How to promote healthy policies – with special emphasis on CVD and NCD

WCC 2012

Dubai 18-21.4.2012

Pekka Puska, MD, PhD,MPolScDirector General, National Institute for Health and Welfare (THL)Past President, World Heart Federation (WHF)Vice President, Int. Ass. of National Public Health Institutes (IANPHI)

Population based CVD prevention calls for changes in lifestyles related to major CVD risk factor

• Diet

• Physical activity

• Tobacco

• Alcohol

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Historical development:

Community and national perspectives

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Health education

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Health education Types of activities:

• Information dissemination

• Persuasion

• Teaching of practical skills

• Empowerment

• Etc.

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Important role of policies and private sector

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Health education

Health promotion

= health education + changing environments (Ottawa Charter)

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Development of evidence based policies and methods for the decisions and actions of policy-makes and the private sector

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How to influence policies and the private sector

• Directly through presenting rational arguments for evidence based policies and through identifying win-win situations

• Through populations: Opinions, intentions and behaviour changes of the population ultimately influence strongly politicians (”voters decide in democracy”) and the private sector (”the consumer is the king”)

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Complex change process with time

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Should we address supply or demand?

SUPPLY DEMAND

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(Tobacco example)

Supermarkets in the middle position in nutrition

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Social change process ”People pull policies and policies pull people”

The role of the health programme is to support this social change process for public health

Relates to many social theories (from social marketing to innovation diffusion)

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• There is rapidly increasing number of documents describing needed effective policies

• The key question is how to promote adoption and implementation of those policies

• We should try to promote a social change process to the desired direction

• Thus we should not blame the patient of blaim the politician!

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Social change process:• Examples from Finland

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Use of Butter on Bread (men age 30–59)

01020304050

60708090

100

1972 1977 1982 1987 1992 1997 2002

North Karelia

Kuopio province

Southwest Finland

Helsinki area

Oulu province

Lapland province

%

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Serum Cholesterol in Men Aged 30–59 Serum Cholesterol in Men Aged 30–59 YearsYears

FINRISK Studies 1997 & 2002

mmol/l

5

5,5

6

6,5

7

7,5

1972 1977 1982 1987 1992 1997 2002 2007

North Karelia

Kuopio

Turku/Loimaa

Helsinki/Vantaa

Oulu

Lapland

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How to influence policies?

• Innovative use of media for advocacy (polls, patient stories etc)

• Organizational support (NGO’s etc)

• Win win situations

• Personal contacts: opinion leaders,

• Policy makers, private sector leaders, media representatives, etc.

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Comprehensive action and partnership for national NCD prevention

• Health services

• Governments (national, local)

• Civil society (NGOs)

• Private sector

• Media

• International collaboration

Intersectoral work towards prevention- ”Health in all policies”

• People’s lifestyles are influenced by decisions in different sectors of society (much of them beyond the health sector)

• Health in general and NCD prevention in particular should be taken into account in decisions made by different sectors (health impact assessment)

• 8th WHO Conference on Health Promotion (Helsinki, June 2013): Health in All Policies in practice

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Complex Process of Social Change – Dynamic Change over Time

”Usually, environmental and policy decisions are key, but such can often be achieved only in health promotion activities that influence the public agenda and people’s intentions. At the same time, the human factor is crucial: persistent and dedicated work is needed, combining enthusiastic and credible leadership with also involvement of, and ownership by, the population.”

Puska 2005. In Coronary Hearth Disease Epidemiology (Marmot & Elliott, eds.)

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Thank you