Nfhk mikael fogelholm_turku2011

Improving public health - does research have an influence?

www.helsinki.fi/yliopisto

Mikael Fogelholm, Professor in Nutrition

Department of Food and Environmental Sciences

4.10.2011

Faculty of Agriculture and Forestry

Department of Food and Environmental Sciences 1

Health-related grand challenges for European research: age distribution

60 %

80 %

100 %

80+

65-79


0 %

20 %

40 %

60 %

1950 1975 2000 2025 2050

50-64

25-49

15-24

0-14

Health-related grand challenges for European research: dementia

30

40

Dementia


0

10

20

60 70 80 90 100

Age (years)

Stroke

Parkinson

%

15

20

25

% with

Health-related grand challenges for European research: obesity

www.helsinki.fi/yliopisto 4.10.2011

0

5

10

67 71 74 77 80 84 85 86 94 95 98 99 2 3

% with

overweight

Overweight among adolescents (12-18 y) in Nordic

countries between years 1967 and 2003.

Health-related grand challenges for European research: type 2 diabetes

25

30

35

Non-obese Obese

Type 2 diabetes

in Finland

• 1970: 50 000

www.helsinki.fi/yliopisto 4.10.2011 5

0

5

10

15

20

46-50 36-40 26-30 46-50 36-40 26-30

Birth year (19..)

%• 1970: 50 000

• 2010: 200 000

• 2030: 400 000?

The proportion (%) of type 2 diabetics among obese

(BMI>30) and non-obese (BMI<30) in Päijät-Häme

(Lahti region), South Finland.

Joint programming perspectives and motivation

l Harmonizing strategic research approaches within countries to

tackle more efficiently societal challenges

l Synergistic use of shrinking research budgets in a difficult

economic climate


economic climate

l Grouping calls for grants at the level of several member states on

a voluntary basis will reinforce the potential for scientific

collaboration in Europe

l Accountability to stakeholders in pooling research efforts

addressing common social issues in Europe

l Simplifying European procedures governing scientific collaboration

(and its administration)

Health-related Joint Programming topics

Neurodegenerative diseases, in particular Alzheimer’s

disease

More Years, Better Lives - The Potential and


More Years, Better Lives - The Potential and

Challenges of Demographic Change

A healthy diet for a healthy life

The microbial challenge – an emerging threat to

human health

4.10.2011 7


Policy and societal challenges

• Social inequalities

• Young generation & elderly

• Obesity, type 2 diabetes


• Obesity, type 2 diabetes

• Determinants of choices & health

• Food supply

• Sustainable & reasonable price

• Competitiveness of food industry


How to change?

Understanding of

• Individual differences

• Relationships between habits-onset disease


• Relationships between habits-onset disease

• Mechanisms

• Genetic basis

• Needs due to social inequalities

‒ Minority groups

• Social environments

• Validation of health claims

• Share databases and large intervention studies

• European Food Research Institute?


Research needs identified


• European Food Research Institute?

• European network on Food-omics

• Long-term European multi-centre intervention studies

• Standardization of investigation procedures and designs

Good Ageing in Lahti Region (GOAL),

Finnish research project on ageing and

well-being


The province of Paijat-Hame in the beginning of GOAL (y. 2000)

� Low-tech industry characteristic for town of Lahti, agriculture for the rural areas

� High unemployment rate

� Ageing rapidly


� Ageing rapidly

� Relatively poor health status

� Unhealthy lifestyles, high BMI

� Municipalities having great economic difficulties, pressure to organizational changes

� Health care sector operating with lowest costs in the country; and with rapidly ageing personnel

Hämeenkoski

Iiitti

Orimattila

Nastola

Lahti

Pukkila

Hollola

Proportion of 65-74 –y old in Päijät-Häme, yr. 2000

(pink) and 2015 (light blue, predicted)

22.6.2006

0 5 10 15 20

Hartola

Padasjoki

Sysmä

Asikkala

Heinola

Kärkölä

Artjärvi

Hämeenkoski

Finland, 2015Finland, 2000

Good Ageing in Lahti Region (GOAL), Finnish research project on ageing and well-being

Collaborators �University of Helsinki, Palmenia

�University of Helsinki, Dept. ofSocial Policy


Social Policy

�University of Helsinki, Division ofNutrition

�National Institute for Health andWelfare

� Lahti Polytechnic (University ofApplied Sciences)

�Päijat-Hame Hospital District andits 15 municipalities

Good Ageing in Lahti Region (GOAL), Finnish research project on ageing and well-being: goals

To empower both the population and the professionals in health promotion


And as a consequence

To increase welfare, diminish morbidity, and improve quality of life among ageing population in Lahti Region

1) 10-year cohort study (2002-2012)

� three birth cohorts (baseline n=2815) will be followed,

those born in 1946-50, 1936-40 and 1926-30

� needs assessment

general program evaluation

Good Ageing in Lahti Region (GOAL), Finnish research project on ageing and well-being: the three parts


� general program evaluation

2) Community-based interventions (2002-2012)

� evidence-based

� implementation studies

� development of policies and practicies

3) Community Diagnoses (2002)

� combining data from cohort study, statistical reports and

policy documens from each municipality

Self-reported health compared to 1 year earlier(GOAL cohort, 2005)

60 %

80 %

100 %

Worse

Similar


0 %

20 %

40 %

46-50 36-40 26-30 46-50 36-40 26-30

Year of birth (19..)

Similar

Better

Ikihyvä Päijät-Häme, interim report 2005 (Fogelholm et al. 2007)

Self-reported difficulties in performing activities

related to daily living in women, born 1926-30,

1936-40 and 1946-50.

0 10 20 30 40 50 60 70 80 90 100

Bathing/dressing

Walk 100 m

Walk 500 m

Stairs 1 floor up

%

Stairs 1 floor up

Walk 2 km

Carrying food-bag

Moderate exertions

Kneeing/bending

Stairs several floors

Vigorous activities

1946-50

1936-40

1926-30

Ikihyvä Päijät-Häme, interim report 2005 (Fogelholm et al. 2007)

Proportion of individuals with severe restrictions in walking 500 m or bending, according to local community type. Results are adjusted for age and sex.

12

14

16

18

20

Urban

* *

%

* = p<0.001

vs. other


0

2

4

6

8

10

12

Walking 500 m Bending

Urban

Semi-urban

Rural

Fogelholm et al. Scand J Publ Health, 2006

%

Intervention I: Group-counselling for prevention of T2D and CVD, based on The Health Action Process Approach. 1-y results.

Intervention goals GOAL, %

N=352

DPS, %

N=265

Total fat < 30E% 48 47

SFA < 10E% * 34 26Those achieving 4-

5 goals had


SFA < 10E% * 34 26

Fibre > 15g/1000 kcal*** 52 25

Exercise > 30 min / d*** 66 86

Weight loss > 5% *** 12 43

4-5 goals achieved 20 18

5 goals had

significantly more

often normal

glucose tolerance at

1-y follow-up

(χ2 = 7.120, p < 0.05)

Absetz et al. Diabetes Care 2007, 30, 2465-2470.

Community health-care3rd sector

Health Action Process Approach

Motivation

Interventions

• Social networking

• Strength and

Identification of

individuals with

mobility

Intervention II: Identification and counselling for individuals with impaired physical functioning


Motivation

Empowerment• Strength and

balance training

• Nutrition

mobility

problems

To the intervention

Back to health care for follow-up measurements

Lessons learned from GOAL

� Emphasis shifted from individual towards social and health care sector and municipal administration as primary targets

� Sensitivity to emerging intervention needs

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Maatalous-metsä tieteellinen tiedekunta / Henkilön

nimi / Esityksen nimi 22

� Sensitivity to emerging intervention needs

� Interventions support each other ideologically, structurally and methodologically

� During its brief history, GOAL has established itself as a developmental resource in Päijät-Häme – but it takes time to overcome resistance!

Nfhk mikael fogelholm_turku2011

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