How health promotion can reduce excess mortality in severe mental disorders, presentation held at WHO expert group meeting in Geneva, Switzerland, 19.11.2015

1. Lessons learned from
integrated health promotion for
people with SMDs
Kristian Wahlbeck
Finnish Association for Mental Health (FAMH)
Geneva, 18.09.2015

2. Finnish championship of users’
organisations’ floorball cup
19.11.2015 Integrated health promotion2

3. Health in all policies –time to forget
silos
19.11.2015 Integrated health promotion3
Source:NationalRuralHealthAlliance

4. Health in all policies - healthification
• Determinants and risk factors amendable by actions in non-
health policies
• The time of silos needs to be overcome: integrated services
• Life course perspective is needed (Barker’s hypothesis): early
action
• Low effectiveness of individual interventions – community
level interventions are needed.
-
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5. Universal interventions
• Machenback et al, 2012
• Review of all successfull prevention programs in
the Netherlands 1970-2010
• Results
• Primary prevention: ¾ of the effects
• Secondary prevention: ¼ of the effects
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6. Shifting the whole population into a lower risk category benefits more
individuals than shifting high risk inviduals into a lower risk category
The Bell curve shift in
populations
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7. Time to stop dualism: From 4x4 to 5x5
Tobacco
use
Unhealthy
diet
Physical
inactivity
Alcohol
use
Adverse
childhood
events
Cardio-vascular
√ √ √ √ √
Diabetes
√ √ √ √ √
Cancer
√ √ √ √
Chronic
respiratory
√ √
Mental
disorders
√ √ √ √

8. Adressing convergence of risk factors
Adressing mortality as a part of the broader health inequalities agenda
Psychiatric diagnoses may not be the best way of identifying the target group
(risk factors distributed in the population)
Primary care health examinations for disadvantaged people
*”occupational health care” for long-term unemployed people
* PHC check of people with schizophrenia revealed that 59 % have metabolic
syndrome
Eskelinen et al. Nord J Psych 2015
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9. Health promotion in disadvantaged
populations
• Healthy lifestyle will prevent mental disorders
• Disadvantaged populations also benefit from general population strategies
• (e.g. breastfeeding, physical activity in schools, restrictions in access to
alcohol, tobacco taxation and ad bans, sugar tax and improved access to
healthy food, healthy city planning….)
• Functional peer support groups are effective in promoting change
• Special population stratgeies include improved access to primary care and
active early identification of risk factors
• Inclusion of target group in health promotion activities
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10. Level of actions
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Mental
health
care
Primary
health and
social care
Health systems &
policies
Health in All
Policies

11. Twitter: @mentalblog
www.linkedin.com/in/wahlbeck
Thanks!