North karelia

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North karelia

  1. 1. Pekka Puska Director General National Public Health Institute – KTL Helsinki, Finland FOOD AND PUBLIC HEALTH NORDIC FOOD WEEK, St. Petersburg 19.9.2007
  2. 2. NORDIC FOOD WEEK 19.9.2007 2
  3. 3. NORDIC FOOD WEEK 19.9.2007 3 3
  4. 4. Global Public Health Transition in Chronic diseases – especially cardiovascular diseases Leading health problem in industrialized countries Main killers and rapidly growing problem in developing countries NORDIC FOOD WEEK 19.9.2007 4
  5. 5. Projected Main Causes of Death, Worldwide, All Ages, 2005 NORDIC FOOD WEEK 19.9.2007 NORDIC FOOD WEEK 19.9.2007 5
  6. 6. NCDs 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. NORDIC FOOD WEEK 19.9.2007 6
  7. 7. Diabetes Prevention Study (DPS) Cumulative incidence of T2D, % 50 Control 40 30 20 Intervention 10 Intervention ceased 0 0 1 Follow-up time, years 2 3 4 5 6 7 Lindström et al, Lancet 2006:368;1673-79 8 8
  8. 8. Prevention targets the population levels of most important risk factors. NORDIC FOOD WEEK 19.9.2007 8
  9. 9. Developed Countries Deaths in 2000 Attributable to Selected Leading Risk Factors B lo o d p ressu re To b acco C h o lestero l H ig h B o d y M ass I n d ex L o w fru it an d veg etab le in take Ph ysical in activity Alco h o l U rb an air p o llu tio n L ead exp o su re Occu p atio n al carcin o g en s I llicit d ru g s U n safe sex Occu p atio n al p articu lates Occu p atio n al risk facto rs fo r in ju ry Number of deaths (000s) 0 500 100 0 1500 NORDIC FOOD WEEK 19.9.2007 20 00 2 500 3 000 9
  10. 10. 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 alcohol, are key determinants of contemporary public health NORDIC FOOD WEEK 19.9.2007 10
  11. 11. WHO’s NCD Strategy 2000 NCD’s a priority Prevention key Integrated approach, targeting main behavioural factors: diet, physical activity and tobacco NORDIC FOOD WEEK 19.9.2007 11
  12. 12. Integrated Prevention - Common Risk Factors CVD TOBACCO USE DIABETES UNHEALTHY DIET CANCER PHYSICAL INACTIVITY COPD MUSCULOSCELETAL ALCOHOL ORAL HEALTH NORDIC FOOD WEEK 19.9.2007 12
  13. 13. Lifestyles in Key Position Individual health Population health Attention to determinants of lifestyle changes NORDIC FOOD WEEK 19.9.2007 13
  14. 14. Two Prevention Strategies 1) High risk strategy (individual) 1) Population strategy (public health) NORDIC FOOD WEEK 19.9.2007 14
  15. 15. NORDIC FOOD WEEK 19.9.2007 16 15
  16. 16. Combing Personal and Public Responsibilities • Personal Responsibility ”Nobody can take better care of your health than yourself” • Public Responsibility ”Make the healthy choices the easy ones” (Ottawa declaration) NORDIC FOOD WEEK 19.9.2007 16
  17. 17. PUBLIC RESPONSIBILITY POLICY INTERVENTIONS NORDIC FOOD WEEK 19.9.2007 17
  18. 18. Strong Interaction Between Different Levels Needed Global Regional EU National Local NORDIC FOOD WEEK 19.9.2007 18
  19. 19. Global Level: Role of WHO Global health policy leadership (”organization of governments”) combined with good partnership and collaboration (other international organizations, NGO’s, private sector) NORDIC FOOD WEEK 19.9.2007 19
  20. 20. Global WHO Development FCTC (Framework Convention on Tobacco Control) - 2003 Global strategy on diet, physical activity and health - 2004 NORDIC FOOD WEEK 19.9.2007 20
  21. 21. Strong Global Influences – Global Health Actions Needed: WHO Global Strategy on Diet, Physical Activity and Health Adopted in 2004 NORDIC FOOD WEEK 19.9.2007 21
  22. 22. WHO Global Strategy on Diet, Physical Activity and Health • Comprehensive roadmap for Member States and other stakeholders • Based on strong evidence and broad consultations • Emphasizes positive actions and collaboration • Supports Member States (WHA 2004) • Addresses global responses NORDIC FOOD WEEK 19.9.2007 22
  23. 23. WHO / FAO Expert Report Recommendations Limit saturated fat (<10%) and replace by unsaturated Total fat intake: 15-30% Limit salt (sodium) intake (<5 g) Limit sugar intake (<10%) Increase fruit and vegetable intake (>400 g) Ensure physical activity: at least 30-60 min Ensure energy balance RECOMMENDATIONS OF WHO / FAO EXPERT REPORT ON DIET, NUTRITION AND PREVENTION OF CHRONIC DISEASES (WHO / TRS s. 16; 2003) NORDIC FOOD WEEK 19.9.2007 23
  24. 24. NORDIC FOOD WEEK 19.9.2007 24
  25. 25. NORDIC FOOD WEEK 19.9.2007 26 25
  26. 26. 27
  27. 27. North Karelia Project Principles for Defining the Intermediate Objectives • 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 NORDIC FOOD WEEK 19.9.2007 27
  28. 28. 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 NORDIC FOOD WEEK 19.9.2007 28
  29. 29. Examples of Innovative Nutrition Activities in North Karelia • • • • • • • Lay leader programme Berry and vegetable project Risk reduction TV programmes Collaboration with housewives’ organization Cholesterol lowering village competitions Widespread fingertip cholesterol measurements Collaborative projects with industry & supermarkets • Health fairs NORDIC FOOD WEEK 19.9.2007 29
  30. 30. Rapeseed Oil NORDIC FOOD WEEK 19.9.2007 30
  31. 31. Fruits And Vegetables – Supermarkets NORDIC FOOD WEEK 19.9.2007 31
  32. 32. Functional food development: Benecol example •BENECOL® products available: •Spread •Cream Cheese •Pasta •Butter Milk •Yoghurt •Yoghurt Drink •Turkey Sausage •Milk Drink •Turkey cold cuts NORDIC FOOD WEEK 19.9.2007 32 sivu
  33. 33. www.sydanmerkki.fi NORDIC FOOD WEEK 19.9.2007 33
  34. 34. NORDIC FOOD WEEK 19.9.2007 34
  35. 35. Evaluation / Monitoring - North Karelia – all Finland - Monitoring systems • health behaviour • risk factors • nutrition • diseases, mortality NORDIC FOOD WEEK 19.9.2007 35
  36. 36. BIG CHANGES IN LIFESTYLES AND RISK FACTORS NORDIC FOOD WEEK 19.9.2007 36
  37. 37. Kg/m2 Use of Butter on Bread (men age 30–59) 100 90 80 70 60 50 40 30 20 10 0 North Karelia Kuopio province Southwest Finland Helsinki area Oulu province Lapland province 1972 1977 1982 1987 1992 1997 2002 NORDIC FOOD WEEK 19.9.2007 37
  38. 38. Use of Vegetable Oil for Cooking (men age 30–59) 70 North Karelia Kuopio province Southwest Finland Helsinki area Oulu province Lapland province 60 50 40 30 20 10 0 1972 1977 1982 1987 1992 1997 2002 NORDIC FOOD WEEK 19.9.2007 38
  39. 39. g/day Salt Intake in Finland 1977–2002 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 NORDIC FOOD WEEK 19.9.2007 39
  40. 40. mmol/l Serum Cholesterol in Men Aged 30–59 Years 7.5 7 North Karelia Kuopio Turku/Loimaa Helsinki/Vantaa Oulu Lapland 6.5 6 5.5 5 1972 1977 1982 1987 1992 1997 2002 FINRISK Studies 1997&2002 NORDIC FOOD WEEK 19.9.2007 40
  41. 41. Systolic Blood Pressure in Women Aged 30–59 Years mmHg 160 North Karelia Kuopio province Southwest Finland Helsinki area Oulu province Lapland province 150 140 130 120 1972 1977 1982 1987 1992 1997 NORDIC FOOD WEEK 19.9.2007 2002 41
  42. 42. Age-adjusted mortality rates of coronary heart disease in North Karelia and the whole of 700 start of the North Karelia Project Finland among 600 males aged extension of the Project nationally 35–64 years 500 from 1969 North Karelia to 2002. 400 300 Mortality per 100 000 population All Finland 200 Year 100 - 82% - 75% 69 72 75 78 81 84 87 90 93 96 99 2002 NORDIC FOOD WEEK 19.9.2007 42
  43. 43. Mortality Changes in North Karelia 1970–1995 (per 100.000, men 35–64 years, age adjusted) Rate in 1970 All causes 1509 All cardiovascular Coronary heart disease All cancers Lung cancers 855 672 271 147 NORDIC FOOD WEEK 19.9.2007 Change in 1970–95 - 49% - 68% - 73% - 44% - 71% 43
  44. 44. Observed and Predicted Declines in Coronary Mortality in Eastern Finland, Men Population dietary changes explain much of the reduction in heart disease mortality in Finland. Decline in mortality 0 -10 -20 -30 -40 Observed Predicted Cholesterol Blood pressure Smoking Vartiainen, Puska et al BMJ 1995 -50 -60 72 NORDIC FOOD WEEK 19.9.2007 74 76 78 80 82 84 86 88 90 92 44
  45. 45. North Karelia Project Conclusions from the North Karelia Project • A comprehensive, determined and theory-based community program can have a meaningful positive effect on risk factors and life styles • Such changes are associated with respective favourable changes in chronic disease rates health of the population and • A major national demonstration program can be a strong tool for favourable national development in chronic disease prevention and health promotion NORDIC FOOD WEEK 19.9.2007 45
  46. 46. NORDIC FOOD WEEK 19.9.2007 47 46
  47. 47. DISCUSSION ON FOOD, NUTRITION INTERVENTIONS AND PUBLIC HEALTH FROM THE FINNISH EXPERIENCE NORDIC FOOD WEEK 19.9.2007 47
  48. 48. Strong Concensus for Nutrition Recommendations WHO / FAO NORDIC RECOMMENDATION FINNISH NAT. NUTR. COUNCIL RECOMMENDATIONS 2003 2004 2005 Numerous national and expert body recommendations NORDIC FOOD WEEK 19.9.2007 48
  49. 49. International Strategies • WHO Global Strategy on Diet, Physical Activity and Health 2004 • Nordic Plan for Action 2006 • WHO / EU Ministerial Charter on Counteracting Obesity (Istanbul 2006) • EU White Paper on Nutrition Overweight and Obesity (2007) NORDIC FOOD WEEK 19.9.2007 49
  50. 50. FOOD IS NOT ONLY HEALTH, BUT ALSO - taste - culture - social FOOD RELATES TO - tradition - agriculture - commercial drivers NORDIC FOOD WEEK 19.9.2007 50
  51. 51. Healthy Food Can Taste Good or Bad Depending on - how prepared - how served - what people are used to (esp. children) - individual preferences NORDIC FOOD WEEK 19.9.2007 51
  52. 52. Healthy Food is not One Type of Diet Instead healthy food can be based on different food cultures, if recommendation for nutritional composition is observed NORDIC FOOD WEEK 19.9.2007 52
  53. 53. Healthy Food - Positive choices Can be based on local traditions Can be domestic or international Can be cheap or expensive NORDIC FOOD WEEK 19.9.2007 53
  54. 54. Partnerships for Public Health Governments (national, local) Civil society (NGO’s) Private sector International collaboration NORDIC FOOD WEEK 19.9.2007 54
  55. 55. Governments Governments have a basic responsibility for public health NORDIC FOOD WEEK 19.9.2007 55
  56. 56. Private Sector Health is increasingly important business argument Product development, marketing ”Health promoting business” – sustainable business Social responsibility NORDIC FOOD WEEK 19.9.2007 56
  57. 57. PUBLIC POLICY POPULATION PRIVATE SECTOR HEALTH PROGRAMME NORDIC FOOD WEEK 19.9.2007 57
  58. 58. Experience in Finland • People are interested in the health message • People attempt and make great changes in their diet • Food industry adopts and supports the new trends; health is a major driver for product development and marketing • Health claims, nutrition labelling and information important NORDIC FOOD WEEK 19.9.2007 58
  59. 59. Economic Drivers for Chronic Prevention Disease 1) Availability and health of the shrinking working age population 1) Health and functional capacity of the increasing elderly population NORDIC FOOD WEEK 19.9.2007 59
  60. 60. 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 national diets and 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 NORDIC FOOD WEEK 19.9.2007 60
  61. 61. NORDIC FOOD WEEK 19.9.2007 62 61
  62. 62. NORDIC FOOD WEEK, St. Petersburg 19.9.2007

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