1. 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 11.-12.12.2007 CHALLENGES OF THE NORTHERN DIMENSION IN PROMOTING PUBLIC HEALTH

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

5. St. Petersburg 11.-12.12.20075 MAJOR CHALLENGE A major challenge of the Northern Dimension in promoting public health is to CLOSE THE CAP - Between countries - Within countries

6. St. Petersburg 11.-12.12.20076 LIFE EXPECTANCY AT BIRTH, RUSSIA AND THE EUROPEAN UNION, 1970–2000 6

7. St. Petersburg 11.-12.12.20077 MORTALITY DIFFERENCES AMONG PEOPLE 30 AND ABOVE ACCORDING TO INCOME (Source: Martikainen P ym. Int J Epid 2001;30:1397-1405) Relative mortality Women Men Highest Decade of income Lowest (Finland)

8. St. Petersburg 11.-12.12.20078 Non communicable diseases and related health problems major determinants of contemporary public health CardiovascularCardiovascular CancerCancer InjuryInjury

9. St. Petersburg 11.-12.12.20079 TRENDS IN STANDARDIZED DEATH RATES FROM DISEASES OF THE CIRCULATORY SYSTEM IN RUSSIA AND EU-15 COUNTRIES

10. St. Petersburg 11.-12.12.200710 Lifestyles in key position! TobaccoTobacco AlcoholAlcohol DietDiet Physical activityPhysical activity (WHO)

11. St. Petersburg 11.-12.12.200711 DEATHS AND DAILY LOST ATTRIBUTABLE TO 10 LEADING RISK FACTORS, 2002

12. St. Petersburg 11.-12.12.200712 Alcohol poisonings and life expectancy at birth Russia (M+F) 1965-2006 R= - 0.94 Source : VM Shkolnikov

13. St. Petersburg 11.-12.12.200713 HEALTH PROMOTION Entry points 1) Diseases, health problems 2) Risk factors (behavioural, biological) 3) Determinants DIFFERENT ENTRY POINTS ARE NEEDED!

14. St. Petersburg 11.-12.12.200714 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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16. St. Petersburg 11.-12.12.200716 THE MAIN CHALLENGE IS NOT WHAT TO DO, BUT HOW TO DO!

17. St. Petersburg 11.-12.12.200717  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

18. St. Petersburg 11.-12.12.200718 PUBLIC RESPONSIBILITY POLICY INTERVENTIONS

19. St. Petersburg 11.-12.12.200719 WHAT POLICIES? HEALTH POLICY AND HEALTH IN ALL POLICIES Health impact assessment Finland’s EU Presidency theme EU’s new health strategy

20. St. Petersburg 11.-12.12.200720 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

21. St. Petersburg 11.-12.12.200721 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

22. St. Petersburg 11.-12.12.200722 PARTNERSHIPS  Governments (national, local)  Civil society (NGO’s)  Private sector  INTERNATIONAL COLLABORATION

23. St. Petersburg 11.-12.12.200723 PUBLIC HEALTH DOES CHANGE AND CAN BE CHANGED!

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

25. 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 2006. Mortality per 100 000 population Age-standadized to European population start of the North Karelia Project extension of the Project nationally North Karelia All Finland 31

26. St. Petersburg 11.-12.12.200726 STRONG INTERACTION BETWEEN DIFFERENT LEVELS NEEDED Global Regional EU NationalLocal

27. St. Petersburg 11.-12.12.200727 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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29. St. Petersburg 11.-12.12.200729 ELEVATED BLOOD PRESSURE Systolic >140 mmHg %

30. St. Petersburg 11.-12.12.200730 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

31. St. Petersburg 11.-12.12.200731 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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33. St. Petersburg 11.-12.12.200733 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

34. St. Petersburg 11.-12.12.200734 SHOULD WE TARGET CHILDREN OR ADULTS? BOTH: they influence each other ultimately the question is social change

35. St. Petersburg 11.-12.12.200735 HEALTH MONITORING  Power of monitoring  Need to emphasize risk factors, lifestyles, determinants  Feed back to people and decision makers  Communication for policy

36. St. Petersburg 11.-12.12.200736 Successful, effective health promotion calls for effective policies, but also for effective supportative structures and the necessary resources!

37. St. Petersburg 11.-12.12.200737 FINAL RECOMMENDATION 1)DO THE RIGHT THINGS AND DO ENOUGH OF IT 2)COMBINE LEADERSHIP WITH BROAD PARTNERSHIP

38. St. Petersburg 11.-12.12.200738 THE NORTHERN DIMENSION IN PROMOTING PUBLIC HEALTH MANY CHALLENCES BUT MANY POSSIBILITIES AND GREAT POTENTIAL FOR HEALTH OF OUR PEOPLES

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