Professor Markku Peltonen, THL, at Genomics to Healthcare EU side event, 13 Sept 2019, THL, Helsinki

1. THL in public health promotion then and now
Markku Peltonen
PhD, Research Professor
Genomics to Healthcare. A side event for the Finnish Presidency of the Council of the EU. #EU2019FI. Helsinki, Finland 13.9.2019
Finnish Institute for Health and Welfare

2. Public health:
The science and art of preventing disease, prolonging life and promoting
health through organized community efforts.
WHO 1952. Technical Report Series No. 55. WHO, Geneva
Health promotion:
Enables people to increase control over their own health.
Covers a wide range of social and environmental interventions
designed to benefit and protect people’s health and quality of life by
addressing and preventing the root causes of ill health,
not just focusing on treatment and cure.
https://www.who.int/features/qa/health-promotion/en/

3. Health Promotion
The Ottawa charter (1986)
https://www.canada.ca/en/public-health/services/health-promotion/population-health/ottawa-charter-health-promotion-
international-conference-on-health-promotion.html

4. Public Health Pyramid
Frieden TR. N Engl J Med 2015; 373:1748-54

5. Prevention paradox
Rose G. British Medical Journal 1981: 282; 1847-51
Preventive health measures can have only small effect for the typical
individual, yet major effect for the population health (and vice versa)
→High-risk approach
• Aims to identify those at highest risk and intervene to lower individual risk
→Population approach
• Aims to lower the mean level of risk in the population and shift the risk-
distribution

6. THL’s role in health promotion
1. Health monitoring and surveillance
- Identification of public health challenges
- Evaluating the implementation and effectiveness of policies and interventions
2. Research on causes of diseases and possibilities for prevention and
health promotion
- Epidemiological research; clinical trials
3. National expert function in health promotion
- Providing evidence-based expert knowledge for decision-making and
implementation

8. The North Karelia Project
• Coronary heart disease (CHD) mortality rates among men highest in the world
• Increasing public discussion
• General opinion related CHD to stress, ageing and genetics
• Referred to as “Disease of the Executives” in the past
• Chronic nature of CHD: the potential lies in the primary prevention
• Using best available knowledge at the time
• Major risk factors – smoking, high blood pressure, high serum cholesterol - were already known
in the late ‘50s (from public health point of view, suprisingly little has changed since then)
• Awareness of numerous “statistical associations”
• Can risk factors and behaviors be changed at the population level?
• If yes, what will happen with the mortality?
• A demonstration project for population-based prevention of CHD was initiated

9. Coronary heart disease mortality rates 1969-2011
North Karelia and the
whole of Finland in
men aged 35-64 years
50
220
390
560
730
69 71 73 75 77 79 81 83 85 87 89 91 93 95 97 99 01 03 05 07 09 11
Year
Pohjois-Karjala projektin alku
Projektin ulottaminen koko maahan
Mortality per
100 000 population
North Karelia
All Finland
start of the North Karelia Project
extension of the Project nationally
>80% reduction

10. Modern day public health challenges
• Increasing prevalence of obesity: type 2 diabetes
• Ageing of the population: dementia and alzheimer’s disease
• A number of modifieable risk factors are known
• Is changing the lifestyle related to these risk factors feasible?
• What happens with the incidence of the disease?

11. Lifestyle intervention to prevent disease:
Scientific evidence from randomized clinical trials at THL
Tuomilehto et al. New Engl J Med 2001
Lindström et al. Diabetologia 2013
Ngandu et al. Lancet 2015
The Finnish Geriatric Intervention Study to
Prevent Cognitive Impairment and Disability (FINGER)
The Finnish Diabetes Prevention Study (DPS)
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
Estimateofprobabilityofremainingfreeofdiabetes
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Intervention
Control
Follow-up time, years Follow-up time, years

12. Public health programmes in Finland
Health challenges
in society
Public need
for change
Research
Knowledge
Results and
experiences
Demonstration
programmes
National action
National policy
Diffusion of
knowledge and
innovation
Adapted from Puska et al. 2009

13. Conclusions
• Health monitoring system which enables identification of health challenges
• Implementation of interventions with evidence-based efficacy
• Follow-up with evaluation and monitoring of effectiveness of implemented activities
• National demonstration-programs as a tool in chronic disease prevention and health
promotion
• Role of health services and health education
• Intersectoral collaboration (NGO’s, media, industry) and policy decisions taking into account
health implications across sectors
• Despite marked improvement during the past decades, CHD risk factor levels in the population
still generally far from optimal
• Still potential for considerable improvement

14. © Juha Länsman
Thank you!
markku.peltonen@thl.fi
@markkupeltonen
http://urn.fi/URN:NBN:fi-
fe201205085218