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

1. 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

2. North Karelia
 population 166.000
 14 municipalities
 territory 21.585km2
 water 3.803 km2
Finland

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. from
NORTH KARELIA PROJECT
to
NORTH KARELIA CENTER
FOR PUBLIC HEALTH

10. 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

11. 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

12. Health prescription

13. Health prescription

17. REGIONAL
GROUPS
• 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
SUPPORTSYSTEM FOR
NGOs
• plan
• training
• feedback
ENTERPRICES
• wellbeing of
employees
• social responsibility
MONITORING EVALUATION INFORMATION
DATA/
KOWLEDGE
Collaboration – community organisation - public health

18. Health promotion structure, municipal model
Municipal management group
Acts often as a steering group for health and welfare promotion
Health
services
Social
sector
Education Culture
and PA
services
Technical
depart-
ment
Environ-
ment
Health and welfare promotion group
- Chairman
- coordinator
Working
group 1
Working
group 2
Working
group 3
•Modified: THL 2010, 15.

19. Electonic municipal welfare
report

20. •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

21. goal
action
data
evalua
tion
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

22. Thank you!