1) The North Karelia Project in Finland in the early 1970s demonstrated that lifestyle interventions could successfully address high rates of non-communicable diseases like cardiovascular disease. 2) Through partnerships across different levels of government and with businesses and non-profits, the Project implemented policies, programs, and media campaigns to reduce smoking, saturated fat intake, and high blood pressure in the population. 3) Evaluation showed the interventions were successful in significantly reducing mortality from non-communicable diseases in North Karelia and informed the national expansion of similar prevention programs in Finland.

1. DEVELOPMENT AND DELIVERY OF EFFECTIVE PUBLIC HEALTH ACTIONS IN FINLAND – WE CAN SUCCESSFUL WITH NEW CHALLENGES ALSO Antti Uutela, PhD, Research professor, Director National Institute for Health and Welfare THL, Department of Lifestyle and Participation, Finland Professor, University of Tampere, Finland President, Finnish Society of Sport Sciences

2. Non-communicable diseases are preventable – in Finland and globally Lifestyle related NCD’s are largely preventable until old age Smoking, diet/alcohol use, and physical activity are relevant lifestyles Lifestyle is greatly influenced industrial structure, culture, and social and physical environments, and well as psychosocial characteristics of individuals Therefore, lifestyle is also apt to respond to interventions, including policies and programs All policies may have health impacts – and all agencies involved with them form therefore the public health system, and, that Implementation partnerships are needed for good results 30/05/2011 2

3. North Karelia Project as demonstration project started NCD prevention work in Finland In early 1970’s North Karelian men of 35-64 years had annual coronary heart disease mortality of 700/100,000 Relevant factors contributing to this were identified as: too high saturated fat intake high prevalence of daily smoking untreated high blood pressure After careful planning and implementation of policies and programs successful change in NCD’s has been achieved 30/05/2011 3

4. Basis and activities of the North Karelia project Public petition to the Parliament, which through state budget committed the region to following activities (state governance): Screening of risk factors and when necessary treatment (hospital districts) Courses for general population on healthy lifestyle(NGO’s) Partnership with industry for healthier foods (less fat, more fiber - business) Use of national media to support the change in diet and regarding smoking (public service) A formative and evaluative study was also initiated

5. 30/05/2011 5 Ensuing national NCD prevention proved successful (Age-adjusted annual mortality rates / 100,000; Males 35-64 years of age (Puska THL 2011))

6. SOME OLD PROBLEMS REMAIN WHILE NEW ONES ALSO EMERGE major Finnish Health challenges are still lifestyle related 30/05/2011 6

7. Current health challenges CVD and cancer are responsible for more than 60% of the population’s mortality Mental disorders and musculo-skeletal problems account for over 60% of work disabilities Among work-age men and women No. 1 cause for mortality is alcohol (men’s No. 2 CHD, women’s breast cancer) T2D is increasing and prospects for future are alarming 30/05/2011 7

8. 2.6.2011 THL 8 kg/m2 Average BMI of Finnish men 25-64 years 1997-2007 (Vartiainen THL 2010)

9. 9 Total consumption of absolute alcohol per capita in litres 1965-2009, Finland (Karlsson THL 2010) 10.2 l Other consumption From sales statistics S

10. Average 24 h energy intake (kcal) of adult Finns 1982-2007, 48h or 24 h recall Energy intake 1982 2009 Men 25-64 years 2873 2206 Women 25-64 years 2071 1620 A very significant drop in energy intake Physical activity must have reduced even more than the decrease of energy intake allows 30/05/2011 10

11. Health enhancing physical activity in Finland (Husu et al. UKK-Institute 2011) Half of adults meet current guidelines for health-enhancing aerobic activity Adult Finns sit in the average 7 hours a day Few Finns do resistance training or stretching/ balance training Thus, only a good part of 10% of adult Finns meet and national (and EU) guidelines 30/05/2011 11

13. WELFARE STATE responds to new health challenges also 30/05/2011 13

14. GDP per capitain Finland 1975-2010, e 14 30/05/2011

16. public expenditures 56.3% of GDP in 2009Universal rights social protection / services (23.9% of GDP) not targeted for specific groups (e.g. poor) in 2009 Public health service: 9.2% of GDP in 2009 Education: 6.6% of GDP in 2009 Unemployment rate 9% in 2009 Individual social security based on resources from taxation on municipal and national level (total average tax rate 43%) Governance highly decentralised into municipalities Guidance from national government essentially by information Relatively high level of welfare benefits (about 6th highest in EU)

17. The Ministry of Social Affairs and Health Legislation Funding and directing activities Coordinates production of tools for information-based guidance 2.6.2011 2.6.2011 Kerttu Perttilä, THLEsityksen nimi / Tekijä 16 16

18. Ministry of Social Affairs and Health and related national authorities 30/05/2011 17

19. 2.6.2011 18 THL promotes nation’s health and welfare THL monitors the state of health and welfare, and studies their determinants, in population groups THL makes reviews, gives briefings, and develops and implements activities, too THL develops instruments for municipal use, especially for theprimary health care: Welfare strategies, planning and review Guidelines for activities Guidelines for organization of work Instruments for primary, secondary and tertiary prevention

20. The basis of THL’s work Strong basic and applied research – from societal level to the level of cells Long-standing and covering population follow-ups Program development, implementation, and reviewing Dissemination of information and skills Home page for innovative interventions (INNOKYLÄ) Expert activities in municipalities, region, national and international level Cooperation and networking with other public health system actors 30/05/2011 19

21. National programmes and recommendations for health promotion Government Resolution on Health 2015 Public Health Programme (2001) Quality Recommendation for Health Promotion (2006) Governmental Policy Programme for Health Promotion (2007) National Action Plan to reduce health inequalities 2008–2011 (2008) Government Resolution on Development Guidelines for Health-enhancing Physical Activity and Nutrition (2008) National Development Plan for Social and Health Care Services, KASTE –programme 2008-2011 2.6.2011 2.6.2011 Kerttu Perttilä, THLEsityksen nimi / Tekijä 20 20

22. Promoting health-enhancing physical activity and nutrition: resolution and implementation document (2008) Objectives: To increase number of physically active, decrease number of people marginalized from physical activity To increase number of people following nutrition recommendations To decrease number of overweight, obese persons (related to physical inactivity and nutrition) Make the above changes especially among the low-SES people 30/05/2011 21

23. Methods Influencing culture, living environments, circumstances, products, and societal structures Ensuring enough information and skills in all population groups Encouraging, supporting, and guiding individuals and communities, especially the most vulnerable 30/05/2011 22

24. Main alcohol policy implementation measures Early intervention model in primary and occupational health care settings Increasing tax of alcohol Reducing use of alcohol by parents and harm to children through purposeful policy measures Ensuring treatment of all pregnant women with alcohol problem Ensuring sufficient support for children whose parents have alcohol problem 30/05/2011 23

25. Main activities to reduce tobacco use (based on FCTC) Keep prices of tobacco products as high as possible Promote smoke-free environments Prohibit sales promotion and advertising of tobacco products Limit the availability of tobacco products Regulate the contents of tobacco products and use warnings on packages Information and communication supporting non-smoking Support for giving up smoking 30/05/2011 24

26. Tobacco act came into force on October 1, 2010 As the first country in the world: aims at gradual elimination of consumption of tobacco products altogether Strives to prevent initiation of smoking among children and youth Controls smoking in their growth environment Tobacco products should not be accessible to children and youth in their everyday environment Ban of smoking in child and youth environments (near day care centers and schools) 30/05/2011 25

27. Some current THL’s programs to develop and implement instruments for local use Local programs (ATH) to increase welfare and health, and health inequalities Regional programs for prevention of T2D DEHKO IKIHYVÄ (GOAL) Regional programs for improvement of functional ability IKIHYVÄ (GOAL) Prevention of home and leisure accidents 30/05/2011 26

28. GOAL model GOAL group Municipal administration Community-based interventions/specific target programmes Type II diabetes prevention Promotion of functional capability Regional application of Current Care guidelines Telephone counseling for person with arterial disease Evaluation and cohort study

29. National strengths Efficient public health system including planning, reporting and evaluation Covering regular population monitoring systems to support prevention Fluent cooperation between governmental sectors Strong research base (including that of THL) Improved synergy and cost-efficiency of public health system institutions (at nationaland local levels) 30/05/2011 28

30. More national strengths Strong focus on primary health care development and Health in All Policies principle Good cooperation with local government, NGO’s and business Demonstration project yielding results that have been widely implemented (DPS, DEHKO, IKIHYVÄ) Increased use of ICT technology 30/05/2011 29

31. Thank you! 30/05/2011 30