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Pekka Puska, Professor, MD, Phd, Mpolsc Director General

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Pekka Puska, Professor, MD, Phd, Mpolsc Director General Pekka Puska, Professor, MD, PhD, MPolSc Director General, National Institute for Health and Welfare (THL), Finland Vice President, International Association of National Public Health Institutes (IANPHI) NCD MONITORING AND NPHI’S IANPHI Meeting Helsinki 26-27.9.2011 CONCEPTS • MONITORING • SURVEILLANCE • EVALUATION • EVALUATIVE RESEARCH 11/10/2011 IANPHI Meeting 26.-27.9.2011 USES OF SURVEILLANCE / HEALTH MONITORING • ASSESMENT OF SITUATION FOR PLANNING / ACTION • DETECTION OF EPIDEMICS • FOLLOW UP OF TRENDS (ARE OBJECTIVES REACHED?) • EVALUATION • FEED BACK TO STAKEHOLDERS, POPULATION • MATERIAL FOR RESEARCH • INTERNATIONAL COMPARISONS 11/10/2011 IANPHI Meeting 26.-27.9.2011 IMPLEMENTATION PLANNING MONITORING EVALUATION 11/10/2011 IANPHI Meeting 26.-27.9.2011 HEALTH MONITORING AT THL: TARGETS AND INSTRUMENTS TARGETS INSTRUMENTS Infectious diseases Infectious disease surveillance Chronic diseases Registers and statistics Functional capacity and subjective health Health 2000 Risk factors Finrisk surveys Nutrition Findiet surveys Health behaviour and health promotion Health behaviour monitoring IANPHI Meeting 26.-27.9.2011 MONITORING AT DIFFERENT LEVELS RISK FACTORS DETERMINANTS DISEASES OUTCOMES - Socioeconomical Health Biological FUNCTIONAL DEATH - Environmental Behavioural CAPACITY SURVIVAL - Cultural HEALTH PREVENTION TREATMENT PROMOTION SECOND PREVENTION 11/10/2011 IANPHI Meeting 26.-27.9.2011 EXAMPLES OF MONITORING RESULTS AT THL 11/10/2011 IANPHI Meeting 26.-27.9.2011 Use of Butter on Bread (men age 30–59) 11/10/2011 Kg/m2 100 North Karelia 90 Kuopio province 80 Southwest Finland 70 Helsinki area 60 Oulu province Lapland province 50 40 30 20 10 0 1972 1977 1982 1987 1992 1997 2002 IANPHI Meeting 26.-27.9.2011 Milk Consumption in Finland in 1970 and 2006 (kg per capita) kg 140 120 Whole milk 100 Low fat milk 80 Whole form milk 60 40 20 Skim milk 0 1960 1970 1980 1990 2000 2010 11/10/2011 IANPHI Meeting 26.-27.9.2011 SALT INTAKE IN FINLAND 1977–2007 11/10/2011 18 16 Calculated, men 14 12 Calculated, 10 women NaCl 24h urine, men g/d 8 6 4 24h urine, women 2 Lin. (Calculated, 0 women) 1977 1979 1981 1982 1987 1991 1992 1994 1997 1998 2002 2007 Year IANPHI Meeting 26.-27.9.2011 SERUM CHOLESTEROL IN MEN AGED 11/10/201130–59 YEARS mmol/l 7,5 7 North Karelia Kuopio 6,5 Turku/Loimaa Helsinki/Vantaa 6 Oulu Lapland 5,5 5 1972 1977 1982 1987 1992 1997 2002 2007 FINRISK Studies 1997 & 2002 IANPHI Meeting 26.-27.9.2011 TAPATURMAISESTI KUOLLEET 1986–2005 TAPATURMATYYPINInjury mortality MUKAAN 1986-2005 No. SUICIDE MORTALITY PER 100,000 POPULATION IN FINLAND IN 1921–2004 70 Men Women 60 All 50 40 30 20 10 0 1980 1985 1990 1995 2000 2005 11/10/2011 IANPHI Meeting 26.-27.9.2011 Change in age-adjusted mortality rates Finland, males aged 35–64 (per 100 000 population) Rate per 100 000 Coronary heart disease 1969- 2006 Change 1971 from 1969- start of the North Karelia Project 1971 to 2006 extension of the Project All causes 1328 583 -56% nationally All 680 172 -75% North Karelia -85% cardiovascular Coronary 489 103 -79% heart disease All cancers 262 124 -53% All Finland -80% Gain of some 10 healthy years in Finnish population 11/10/2011 IANPHI Meeting 26.-27.9.2011 STANDARDIZATION OF MEASUREMENTS • WITH TIME • BETWEEN AREAS / COUNTRIES • INTERNATIONAL RECOMMENDATIONS (WHO etc.) 11/10/2011 IANPHI Meeting 26.-27.9.2011 SOURCES OF DATA • STATISTICS (DEATHS etc.) • HEALTH SERVICE DATA (PATIENTS, LABORATORY, etc.) • NOTIFICATION (INFECTIOUS DISEASES) • REGISTRATION (CANCER REGISTER etc.) • SURVEYS - INTERVIEWS (PERSONAL, TELEPHONE, MAIL) - MEASUREMENTS 11/10/2011 IANPHI Meeting 26.-27.9.2011 SURVEILLANCE / HEALTH MONITORING • STRONG TOOL OF NATIONAL PUBLIC HEALTH • VITAL FUNCTION OF ANY NPHI • NCD MONITORING OF INCREASING IMPORTANCE 11/10/2011 IANPHI Meeting 26.-27.9.2011 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 11/10/2011 IANPHI Meeting 26.-27.9.2011 Surveillance • Monitoring of • ”Best buys”: Diseases NCD mortality trend Risk factors/behaviours Core risk factor trends 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 11/10/2011 IANPHI Meeting 26.-27.9.2011 Note • It is important to keep the monitoring simple enough for sake of feasibility, high participation and rapid feed back • Monitoring does not replace more in- depth studies to understand better the issues and to help develop the monitoring 11/10/2011 IANPHI Meeting 26.-27.9.2011 Role of NPHIs 1. • It is one thing to decide on WHAT TO MONITOR, but the big question is: • WHO WILL CARRY OUT THE MONITORING in a sustainable way INSTITUTIONAL BASE 11/10/2011 IANPHI Meeting 26.-27.9.2011 Role of NPHIs 2. • A NPHI under the Ministry of Health is the agency for sustainable monitoring in the area of NCD prevention and control, and more generally in the area of health • The NPHI not only carries out the monitoring, but has the expertise and skills to –analyse the results –to interprete the results to policymakers –to communicate the results to the great public 11/10/2011 IANPHI Meeting 26.-27.9.2011 11/10/2011 IANPHI Meeting 26.-27.9.2011 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” Outcome document 11/10/2011 IANPHI Meeting 26.-27.9.2011 Thank you 11/10/2011 IANPHI Meeting 26.-27.9.2011.
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