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Sustained population based prevention of NCDs: From North Karelia Project to North Karelia Center for Public Health. Vesa Korpelainen, North Karelia Center for Public Health
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SUSTAINED POPULATION BASED
PREVENTION OF NCDs: From North
Karelia Project to North Karelia Center
for Public Health
Vesa Korpelainen, MSc, MPH
Executive Manager
North Karelia Center for Public Health (North Karelia Project)
Siltakatu 10 A
FIN-80100 Joensuu, Finland vesa.korpelainen@kansanterveys.info
Pekka Puska
Tiina Laatikainen
Erkki Vartiainen
National Institute for Health and Welfare
North Karelia population 166.000
14 municipalities
territory 21.585km2
water 3.803 km2
Finland
North Karelia in the beginning of 1970’s
CHD mortality rates among men highest in the world, short life expectancy
Increasing public discussion and attention to
extremely high CVD mortality
→ North Karelia Project: Community-based
action for CVD prevention
Community intervention model of North Karelia Project
COMMUNITY
action
maintenance
External project input
Changes in health behavior and risk factors
Changes in
disease rates and
health
COMMUNITY ORGANIZATION
-mass media
-health and other services
-other organizations
-industry, business
-legislation
Opinion leaders
-formal
-informal
Early adopters
POPULATION
-knowledge
-motivation
-skills
-social support
-environmental support
influence
diffusion
6. COMMUNITY ORGANIZATION
5. ENVIRONMENTAL
SUPPORT
4. SOCIAL SUPPORT
3. PRACTICAL SKILLS
2. PERSUASION
1. KNOWLEDGE
BEHAVIOUR MODIFICATION MODEL(modified by P. Puska and A. McAllister)
NORTH KARELIA PROJECT
PRIVATE SECTOR
POPULATION
PUBLIC POLICY
Media•Health and other •public services•NGOs•Industry, business•Legistlation
Change in age-adjusted mortality rates North Karelia, 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
2006 Change from 1969-1971 to 2006
All causes 1509 572 -62%
All cardiovascular
855 182 -79%
Coronary heart disease
672 103 -85%
All cancers 271 96 -65%
Coronary heart disease
•Gain of nearly 10 healthy years• in North Karelian popupaltion
Effect of risk factors on decreasing
CHD mortality in Finland 1982-1997
16 % 7 % 9 %
37 %
22 %
9 %
Cholesterol
Smoking
Blood pressure
Improved treatment
Sec. Prevention
Unknown
Laatikainen et al. Am J Epid 2005
North Karelia Project has shown
• Prevention of cardiovascular and many other NCDs 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)
• Influencing diet and especially quality of fat is a key issue
• 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 are key
elements for success
from NORTH KARELIA PROJECT
to NORTH KARELIA CENTER FOR PUBLIC HEALTH
North Karelia
PROVINCE OF HEALTHINESS
Peoples’ health consciousness and health behaviour
Health knowledge of decision-makers and commitment of stakeholders
Evaluation
Monitoring
Information
Indicators
POHJOIS-KARJALAN KANSANTERVEYDEN KESKUS
toiminnallinen ja fyysinen keskus, joka• kehittää• koordinoi ja• tekee terveyden edistämistyötä
Key stakeholders on regional level
•POHJOIS-KARJALAN KANSANTERVEYDEN KESKUS
toiminnallinen ja fyysinen keskus, joka• kehittää• koordinoi ja• tekee terveyden edistämistyötä
Regional Council of North Karelia: Welfare plan
Hospital district: Primary health care unit, professor of health
promotion
University of Eastern Finland, University of Applied Sciences
Regional units of NGOs
Health prescription
Health prescription
REGIONALGROUPS• SMOKEFREE• PA• NUTRITION• NGOs
REGIONAL STAKEHOLDERS
NORTH KARELIA CENTER FOR PUBLIC HEALTH
MUNICIPAL DECISION-MAKING• evaluation of influences of decisions• common indicators
MUNICIPAL HEALTH PROMOTION GROUP• action plan
SUPPORT SYSTEM FOR NGOs• plan• training• feedback
ENTERPRICES• wellbeing of
employees• social responsibility
MONITORING EVALUATION INFORMATIONDATA/
KOWLEDGE
Collaboration – community organisation - public health
Health promotion structure, municipal model
Municipal management groupActs often as a steering group for health and welfare promotion
Healthservices
Social sector
Education Culture and PA services
Technicaldepart-ment
Environ-ment
Health and welfare promotion group- Chairman
- coordinator
Workinggroup 1
Workinggroup 2
Workinggroup 3
•Modified: THL 2010, 15.
Electonic municipal welfare report
•Health and welfare
How things are?•Mikä on väestön hyvinvoinnin ja palvelujen tila indikaattoritiedon valossa?
•Virkamiesten kokoama ja tulkitsema
hyvinvointitieto: kansallisesti sovitut indikaattorit ja muu
täydentävä tieto.
How they should be?•Mitä kehittämistarpeita hyvinvoinnin ja palvelujen tilasta nousee ja mitä tavoitteita asetetaan?
•Poliittisten päättäjien sitoutuminen kehittä-miskohteisiin, tarvitta-viin lisäresursseihin, kehittämistyöhön,
hankkeisiin.
How the goal will be achieved?•Mitkä ovat hallintokuntien toimenpide-ehdotukset tavoitteisiin pääsemiseksi?
•Hallintokuntien toimenpiteiden suunnittelu ja
niihin sitoutuminen.
Information
Objective
Action
goal
action
data
evaluation
Electornic welfare report
package of essential data for welfare planning and desicion making
is prepared in collaboration with different administrative sectors in municipality
easy to use
structured
same basic indicators in every municipality
strenghtens intersectoral collaboration
http://www.hyvinvointikertomus.fi/demo demo
-> health
Thank you!
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