ACHIEVEMENTS AND

CHALLENGES IN NCD

PREVENTION IN

FINLAND

Northern Dimension Partnership in Public Health meeting

Helsinki 11.10.2018

Pekka Puska

Professor, Member of Parliament

Past Director General, National Institute for Health and Welfare (THL), Finland

Past President, International Association of National Public Health Institutes

(IANPHI)

HISTORY IN FINLAND

• Hardships of war and postwar years

• Relative increase in standard of living

Great increase in CVD

• Attention to extremely high CVD mortality

• Determined action: North Karelia Project

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NORTH KARELIA PROJECT

PRINCIPLES

• 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 ofbest available knowledge: - previous studies- collective international recommendations- epidemiological situation in North Karelia

• Chosen risk factors:- smoking- elevated serum cholesterol (diet)- elevated blood pressure (diet & treatment

• Community based approach to change lifestyles

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EVALUATION / MONITORING

• North Karelia – all Finland

• Monitoring systems

health behaviour

risk factors

nutrition

diseases, mortality

Monitoring developed to a national NCD monitoring system by THL

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RESULTS

Lifestyles and publichealth can change!

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USE OF BUTTER SERUM

ON BREAD CHOLESTEROL

(MEN 30-59) (MEN30-59)

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mmol/L

Laboratory bias corrected

SALT INTAKE IN SYSTOLIC BLOOD

FINLAND 1977-2007 PRESSURE

FINNDIET STUDY (MEN 30-59)

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Now official aim: Smokefree Finland

CHANGE IN AGE-ADJUSTED MORTALITY RATES

FINLAND, MALES AGED 35–64 (PER 100 000 POPULATION)

extension of the Project

nationally

start of the North Karelia Project

North Karelia -85%

All Finland -80%

Rate per 100 000

1969-1971

2006 Change from 1969-1971 to 2006

All causes 1328 583 -56%

All cardiovascular 680 172 -75%

Coronary heart disease

489 103 -79%

All cancers 262 124 -53%

Coronary heart disease

Gain of some 10 healthy years

in Finnish population

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SIHVONEN YM. 2003

Healthy and sick years of life expectancy of 65 yearold Finns in 1980 and in 2000

Subjective health

0

5

10

15

20

1980 2000 1980 2000

ye

ars

Managing basic functions

0

5

10

15

20

1980 2000 1980 2000

ye

ars

men women men women

Healthy/no disability

Sick/disability

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RESULTS: SUMMARY

Big change in lifestyles and biological risk factors

Big reduction in premature NCD mortality and incidence

Increased subjective health

Healthy ageing

x x x

NCD changes explained to great

extent by risk factor changes

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MAJOR ELEMENTS OF FINNISH MAJOR ELEMENTS OF

NATIONAL ACTION 1. FINNISH NATIONAL ACTION 2.

Research & international research collaboration

Health services (especially primary health care)

North Karelia Project, other demonstration programmes

Health Promotion Programmes (coalitions,

NGO’s, collaboration with media etc.)

Schools, educational institutions

Industry, business – collaboration Policy decisions, intersectional

collaboration, legislation

Monitoring system: health behaviours, risk factors, nutrition, diseases, mortality

International collaboration

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INTERSECTORAL WORK FOR NCD

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)

Ultimately success calls for a social change process, combining government policies, expert guidance, broad health promotion and mobilization of people

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8th Global WHO Conference on health promotion - “Health in all policies”

From Ottawa to Helsinki (June 2013)

HELSINKI STATEMENT

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EXAMPLES OF INTERSECTORAL WORK (1/3)

Development of Finnish Rapeseed oil

Fen: y = -0.16x + 362

Gen: y = -0.16x + 358

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42

42

43

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44

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45

45

1970 1975 1980 1985 1990 1995 2000 2005 2010

Year

g/k

g

Fen

Gen

Change in fat content

of Finnish cow milk

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EXAMPLES OF INTERSECTORAL WORK

(2/3)

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

Meat product example:

HK (Leading Finnish meat company)

since 2007 annually:

40.000 kg less salt

100.000 kg less saturated fat in their products 1975 1980 1985 1990 1995

YEAR

1. 6

1. 8

2. 0

2. 2

2. 4

Salt

con

cent

rati

on (

%)

Sal t l evel i n Fi nni sh sausages

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Berry project in North Karelia

•To promote berry farming, product development and

consumption

•Dairy farmers could switch over to berry farming

•Financing from Ministries of Agriculture and Commerce

Finnish Heart Symbol

EXAMPLES OF INTERSECTORAL WORK (3/3)

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REDIRECTION OF HEALTH SERVICES

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• Reorientation and strengthening of health systems

•Primary health care:

”Now more than ever”

(WHR 2008)

• Special emphasis for NCDs

• Chronic care model

• Preventive practices

REFORM OF SOCIAL AND HEALTH CARE

IN FINLAND (SOTE)

Background:

Changing needs

Changing possibilities

Ageing of population

Increasing costs

Objectives:

Larger population base

Integration (primary sectorcare, social services)

Wider choice of services

Equal acces to services

Control of increasing costs

Greater emphasis on primary care and prevention

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SOLUTION

Regions (maakunnat) to be responsible

Integration

Additional contribution of private services to public primary care

Strenghtened ICT systems

Digitalization

Strengthened prevention & health promotion (regions, municipalities, NGO’s – incentives)

The reform will create 18 autonomous regions with elected councils

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CORNERSTONES OF NCD PREVENTION

AND CONTROL (WHO GLOBAL

STRATEGY)

Attention to behavioral 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

– Chronic care model

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GLOBAL TARGETS (WHO NCD ACTION PLAN)

1. 25 % reduction of avoidable mortality

2. 10 % reduction in harmful use of alcohol

3. 10 % reduction in insufficient physical activity

4. 30 % reduction in mean population salt intake

5. 30 % reduction in tobacco use

6. 25 % reduction in raised blood pressure

7. Halt the raise in diabetes and obesity

8. At least 50 % of eligible (=high risk) people receive drug treatment and councelling to preventheart attack and stroke

9. In 80 % availability of affordable basic technologies and essential medicines for NCD

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INTEGRATED PREVENTION

COMMON RISK FACTORS

TOBACCO USE

UNHEALTHY DIET

PHYSICAL INACTIVITY

ALCOHOL

CVD

DIABETES

CANCER

COPD

MUSCULOSCELETAL

ORAL HEALTH

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SOUND COMBINATION OF POPULATION

STRATEGY WITH HIGH RISK STRATEGY

1. Population strategy:

- Greatest public health gains

- Cost effective

- Results also in other health benefits

2. High risk strategy:

- Great benefits to the persons concerned

- Effective use of health services

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PUBLIC RESPONSIBILITY

POLICY INTERVENTIONS

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DURING THE LAST FEW YEARS A GREAT

NUMBER OF STRATEGIES AND PLANS FOR

EVIDENCE-BASED, EFFECTIVE PREVENTION OF

NCD’S AND HEART HEALTH PROMOTION HAVE

BEEN PRODUCED

Many important

priorities have been

identified

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IDENTIFYING IMPLEMENTING

PRIORITIES THEM

FROM PRIORITIES TO IMPLEMENTATION

Implementation gap

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From strategies to effectiveaction

IDENTIFYINGPRIORITIES

“Less is more”

IMPLEMENTING

THEM

• Policy support

• Institutional

base

• Media support

• Resources

• Monitoring

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MAIN CAUSES OF MORTALITY

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COMPREHENSIVE ACTION AND

PARTNERSHIP FOR NATIONAL NCD

PREVENTION

Governments, policies

(national, local)

Health services

Civil society (NGOs)

Private sector

Media

International collaboration

(esp. WHO)

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MOBILIZATION OF PEOPLE IS THE KEY

CHANGES IN PEOPLE’S LIFESTYLES

POLICY DECISIONS

SOCIAL CHANGE PROCESS!

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SUCCESFUL PREVENTION OF NCD’S IS

NOT ONE TIME DECISION

It is an incremental process, applying- Health promotion- Series of policy decisions Policies (laws) influence people and people influence policy

(example: tobacco control process) Monitoring of changes crucial, for both the policy makers and

the public Strong public health institutional base + strong NGO’s Leadership – focal point(s) - collaboration

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Sustained changes in population health canonly take place with permanent changes in people’s lifestyles and environments, and

represent a long term social change process!

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Thank you

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