diabetes and the heart meet the experts august 30 2009 responding to the challenge: determining...
TRANSCRIPT
Diabetes and the HeartMeet the experts
August 30 2009
Responding to the challenge: determining health policyIntroductory remarks
Lars RydénDepartment of MedicineKarolinska InstitutetStockholm, Sweden
The Future of Health Care in EuropeLondon May 13, 2011
Health and diseaseThe ideal solution
Lucas Cranach 1546 The Youth Fountain
Health and DiseaseThe ideal situation
Health and diseaseThe ideal solution
Preservation of healthSome prerequisites
Political support Common pathways Professional collaboration Persistancy and endurance Shared view on important steps Redirection of available resources A long-term view on the total impact
Presently established factors Life style Physical inactivity, obesity,
food habits, stress, smoking Medical Hypertension, dyslipidemia
diabetes…….
Fundamental reasonsAgricultural politicsSocial disintegrationClimate changesTax politics (e.g. tobacco)Industrialisation/urbanisation
Preservation of healthImportant threats
Diabetes and the HeartMeet the experts
August 30 20091992”The primary determinants of disease are mainly economic and social.
Therefore its remedies must also be economic and social.
Medicine and politics
cannot and should
not be kept apart.”
Geoffrey RoseGeoffrey Rose1926 - 19931926 - 1993
Choice and informationChoice and information
Choice and informationChoice and information
Scientific evidenceUrge Member States toimplement and enforce smoke free legislation
Preservation of healthExample - tobacco
Hospital admissions forAMI in eight studies 2004 - 2008
Reduction19% (95% CI 14-24)Non-smokers 70%
Preservation of healthBlocking common pathways towards disease
PulmonaryPulmonarycancercancer
MyocardialMyocardialinfarctioninfarction
Behind 86% of deaths in WHO region Europe
DiseasesMain determinants
Cardiovascular
Kidney
Hepatic
Respiratory
Malignant
Diabetes
Chronic non-communicable diseases (CNCD)Dimension and common pathways
Tobacco
Alcohol
Diet
Physical inactivity
Lars RydénKarolinska InstitutetStockholm, Sweden
Policy conference June 2009
Preservation of healthTransprofessional collaboration
Distinguish myths from evidence based knowledge
Explore the ”climate” for collaborative efforts to gain political support
Bringing 10 professional organisations together
Recommendations onTaxationAgricultureFood labellingUrban planningEducationSport and recreation
Paramount legislative principleHealth in all policies
The European Chronic Disease AllianceECDA
(Gyberg & Rydén Europ J Cardiovasc Prev Rehab 2011. In press)
0 smoking
3 km of daily walking
5 fruit & vegetables/day
<140/90 mm Hg blood pressure
<5.0 mmol/l cholesterol
<3.0 mmol/l LDL-cholesterol
0 diabetes
Preservation of healthOn the importance of a unified approach
The three most important measures toimplement EHHC
Hinder för förbättrad folkhälsa
Most important
Least important
PoliticalEconomic
OrganisationMediarelated
AwarenessAttitudes
Life styleOther
(Gyberg & Rydén Europ J Cardiovasc Prev Rehab 2011. In press)
Group Politician NGO Health admin Professionals
Preservation of healthOn the importance of a unified approach
13,180fewer deaths 2002
20021986
Risk Factors worse +11%Diabetes +8Obesity +3
Risk Factors better - 66%Cholesterol (diet) -39Smoking -20Population BP fall -9Physical activity -3
Treatments - 36%AMI -6Secondary prevention -12Heart failure -7 Angina ASA, CABG & PTCA -3Hypertension -4Primary prevention (statins) -2
Unexplained- 9%
(Björk, Rosengren, Bennett, Lappas,Capewell Europ Heart J 2009; 30:1046-56 )
The power of prevention of chronic diseaseExplaining the fall in CHD deaths (ex: Sweden)
100
80
60
40
20
0
%
Treatment Prevention
97
3
From the appeal to the European Commission on the occasion of the incoming European Commission, February 2010
Resource allocationEuropean health care
www.sph.uq.edu.au/bodce-ace-preventionwww.nice.org.uk/guidance/PH25
June 25 2010
Preservation of healthA long-term view of the total impact
www.sph.uq.edu.au/bodce-ace-prevention
Cost-saving interventions in 2003 Australian population
Taxation andregulation andinterventionson salt, alcoholand tobacco
Polypill forCVD prevention(ACE-i+Ca-antag+diuretic+statin)
Investment cost A$4.6 billion
Averted expensesA$ 11 billions
(Vos et al Assessing Cost-Effectiveness in Prevention. Univ Queensland, Brisbane and Melbourne 2010)
Preservation of healthA long-term view of the total impact
Health and diseaseThe ideal solution
Preservation of healthSome prerequisites
Political support Common pathways Professional collaboration Persistancy and endurance Shared view on important steps Redirection of available resources A long-term view on the total impact
ThanksThanksfor the attention!!!for the attention!!!