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Diabetes and the Heart Meet the experts August 30 2009

The Future of Health Care in Europe London May 13, 2011. Diabetes and the Heart Meet the experts August 30 2009. Responding to the challenge: determining health policy Introductory remarks. Lars Rydén Department of Medicine Karolinska Institutet Stockholm, Sweden. Health and Disease

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Diabetes and the Heart Meet the experts August 30 2009

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  1. The Future of Health Care in Europe London May 13, 2011 Diabetes and the Heart Meet the experts August 30 2009 Responding to the challenge: determining health policy Introductory remarks Lars Rydén Department of Medicine Karolinska Institutet Stockholm, Sweden

  2. Health and Disease The ideal situation Health and disease The ideal solution Lucas Cranach 1546 The Youth Fountain

  3. Preservation of health Some 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 Health and disease The ideal solution

  4. Presently established factors Life style Physical inactivity, obesity, food habits, stress, smoking Medical Hypertension, dyslipidemia diabetes……. Fundamental reasons Agricultural politics Social disintegration Climate changes Tax politics (e.g. tobacco) Industrialisation/urbanisation Preservation of health Important threats

  5. Diabetes and the Heart Meet the experts August 30 2009 Geoffrey Rose 1926 - 1993 1992 ”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.”

  6. Choice and information Choice and information Preservation of health Example - tobacco Hospital admissions for AMI in eight studies 2004 - 2008 Scientific evidence Urge Member States to implement and enforce smoke free legislation Reduction 19% (95% CI 14-24) Non-smokers  70%

  7. Preservation of health Blocking common pathways towards disease Pulmonary cancer Myocardial infarction

  8. Chronic non-communicable diseases (CNCD) Dimension and common pathways Behind 86% of deaths in WHO region Europe Main determinants Diseases Cardiovascular Tobacco Diabetes Alcohol Malignant Diet Respiratory Physical inactivity Hepatic Kidney

  9. Preservation of health Transprofessional collaboration Policy conference June 2009 Bringing 10 professional organisations together Distinguish myths from evidence based knowledge Explore the ”climate” for collaborative efforts to gain political support Lars Rydén Karolinska Institutet Stockholm, Sweden

  10. The European Chronic Disease Alliance ECDA • Recommendations on • Taxation • Agriculture • Food labelling • Urban planning • Education • Sport and recreation • Paramount legislative principle • Health in all policies

  11. Preservation of health On the importance of a unified approach 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 (Gyberg & Rydén Europ J Cardiovasc Prev Rehab 2011. In press)

  12. Preservation of health On the importance of a unified approach Hinder för förbättrad folkhälsa Group Politician NGO Health admin Professionals The threemost important measures to implement EHHC Most important Least important (Gyberg & Rydén Europ J Cardiovasc Prev Rehab 2011. In press) Political Organisation Awareness Life style Other Economic Mediarelated Attitudes

  13. The power of prevention of chronic disease Explaining the fall in CHD deaths (ex: Sweden) • Risk Factors worse +11% • Diabetes +8 • Obesity +3 • Risk Factors better - 66% • Cholesterol (diet) -39 • Smoking -20 • Population BP fall -9 • Physical activity -3 • Treatments - 36% • AMI -6 • Secondary prevention -12 • Heart failure -7 • Angina ASA, CABG & PTCA -3 • Hypertension -4 • Primary prevention (statins) -2 • Unexplained - 9% 13,180 fewer deaths 2002 1986 2002 (Björk, Rosengren, Bennett, Lappas,Capewell Europ Heart J 2009; 30:1046-56 )

  14. Resource allocation European health care % 100 80 60 40 20 0 97 Treatment Prevention 3 From the appeal to the European Commission on the occasion of the incoming European Commission, February 2010

  15. Preservation of health A long-term view of the total impact June 25 2010 www.nice.org.uk/guidance/PH25 www.sph.uq.edu.au/bodce-ace-prevention

  16. Preservation of health A long-term view of the total impact Cost-saving interventions in 2003 Australian population Taxation and regulation and interventions on salt, alcohol and tobacco Polypill for CVD prevention (ACE-i+Ca-antag+ diuretic+statin) Investment cost A$4.6 billion Averted expenses A$ 11 billions www.sph.uq.edu.au/bodce-ace-prevention (Vos et al Assessing Cost-Effectiveness in Prevention. Univ Queensland, Brisbane and Melbourne 2010)

  17. Preservation of health Some 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 Health and disease The ideal solution Thanks for the attention!!!

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