br />5<br />Ensuing national NCD prevention proved successful <br />(Age-adjusted annual mortality rates / 100,000; Males 35-64 years of age (Puska THL 2011))<br />
  6. 6. SOME OLD PROBLEMS REMAIN WHILE NEW ONES ALSO EMERGE<br />major Finnish Health challenges are still lifestyle related<br />30/05/2011<br />6<br />
  7. 7. Current health challenges<br />CVD and cancer are responsible for more than 60% of the population’s mortality<br />Mental disorders and musculo-skeletal problems account for over 60% of work disabilities<br />Among work-age men and women No. 1 cause for mortality is alcohol (men’s No. 2 CHD, women’s breast cancer)<br />T2D is increasing and prospects for future are alarming<br />30/05/2011<br />7<br />
  8. 8. 2.6.2011<br />THL<br />8<br />kg/m2<br />Average BMI of Finnish men 25-64 years 1997-2007 (Vartiainen THL 2010)<br />
  9. 9. 9<br />Total consumption of absolute alcohol per capita in litres 1965-2009, Finland (Karlsson THL 2010)<br />10.2 l<br />Other consumption<br />From sales statistics<br />S<br />
  10. 10. Average 24 h energy intake (kcal) of adult Finns 1982-2007, 48h or 24 h recall<br />Energy intake 1982 2009<br />Men 25-64 years 2873 2206<br />Women 25-64 years 2071 1620<br /> A very significant drop in energy intake<br />Physical activity must have reduced even more than the decrease of energy intake allows<br />30/05/2011<br />10<br />
  11. 11. Health enhancing physical activity in Finland (Husu et al. UKK-Institute 2011)<br />Half of adults meet current guidelines for health-enhancing aerobic activity <br />Adult Finns sit in the average 7 hours a day<br />Few Finns do resistance training or stretching/ balance training<br />Thus, only a good part of 10% of adult Finns meet and national (and EU) guidelines<br />30/05/2011<br />11<br />
  12. 12. 2.6.2011<br />THL<br />12<br />19-34<br />35-49<br />50-64<br />25-49<br />25-49<br />19-34<br />35-49<br />50-64<br />25-49<br />25-49<br /><ul><li>Initiation of smoking by time period 25-49 yrs, red stands for women (impact of tobacco laws)</li></ul>Daily smoking, men and<br />Women, 15-64 years<br />%<br />%<br />60<br />100<br />90<br />50<br />80<br />Miehet<br />Men<br />70<br />40<br />60<br />30<br />50<br />40<br />20<br />30<br />Naiset<br />Women<br />20<br />10<br />10<br />0<br />0<br />1961–65<br />1916–20<br />1956–60<br />1966–70<br />1951–55<br />1946–50<br />1941–45<br />1936–40<br />1931–35<br />1926–30<br />1921–25<br />1976–80<br />1971–75<br />1960<br />1970<br />1997<br />1999<br />2001<br />2003<br />2005<br />83-85<br />78-79<br />89-90<br />93-94<br />
  13. 13. WELFARE STATE responds to new health challenges also<br />30/05/2011<br />13<br />
  14. 14. GDP per capitain Finland 1975-2010, e<br />14<br />30/05/2011<br />
  15. 15. 15<br />Characteristics of Finnish public sector <br /><ul><li>Large & strong public sector
  16. 16. public expenditures 56.3% of GDP in 2009</li></ul>Universal rights<br />social protection / services (23.9% of GDP) not targeted for specific groups (e.g. poor) in 2009<br />Public health service: 9.2% of GDP in 2009<br />Education: 6.6% of GDP in 2009<br />Unemployment rate 9% in 2009<br />Individual social security based on resources from taxation on municipal and national level (total average tax rate 43%)<br />Governance highly decentralised into municipalities<br />Guidance from national government essentially by information<br />Relatively high level of welfare benefits (about 6th highest in EU)<br />
  17. 17. The Ministry of Social Affairs and Health<br />Legislation<br />Funding and directing activities<br />Coordinates production of tools for information-based guidance<br />2.6.2011<br />2.6.2011<br />Kerttu Perttilä, THLEsityksen nimi / Tekijä<br />16<br />16<br />
  18. 18. Ministry of Social Affairs and Health and related national authorities<br />30/05/2011<br />17<br />
  19. 19. 2.6.2011<br />18<br />THL promotes nation’s health and welfare <br />THL monitors the state of health and welfare, and studies their determinants, in population groups<br />THL makes reviews, gives briefings, and develops and implements activities, too<br />THL develops instruments for municipal use, especially for theprimary health care:<br />Welfare strategies, planning and review<br />Guidelines for activities<br />Guidelines for organization of work<br />Instruments for primary, secondary and tertiary prevention<br />
  20. 20. The basis of THL’s work<br />Strong basic and applied research – from societal level to the level of cells<br />Long-standing and covering population follow-ups <br />Program development, implementation, and reviewing<br />Dissemination of information and skills<br />Home page for innovative interventions (INNOKYLÄ)<br />Expert activities in municipalities, region, national and international level<br />Cooperation and networking with other public health system actors<br />30/05/2011<br />19<br />
  21. 21. National programmes and recommendations for health promotion<br />Government Resolution on Health 2015 Public Health Programme (2001)<br />Quality Recommendation for Health Promotion (2006)<br />Governmental Policy Programme for Health Promotion (2007)<br />National Action Plan to reduce health inequalities 2008–2011 (2008)<br />Government Resolution on Development Guidelines for Health-enhancing Physical Activity and Nutrition (2008)<br />National Development Plan for Social and Health Care Services, KASTE –programme 2008-2011<br />2.6.2011<br />2.6.2011<br />Kerttu Perttilä, THLEsityksen nimi / Tekijä<br />20<br />20<br />
  22. 22. Promoting health-enhancing physical activity and nutrition: resolution and implementation document (2008)<br />Objectives:<br />To increase number of physically active, decrease number of people marginalized from physical activity<br />To increase number of people following nutrition recommendations <br />To decrease number of overweight, obese persons (related to physical inactivity and nutrition)<br />Make the above changes especially among the low-SES people<br />30/05/2011<br />21<br />
  23. 23. Methods<br />Influencing culture, living environments, circumstances, products, and societal structures<br />Ensuring enough information and skills in all population groups<br />Encouraging, supporting, and guiding individuals and communities, especially the most vulnerable<br />30/05/2011<br />22<br />
  24. 24. Main alcohol policy implementation measures<br />Early intervention model in primary and occupational health care settings<br />Increasing tax of alcohol<br />Reducing use of alcohol by parents and harm to children through purposeful policy measures<br />Ensuring treatment of all pregnant women with alcohol problem<br />Ensuring sufficient support for children whose parents have alcohol problem<br />30/05/2011<br />23<br />
  25. 25. Main activities to reduce tobacco use (based on FCTC)<br />Keep prices of tobacco products as high as possible<br />Promote smoke-free environments<br />Prohibit sales promotion and advertising of tobacco products<br />Limit the availability of tobacco products<br />Regulate the contents of tobacco products and use warnings on packages<br />Information and communication supporting non-smoking<br />Support for giving up smoking<br />30/05/2011<br />24<br />
  26. 26. Tobacco act came into force on October 1, 2010<br />As the first country in the world: aims at gradual elimination of consumption of tobacco products altogether<br />Strives to prevent initiation of smoking among children and youth <br />Controls smoking in their growth environment<br />Tobacco products should not be accessible to children and youth in their everyday environment<br />Ban of smoking in child and youth environments (near day care centers and schools)<br />30/05/2011<br />25<br />
  27. 27. Some current THL’s programs to develop and implement instruments for local use<br />Local programs (ATH) to increase welfare and health, and health inequalities<br />Regional programs for prevention of T2D<br />DEHKO<br />IKIHYVÄ (GOAL)<br />Regional programs for improvement of functional ability<br />IKIHYVÄ (GOAL)<br />Prevention of home and leisure accidents <br />30/05/2011<br />26<br />
  28. 28. GOAL model<br />GOAL group<br />Municipal <br />administration<br />Community-based interventions/specific target programmes<br />Type II <br />diabetes<br />prevention<br />Promotion <br />of<br />functional <br />capability <br /> Regional <br />application<br />of Current<br />Care <br />guidelines<br />Telephone counseling for person with arterial disease<br />Evaluation and cohort study<br />
  29. 29. National strengths <br />Efficient public health system including planning, reporting and evaluation<br />Covering regular population monitoring systems to support prevention<br />Fluent cooperation between governmental sectors<br />Strong research base (including that of THL)<br />Improved synergy and cost-efficiency of public health system institutions (at nationaland local levels)<br />30/05/2011<br />28<br />
  30. 30. More national strengths <br />Strong focus on primary health care development and Health in All Policies principle<br />Good cooperation with local government, NGO’s and business<br />Demonstration project yielding results that have been widely implemented (DPS, DEHKO, IKIHYVÄ)<br />Increased use of ICT technology<br />30/05/2011<br />29<br />
  31. 31. Thank you!<br />30/05/2011<br />30<br />

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