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Prevention of Heart Diseases in Switzerland Gaudenz Silberschmidt Vice director and Head of International Affairs Swiss Federal Office of Public Health European Heart Network Annual Workshop, Geneva: 17.5.2006. Prevention of Heart Diseases in Switzerland Contents.

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Prevention of

Heart Diseases in Switzerland

Gaudenz Silberschmidt

Vice director and Head of International Affairs

Swiss Federal Office of Public Health

European Heart Network Annual Workshop, Geneva: 17.5.2006


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Prevention of Heart Diseases in SwitzerlandContents

1. Prevention in Switzerland: A Challenging Task

2. Heart Diseases: A Public Health Challenge: Why?

3. Targets of Preventive Efforts

4. Many Actors: Remarkable Achievements

5. Conclusion: Why NGO’s matter


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Prevention of Heart Diseases in Switzerland

1. Prevention in Switzerland:

A Challenging Task


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Switzerland

Permanent population : ~ 7’200’000 : Swiss ~ 5’800’000 Foreigners ~ 1’400’000 (2001)

Preventon in Switzerland: A Challenging Task26 Cantons = 26 Health systems


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German

65%

French

18%

Rumantsch

1%

Italian

10%

1. Prevention in Switzerland: A Chllenging Task 4 languages


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Prevention in Switzerland: A Challenging TaskPreoccupations: Shaky Grounds for Prevention

  • Legal basis (prevention law) does not exist

  • Scattered responsibilities for prevention (federal, cantonal, communal level, semi-public organisations, NGO’s)

  • Predominance of health care in health system

  • Prevention represents only 2,1% of the Swiss health expenditures in 2003

  • Strong pressure groups


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1. Prevention in Switzerland: A Challenging Task

Preoccupations: Health Costs - Nr. 2 in OECD countries


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Preoccupations: Life Style of Resident Population

1. Prevention in Switzerland: A Challenging Task

  • 36% of men and 25% of women are current smokers

  • 53% of men and 58% of women lack physical exercise.

  • 30% of women and 46% of men are overweight.

  • 13% of women and 17% of the men present high cholesterol levels.

  • 19% of the Swiss resident population have arterial hypertension

  • 4.2% of men and 3.7% of women over 15 years of age are affected by diabetes.

    Source: Swiss Health Survey 2002


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Prevention of Heart Diseases in Switzerland

2. Heart Diseases

A Public Health Priority : Why?


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Basic Facts:

2. Heart Diseases: Public Health Priority Nr. 1 : Why

  • Cardiovascular diseases are the principal cause of mortality in Switzerland

  • Within the cardio-vascular diseases, myocardial infarction (MI) is the main cause of death.

  • With a prevalence of 9.2%, cardiovascular diseases constitute the main reason for hospitalization. (Swiss Hospital Statistics, 2002)

  • In Switzerland, 15% of the drugs delivered in premises, and 17% of pharmaceutical sales are associated with the treatment of cardiovascular diseases . (Statistics 2002, IHA-IMS Health)

  • Women wait 70’ longer than men after first signs of intense breast pain before they get hospitalised. Waiting time for women: 5 h, for men less than 4 hours (OBSAN 2005).



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Deaths attributable to cardio-vascular diseases

% of cardio vascular deaths

CHD

Cerebrovascular

Blood vessels

Other


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Prevention of Heart Diseases in Switzerland

3. Targets of Preventive Efforts


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3.Targets of Preventive Efforts

Risk and protective factors

  • Given Risk Factors

  • Genetic predisposition

  • Gender

  • Age

  • Family health

  • Past history of diseases

  • Personnal antecedents

  • Social Protective Factors

  • High Income

  • High Status

  • Job Security

  • Social Networks

  • Social Capital

  • Supportive Environment


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3.Targets of Preventive Efforts

Reduce Risk Factors Enhance Protective Factors

  • Physical Exercice

  • Moderate Alcohol Intake

  • Mediterranean Diet

  • Blood Sugar Monitoring

  • Early Diabetes Treatment

  • Cholesterol Monitoring

  • Access to Medical Care

  • Health Literacy

  • Work-Life Balance

  • Smoking

  • High Alcohol Consumption

  • Inedequate Diet

  • Diabetes

  • Arterial Hypertension

  • Delay of medical care

  • Stress


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3.Targets of Preventive Efforts

Redress Overweight and Obesity

Overweight (BMI 25 – 29.9)

Obesity (BMI >= 30)

USA: Daten aus NHANES-Studien

CH: Daten aus Gesundheitsbefragung


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3.Targets of Preventive Efforts

Adjust Nutrition

Consumption of Fruits and Vegetables


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3.Targets of Preventive Efforts

Increase Physical Activity

Caloric Intake and Physical Activity

Caloric intake

Physical Activity

WHO, 2003, adapted


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Prevention of Heart Diseases in Switzerland

4. Many Actors: Remarkable Achievements


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4. Many Actors: Remarkable Achievements

Important Stakeholders

NGO

Medical profession

Science

Consumer organisation

Prevention of Cardiovascular Diseases

Confederation /Cantons

Sport Organizations

Pharmaceutical Industry

Food Industry

WHO/EU

Media


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Encouraging developments in Swiss health system

4. Many Actors: Remarkable Achievements

  • A reduction in mortality due to cardio-vascular diseases since 1980 is noteworthy.

  • Health outcome indicators are among the best worldwide and continue to improve (exceptions: mental health, substance abuse)

  • High customer satisfaction, hardly any waiting times

  • No accumulated deficits

  • Health is one of the most important economic sectors

  • Excellent biomedical research


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Ongoing Initiatives

4. Many Actors: Remarkable Achievements

  • Preparations for a legislation to strengthen health promotion and prevention

  • Bologna Reform of health care education

  • OECD / WHO review of Swiss health system

  • Efforts to enhance Health Literacy

  • Important tobacco prevention efforts

  • Implementation of the WHO Global Strategy on Diet and Physical activity

  • Empowerment of NGO’s


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Prevention of Heart Diseases in Switzerland

5. Conclusion:

Why NGO’s Matter


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5. Conclusion: Why NGO’s matterAgenda Setting or what the Federal Office cannot do

  • Prevention of Cardiovascular Diseases Requires:

    • coordinated strong pressure groups

    • political and public lobbying

    • steady information of all health professionals

    • targeted information for vulnerable groups

    • support and participation in campaigns for a healthier lifestyle

    • support for new legislative efforts in prevention


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5. Conclusion: Why NGO’s matterSpecial targets

  • Primary Prevention:

    • Increase Health Literacy in the General Public.

    • Support nutritional and physical activity initiatives

    • Promote cholesterol testing in vulnerable groups

    • Support national, cantonal and communal networking efforts

  • Secondary Prevention:

    • Reduce time lapse between signs of breast pain and hospitalisation.

    • Inform Health professionals about gender bias in the diagnosis of potential MI

  • Tertiary Prevention:

    • Offer follow-up of MI patients through commitment + contracting

    • Support voluntary follow-up testing


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5. Conclusion: Why NGO’s matterGoals for the Future:

  • Longevity in better health is possible, if all

    stakeholders work together to prevent

    cardio-vascular diseases.

  • We need an international effort to learn from

    the experience and findings of others.

  • This congress provides a excellent

    opportunity to foster new efforts.


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5. Conclusion: Why NGO’s matterConclusion

The Federal Office of Public Health hopes

that this congress will be remembered as

a step forward in an European effort to

prevent cardio-vascular diseases.

Thank you.


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