Pekka Puska, MD, PhD, MPolSc Director General, National Public Health Institute of Finland KTL Forma

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Pekka Puska, MD, PhD, MPolScDirector General,
National Public Health Institute of Finland
(KTL)Formarly Director, NCD Prevention and
Health Promotion, WHO/HQPresident Elect, World
Heart Federation (WHF)Vice President, Int. Ass.
of National Public Health Institutes (IANPHI)
OPENING REMARKS
The 2007 McGill Health Challenge Think Tank,
Montreal 8.-9. Nov., 2007
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CHILDHOOD OBESITY

• FACTS
• QUESTIONS
• SOLUTIONS

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FACTS

• Growing childhood obesity problem in most parts
  of world
• Large public health consequences in the world
• Determinants of childhood obesity crowth are
  multiple and deeply enrooted in modern societies
• Successful solutions, curbing the trends, call
  for profound changes and are among greatest
  challenges of contemporary public health

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HUMAN FACTOR IN MODERN OBESITY

• Mankind has throughout history strived at
  situation where there would be enough food and
  one would not have to work hard
• Now we are there obesity to follow
• HOW TO TURN THE WHEEL?

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OBESITY

• ENERGY IN
• ENERGY OUT
• ON WHICH SIDE IS THE PROBLEM?

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OBESITY PREVENTION

• ENERGY IN
• ENERGY OUT
• BOTH SIDES SHOULD BE TARGETED!

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STICK OR CARROT?

• Restrictions or positive insentives / solutions?
• Both are needed
• What is the right balance?

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ENERGY IN

• Restrictions Reduce the pressures for energy
  dense (and unhealthy) food and drinks
• Positive solutions increase consumption of
  healthy, less energy dense foods and drinks
  (healthy meals at school, homes healthy snacks,
  drinks)

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ENERGY OUT

• Restrict TV watching, computer cames, indoor
  staying, motorized transport, etc.
• Increase outdoor playing, sports, school
  physical activities etc.
• CHILDREN ARE BASICALLY PHYSICALY ACTIVE AND LIKE
  TO PLAY

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WHOSE RESPONSIBILITY IS CHILDRENS OBESITY
PREVENTION?

• NOT CHILDRENS
• HOMES (PARENTS), SCHOOLS, SOCIETY

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• PUBLIC RESPONSIBILITY
• POLICY INTERVENTIONS

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WHAT STRATEGIES EFFECTIVE?

• Information and health education has little
  impact because of the strong environmental
  influences
• PRIORITY IN EFFECTIVE POLICY ACTIONS

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STRONG INTERACTION BETWEENDIFFERENT LEVELS NEEDED
Global Regional EU National Local
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GLOBAL

• Strong global influences marketing, trade
  agreements, communication, fashions, etc.
  (social consequences of globalization)
• WHO should lead global action, in collaboration
  with other UN agencies and in interaction with
  international organizations, industry and media!

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PIONEERING EXAMPLE OF FCTC (Framework Convention
on Tobacco Control)

• International law applied to a major public
  health problem
• Concerted and binding response to public health
  consequences of globalization
• (ILO Commission on Social Consequences of
  Globalization)

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• The early success of FCTC should be an
  encouracing example to take further advantage of
  strong international instruments in tackling
  other major global public health problems

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STRONG GLOBAL INFLUENCES GLOBAL HEALTH
ACTIONS NEEDED WHO GLOBAL STRATEGY ON DIET,
PHYSICAL ACTIVITY AND HEALTH ADOPTED IN 2004
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STAGES OF INTERNATIONAL POLITICS

• Foreign policy (wars, security)
• Trade, commerce
• Environment, health

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• WE NEED STRONGER USE OF GLOBAL PUBLIC HEALTH
  INSTRUMENTS!
• Further developments with Global Strategy on Diet
  and Physical Activity

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• There is a proliferation of global health
  initiatives and resources. Strengthened work is
  needed that targets major global health problems
  in more coordinated way in which WHO shows
  strong leadership, together with global
  partnership.
• At the same time public health infrastructures in
  countries should be strengthened, in the way that
  Int. Ass. of National Public Health Institutes
  (IANPHI) has suggested.

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NATIONAL

• Governments have a basic responsibility for
  public health

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PARTNERSHIPS

• Governments (national, local)
• Civil society (NGOs)
• Private sector
• International collaboration

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PRIVATE SECTOR

• Food, eating, physical activity
• Commercial issues of increasing impact to public
  health
• Health is increasingly important business
  argument
• Product development, marketing
• Social responsibility? Regulation? Market push?

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HEALTH SERVICES

• High risk / population approaches
• Health services in interaction with other
  community activities and general health promotion
  work
• Evidence based interventions
• Use of IT technology

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CIVIL SOCIETY

• The role of civil society increasing in most
  countries
• NGOs mobilize people, serve people, watchdogs,
  etc.
• Push for childhood obesity to public / political
  agenda

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THERE IS A PROLIFERATION OF GOOD STRATEGIES,
PROGRAMMES AND PLANS

• WHO Global Strategy on Diet, Physical Activity
  and Health (2004)
• WHO/EURO Ministerial Charter on Counteraction
  Obesity (2006)
• EU White Paper (2007)
• THEY ALL IDENTIFY EFFECTIVE PRIORITIES

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FROM PRIORITIES TO IMPLEMENTATION

• IDENTIFYING IMPLEMENTING
• PRIORITIES THEM

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STRONGER SUPPORT FOR IMPLEMENTATION

• Stronger public health infrastructures
• Stronger health surveillance / monitoring
• Innovative financial support mechanisms

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EVIDENCE FOR POLICY

• Evidence on causes of diseases
• risk factors
• disease mechanisms
• determinants of risk factors
• Evidence on intervention effectiveness
• clinical interventions
• health promotion interventions
• policy interventions
• Evidence is not the only driver of healthy
  policy!

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WHAT POLICIES?

• Health policy vs. Health in all policies
• Health impact assessment

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HEALTH MONITORING

• Power of monitoring
• Feed back to people and decision makers
• Need to emphasize risk factors, lifestyles,
  determinants

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ECONOMIC DRIVES

• Society Investment in health
• Government Control of health care costs
• Private sector
• - Availability and performance of workforce
• - Health as a business argument

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OPTIMISM

• People are increasingly interestred in health and
  quality of life
• Health is higher on public agenda
• Increasing number of partners in health work

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PESSIMISM

• FORCES TO UNDERMINE HEALTH NEEDS AND PUSH OBESITY
  ARE STRONG

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• LIFESTYLES CAN BE CHANGED AND PUBLIC HEALTH
  IMPROVED

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USE OF BUTTER ON BREAD (MEN AGE 3059)
Kg/m2
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AGE-ADJUSTED MORTALITY RATES OF CORONARY HEART
DISEASE IN NORTH KARELIA and the whole of
Finland among males aged 35-64 years from
1969 to 2002.
700
start of the North Karelia Project
600
extension of the Project nationally
500
North Karelia
400
300
- 82
All Finland
Mortality per 100 000 population
200
- 75
100
Year
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KTL REPORT TO THE NATIONAL ECONOMIC COUNCIL OF
FINLAND ECONOMIC CONSEQUENCES OF PREVENTION

• Availability and quality of shrinking labour
  force
• Health and functional capacity of growing elderly
  population (control of health costs increase)

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HOW TO PROMOTE POLICY CHANGES?
POPULATION
PUBLIC POLICY
PRIVATE SECTOR
NATIONAL HEALTH PROGRAMME
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• BLAME THE VICTIMS or BLAME THE POLITICIANS?

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CRUCIAL ASPECTS FOR SUCCESS

• Strong health leadership, combined with broad
  partnership
• Do the right things, but also enough of it

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• The key and the challenge is to mobilize people
  for such social change that leads to effective
  policies and responses by the industry that in
  turn support needed changes!

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• Usually, environmental and policy decisions are
  key, but such can often be achieved only in
  health promotion activities that influence public
  agenda and peoples intentions. At the same time,
  the human factor is crucial persistent and
  dedicated work is needed, combining enthusiastic
  and credible leadership with close involvment of,
  and ownership by, the population.
• Puska 2005. In Coronary Heart Disease
  Epidemiology (Marmott Elliott, eds.)

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KIITOS
THANK YOU
MERCI BEAUCOUP
Montreal 8.-9. Nov., 2007