1 / 58

International Seminar on the Public Health Aspects of Noncommunicable Diseases Lausanne -Geneva

International Seminar on the Public Health Aspects of Noncommunicable Diseases Lausanne -Geneva. Finland’s experience in implementing NCD prevention Dr. Tiina Laatikainen, Director Department of Chronic Disease Prevention Erkki Vartiainen, MD, Professor, Assistant Director General. 5.

aliza
Download Presentation

International Seminar on the Public Health Aspects of Noncommunicable Diseases Lausanne -Geneva

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. International Seminar on the Public Health Aspects of Noncommunicable Diseases Lausanne -Geneva Finland’s experience in implementing NCD preventionDr. Tiina Laatikainen, Director Department of Chronic Disease Prevention Erkki Vartiainen, MD, Professor, Assistant Director General CVD prevention/ Tiina Laatikainen

  2. 5

  3. In the 1970’s • Statistics showed very bad public health situation • CHD mortality rates among men highest in the world • Short life expectancy • Increasing public discussion • General opinion related CHD to stress, ageing and genetics (but little to lifestyle) • CHFD also referred to as “Disease of the Executives” • Cardiologists were aware that there are numerous “Statistical Associations”

  4. Serum cholesterol distribution in Finland and Japan in the 1970s Frequency % mmol/l

  5. Two main questions in 1970s • Can risk factors and behaviors be changed on population level ? • If risk factors reduce what will happen to the mortality?

  6. Aims of the North Karelia Project North Karelia Project MAIN OBJECTIVE: • Initially: To reduce CVD mortality • Later: To reduce major chronic disease mortality and promote health INTERMEDIATE OBJECTIVES: • To reduce the population levels of main risk factors, emphasizing lifestyle changes and to promote secondary prevention NATIONAL OBJECTIVE: • Initially: To be pilot for all Finland • Later: To be demonstration and model program

  7. Main Principles of the North Karelia Project • Primary prevention is the only sustainable approach • Community based preventive programme 1 Target: the community (not individuals) 2 Intervention: through changes in the community organization/structures (not external intervention) • Risk factors identified by prospective studies, closely linked with certain behaviours - deeply enrooted in the community • - smoking - elevated serum cholesterol (diet) - elevated blood pressure

  8. CLINICAL INTERVENTION RISK FACTORS PUBLIC HEALTH INTERVENTION

  9. 25 % 5 % 70 % People with average risk factor level People with clinically high risk factor level People with low risk factor level Individual risk of CHD Distribution of people according to risk factor level Theoretical presentation of the difference between individual risk and the proportional attributable risk

  10. Constraints • Suspicions from the scientific community of cardiologists • Medical knowledge on prevention questionable: community prevention new concept • North Karelia socially deprived area, poor and with many social problems (unemployment, migration, shortage of doctors etc) • Post war years: great poverty, then increase in consumption • Dairy farming main agriculture: butter and animal fat culturally highly valued • Strong commercial pressures (“FAT WAR”), supported by political pressures • Raising the funding (intervention and evaluation research) • To maintain interest and funding over decades

  11. Advantages • Magnitude of problem, concern of people • Relatively homogenous population, traditions of community action • Trust in experts and in public action • Good information system • Good collaboration with people • Good leadership

  12. Community intervention model of the North Karelia Project

  13. North Karelia ProjectPractical intervention • Emphasis on persuasion, practical skills, social & environmental support for change • Research team & local project office with comprehensive community involvement • Main areas: 1. Media activities (materials, mass media, campaigns) 2. Preventive services (primary health care etc.) 3. Training of professional and other workers 4. Environmental changes (smoke-free areas, supermarkets, food industry etc.) 5. Monitoring and feed-back

  14. ANTISMOKING LEGISLATION IN FINLAND IN 1977: Prohibition of all forms of advertising Restrictions in smoking in public places Health warnings etc. 1/2% level of tobacco tax for antismoking activities Prohibition of sale to under 16 years old ANTISMOKING LEGISLATION IN FINLAND IN 1995, 2000 AND 2007: Worksite smoking policy Sales to persons under 18 years of age prohibited Restaurant, bar smoking policy

  15. Smoking control programmes • Worksite programmes • School programmes • TV programmes • Radio programmes • Smoke Free Class Competition • Quit and Win - Do Not Start and Win for Young People

  16. A comprehensive television smokingcessation programme in Finland • Voluntary smokers in TV studio tried to stop smoking • 6 sessions + 2 follow-up sessions • Intensified field activity in North Karelia • 250 000 saw at least 4 sessions • 30 000 attempted to quit • 20 000 quitted • 10 000 remained non-smokers

  17. North Karelia ProjectCholesterol programme • SPECIAL INTENSIFIED PROGRAM - New consensus recommendations - New reference values (< 5 mmol/L = “normal”) - Fingertip determination method - Interest of food industry - Finnish rapeseed oil • MAIN COMPONENTS - Population-wide cholesterol measurements - Dietary counseling - Mass media and many campaigns (incl. Village competition) - Collaboration with industry and supermarkets

  18. Co-operation with the Martta (housewifes’) organization • Active co-operation since 1972 • Several hundred clubs and many thousand members • Promotion of healthy cooking = dietary habits • Many special campaigns, notably: - “Parties for longlife” 1976-77 - Evenings of “Happy Heart” 1990-91

  19. Use of lay opinion leaders to promote health innovations in community • Innovation-diffusion theory • Training seminars in municipalities • Discuss health issues in normal life • 805 persons participated • Recruitment by local people and Heart Association • 1975-1982 • Evaluation in 1982: 399 (50%) still active

  20. Fruits And Vegetables – Supermarkets

  21. Village competition to lower cholesterol • 1991: 7 villages, population 105-210 • 1997: 16 villages, population 85-420 • Village committees organized • 2 months competition • Baseline and follow-up cholesterol measurement • Best village won 2000 €

  22. Cholesterol changes in 1991 competition

  23. North Karelia ProjectBerry project • Aim to increase the consumption of eastern Finnish berries • Rationale: 1) Berries are healthy 2) Enhances switch from dairy farming • First Berry Project 1985-90 • Second Berry Project 1992 - • Methods: various co-operative and innovative interventions • Funding from government

  24. Examples of intersectoral work 1. Change in SFA content of Finnish cow milk

  25. Examples of intersectoral work 2 Biscuit example (trans fat): Leading Finnish biscuit manufacturer (LU Finland Ltd) has removed some 80.000 kg of SFA by changing the fats used All trans fats removed and major transfer to rapeseed oil Meat product example (SFA): HK (Leading Finnish meat company) since 2007 annually: 60.000 kg less salt 100.000 kg less SFA in their products (will be increased to 500 000 kg due to change in pig feeding) The average salt content of HK products

  26. Changes in Finnish food habits Year

  27. Fat used for cooking at home in Finland in 1978-2006 Health Behaviour among the Finnish Adult Population 1978–2006

  28. Cholesterol distribution in North Karelia in 1972 and 2007, men 4 6 8 10 12 mmol/l

  29. Saltintake in Finland 1977-2007 g/day The FINDIET Study

  30. Systolic blood pressure in men (30–59 y) mmHg North Karelia project evaluation and FINMONICA and the National FINRISK Studies 1972 - 2007

  31. per 100 000 North Karelia All Finland Decline in CHD mortality in men aged 35-64

  32. Observed and Predicted Decline in CHD mortality 35-64 year old men Vartiainen E et al.

  33. CHD mortality fall in Finland 1982 – 1997 • Risk Factors -71% • Cholesterol - 53% • Smoking - 11% • Blood pressure - 7% • Treatments -24% • AMI treatments - 4% • Secondary prevention - 8% • Heart failure - 2% • Angina: CABG & PTCA - 8% • Angina: Aspirin etc - 2% • Other Factors -5% 373 fewer deaths 1982 1997 T Laatikainen et al Am J Epid 2005

  34. Finland Has Shown • Prevention of major chronic diseases is possible and pays off • Population based prevention is the only cost effective and sustainable public health approach to chronic disease control • Prevention of CVD calls for simple changes in some lifestyles (individual, family, community, national and global level action) • Many results of prevention occur surprisingly quickly (CVD, diabetes) • Comprehensive action, broad collaboration with dedicated leadership and strong government policy support are crucial

  35. Why success in North Karelia • Appropriate epidemiological and behavioural framework • Restricted, well defined targets • Good monitoring of immediate targets (behaviours, processes) • Emphasis in changing environment and social norms • Working closely with the community • Work with media • International collaboration, support from WHO • Close interaction with national health policy, integration with National Public Health Institute • Long term, dedicated leadership

  36. Major Elements of Finnish National Action • Research & international research collaboration • Health services (especially primary health care) • North Karelia Project, other demonstration programmes • Health Promotion Programs (coalitions, NGOs, media,etc) • Schools, educational institutions • Collaboration with industry, business • Policy decisions, intersectoral collaboration, legislation • Monitoring system: health behaviours, risk factors, nutrition

  37. Working intersectorally Work sites Education Food industry Taxation Business Media Agriculture Legislation Third sector Research Health services

  38. POPULATION PUBLIC POLICY PRIVATE SECTOR HEALTH PROGRAMME

  39. Conclusions North Karelia Project • A comprehensive, determined and theory-based community program can have a meaningful positive effect on risk factors and life styles • Such changes are associated with respective favorable changes in chronic disease rates and health of the population • A major national demonstration program can be a strong tool for favourable national development in chronic disease prevention and health promotion

  40. New textbook on North Karelia project Pekka Puska, Erkki Vartiainen, Tiina Laatikainen, Pekka Jousilahti, Meri Paavola (eds.) The North Karelia project: from North Karelia to national action http://www.thl.fi/thl-client/pdfs/731beafd-b544-42b2-b853-baa87db6a046 Also available in Russian

  41. Training seminar on NCD prevention www.thl.fi/ncdseminar Helsinki, Finland and in North Karelia 12-16 March, 2012 11-15 March, 2013

  42. Presentation name / Author

  43. Fat intake Recommendations EN% Year • The FINDIET Study

  44. Change (%) in cholesterol value by village activity

  45. Serum cholesterol in men aged 30-59 years mmol/L

  46. Discussions with target groups

  47. NGO’s role • Heart Association • Martta (house wife’s) association

  48. Smoking in men (30–59 y) % North Karelia project evaluation and FINMONICA and the National FINRISK Studies 1972 - 2007

More Related