1. Healthy lifestyles and noncommunicable disease control Nordic Dimension Meeting, St Petersburg 24.11.2011 Pekka Puska, professor, MD, PhD,MPolSc Past President, World Heart Federation (WHF) Director General, National Institute for Health and Welfare (THL) Vice President, Int. Ass.of National Public Health Institutes (IANPHI)

2. Pekka Puska, Director General GREETINGS FROM FINLAND 25/06/2016

3. 7 July 2011 Main killer diseases in the WHO European Region 25/06/2016 Pekka Puska, Director General

4. 25/06/2016 Pekka Puska, Director General

5. 25/06/2016 Pekka Puska, Director General

6. 25/06/2016 Pekka Puska, Director General

7. 25/06/2016 Pekka Puska, Director General

8. 25/06/2016 Pekka Puska, Director General

9. 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 CVD rates.  Major changes in population rates can take place in a surprisingly short time. WHAT TO DO HOW TO DO! 25/06/2016

10. Pekka Puska, Director General Prevention targets the population levels of most important risk factors. 25/06/2016

11. Pekka Puska, Director General Developed Countries Deaths in 2000 Attributable to Selected Leading Risk Factors Number of deaths (000s) 25/06/2016

12. Pekka Puska, Director General SEVEN TOP DETERMINANTS OF MORTALITY IN THE DEVELOPED WORLD RELATE TO NCD RISK BEHAVIOURS DIET AND PHYSICAL ACTIVITY, TOGETHER WITH TOBACCO AND ALCOHOL, ARE KEY DETERMINANTS OF CONTEMPORARY PUBLIC HEALTH 25/06/2016

13. Cornerstones of NCD prevention and control (WHO global strategy, 2000) 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 25/06/2016

14.  Although comprehensive NCD control measures are needed, prevention should be a priority from human and economic point of view  Prevention targets the most important causal risk factors  The strong NCD risk factors relate closely to a few lifestyles  The NCD related lifestyles relate also to prevention of several major NCDs INTEGRATED PREVENTION 25/06/2016 Pekka Puska, Director General Integrated prevention

15. 25/06/2016 Pekka Puska, Director General

16. 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 25/06/2016

17. Contribution of different factors on premature mortality –Lifestyles 40 % –Genetic factors 30 % –Social conditions 15 % –Health services 10 % –Physical environmental exposures5 % 25/06/2016 Pekka Puska, Director General

18. Closing the gap is clearly a public health challenge, while there certainly is much work to do also with the health service system 25/06/2016 Pekka Puska, Director General

19. 25/06/2016 Pekka Puska, Director General

20. 25/06/2016 Pekka Puska, Director General

21. Conclusions for closing the European healthh gap Needed for reducing the excess health losses in the East of Europe (closing the gap) 1.Favourable shift in vascular risk factors by population wide and personal measures 2.Intensified tobacco control 3.Reduced alcohol consumption and injury control strategies Cost effective population wide strategies and strengthened institutional support. (Powles, Zatonski, Van der Hoorn, Ezzati 2005) 25/06/2016 Pekka Puska, Director General

22. SOUND COMBINATION OF POPULATION STRATEGY WITH HIGH RISK STRATEGY 1. HIGH RISK STRATEGY: - Great benefits to the persons concerned - Effective use of health services 2. POPULATION STRATEGY: -Greatest public health gains -Cost effective -Results also in other health benefits 25/06/2016 Pekka Puska, Director General

23. LIFESTYLES IN KEY POSITION  Individual health  Population health HOW TO INFLUENCE LIFESTYLES? 25/06/2016

24. Lifestyle changes – whose responsibility?  Individual responsibility is important but:  people’s behaviours are much related to socioeconomic determinants,  national lifestyles are deeply rooted in national, social and physical environmets  And are amendable to policy interventions Public responsibility Policy actions Pekka Puska, Director General 25/06/2016

25. Pekka Puska, Director General LIFESTYLES, RISK FACTORS AND CVD RATES CAN AND DO CHANGE! 25/06/2016

26. Pekka Puska, Director General 25/06/2016

27. Milk Consumption in Finland in 1970 and 2006 (kg per capita) 0 20 40 60 80 100 120 140 kg 196019701980199020002010 Whole milk Whole form milk Low fat milk Skim milk Pekka Puska, Director General 25/06/2016

28. Salt intake in Finland 1977-2007 FinnDiet Study 25/06/2016 Pekka Puska, Director General

29. Daily smoking in Finland 1950-2008 Men Women Year % 25/06/2016Pekka Puska, Director General

30. Intersectoral work for NCD prevention - Examples from Finland People’s lifestyles are influenced by decisions in different sectors of society (much of them beyond the health sector) Health in general and NCD prevention in particular should be taken into account in decisions made by different sectors (health impact assessment) Identification of possibilities for “win-win” situations Pekka Puska, Director General 25/06/2016

31. Intersectoral actions Legislation Taxation Acriculture Community planning Private sector NGO’s Examples 25/06/2016 Pekka Puska, Director General

32. Examples of intersectoral work 1. Development of Finnish Rapeseed oil Change in fat content of Finnish cow milk 25/06/2016 Pekka Puska, Director General

33. 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) in 2010 compared with 2007: 40.000 kg less salt 100.000 kg less saturated fat in their products (will be increased to 500.000 kg due to change in pig feeding) 25/06/2016 Pekka Puska, Director General

34. www.sydanmerkki.fi The Finnish Heart Symbol 25/06/2016 Pekka Puska, Director General

35. 25/06/2016 Systolic blood pressure in women (30–59 y) North Karelia project evaluation and FINMONICA and the National FINRISK Studies 1972 - 2007 mmHg Pekka Puska, Director General

36. SERUM CHOLESTEROL IN MEN AGED 30–59 YEARS FINRISK Studies 1997 & 2002 mmol/l 5 5,5 6 6,5 7 7,5 19721977198219871992199720022007 North Karelia Kuopio Turku/Loimaa Helsinki/Vantaa Oulu Lapland 25/06/2016

37. Serum cholesterol distribution in North Karelia in 1972 and 2007 Pekka Puska, Director General

38. 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 25/06/2016 Pekka Puska, Director General

39. Observed and Predicted Declines in Coronary Mortality in Eastern Finland, Men -90 -80 -70 -60 -50 -40 -30 -20 -10 0 19721977198219871992199720022007 Year % Observed Predicted Cholesterol Blood pressure Smoking Pekka Puska, Director General 25/06/2016

40. Work on different levels individual local national and global level 25/06/2016 Pekka Puska, Director General 40 Global Regional EU National Local 25/06/2016

41. Comprehensive action and partnership for national NCD prevention Health services Governments (national, local) Civil society (NGOs) Private sector Media International collaboration 25/06/2016 Pekka Puska, Director General

42. Surveillance Monitoring of  Diseases  Risk factors/behaviours  Determinants  Prevention & control process National institutional base for surveillance and links with national health monitoring International standardization and collaboration Active use of surveillance results: Feed-back, communication 25/06/2016 42 ”Best buys”:  NCD mortality trend  Core risk factor trends Pekka Puska, Director General 25/06/2016

43. Redirection of health services 25/06/2016 43 Reorientation and strengthening of health systems Primary health care: ”Now more than ever” (WHR 2008) Special emphasis for NCDs Chronic care model Preventive practices Pekka Puska, Director General 25/06/2016

44. Global level action Increasing burden of NCDs in the developing world is a consequence of globalisation of unhealthy lifestyles – related to urbanization, global communication and marketing etc. WHO’s leadership WHO’s global Action Plan 2007-12 Pekka Puska, Director General 25/06/2016

45. 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 25/06/2016 Pekka Puska, Director General

46. Tobacco legislation (FCTC framework) Ban on advertising and promotion Taxation Labelling, warnings Prohibition of sale to minors Smokefree environment Etc. 25/06/2016 Pekka Puska, Director General

47. 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. 25/06/2016 Pekka Puska, Director General

48. ”Best buys” for NCD prevention Top priority National tobacco policy (FCTC implementation) Reduction of salt intake (industry collaboration & regulation Others Reduction of saturated & transfats (industry collaboration & regulation) Promotion of availability & affordability of fruits & vegetables Promotion of daily physical activity (increased PA possibilities) National alcohol policy (taxes, availability – in many countries) Preventative practices in primary health care 25/06/2016 Pekka Puska, Director General

49. From priorities to implementation IDENTIFYING PRIORITIES “Less is more” IMPLEMENTING THEM Policy support Institutional base Media support Resources Monitoring 25/06/2016

50. Pekka Puska, Director General 43 25/06/2016

51. Global level: recent developments Increasing burden of NCD’s in the developing world is a consequence of globalisation of unhealthy lifestyles Global epidemic calls for global action WHO’s leadership WHO’s global Action Plan 2007-12 25/06/2016 Pekka Puska, Director General

52. WHO’s ministerial conference on NCD’s Moscow April 2011 Ministry of Health of Russian Federation, together with WHO Declaration 25/06/2016 Pekka Puska, Director General

53. 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 25/06/2016 Pekka Puska, Director General

54. The Example of Finland Has Shown Prevention of noncommunicable diseases is possible and pays off Population based prevention is the most cost effective and sustainable public health approach to CVD control Prevention calls for simple changes in some lifestyles (individual, family, community, national and global level action) 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 Pekka Puska, Director General 6/25/2016

55. 25/06/2016 Pekka Puska, Director General

56. 25/06/2016 Thank you Pekka Puska, Director General