Nordic School of Public Health Nordic Centre for research and studies in Public Health Nordic School of Public Health (NHV) was established by the five Nordic countries through the Nordic Council of Ministers Priorities for Healthy Lifestyle Promotion for most effective NCD prevention

Nordic School of Public Health Public Health Systematic development of knowledge on Health development and the factors affecting health and Theories and methods for implementation and follow-up Application of theories and methods from several disciplines therefore multidisciplinary in nature Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity Health

Nordic School of Public Health INTERHEART Study ”nine potentially modifiable risk factors account for over 90% of the risk of an initial acute myocardial infarction” Population attributable risk fractions Salim Yusuf et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study). Lancet Sept 2004 DIET and exercise explain +50% CHD deaths

Nordic School of Public Health Ischaemic heart disease

Nordic School of Public Health

Comparisons with other studies: % CHD mortality falls attributed to * Beaglehole 15 analysis focused on specific treatments, inferred contribution from risk factors † Vartiainen 16 analysis focused on risk factors, inferred contribution from treatments

Nordic School of Public Health Health Protection Health Promotion Health Maintenance Disease Prevention Different aspects of implementation of Public Health Public health is the science and art of promoting health. It does so on the understanding that health is a process engaging social, mental, spiritual and physical wellbeing. Public health acts on the knowledge that health is a fundamental resource to the individual, to the community and to the society as a whole and must be supported by soundly investing in living conditions that create, maintain and protect health (Kickbusch 1989).

Nordic School of Public Health Health Protection Regulations and laws Taxation Financing health measures, supporting research Organization Training (public health, health promotion, medicine and care) Role of insurance systems Health Promotion Education Didactic methodology Participation Evidence base Health Maintenance – Disease Prevention Individual (high-risk strategy) Collective (population risk factors) Hierarchic and non-participatory

Nordic School of Public Health Strengths in public health implementation Health (medical) research during the last decades High quality in epidemiology – descriptive information The welfare state Success in decreasing heart disease – it is possible New basic knowledge – genetics Information technology Pharmaceutical treatment Knowledge from successful experience - smoking

Nordic School of Public Health SWEDEN RUSSIA FINLAND DENMARK The good examples, smoking in Finland and Sweden. A combination of health promotion and health protection

Nordic School of Public Health Weaknesses in public health implementation Normative tendencies - credibility Lack of knowledge concerning equity and health Success in preventing heart disease poorly explained Definition of health Can we afford prolonging life? Insufficient knowledge base on techniques for implementation Role of industry and agriculture

Nordic School of Public Health Schools of Public Health ”New” public health vs ”old” public health Postgraduate or Basic educations? o Carreers Postgraduate Public health o Domination by other paradigms Imbalance between medicine and social sciences in public health Readiness for Mode 2 research?

Nordic School of Public Health

Regional variations in Health Compare Copenhagen and Malmö times more diabetes in Copenhagen 1.5 times more heart disease in Copenhagen Is this due to Life style? Quality and organisation of health care? Differences in registration?

Nordic School of Public Health Unal et al J Clin Epid Potential changes in CHD mortality in England & Wales between 2000 and 2010 If risk factors a) continue recent trends b) additional reductions already achieved elsewhere

Nordic School of Public Health Specific problems Inequity persists and even increases in some countries Increased migration with specific problems Health behaviour in childhood and adolescence Financing of research in public health National differences. Impact in Finland. Russia. Political considerations: Nutritional advice vs agricultural and food industry Human resources – capacity building Medical vs social science paradigms

Nordic School of Public Health Key issues for public health and non- communicable diseases in the future Improved knowledge on implementation techniques Development towards mode 2 reseach Improved scientific basis for informed policy decisions on health promotion New areas of knowledge: Behaviour economics, Applied ethnography, Consumer behaviour research Capacity building in public health Reinforcement (recognition) of Public Health in health organizations

Nordic School of Public Health Priorities for health promotion related to non-communicable diseases The problems are well described (sufficiently?) Methods for health promotion should be better developed Methods to monitor effects of health promotion should be improved Lack of public health workforce focused on implementation Increased financial support for public health Development of ”new” knowledge areas

Nordic School of Public Health Concerning obesity/diabetes If we fail to act, we will not be forgiven by the people who live shorter and poorer lives than they deserve Fmr president Bill Clinton 2006

Nordic School of Public Health

Nordic School of Public Health

What Next? Challenges for Future Cooperation  Coordinating natural experiments in health promotion  Randomized control trials and health promotion on the societal level  Comparative studies in health, health determinants, disease, organization  Human resources for Health

Nordic School of Public Health From NordForsk report november 2007

Nordic School of Public Health