Nordic Centre for research and studies in Public Health

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Nordic School of Public Health (NHV) was
established by the five Nordic countries through
the Nordic Council of Ministers
Priorities for Healthy Lifestyle Promotion for
most effective NCD prevention

• Nordic Centre for research and studies in Public
  Health

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Public Health
Health

• Health is a state of complete physical,
  mental and social well-being and not
  merely the absence of disease or infirmity

• Systematic development of knowledge on
• Health development and the factors affecting
  health and
• Theories and methods for implementation and
  follow-up
• Application of theories and methods from several
  disciplines therefore multidisciplinary in nature

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 INTERHEART Study nine potentially modifiable
risk factors account for over 90 of the risk of
an initial acute myocardial infarction
Population attributable risk fractions
DIET and exercise explain 50 CHD deaths
Salim Yusuf et al . Effect of potentially
modifiable risk factors associated with
myocardial infarction in 52 countries (the
INTERHEART study). Lancet  364  9437   11 Sept
2004
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Ischaemic heart disease
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Comparisons with other studies CHD mortality
falls attributed to
Beaglehole15 analysis focused on specific
treatments, inferred contribution from risk
factors Vartiainen16 analysis focused on risk
factors, inferred contribution from treatments
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Different aspects of implementation of Public
Health
Health Protection
Health Promotion
Health Maintenance Disease Prevention
Public health is the science and art of promoting
health. It does so on the understanding that
health is a process engaging social, mental,
spiritual and physical wellbeing. Public health
acts on the knowledge that health is a
fundamental resource to the individual, to the
community and to the society as a whole and must
be supported by soundly investing in living
conditions that create, maintain and protect
health (Kickbusch 1989).
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• Health Protection
• Regulations and laws
• Taxation
• Financing health measures, supporting research
• Organization
• Training (public health, health promotion,
  medicine and care)
• Role of insurance systems
• Health Promotion
• Education
• Didactic methodology
• Participation
• Evidence base
• Health Maintenance Disease Prevention
• Individual (high-risk strategy)
• Collective (population risk factors)
• Hierarchic and non-participatory

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• Strengths in public health implementation
• Health (medical) research during the last decades
• High quality in epidemiology descriptive
  information
• The welfare state
• Success in decreasing heart disease it is
  possible
• New basic knowledge genetics
• Information technology
• Pharmaceutical treatment
• Knowledge from successful experience - smoking

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SWEDEN
The good examples, smoking in Finland and Sweden.
A combination of health promotion and health
protection
RUSSIA
DENMARK
FINLAND
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• Weaknesses in public health implementation
• Normative tendencies - credibility
• Lack of knowledge concerning equity and health
• Success in preventing heart disease poorly
  explained
• Definition of health
• Can we afford prolonging life?
• Insufficient knowledge base on techniques for
  implementation
• Role of industry and agriculture

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• Schools of Public Health
• New public health vs old public health
• Postgraduate or Basic educations?
• Carreers
• Postgraduate Public health
• Domination by other paradigms
• Imbalance between medicine and social sciences in
  public health
• Readiness for Mode 2 research?

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• Regional variations in Health
• Compare Copenhagen and Malmö
• 1.5-2 times more diabetes in Copenhagen
• 1.5 times more heart disease in Copenhagen
• Is this due to
• Life style?
• Quality and organisation of health care?
• Differences in registration?

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Potential changes in CHD mortality in England
Wales between 2000 and 2010 If risk factors
a) continue recent trends b) additional
reductions already achieved elsewhere
  Unal et al J Clin Epid 2005 58 733
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• Specific problems
• Inequity persists and even increases in some
  countries
• Increased migration with specific problems
• Health behaviour in childhood and adolescence
• Financing of research in public health
• National differences. Impact in Finland. Russia.
• Political considerations Nutritional advice vs
  agricultural and food industry
• Human resources capacity building
• Medical vs social science paradigms

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• Key issues for public health and non-communicable
  diseases in the future
• Improved knowledge on implementation techniques
• Development towards mode 2 reseach
• Improved scientific basis for informed policy
  decisions on health promotion
• New areas of knowledge Behaviour economics,
  Applied ethnography, Consumer behaviour research
• Capacity building in public health
• Reinforcement (recognition) of Public Health in
  health organizations

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Priorities for health promotion related to
non-communicable diseases

• The problems are well described (sufficiently?)
• Methods for health promotion should be better
  developed
• Methods to monitor effects of health promotion
  should be improved
• Lack of public health workforce focused on
  implementation
• Increased financial support for public health
• Development of new knowledge areas

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Concerning obesity/diabetes If we fail to
act, we will not be forgiven by the people who
live shorter and poorer lives than they
deserve Fmr president Bill Clinton 2006
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www.nhv.se

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What Next? Challenges for Future Cooperation

• Coordinating natural experiments in health
  promotion
• Randomized control trials and health promotion on
  the societal level
• Comparative studies in health, health
  determinants, disease, organization
• Human resources for Health

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From NordForsk report november 2007
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