Diabetes and the HeartMeet the experts

August 30 2009

Responding to the challenge: determining health policyIntroductory remarks

Lars RydénDepartment of MedicineKarolinska InstitutetStockholm, Sweden

The Future of Health Care in EuropeLondon May 13, 2011

Health and diseaseThe ideal solution

Lucas Cranach 1546 The Youth Fountain

Health and DiseaseThe ideal situation

Health and diseaseThe ideal solution

Preservation of healthSome prerequisites

Political support Common pathways Professional collaboration Persistancy and endurance Shared view on important steps Redirection of available resources A long-term view on the total impact

Presently established factors Life style Physical inactivity, obesity,

food habits, stress, smoking Medical Hypertension, dyslipidemia

diabetes…….

Fundamental reasonsAgricultural politicsSocial disintegrationClimate changesTax politics (e.g. tobacco)Industrialisation/urbanisation

Preservation of healthImportant threats

Diabetes and the HeartMeet the experts

August 30 20091992”The primary determinants of disease are mainly economic and social.

Therefore its remedies must also be economic and social.

Medicine and politics

cannot and should

not be kept apart.”

Geoffrey RoseGeoffrey Rose1926 - 19931926 - 1993

Choice and informationChoice and information

Choice and informationChoice and information

Scientific evidenceUrge Member States toimplement and enforce smoke free legislation

Preservation of healthExample - tobacco

Hospital admissions forAMI in eight studies 2004 - 2008

Reduction19% (95% CI 14-24)Non-smokers 70%

Preservation of healthBlocking common pathways towards disease

PulmonaryPulmonarycancercancer

MyocardialMyocardialinfarctioninfarction

Behind 86% of deaths in WHO region Europe

DiseasesMain determinants

Cardiovascular

Kidney

Hepatic

Respiratory

Malignant

Diabetes

Chronic non-communicable diseases (CNCD)Dimension and common pathways

Tobacco

Alcohol

Diet

Physical inactivity

Lars RydénKarolinska InstitutetStockholm, Sweden

Policy conference June 2009

Preservation of healthTransprofessional collaboration

Distinguish myths from evidence based knowledge

Explore the ”climate” for collaborative efforts to gain political support

Bringing 10 professional organisations together

Recommendations onTaxationAgricultureFood labellingUrban planningEducationSport and recreation

Paramount legislative principleHealth in all policies

The European Chronic Disease AllianceECDA

(Gyberg & Rydén Europ J Cardiovasc Prev Rehab 2011. In press)

0 smoking

3 km of daily walking

5 fruit & vegetables/day

<140/90 mm Hg blood pressure

<5.0 mmol/l cholesterol

<3.0 mmol/l LDL-cholesterol

0 diabetes

Preservation of healthOn the importance of a unified approach

The three most important measures toimplement EHHC

Hinder för förbättrad folkhälsa

Most important

Least important

PoliticalEconomic

OrganisationMediarelated

AwarenessAttitudes

Life styleOther

(Gyberg & Rydén Europ J Cardiovasc Prev Rehab 2011. In press)

Group Politician NGO Health admin Professionals

Preservation of healthOn the importance of a unified approach

13,180fewer deaths 2002

20021986

Risk Factors worse +11%Diabetes +8Obesity +3

Risk Factors better - 66%Cholesterol (diet) -39Smoking -20Population BP fall -9Physical activity -3

Treatments - 36%AMI -6Secondary prevention -12Heart failure -7 Angina ASA, CABG & PTCA -3Hypertension -4Primary prevention (statins) -2

Unexplained- 9%

(Björk, Rosengren, Bennett, Lappas,Capewell Europ Heart J 2009; 30:1046-56 )

The power of prevention of chronic diseaseExplaining the fall in CHD deaths (ex: Sweden)

100

80

60

40

20

0

%

Treatment Prevention

97

3

From the appeal to the European Commission on the occasion of the incoming European Commission, February 2010

Resource allocationEuropean health care

www.sph.uq.edu.au/bodce-ace-preventionwww.nice.org.uk/guidance/PH25

June 25 2010

Preservation of healthA long-term view of the total impact

www.sph.uq.edu.au/bodce-ace-prevention

Cost-saving interventions in 2003 Australian population

Taxation andregulation andinterventionson salt, alcoholand tobacco

Polypill forCVD prevention(ACE-i+Ca-antag+diuretic+statin)

Investment cost A$4.6 billion

Averted expensesA$ 11 billions

(Vos et al Assessing Cost-Effectiveness in Prevention. Univ Queensland, Brisbane and Melbourne 2010)

Preservation of healthA long-term view of the total impact

Health and diseaseThe ideal solution

Preservation of healthSome prerequisites

Political support Common pathways Professional collaboration Persistancy and endurance Shared view on important steps Redirection of available resources A long-term view on the total impact

ThanksThanksfor the attention!!!for the attention!!!