1. HEALTH PROMOTION AND SUSTAINABLE DEVELOPMENT PAHO/SDES seminar 30.5.2012 Pekka Puska Director General National Institute for Health and Welfare (THL) Past President, World Heart Federation (WHF) Vice Precident, Int. Ass. of National Public Health Institutes (IANPHI)

2. Pekka Puska, Director General GREETINGS FROM FINLAND

3. Global Public Health in Transition Chronic diseases – especially cardio-vascular diseases  Leading health problem in industrialized countries  Main killers and rapidly growing problem in developing countries 12.6.2016 Pekka Puska, Director General

4. Global Health Burden Estimated global deaths by cause, all ages, 2005 Source : WHO 2005: «Preventing Chronic Diseases: A Vital Investment» 3

5. Lifestyle Transition  Emerging global epidemic of NCDs is to a great extent a consequence of changes in the diets, of declining physical activity and of increase of tobacco use  The determinants of these changes are urbanisation, changes in occupations, population ageing and many global influences  Risks are increasingly accumulating in lower socio-economic groups of the population 12.6.2016 Pekka Puska, Director General

6. NCDs are preventable From a medical point of view NDCs are to a great extent preventable diseases until late in life Prevention is based on the elimination of lifestyle-related risk factors (tobacco, diet, physical activity, alcohol) Lifestyles are greatly influenced by social and physical environments Amenable to policies Pekka Puska, Director General

7. NCD prevention pays off For the individual, successful prevention means avoidance of diseases and related costs, promotion of health and well being, and healthy ageing For the society and the nation, prevention means reduced disease burden, control of health care costs, increased productivity and a promotion of sustainable and favourable socio economic development Globally, special responsibilities fall to low- and middle-income countries Pekka Puska, Director General

8. History in Finland Hardships of war and postwar years Relative increase in standard of living Great increase in CVD Attention to extremely high CVD mortality Determined action: North Karelia Project Pekka Puska, Director General 6/12/2016

9. 12/06/2016 Pekka Puska, Director General9 3

10. 12/06/2016 Pekka Puska, Director General10 Main Principles of the North Karelia Project Prevention is the only sustainable public health approach Risk factors identified by prospective studies, closely linked with certain behaviours - deeply enrooted in the community Community based preventive programme 1Target: the community (not individuals) 2Intervention: through community structures (not external intervention) Emphasis on community organization, general community changes NORTH KARELIA NATIONAL ACTION

11. 12/06/2016 Pekka Puska, Director General11 LIFESTYLES, RISK FACTORS AND NCD RATES CAN CHANGE!

12. 12/06/2016 Pekka Puska, Director General12 Use of Butter on Bread (men age 30 – 59) Kg/m 2

13. 12/06/2016 Pekka Puska, Director General13

14. 12/06/2016 Pekka Puska, Director General14 Figure X. Prevalence of daily smoking in Finland in 1960–2010 and selected tobacco control actions. Sources: National Institute for Health and Welfare, Health Behaviour and Health among the Finnish Adult Population –studies 1978– 2010; Leppo & Vertio (1986).

15. Change in age-adjusted mortality rates Finland, males aged 35–64 (per 100 000 population) extension of the Project nationally start of the North Karelia Project North Karelia -85% All Finland -80% Rate per 100 000 1969- 1971 2006Change from 1969- 1971 to 2006 All causes 1328583-56% All cardiovascular 680172-75% Coronary heart disease 489103-79% All cancers 262124-53% Coronary heart disease Gain of some 10 healthy years in Finnish popupaltion Gain of some 10 healthy years in Finnish popupaltion

16. 6/12/2016 Pekka Puska, Director General Sihvonen ym. 2003 Subjective health 0 5 10 15 20 1980200019802000 years 0 5 10 15 20 1980200019802000 years sic / disability healthy / no disability sic / disability healthy / no disability men womenmenwomen Healthy and sick years of life expectancy of 65 year old Finns in 1980 and in 2000 Managing basic functions

17. Health in All Policies: Examples of intersectoral work in Finland Development of Finnish Rapeseed oil Change in fat content of Finnish cow milk

18. Examples of intersectoral work 2. Biscuit example: Leading Finnish biscuit manufacturer (LU Finland Ltd) has removed some 80.000 kg of SAFA by changing the fats used All trans fats removed and major transfer to rapeseed oil Meat product example: HK (Leading Finnish meat company) since 2007 annually: 40.000 kg less salt 150.000 kg less saturated fat in their products

19. 12/06/2016 Pekka Puska, Director General19

20. Pekka Puska, Director General20 Prevention targets the population levels of most important risk factors. 12/06/2016

21. GLOBAL PUBLIC HEALTH BURDEN FROM RISK FACTORS LIFESTYLE RELATED NCD-RISK FACTORS IN KEY POSITION DIET AND PHYSICAL ACTIVITY, TOGETHER WITH TOBACCO AND ALCOHOL, ARE KEY DETERMINANTS OF CONTEMPORARY PUBLIC HEALTH 12/06/2016 Pekka Puska, Director General21

22. Pekka Puska, Director General

23. 23 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) 12/06/2016

24. Cornerstones of NCD prevention and control (WHO global strategy) Attention to behavioural risk factors –Tobacco use –Unhealthy diet –Physical inactivity –Harmful use of alcohol Monitoring and surveillance of –Risk factors and diseases –Preventive actions Redirection of health services –Prevention –Chronic care model Pekka Puska, Director General

25. 25 NATIONAL LEVEL Governments have a basic responsibility for public health. 12/06/2016

26. Comprehensive action and partnership for national NCD prevention Health services Governments (national, local) Civil society (NGOs) Private sector Media International collaboration

27. Entry points for NCD prevention & control Diseases –Vertical, clinical, limited public health impact Risk factors/lifestyles –Direct impact on many NCDs, cost-effective at a population level Determinants –Basic, general political decisions for health promoting conditions and possibilities Pekka Puska, Director General

28. 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 Emphasis on implementation! Pekka Puska, Director General

29. Global instruments for influencing NCD lifestyles Tobacco: FCTC (2003) Diet & Physical activity: global strategy (2004) Alcohol: global strategy (2010) Global instruments needed for counteracting negative social consequences of globalization

30. Global action: low- and middle- income countries in focus Global action is needed to reverse negative trends and to take effective action for NCD prevention and control - as a major issue for supporting positive and sustainable socioeconomic development: Advocacy Development of global instruments Global agreements Global financial decisions Monitoring and reporting

31. Health is essential part of sustainable social development Level of public health Reduction of inequity within and between population Poverty healthpoverty 12/06/2016 Pekka Puska, Director General31

32. National economics and public health (NCD prevention) Control on health care costs Availability and capacity of labour force Functional capacity of the growing elderly population (control of social care costs) 12/06/2016 Pekka Puska, Director General32

33. WHO’s ministeral conference on NCDs Moscow April 2011 Ministry of Health of Russian Federation, together with WHO Resolution for necessary actions Pekka Puska, Director General

34. UN high-level summit on NCDs New York Sept 2011 ”Unprecedented opportunity” for high- level political support and action on global NCD prevention and control” Political declaration

35. NCD prevention/public health improvement as a key for global health WHO’s leadership Strengthened instruments (like FCTC) Good national and global monitoring Development resources to NCD prevention (New York political declaration) 12/06/2016 Pekka Puska, Director General35

36. 12/06/2016 Pekka Puska, Director General36

37. From Ottawa to Helsinki

38. Jointly organized by the Ministry of Social Affairs and Health of Finland and the World Health Organization Helsinki, Finland from 10 to 14 June 2013 Target audience: –High and mid-level representatives from Member State Governments –NGOs, experts Up to 800 participants from all WHO regions - by invitation only 8 plenary sessions, 24 parallel sessions Europe Day Finnish site visits – get to know the Finnish way of working Follow-up 8 th Global Conference on Health Promotion

39. 6/12/2016 Muchas gracias Thanks

40. 12/06/2016 Pekka Puska, Director General40