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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 CASE STUDY OF FINLAND: concerted national public health actions Healthcare Conference Brussels 20.1.2005 1 Levels of welfare and Health Administration in Finland:  Levels of welfare and Health Administration in Finland President Government Parliament Ministry of Social Affairs and Health Agencies and Institutions Provincial Governments/Units for social affairs and health Municipal administration Healthcare Conference Brussels 20.1.2005 2 KTL under Ministry of Social Affairs and Health:  Administrative Department Insurance Department Department for Family and Social Affairs Health Department Finance and Planning Department Department for Occupational Safety and Health Insurance Supervisory Authority Unemployment Appeal Board Appeal Board Central Pension Security Institute Social Insurance Institution Unemployment Insurance Fund and the Support Fund Education and Redundancy Payments Fund Slot Machine Association Alko Inc. Finnish Institute of Occupational Health National Research and Development Centre for Welfare and Health National Product Control Agency for Welfare and Health Radiation and Nuclear Safety Authority National Agency for Medicines National Authority for Medicolegal Affairs Occupational Safety and Health Inspectorate of Finland Finnish Work Environment Fund Social and Health Departments of the State Provincial Offices KTL under Ministry of Social Affairs and Health Healthcare Conference Brussels 20.1.2005 3 Slide4:  Strategic MSAH Programmes implementing the Government Programme 2003-2007 Health 2015 – Public Health Programme, Alcohol Programme, Ageing Policy 'Veto' Programme for making the working life more attractive, Incentives in social security (to make work pay) Level and clarity of social security, EU-National Action Plan against poverty and social exclusion (NAP/incl.) National Health Care Programme, Development Programme on Social Services Strategy for Family Policies Mainstreaming of equality between sexes, Revised Equality Act Healthcare Conference Brussels 20.1.2005 4 Aim and Functions :  Aim and Functions AIM KTL promotes people's possibilities to live healthy life. KTL, as research institute and expert body under Ministry of Social Affairs and Health, is responsible for providing decision makers, health personnel and the public with best available health information as tool for their choices. KTL promotes actions for healthy options at all levels. FUNCTIONS scientific knowledge public health international collaboration Healthcare Conference Brussels 20.1.2005 5 Slide6:  Public Health in Finland in General better than ever before many challenges and threats much to be improved based upon medical knowledge health is an increasingly important value in life Healthcare Conference Brussels 20.1.2005 6 Public Health Development in Finland :  Public Health Development in Finland Before the War Long, heavy war and difficult post war years In the 1950’s and 60’s In the 1970’s and 80’s In the 1990’s and 2000’s Mainly Infectious Diseases Rapid increase in the CVD and other NCD rates Start of national preventive actions (incl. North Karelia Project) Concerted public health policies, information guidance Healthcare Conference Brussels 20.1.2005 7 Slide8:  Healthcare Conference Brussels 20.1.2005 8 North Karelia ProjectPrinciples for Defining the Intermediate Objectives:  North Karelia Project Principles 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 of best available knowledge: - previous studies - collective international recommendations - epidemiological situation in North Karelia • Chosen risk factors: - smoking - elevated serum cholesterol (diet) - elevated blood pressure Healthcare Conference Brussels 20.1.2005 9 From Karelia to National Action:  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 Healthcare Conference Brussels 20.1.2005 10 Major Elements of Finnish National Action 1.:  Major Elements of Finnish National Action 1. Research andamp; international research collaboration Health services (especially primary health care) North Karelia Project, other demonstration programmes Health Promotion Programmes (coalitions, NGO’s, collaboration with media etc.) Schools, educational institutions Healthcare Conference Brussels 20.1.2005 11 Major Elements of Finnish National Action 2.:  Major Elements of Finnish National Action 2. Industry, business - collaboration Policy decisions, intersectoral collaboration, legislation Monitoring system: health behaviours, risk factors, nutrition International collaboration Healthcare Conference Brussels 20.1.2005 12 Fat Intake as Percentage of Energy in Finland:  Fat Intake as Percentage of Energy in Finland En% Year Sources: Hasunen et al. 1976 Uusitalo et al. 1986 Kleemola et al. 1994 Findiet Study Group 1998 Männistö et al. 2003 Recommendations Healthcare Conference Brussels 20.1.2005 13 Slide14:  Fruits And Vegetables – Supermarkets Healthcare Conference Brussels 20.1.2005 14 Serum Cholesterol in Men Aged 30–59 Years:  Serum Cholesterol in Men Aged 30–59 Years mmol/l FINRISK Studies 1997andamp;2002 Healthcare Conference Brussels 20.1.2005 15 Slide16:  Age-adjusted mortality rates of coronary heart disease in North Karelia and the whole of Finland among males aged 35-64 years from 1969 to 2002. Mortality per 100 000 population 100 200 300 400 500 600 700 Year North Karelia All Finland start of the North Karelia Project - 82 % - 75% extension of the Project nationally Healthcare Conference Brussels 20.1.2005 16 Why Dehko (Diabetes) Programme?:  Why Dehko (Diabetes) Programme? The first diabetes plan in Finland in 1976 Diabetes is increasing, as costs for individuals and for society Gap between knowledge andamp; possibilities of diabetes care and outcome of treatment Strong science base: DPS (Finland), international Links with CVD and other national programmes Healthcare Conference Brussels 20.1.2005 17 Slide18:  The main aim: To determine whether lifestyle intervention of overweight, middle-aged subjects with impaired glucose tolerance (IGT) will prevent or delay the development of type 2 diabetes Study subjects: 522 subjects with IGT according to WHO (1985) criteria in two oral glucose tolerance tests (OGTT) Age 40–65 years BMI andgt; 25 kg/m2 DPS: The Finnish Diabetes Prevention Study Healthcare Conference Brussels 20.1.2005 18 Slide19:  Risk reduction: 58% Risk reduction: 58% Risk reduction: 45% Risk reduction: 58% Cumulative no DM 21 52 73 77 84 86 Total no 507 471 374 167 53 27 Cumulative incidence of diabetes in the intervention and control groups: March 2000 Healthcare Conference Brussels 20.1.2005 19 Obesity (BMI>30) Trends Among Men* in England and Finland:  Obesity (BMIandgt;30) Trends Among Men* in England and Finland 0 5 10 15 20 25 30 1980/1982 1986/1987 1991/1992 1997 2002 prevalence, % England Finland Data sources: IOTF, UK/Dept Health: Health Surveys for England 1997 andamp; 2002, KTL: The FINRISK studies 1982-2002 * England 16-64 y./andgt;15 y, Finland 25-64 y. Fin Eng Healthcare Conference Brussels 20.1.2005 20 Obesity (BMI>30) Trends Among Women* in England and Finland:  Obesity (BMIandgt;30) Trends Among Women* in England and Finland 0 5 10 15 20 25 30 1980/1982 1986/1987 1991/1992 1997 2002 prevalence, % England Finland Data sources: IOTF, UK/Dept Health: Health Surveys for England 1997 andamp; 2002, KTL: The FINRISK studies 1982-2002 * England 16-64 y./andgt;15 y, Finland 25-64 y. Fin Eng Healthcare Conference Brussels 20.1.2005 21 Programme for the Prevention of Type 2 Diabetes in Finland 2003–2010:  Programme for the Prevention of Type 2 Diabetes in Finland 2003–2010 Planning: diabetes, PA, nutrition and obesity researchers, health care providers, authorities and organizations Based on sound prevention strategies Training in all (21) hospital districts 2002–2003 Essential: a strong partnership with the National Heart Association, Cardiovascular Programme and National Public Health Institute – KTL FinD2D: Specific intervention project in 5 hospital districts Healthcare Conference Brussels 20.1.2005 22 Main Public Health Challenges:  Main Public Health Challenges increasing diseases and conditions (diabetes, asthma, mental health problems etc.) to ensure continuation of positive development (cardiovascular diseases, lung cancer, dental health etc.) new health threats (SARS, influenza, bio threats etc.) increasing health risks (alcohol, obesity, drugs etc.) health inequities health care costs health and availability of labour force functional capacity of the elderly children, youth new forms of communication, role of commercial issues international challenges Healthcare Conference Brussels 20.1.2005 23 Finnish Model:  Finnish Model 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 calls for simple changes in some lifestyles (individual, family, community, national and global level action) Influencing national diets andamp; other lifestyles is a key issue Many results of prevention occur surprisingly quickly (CVD, diabetes) and also at relatively late age Comprehensive action, broad collaboration with dedicated leadership and strong government policy support andamp; policy framework 24 Healthcare Conference Brussels 20.1.2005 Slide25:  25 Healthcare Conference Brussels 20.1.2005 Slide26:  Healthcare Conference Brussels 20.1.2005 26

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