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Published on September 7, 2007

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Pekka PuskaDirector GeneralNational Public Health Institute – KTLHelsinki, Finland:  Pekka Puska Director General National Public Health Institute – KTL Helsinki, Finland DIET AND HEALTH – THE WAY FORWARD: The nature and extent of the problem and the public health potential of sound strategies TACD seminar Brussels 3.2.2004 Slide2:  Contents:  Contents Burden of Non-Communicable diseases The main risk factors: diet andamp; physical activity Prevention works: evidence The response: diet and physical activity – global and national strategies Death, by Broad Cause Group 2000 :  Injuries (9.1%) Noncommunicable conditions (59.0%) Communicable diseases, maternal and perinatal conditions and nutritional deficiencies (31.9%) Total deaths: 55,694,000 Source: WHO, World Health Report 2001 Death, by Broad Cause Group 2000 Deaths, by Broad Cause Group and WHO Region, 2000:  Deaths, by Broad Cause Group and WHO Region, 2000 Injuries Noncommunicable conditions Communicable diseases, maternal and perinatal conditions and nutritional deficiencies AFR EMR EUR SEAR WPR AMR 25 50 75 % Source: WHO, World Health Report 2001 World Health Report 2002 ”Reducing Risks, Promoting Healthy Life”:  World Health Report 2002 'Reducing Risks, Promoting Healthy Life' Latest estimates of disease burden Health effects of selected major health risks: globally and in regions Strategies to reduce risk Slide7:  World Deaths in 2000 attributable to selected leading risk factors Number of deaths (000s) Source: WHR 2002 Slide8:  Developed Countries Deaths in 2000 attributable to selected leading risk factors Number of deaths (000s) Six of the Seven Top Determinants of Mortality in Developed Countries Relate to How We Eat, Drink and Move.:  Six of the Seven Top Determinants of Mortality in Developed Countries Relate to How We Eat, Drink and Move. DIET AND PHYSICAL ACTIVITY ARE KEY DETERMINANTS OF CONTEMPORARY PUBLIC HEALTH Lifestyle Transition:  Lifestyle Transition Emerging epidemic of NCDs is to a great extent a consequence of rapid changes in the diets, of declining physical activity and of increase of tobacco use The determinants of these changes are urbanization, changes in occupations and many global influences The transition concerns adults and children Risks are increasingly accumulating in lower socio-economic groups of the population PREVENTION WORKS:  PREVENTION WORKS NCD:s are to a Great Extent Preventable Diseases:  NCD: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 NCD rates. Major changes in population rates can take place in a surprisingly short time. Diet and Risk of NCD:  Diet and Risk of NCD Up to 80 % of coronary heart disease and up to 90 % of type 2 diabetes could be avoided through changing lifestyle factors. About one third of cancers could be prevented by eating healthily, maintaining normal weight and being physically active throughout the life span. Diet and Risk of NCD:  Diet and Risk of NCD Trials in China, US, and Finland show that among high-risk individuals, close to 60 % of type 2 diabetes cases could be prevented by modest changes in diet and physical activity. The impact of these measures can be double that of drug intervention. Major changes in rates of CHD and diabetes can be seen in a few years. CHD mortality in all Finland and in North Karelia35-64 year old men:  -75% -82% CHD mortality in all Finland and in North Karelia 35-64 year old men 100 200 300 400 500 600 700 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 2000 2001 2002 Year North Karelia All Finland start of the North Karelia Project extension of the Project nationally Population dietary changes explain much of the reduction in heart disease mortality in Finland.:  Population dietary changes explain much of the reduction in heart disease mortality in Finland. Vartiainen, Puska et al BMJ 1995 Observed Predicted Cholesterol Blood pressure Smoking 72 92 76 80 84 88 74 78 82 86 90 Observed and Predicted Declines in Coronary Mortality in Eastern Finland, Men 0 -10 -20 -30 -40 -50 -60 Decline in mortality Strategies to Reduce Risk: World Health Report 2002 Messages I:  Strategies to Reduce Risk: World Health Report 2002 Messages I Very substantial health gains can be made for relatively modest expenditures on interventions Changing population distributions of risk factors (like blood pressure, blood cholesterol) through general lifestyle changes CVD: Population wide strategies to lower cholesterol (Quality of Fat) and blood pressure (Salt Reduction) key Strategies to Reduce Risk: World Health Report 2002 Messages II:  Strategies to Reduce Risk: World Health Report 2002 Messages II Tobacco: Higher taxes, comprehensive advertisement ban Mix of population wide, high risk and secondary prevention measures, in a cost effective balance Sustained policy action Strengthening of national institutions to implement and evaluate risk reduction programmes Health diet and physical activity are:  Health diet and physical activity are For the individual: an effective way to prevent disease and promote health For society: a cost effective and sustainable way to improve public health The Global Strategy on Diet, Physical Activity and Health is of great importance for global public health. Slide20:  The Big Picture WHO Global Strategy on Diet, Physical Activity and Health: The Way Forward:  WHO Global Strategy on Diet, Physical Activity and Health: The Way Forward WHO/EB in January passed it to WHA in May for adoption Member States can comment until end of February: important to have supportative comments for strong strategy Regional (and EU) collaboration important on the road forward Important to ensure resources and support for effective implementation at WHO/HQ and in regions and countries Should lead to strengthened national strategies Principles of the Global Strategy:  Principles of the Global Strategy Comprehensive roadmap for Member States and other stakeholders Based on strong evidence and broad consultations Emphasizes positive actions and collaboration Supports Member States Addresses global responses Strong Interaction Between Different Levels Needed:  Strong Interaction Between Different Levels Needed Global Regional EU National Local Slide24:  THANK YOU:  THANK YOU

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