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!