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Pekka Puska, MD, PhD, MPolSc
Director General
National Institute for Health and Welfare (THL),Finland
Vice President, Int. Association of National Public Health Institutes
(IANPHI)
Past President, World Heart Federation (WHF), Geneve


                     The vision and road map for
                          addressing NCDs




                 Int. Conference on Healthy Lifestyles and NCDs in the Arab World
                          and the Middle-East; Riyadh, KSA, 10-12.9.2012
      12.09.12                                                                      1
Background and vision
• Health is important for every individual, public welfare
  and sustainable social and economic development
• Current situation and the future
– A few chronic non communicable diseases are greatest
  determinants of public health
– These NCD’s are to great extent and to late in life
  preventable

           Vision: world free of avoidable NCD’s
           (=healthy ageing)
           Goal: Effective comprehensive action on global,
           regional, national and local level



12.09.12                Pekka Puska, Director General        2
:Source
of premature deaths from NCDs occur in developing countries 90%


         million 25
                               Total number of deaths in the world
                                                                                                  2.3M



         million 20
                                                                                              M 6 ..8
                                                                                              M6 8
                                                                            2.3M
         million 15
                                                                       10.2M                   3.7M
                                                                       10.2M                     13.6M
                                                                                                  13.6M
         million 10
                0.5M


                       5.9M
                        5.9M

                                                                       M 3 ..3
                                0.6M



                                                                       M3.0M 3
                                                                           3
                                           3.3M3.0M
                                                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



  12.09.12                                       Pekka Puska, Director General                                        3
12.09.12   Pekka Puska, Director General   4
12.09.12   Pekka Puska, Director General   5
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 support


12.09.12              Pekka Puska, Director General   6
Changing global burden of disease
    WHO´s NCD strategy in 2000
• NCD prevention and control is a global
  health priority
• Comprehensive actionis needed, but from
  public health point of view population
  based prevention is the key (most cost-
  effective and sustainable)
• Integrated prevention: targeting common,
  lifestyle related risk factors (tobacco, diet,
  physical activity, alcohol)


12.09.12           Pekka Puska, Director General   7
INTEGRATED PREVENTION




12.09.12           Pekka Puska, Director General   8
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 (esp. primary health care)
           – Chronic care model

12.09.12                       Pekka Puska, Director General   9
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 practices




12.09.12               Pekka Puska, Director General   10
Surveillance/monitoring
• Monitoring of                   • ”Best buys”:
    Diseases                        NCD mortality trend
    Risk factors/behaviours         Risk factor trends
    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

 12.09.12              Pekka Puska, Director General        11
NCD FRAMEWORK FOR ACTION/MONITORING

                                GENETICS




           Health               Prevention                 Treatment
           promotion


                 SOCIETAL                         HEALTH SERVICES
                 RESPONSES
                 (HiAP)



12.09.12                 Pekka Puska, Director General                 12
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 NCDs
12.09.12                                  Pekka Puska, Director General                                             13
Action Plan 2007-
      2012
        #
New Action Plan
 in preparation




 12.09.12           Pekka Puska, Director General   14
Comprehensive action and partnership
for national NCD prevention
•   Health services
•   Governments (national, local)
•   Civil society (NGOs)
•   Private sector
•   Media
•   International collaboration




12.09.12               Pekka Puska, Director General   15
During the last few years a great
number of strategies and plans for
evidence-based, effective prevention
and health promotion have been
produced

Many important priorities
have been identified




12.09.12               Pekka Puska, Director General   16
From priorities to implementation

    IDENTIFYING                                        IMPLEMENTING
    PRIORITIES                                         THEM
    • “Less is more”                                   • Policy support
                                                       • Institutional base
                                                       • Media support
                                                       • Resources
                                                       • Monitoring




12.09.12               Pekka Puska, Director General                          17
NCD prevention is possible!
The potential is great
  • Quite rapid impact
  • Human impact on health and
    wellbeing
  • Impact on health service costs and
    socioeconomic development



12.09.12       Pekka Puska, Director General   18
Change in age-adjusted mortality rates
Finland, males aged 35–64 (per 100 000 population)

                                                                           Rate per 100 000

Coronary heart disease                                                     1969-   2006   Change
                                                                           1971           from
           start of the North Karelia Project                                             1969-1971
                                                                                          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 popupaltion

12.09.12                               Pekka Puska, Director General                              19
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



12.09.12             Pekka Puska, Director General     20
Examples of intersectoral work 1.
Development of Finnish                             Change in fat content
Rapeseed 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
                                                              Year




12.09.12                 Pekka Puska, Director General                                                 21
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 sausages

Meat product example:                                                     2.4




HK (Leading Finnish meat company)                                         2.2




since 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

                                                                                                  YEAR




12.09.12               Pekka Puska, Director General                                                               22
12.09.12   Pekka Puska, Director General   23
8th Global WHO Conference on health promotion
- “Health in all policies”
          From Ottawa to Helsinki (June 2013)




12.09.12           Pekka Puska, Director General   24
WHO/EMRO region
• Shows great leadership and
  example on effective regional
  action
• Great experience and potential




12.09.12     Pekka Puska, Director General   25
World Congress of Cardiology
                                   Scientific Sessions



18-21 April, 2012
    Dubai, UAE




   www.worldcardiocongress
            .org
12.09.12               Pekka Puska, Director General    26
THE MAIN CHALLENGE FOR
          SUCCESSFUL NCD
           PREVENTION IS NOT WHAT
             TO DO, BUT HOW TO
           IMPLEMENT THE NEEDED
                  ACTIONS!

12.09.12           Pekka Puska, Director General   27
The Future Challenge
    To match the public health
    importance of NCD’s and
    potential health gains with
    needed attention, resource
    use and political decision
    making.

12.09.12      Pekka Puska, Director General   28
Ban Ki-Moon:
”We should all work to meet the targets to reduce NCDs”




12.09.12                 Pekka Puska, Director General    29
Thank you


12.09.12     Pekka Puska, Director General   30

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The vision and road map for addressing NCDs

  • 1. Pekka Puska, MD, PhD, MPolSc Director General National Institute for Health and Welfare (THL),Finland Vice President, Int. Association of National Public Health Institutes (IANPHI) Past President, World Heart Federation (WHF), Geneve The vision and road map for addressing NCDs Int. Conference on Healthy Lifestyles and NCDs in the Arab World and the Middle-East; Riyadh, KSA, 10-12.9.2012 12.09.12 1
  • 2. Background and vision • Health is important for every individual, public welfare and sustainable social and economic development • Current situation and the future – A few chronic non communicable diseases are greatest determinants of public health – These NCD’s are to great extent and to late in life preventable Vision: world free of avoidable NCD’s (=healthy ageing) Goal: Effective comprehensive action on global, regional, national and local level 12.09.12 Pekka Puska, Director General 2
  • 3. :Source of premature deaths from NCDs occur in developing countries 90% million 25 Total number of deaths in the world 2.3M million 20 M 6 ..8 M6 8 2.3M million 15 10.2M 3.7M 10.2M 13.6M 13.6M million 10 0.5M 5.9M 5.9M M 3 ..3 0.6M M3.0M 3 3 3.3M3.0M 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 12.09.12 Pekka Puska, Director General 3
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  • 6. 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 support 12.09.12 Pekka Puska, Director General 6
  • 7. Changing global burden of disease WHO´s NCD strategy in 2000 • NCD prevention and control is a global health priority • Comprehensive actionis needed, but from public health point of view population based prevention is the key (most cost- effective and sustainable) • Integrated prevention: targeting common, lifestyle related risk factors (tobacco, diet, physical activity, alcohol) 12.09.12 Pekka Puska, Director General 7
  • 8. INTEGRATED PREVENTION 12.09.12 Pekka Puska, Director General 8
  • 9. 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 (esp. primary health care) – Chronic care model 12.09.12 Pekka Puska, Director General 9
  • 10. 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 practices 12.09.12 Pekka Puska, Director General 10
  • 11. Surveillance/monitoring • Monitoring of • ”Best buys”:  Diseases NCD mortality trend  Risk factors/behaviours Risk factor trends  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 12.09.12 Pekka Puska, Director General 11
  • 12. NCD FRAMEWORK FOR ACTION/MONITORING GENETICS Health Prevention Treatment promotion SOCIETAL HEALTH SERVICES RESPONSES (HiAP) 12.09.12 Pekka Puska, Director General 12
  • 13. 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 NCDs 12.09.12 Pekka Puska, Director General 13
  • 14. Action Plan 2007- 2012 # New Action Plan in preparation 12.09.12 Pekka Puska, Director General 14
  • 15. Comprehensive action and partnership for national NCD prevention • Health services • Governments (national, local) • Civil society (NGOs) • Private sector • Media • International collaboration 12.09.12 Pekka Puska, Director General 15
  • 16. During the last few years a great number of strategies and plans for evidence-based, effective prevention and health promotion have been produced Many important priorities have been identified 12.09.12 Pekka Puska, Director General 16
  • 17. From priorities to implementation IDENTIFYING IMPLEMENTING PRIORITIES THEM • “Less is more” • Policy support • Institutional base • Media support • Resources • Monitoring 12.09.12 Pekka Puska, Director General 17
  • 18. NCD prevention is possible! The potential is great • Quite rapid impact • Human impact on health and wellbeing • Impact on health service costs and socioeconomic development 12.09.12 Pekka Puska, Director General 18
  • 19. Change in age-adjusted mortality rates Finland, males aged 35–64 (per 100 000 population) Rate per 100 000 Coronary heart disease 1969- 2006 Change 1971 from start of the North Karelia Project 1969-1971 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 popupaltion 12.09.12 Pekka Puska, Director General 19
  • 20. 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 12.09.12 Pekka Puska, Director General 20
  • 21. Examples of intersectoral work 1. Development of Finnish Change in fat content Rapeseed 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 Year 12.09.12 Pekka Puska, Director General 21
  • 22. 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 sausages Meat product example: 2.4 HK (Leading Finnish meat company) 2.2 since 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 YEAR 12.09.12 Pekka Puska, Director General 22
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  • 24. 8th Global WHO Conference on health promotion - “Health in all policies” From Ottawa to Helsinki (June 2013) 12.09.12 Pekka Puska, Director General 24
  • 25. WHO/EMRO region • Shows great leadership and example on effective regional action • Great experience and potential 12.09.12 Pekka Puska, Director General 25
  • 26. World Congress of Cardiology Scientific Sessions 18-21 April, 2012 Dubai, UAE www.worldcardiocongress .org 12.09.12 Pekka Puska, Director General 26
  • 27. THE MAIN CHALLENGE FOR SUCCESSFUL NCD PREVENTION IS NOT WHAT TO DO, BUT HOW TO IMPLEMENT THE NEEDED ACTIONS! 12.09.12 Pekka Puska, Director General 27
  • 28. The Future Challenge To match the public health importance of NCD’s and potential health gains with needed attention, resource use and political decision making. 12.09.12 Pekka Puska, Director General 28
  • 29. Ban Ki-Moon: ”We should all work to meet the targets to reduce NCDs” 12.09.12 Pekka Puska, Director General 29
  • 30. Thank you 12.09.12 Pekka Puska, Director General 30

Editor's Notes

  1. World Health Organization September 12, 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).