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ROLE OF GOVERNMENTS AND SOCIETY IN THE PREVENTION OF OBESITY AND RELATED CHRONIC DISEASES

Pekka Puska, professor, MD, PhD, MPolSc Director General, National Public Health Institute (KTL) President Elect, World Heart Federation (WHF) Vice President, Int. Ass. of National Public Health Institutes (IANPHI).

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ROLE OF GOVERNMENTS AND SOCIETY IN THE PREVENTION OF OBESITY AND RELATED CHRONIC DISEASES

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  1. Pekka Puska, professor, MD, PhD, MPolSc Director General, National Public Health Institute (KTL) President Elect, World Heart Federation (WHF) Vice President, Int. Ass. of National Public Health Institutes (IANPHI) ROLE OF GOVERNMENTS AND SOCIETY IN THE PREVENTION OF OBESITY AND RELATED CHRONIC DISEASES Chile, March 24-25, 2008

  2. GREETINGS FROM FINLAND CHILE, March 24-25, 2008

  3. 3 CHILE, March 24-25, 2008

  4. GLOBAL PUBLIC HEALTH IN TRANSITION Chronic diseases – especially cardiovascular diseases • Leading health problem in industrialized countries • Main killers and rapidly growing problem in developing countries CHILE, March 24-25, 2008

  5. Projected Main Causes of Death, Worldwide, All Ages, 2005 CHILE, March 24-25, 2008

  6. CVD’S ARE TO A GREAT EXTENT PREVENTABLE DISEASES • Medical evidence for prevention exists. • Population-based prevention is the most cost-effective and the only affordable option for major public health improvement in CVD rates. • Major changes in population rates can take place in a surprisingly short time. CHILE, March 24-25, 2008

  7. Prevention targets the population levels of most important risk factors. CHILE, March 24-25, 2008

  8. WORLD DEATHS IN 2000 ATTRIBUTABLE TO SELECTED LEADING RISK FACTORS Number of deaths (000s) Source: WHR 2002 CHILE, March 24-25, 2008

  9. SIX OF THE SEVEN TOP DETERMINANTS OF MORTALITY IN DEVELOPED COUNTRIES RELATE TO HOW WE EAT, DRINK AND MOVE DIET AND PHYSICAL ACTIVITY, TOGETHER WITH TOBACCO AND ALCOHOL, ARE KEY DETERMINANTS OF CONTEMPORARY PUBLIC HEALTH CHILE, March 24-25, 2008

  10. WHO’S NCD STRATEGY 2000 • NCD’s a priority • Prevention key • Integrated approach, targeting main behavioural factors: diet, physical activity and tobacco WHO NCD ACTION PLAN (WHA 2008) CHILE, March 24-25, 2008

  11. DIFFERENT LEVELS OF PREVENTION TARGETS POPULATION HIGH RISK PATIENTS • Determinants • sosial • economical • cultural • political Risk factors behavioural biological CVD/NCD Consequencies PREVENTION HEALTH PROMOTION TREATMENT, REHABILITATION, SEC. PREVENTION CHILE, March 24-25, 2008

  12. SOUND COMBINATION OF POPULATION STRATEGY WITH HIGH RISK STRATEGY • POPULATION STRATEGY: - Greatest public health gains - Cost effective - Results also in other health benefits • HIGH RISK STRATEGY: - Great benefits to the persons concerned - Effective use of health services CHILE, March 24-25, 2008

  13. LIFESTYLES IN KEY POSITION • Individual health • Population health HOW TO INFLUENCE LIFESTYLES? CHILE, March 24-25, 2008

  14. LIFESTYLES AND RISK FACTORS CAN CHANGE! CHILE, March 24-25, 2008

  15. 15 CHILE, March 24-25, 2008

  16. 6 16

  17. North Karelia ProjectPRINCIPLES FOR DEFINING THE INTERMEDIATE OBJECTIVES • 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 CHILE, March 24-25, 2008

  18. FROM KARELIA TO NATIONAL ACTION • First province of North Karelia as a pilot (5 years), then national action (1972–77) • Continuation is North Karelia as national demonstration (1977–95) • Good scientific evaluation to learn of the experience • Comprehensive national action CHILE, March 24-25, 2008

  19. EVALUATION / MONITORING • North Karelia – all Finland • Monitoring systems • health behaviour • risk factors • nutrition • diseases, mortality CHILE, March 24-25, 2008

  20. USE MAINLY BUTTER ON BREAD (men age 30–59) % 100 North Karelia Kuopio province 80 Southwest Finland Helsinki area Oulu province 60 Lapland province 40 20 0 1972 1977 1982 1987 1992 1997 2002 CHILE, March 24-25, 2008

  21. MILK CONSUMPTION IN FINLAND IN 1970 AND 2006(kg per capita) kg 140 Whole milk 120 100 Low fat milk 80 Whole form milk 60 40 20 Skim milk 0 1960 1970 1980 1990 2000 2010 CHILE, March 24-25, 2008

  22. USE MAINLY VEGETABLE OIL FOR COOKING (men age 30–59) % 70 North Karelia Kuopio province 60 Southwest Finland 50 Helsinki area Oulu province 40 Lapland province 30 20 10 0 1972 1977 1982 1987 1992 1997 2002 2007 CHILE, March 24-25, 2008

  23. SALT INTAKE IN FINLAND 1977–2002 g/day Year Sources: Karvonen et al. 1977, Nissinen et al. 1982, Pietinen et al. 1981, Pietinen et al. 1990, Valsta 1992, KTL/Nutrition Report 1995, KTL/ FINDIET 1997 and FINDIET2002 Studies, KTL/unpublished information

  24. SERUM CHOLESTEROL IN MENAGED 30–59 YEARS mmol/l 7,5 7 North Karelia Kuopio 6,5 Turku/Loimaa Helsinki/Vantaa Oulu 6 Lapland 5,5 5 1972 1977 1982 1987 1992 1997 2002 2007 FINRISK Studies 1997 & 2002 CHILE, March 24-25, 2008

  25. CHD MORTALITY IN ALL FINLAND AND IN NORTH KARELIA, MEN AGED 35–64 Per 100 000 700 start of the North Karelia Project extension of the Project nationally 600 500 North Karelia 400 300 - 85% 200 All Finland 100 - 80% 0 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 25 Year Source: Statistics Finland

  26. OBSERVED AND PREDICTED DECLINES IN CORONARY MORTALITY IN EASTERN FINLAND, MEN % 0 -10 Observed -20 Predicted -30 Cholesterol Blood pressure -40 Smoking -50 -60 -70 -80 -90 1972 1977 1982 1987 1992 1997 2002 2007 Year CHILE, March 24-25, 2008

  27. MORTALITY CHANGES IN NORTH KARELIA from 1969–71 to 2006(Men 35–64 Years, Age Adjusted) Rate (per 100.000) Change from1969–71 2006 1969–71 to 2006All causes 1509 572- 62%All cardiovascular 855 182- 79%Coronary heart disease 672 103- 85%All cancers 271 96- 65%Lung cancers 147 30- 80% CHILE, March 24-25, 2008

  28. North Karelia ProjectCONCLUSIONS • 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 favourable 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. CHILE, March 24-25, 2008

  29. CHILE, March 24-25, 2008 29

  30. COMBING PERSONAL AND PUBLIC RESPONSIBILITIES • Personal Responsibility ”Nobody can take better care of your health than yourself” • Public Responsibility ”Make the healthy choices the easy ones” (Ottawa declaration) CHILE, March 24-25, 2008

  31. CHILE, March 24-25, 2008 31

  32. PUBLIC RESPONSIBILITY POLICY INTERVENTIONS CHILE, March 24-25, 2008

  33. STRONG INTERACTION BETWEENDIFFERENT LEVELS NEEDED Global Regional EU National Local CHILE, March 24-25, 2008

  34. 34 CHILE, March 24-25, 2008

  35. STRONG GLOBAL INFLUENCES – GLOBAL HEALTH ACTIONS NEEDED: WHO GLOBAL STRATEGY ON DIET, PHYSICAL ACTIVITY AND HEALTH ADOPTED IN 2004 CHILE, March 24-25, 2008

  36. WE NEED STRONGER USE OF GLOBAL PUBLIC HEALTH INSTRUMENTS! Further developments with Global Strategy on Diet and Physical Activity. CHILE, March 24-25, 2008

  37. NATIONAL Governments have a basic responsibility for public health. CHILE, March 24-25, 2008

  38. PARTNERSHIPS FOR NATIONAL PUBLIC HEALTH WORK • Health services • Governments (national, local) • Civil society (NGO’s) • Private sector • International collaboration CHILE, March 24-25, 2008

  39. PRIVATE SECTOR • Food, eating, physical activity • Commercial issues are of increasing impact to public health • Health is increasingly important business argument • Product development, marketing • Social responsibility? Regulation? Market push? CHILE, March 24-25, 2008

  40. HEALTH SERVICES • High risk / population approaches • Health services in interaction with other community activities and general health promotion work • Evidence – based interventions • Use of IT technology CHILE, March 24-25, 2008

  41. CIVIL SOCIETY • The role of civil society is increasing in most countries • NGO’s: mobilize people, serve people, watchdogs, etc. • Push for childhood obesity to public / political agenda CHILE, March 24-25, 2008

  42. During the last few years a great number of strategies and plans for evidence – based, effective prevention and health promotion have been produced. Many important priorities have been identified. CHILE, March 24-25, 2008

  43. 43 CHILE, March 24-25, 2008

  44. THE MAIN CHALLENGE IS NOT WHAT TO DO, BUT HOW TO DO! CHILE, March 24-25, 2008

  45. FROM PRIORITIES TO IMPLEMENTATION IDENTIFYING IMPLEMENTING PRIORITIES THEM CHILE, March 24-25, 2008

  46. STRONGER SUPPORT FOR IMPLEMENTATION • Stronger public health infrastructures • Stronger health surveillance / monitoring • Innovative financial support mechanisms CHILE, March 24-25, 2008

  47. MEDICAL KNOWLEDGESOCIAL & EFFECTIVE BEHAVIORAL PROGRAMS THEORY POLICIES STRONG SUSTAINED IMPLEMENTATION KEY ELEMENTS CHILE, March 24-25, 2008

  48. HEALTH MONITORING • Power of monitoring • Feed back to people and decision makers • Need to emphasize risk factors, lifestyles, determinants CHILE, March 24-25, 2008

  49. MAJOR ELEMENTS OF NATIONAL ACTION • Research • Health services (especially primary health care) • Demonstration programmes • Building coalitions • Schools, educational institutions CHILE, March 24-25, 2008

  50. MAJOR ELEMENTS OF NATIONAL ACTION • Industry, business • Policy decisions, intersectoral collaboration, legislation • Monitoring: health behaviours, risk factors, diseases • International collaboration CHILE, March 24-25, 2008

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