Pekka Puska, Professor Director General, National Public Health Institute (KTL) President Elect, World Heart Federation (WHF) Vice President, Int. Ass. of National Public Health Institutes (IANPHI) International Conference on ”Social Inclusion and Promotion of Healthy Lifestyles” St. Petersburg, Russia CHALLENGES OF THE NORTHERN DIMENSION IN PROMOTING PUBLIC HEALTH

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4 HEALTH -Important human value -Important for social and economic development

St. Petersburg MAJOR CHALLENGE A major challenge of the Northern Dimension in promoting public health is to CLOSE THE CAP - Between countries - Within countries

St. Petersburg LIFE EXPECTANCY AT BIRTH, RUSSIA AND THE EUROPEAN UNION, 1970–2000 6

St. Petersburg MORTALITY DIFFERENCES AMONG PEOPLE 30 AND ABOVE ACCORDING TO INCOME (Source: Martikainen P ym. Int J Epid 2001;30: ) Relative mortality Women Men Highest Decade of income Lowest (Finland)

St. Petersburg Non communicable diseases and related health problems major determinants of contemporary public health CardiovascularCardiovascular CancerCancer InjuryInjury

St. Petersburg TRENDS IN STANDARDIZED DEATH RATES FROM DISEASES OF THE CIRCULATORY SYSTEM IN RUSSIA AND EU-15 COUNTRIES

St. Petersburg Lifestyles in key position! TobaccoTobacco AlcoholAlcohol DietDiet Physical activityPhysical activity (WHO)

St. Petersburg DEATHS AND DAILY LOST ATTRIBUTABLE TO 10 LEADING RISK FACTORS, 2002

St. Petersburg Alcohol poisonings and life expectancy at birth Russia (M+F) R= Source : VM Shkolnikov

St. Petersburg HEALTH PROMOTION Entry points 1) Diseases, health problems 2) Risk factors (behavioural, biological) 3) Determinants DIFFERENT ENTRY POINTS ARE NEEDED!

St. Petersburg During the last few years there has been produced a great number of strategies and plans for evidence – based, effective health promotion and health policies. MANY IMPORTANT PRIORITIES HAVE BEEN IDENTIFIED. EFFECTIVE INTERVENTIONS AVAILABLE

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St. Petersburg THE MAIN CHALLENGE IS NOT WHAT TO DO, BUT HOW TO DO!

St. Petersburg  Personal Responsibility ”Nobody can take better care of your health than yourself”  Public Responsibility ”Make the healthy choices the easy ones” (Ottawa declaration) Combing Personal and Public Responsibilities

St. Petersburg PUBLIC RESPONSIBILITY POLICY INTERVENTIONS

St. Petersburg WHAT POLICIES? HEALTH POLICY AND HEALTH IN ALL POLICIES Health impact assessment Finland’s EU Presidency theme EU’s new health strategy

St. Petersburg CONTENTS OF POLICIES ”Stick & Carrot” -Restrictions and enabling actions -Restrictions: e.g. alcohol and tobacco tax, smokefree areas -Enabling: availability of healthy food e.g. -Good mix

St. Petersburg POLICIES AND PRACTICAL ACTIVITIES NEEDED TO DIMINISH INEQUALITIES IN HEALTH WHO’s Commission on Health Determinants raport in 2008 will hopefully put further international and national emphasis on reduction of health inequalities MANY NATIONAL STRATEGIES + EU INTEREST

St. Petersburg PARTNERSHIPS  Governments (national, local)  Civil society (NGO’s)  Private sector  INTERNATIONAL COLLABORATION

St. Petersburg PUBLIC HEALTH DOES CHANGE AND CAN BE CHANGED!

mmol/l SERUM CHOLESTEROL IN MEN AGED 25–64 YEARS North Karelia Kuopio Turku/Loimaa Helsinki/Vantaa Oulu Lapland 30

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 Mortality per population Age-standadized to European population start of the North Karelia Project extension of the Project nationally North Karelia All Finland 31

St. Petersburg STRONG INTERACTION BETWEEN DIFFERENT LEVELS NEEDED Global Regional EU NationalLocal

St. Petersburg HEALTH COLLABORATION BETWEEN FINLAND AND THE REPUBLIC OF KARELIA The Ministry of Health in the Republic of Karelia, and KTL and the North Karelia project in Finland started collaboration in 1991 Aim was to decrease mortality and morbidity due to chronic diseases and promote the health of population  Establishment and development of health monitoring systems  Planning and evaluation of interventions  Training

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St. Petersburg ELEVATED BLOOD PRESSURE Systolic >140 mmHg %

St. Petersburg HEALTHY LIFESTYLES FOR INDIVIDUAL: FOR INDIVIDUAL: Effective Way to Prevent Diseases and Promote Health FOR THE SOCIETY: FOR THE SOCIETY: A Cost Effective and Sustainable Way to Improve Public Health MAJOR HEALTH GAINS CAN BE ACHIEVED BY MODEST CHANGES IN LIFESTYLES IF THEY CONCERN MAJOR PARTS OF POPULATION

St. Petersburg ECONOMIC DRIVERS FOR DISEASE PREVENTION AND HEALTH PROMOTION  Health expenditures not only costs but also investments  Healthier population: Benefits to national economy and health care  Healthier worksite: Benefits to private sector productivity  Special issues Russia: Demographic crises Finland: Labour force, growing older population

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St. Petersburg SPECIFIC AND PRACTICAL ATTENTION TO  Alcohol policy (price & availability)  Tobacco policy (ref. WHO/FCTC)  Nutrition information + interaction with food industry  Physical activity promotion  Public health infrastructure; institutional base and monitoring

St. Petersburg SHOULD WE TARGET CHILDREN OR ADULTS? BOTH: they influence each other ultimately the question is social change

St. Petersburg HEALTH MONITORING  Power of monitoring  Need to emphasize risk factors, lifestyles, determinants  Feed back to people and decision makers  Communication for policy

St. Petersburg Successful, effective health promotion calls for effective policies, but also for effective supportative structures and the necessary resources!

St. Petersburg FINAL RECOMMENDATION 1)DO THE RIGHT THINGS AND DO ENOUGH OF IT 2)COMBINE LEADERSHIP WITH BROAD PARTNERSHIP

St. Petersburg THE NORTHERN DIMENSION IN PROMOTING PUBLIC HEALTH MANY CHALLENCES BUT MANY POSSIBILITIES AND GREAT POTENTIAL FOR HEALTH OF OUR PEOPLES

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