MISSION POSSIBLE -
ELEMENTS OF A SUCCESSFUL PROGRAMME
Professor Erkki Vartiainen, Assistant Director General
08/09/200910.9 Presentation name / AuthorErkki Vartiainen 2 .2009 08/09/200910.9 Presentation name / AuthorErkki Vartiainen 3 .2009
Two mai n questi ons in 1970’ s
• Can risk factors and behaviors be changed on population level ? • If risk factors will reduce what will happen to the mortality?
08/09/200910.9 Presentation name / AuthorErkki Vartiainen 4 .2009 North Karelia Project HIERARCHY OF OBJECTIVES
GENERAL GOAL: Improved health
Medical /Eppgidemiological framework: MAIN OBJECTIVES: Prevention of - earlier research - local prevalence chronic diseases & promotion of health
Social / Behavioural framework:
INTERMEDIATE OBJECTIVES: Risk factors, life-styles and treatment
- theory PRACTICAL OBJECTIVES: - community analysis Intervention programme 08/09/200910.9 Presentation name / AuthorErkki Vartiainen 5 .2009
FROM KARELIA TO NATIONAL ACTION • First province of North Karelia as a pilot (5 years), then national action • GdGood scitifiientific evaltiluation to learn of the experience
08/09/200910.9 Presentation name / AuthorErkki Vartiainen 6 .2009 North Karelia Project
THEORETICAL PRINCIPLES OF THE INTERVENTIONS
MEDICAL FRAMEWORK: - Primary prevention - Main targets: smoking, diet, cholesterol, blood pressure - popupation approach, general risk factor reduction emphasizing lifestyle changes
SOCIAL / BEHAVIOURAL FRAMEWORK - Social marketing - Behaviour modification - Communication - Innovation - diffusion - Community organization
08/09/200910.9 Presentation name / AuthorErkki Vartiainen 7 .2009
Serum cholesterol in men aged 30-59 years mmol/L 7,5 North Karelia KiKuopio provi nce 7 Southwest Finland Helsinki area 6,5 Oulu province Lapland province
6
5,5
5 1972 1977 1982 1987 1992 1997 2002 2007
08/09/200910.9 Presentation name / AuthorErkki Vartiainen 8 .2009 Serum cholesterol in women aged 30-59 years
mmol/L 7,5 North Karelia Kuopppio province 7 Southwest Finland Helsinki area 6,5 Oulu province LldLapland provi nce
6
5,5
5 1972 1977 1982 1987 1992 1997 2002 2007
08/09/200910.9 Presentation name / AuthorErkki Vartiainen 9 .2009
Use of butter for cooking % 80 North Karelia 70 Kuopio province Southwest Finland 60 Helsinki area 50 Oulu province Lapland province 40 30 20 10 0 1972 1977 1982 1987 1992 1997 2002 2007
08/09/200910.9 Presentation name / AuthorErkki Vartiainen 10 .2009 Use of vegetable oil for cooking (men age 30-59)
70 North Karelia 60 Kuopio province Southwest Finland 50 Helsinki area Oulu province 40 Lapland province 30 20
10 0 1972 1977 1982 1987 1992 1997 2002 2007
08/09/200910.9 Presentation name / AuthorErkki Vartiainen 11 .2009
Use of butter on bread %(men age 30-59) 100 North Karelia 90 KiKuopio provi nce 80 Southwest Finland 70 Helsinki area 60 Oulu province Lapland province 50 40 30 20 10 0 1972 1977 1982 1987 1992 1997 2002 2007
08/09/200910.9 Presentation name / AuthorErkki Vartiainen 12 .2009 FtitkFat intake
40 Recommendations
30 Tot al lf fat t( (~ 30 30EN%) EN%)
SAFA (~10 EN%) 20
EN% MUFA (10-15 EN%) 10 PUFA (5-10 EN%) 0 1982 1987 1992 1997 2002 2007
Year
08/09/200910.9 Presentation name / AuthorErkki Vartiainen 13 .2009
Estimated effects on serum cholesterol 0.0 4-0.2 l/l . mmo -0.6 -0
Medication effect Dietary effect Medication+dietary effect Observed S-Chol 1.0 -0.8 -
1982 1992 2002 2007
Year
08/09/200910.9 Presentation name / AuthorErkki Vartiainen 14 .2009 Systolic blood pressure in men aged 30-59
mmHg 160 North Karelia Kuopio province Southwest Finland 150 Helsinki area Oulu province Lapland province 140
130
120 1972 1977 1982 1987 1992 1997 2002 2007
08/09/200910.9 Presentation name / AuthorErkki Vartiainen 15 .2009
Salt intake in Finland 1977-2007
g/day 18 16 Calculated, men 14 Calculated, women 12 24 hour urine, men 10 8 24 hour urine, women 6 Linear (24 hour urine, 4 men) Linear (24 hour urine , 2 women) 0 Linear (Calculated, men)
7 9 1 2 7 1 2 4 7 8 2 7 Linear (Calculated, 98 99 99 99 99 99 00 00 197 197 198 198 1 1 1 1 1 1 2 2 women)
08/09/200910.9 Presentation name / AuthorErkki Vartiainen 16 .2009 Body mass index in men aged 30-59
Kg/m2 30 North Karelia Kuopio province 29 Southwest Finland Helsinki area 28 Oulu province Lapland province
27
26
25 1972 1977 1982 1987 1992 1997 2002 2007
08/09/200910.9 Presentation name / AuthorErkki Vartiainen 17 .2009
Why did di et ch ange?
• North Karelia Project (community based CVD prevention program) • Consensus in the medical community • Political consensus • Recommendations • Cholesterol screening • Fat debates • Educational programs • Business got interested
08/09/200910.9 Presentation name / AuthorErkki Vartiainen 18 .2009 Smoking in men aged 30-59 years
60 % North Karelia Kuopio province 50 Southwest Finland Helsinki area 40 Oulu province Lapland province 30
20
10
0 1972 1977 1982 1987 1992 1997 2002 2007
08/09/200910.9 Presentation name / AuthorErkki Vartiainen 19 .2009
Smoking in women aged 30-59 years
60 % North Karelia Kuopio province 50 Southwest Finland 40 Helsinki area Oulu province 30 Lapland province
20
10
0 1972 1977 1982 1987 1992 1997 2002 2007
08/09/200910.9 Presentation name / AuthorErkki Vartiainen 20 .2009 AgeAge--adjustedadjusted mortality rates of coronary htdiiNthheart disease in North Karelia 700 andthd the wh ol e of start of the North Karelia Project Finland among600 extension of the Project nationally maldles aged 500 35–64 years North Karelia from 1969 400 to 2006. Mortality 300 per 100 All Finland 200 000
population 100 69 72 75 78 81 84 87 90 93 96 99 2002 2005 AgeAge--standadizedstandadized to European Year population
08/09/200910.9 Presentation name / AuthorErkki Vartiainen 21 .2009
North Karelia Project
PREVENTION OF CVD
DthikftDo the risk factor c hanges explain the CVD mortality changes?
08/09/200910.9 Presentation name / AuthorErkki Vartiainen 22 .2009 Observed and ppyredicted decline in CHD mortality in men
0 -10 -20 -30 Observed -40 All risk factors % Cholesterol -50 Diastolic BP -60 Smoking -70 -80 -90 1972 1977 1982 1987 1992 1997 2002 2007 Year 08/09/200910.9 Presentation name / AuthorErkki Vartiainen 23 .2009
CHD mortality fall in Finland 1982 – 1997
0
Risk Factors -71% -100 Chol est erol - 53% Smoking - 11% Blood pressure - 7%
-200 Treatments -24% AMI treatments - 4% Secondary prevention - 8% -300 Heart failure - 2% 373 fewer deaths Angina: CABG & PTCA - 8% Angina: Aspirin etc - 2% Other Factors -5% -400
08/09/200910.91982 1997 T Laatikainen et al Am J Epid 2005 Presentation name / AuthorErkki Vartiainen 24 .2009 MAJOR ELEMENTS OF SUCCESSFUL NATIONAL PREVENTIVE PROGRAM 1
RESEARCH HEALTH SERVICES (ESPECIALLY PRIMARY HEALTH CARE) HEALTH EDUCATION PROGRAMMES (COALITIONS, NGO’S, COLLABORATION WITH MEDIA ETC.) SCHOOLS, EDUCATIONAL INSTITUTIONS INDUSTRY, BUSINESS
08/09/200910.9 Presentation name / AuthorErkki Vartiainen 25 .2009
MAJOR ELEMENTS OF SUCCESSFUL NATIONAL PREVENTIVE PROGRAM 2
NATIONAL DEMONSTRATION PROGRAMME(S), FOCAL POINT(S) POLICY DECISIONS, INTERSECTORAL COLLABORATION, LEGISLATION MONITORING SYSTEM INTERNATIONAL COLLABORATION
08/09/200910.9 Presentation name / AuthorErkki Vartiainen 26 .2009 FINNISH HEART PLAN HdhbfdilHow to reduce the number of cardiovascular disease morbidity and mortality by half PROMOTING REHABILITATION AND CARDIOVASCULAR HEALTH STRAGEGIES OF EARLY SECUNDARY PREVENTION AND PREVENTING DIAGNOSTICS AND CARDIOVASCULAR TREATMENT DISEASES
Health Promotion
• Health in all decision making in the society - Developing cooperation between - Developing cooperation • Differences in health between population groups spppyecial health care and primary between special health care • RtildilllResources on national and regional level – lllocal health care and primary health care units/networks in health promotion - Local treatment plans - Rehabilitation resources Prevention Risk group strategy - Diminishing differences in - ”Out patient rehabilitation Population strategy - Prevention programme of treatment between social ggproups model” in health centres for t2dibttype 2 diabetes heart patients • Cardiovascular - Increasing the number of coronary diseases and life style - Current Care Guidelines angiographies - Heart patient working and for Hypertension returning to work • Physical activity - Increasing the number of • Nutrition - Current Care Guidelines coronary angioplasties for Smoking , Nicotine – Heart Symbol Dependency and - On call cardiology service – Canteen catering Interventions for - Increasing the number of Cessation • Weight control cardiologists • Non-Smoking - Guidelines of European - Adequate medical treatment Society of Cardiology on cardiovascular disease - Woman’s heart prevention in clinical practice 10.9.2009
Thank you !
08/09/200910.9 Presentation name / AuthorErkki Vartiainen 28 .2009