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Lifestyle & Public Health Antti Uutela National Public Health Institute (KTL) Lecture at Exploratory Workshop: Responding to Public Health Challenges,

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Presentation on theme: "Lifestyle & Public Health Antti Uutela National Public Health Institute (KTL) Lecture at Exploratory Workshop: Responding to Public Health Challenges,"— Presentation transcript:

1 Lifestyle & Public Health Antti Uutela National Public Health Institute (KTL) Lecture at Exploratory Workshop: Responding to Public Health Challenges, January 11, 2007 Hotel Arthur, Helsinki

2 Impact of ill health

3 Major causes for death in 2002; and pensions due to inability to work in 2000 Deaths in 2002 number % % Cardiovascular21 13343Mental disorders62 50055 Neoplasms10 52221 Musculo-skeletal 16 30014 Injuries and poisonings 4 0778 Nervous and sense organs 11 90010 Respiratory 3 8658 Injuries and poisonings 6 0005 Mental disorders 3 2467 Cardiovascular 5 4005 Nervous and sense organs 2 1654 Neoplasms 2 4002 Digestive 2 0364 Metabolic 2 0002 Metabolic 6411 Infectious 5000 Infectious 3811 Others 7 7007 Musculo-skeletal 2851 Others 1 0352 Total49 389100Total114 700100 Pensions due to inability to work 2000 Sources: Statistics Finland (Mortality 2002); Statistics of Centre of Pensions Security and Social Insurance Institution 2000 compiled for Puska to be used at the Regional Health Promotion Meeting Round in 2005-2006

4 Remaining years of life for a 35 yr old man and women by social group, 1981-2000

5 1971453 Direct costs of care and imputed value of lost labor by disease group in 1995 Direct costs 1995 1000 e % % Cardiovascular91835317Cardiovascular110413212 Neoplasms3343026 Neoplasms 6076926 Injuries and poisonings 3168856 Injuries and poisonings 149493216 Respiratory 58906211 Respiratory 2793333 Mental disorders 6920747 Mental disorders 254214926 Nervous and sense organs 4462118 Nervous and sense organs 5891506 Digestive 3014466 Digestive 2250152 Metabolic 1781063 Metabolic 1668492 Infectious 753901 Infectious 7950981 Musculo-skeletal 58296811 Others 96798522 Total5402782100Total9597203100 Imputed value of labor lost Compiled from the information from tables 25-26 in the chapter by Kiiskinen et al. in Koskinen et al (eds.) Health in Finland 2006 Musculo-skeletal Others 21 821400 4

6 What impacts health?

7 Factors affecting health Social, economic, cultural &environmental conditions Health Lifestyle Health and medical services Genetic influences (Source: Tones and Tilford: Health Promotion, 2001, Figure 1.1)




11 Lifestyle of youth

12 Youth (12, 14, 16, 18 yrs) health habit survey, University of Tampere, biennially, from 1977- WHO Health Behaviour School-aged (11, 13, 15 yrs) Children Study, University of Jyväskylä, every four years, from 1982- School Health Study (8th and 9nth graders, 14-16 yrs), biennially, on a customer, National Research and Development Centre for Social Affairs and Health, Stakes, from 1997- Health Monitoring System Sources of lifestyle information on youth

13 Lifestyle of 14-18 yrs old boys Source: Fig 45 in A. Rimpeläs chapter in Koskinen & al (eds): Health in Finland 2006

14 Lifestyle of 14-18 yrs old girls Source: Fig 45 in A. Rimpeläs chapter in Koskinen & al (eds): Health in Finland 2006

15 Youths lifestyle in short Physical activity developed positively among boys and girls (but that does not prevent increasing eating disorders) Use of tobacco and heavy use of alcohol have increased till the shift of the centuries, after that they have decreased The unobtrusive measure of illicit drugs experimentation hints that after a clear rise till the shift of the centuries this experimentation is becoming rarer (there is other information confirming this also) There has been a tendency toward more unhealthy eating including too much energy intake Among girls intake of too little energy is also clearly observed (Information on food choices from Räsänen: School health study 2005; Pietikäinen: School health study 2006)

16 Lifestyle of working-age population

17 Repeated mail surveys done at the National Public Health Institute, KTL Involves working age persons 15-64/74 yrs Monitors health & health-related lifestyle Repeated on an annual basis from 1978 Known by the nickname AVTK (AikuisVäestön TerveysKäyttymistutkimus) Basic report B18/2005 available as pdf at 2006 version coming out soon Health Monitoring System Source of lifestyle information on working age population

18 Health Monitoring System

19 Smoking

20 year Proportion of daily smokers in the population aged 15-64 years, 1978-2005

21 Daily exposure to environmental tobacco smoke at work for at least one hour, 1985-2005

22 MenWomen Education Proportion of daily smokers by educational group, 25-64 yrs

23 Food choices

24 Food choices, 1978-2005 Men Women

25 Healthy food choices* by educational group Men Women *Person indicates used of at least 3 out the next four usual choices: Eating vegetables daily, Doesnt drink whole milk, using low-fat spread or margarine on bread or not using any spread on bread, eating at least six (men) or at least five slices (women) of bread per day

26 Consumption of alcohol

27 Self-reported alcohol consumption during the previous 12 months and 7 days Men Women

28 Percentage of men reporting at least 8 units and women reporting at least 5 units alcohol consumption during the previous 7 days

29 Percentage of men reporting at least 8 units and women reporting at least 5 units alcohol consumption during the previous 7 days by educational groups Men Women

30 Physical activity

31 Physical activity, 1978-2005 * * * To be physically active for at least 30 minutes so that (s)he is at least slightly out of breath or sweaty

32 Leisure-time physical activity at least 2-3 times a week by educational group Men Women

33 About lifestyle of working age population in short Lifestyle trends relevant for major chronic diseases have been quite positive Differences in health behaviour between educational groups arise concern though, e.g., albeit differences fat type used on bread have become smaller between educational groups differences in smoking have increased An increasing number of Finns are not available as informants – so the external validity of the results decrease. Refusing to answer characterizes men and young men in the capital region especially; non-native Finns; and persons with unhealthy lifestyle Non-citizens do not belong to the sampling frame

34 Response rate in the lifestyle survey of the working age population two reminders three reminders one reminder

35 Lifestyle of pensioners

36 Gathered at the National Public Health Institute, KTL Includes information on those in pension age 65-79 yrs in 1985-1989 65 – 84 yrs from 1993- Involves self-reported health, lifestyle and functional ability indicators Done biennially Known as EVTK (Eläkeikäisen Väestön Terveyskäyttäytymis- ja toimintakykytutkimus) Basic report B1/2006 available as pdf at Health Monitoring System Source of lifestyle information on pensioners

37 Health Monitoring System

38 Daily smoking among the 65-84 yrs old, 1993-2005 (%)

39 Consumption of butter on bread (black) vegetable oil in cooking (blue) and non-fat milk (red) at meals

40 Daily use of vegetables and berries among the 65-79 yrs old, 1985-2005

41 Percentage of teetotalers among men and women (red), 65-84 yrs old,1993-2005

42 Reported average weekly consumption of alcohol units among 65-84 yrs old men and women (red)

43 Reported consumption of at least 8 units (men) or at least 5 units (women) of alcohol weekly, 65-84 yrs old (%)

44 Trend of food choices positive, and follows that of working age persons Mens daily smoking has decreased, womens smoking has maintained the very low level Consumption of alcohol has increased at relatively slow pace during the time period – nothing special in the development from 2003 to 2005 either Number of teetotalers decreased and alcohol consumption of males increased somewhat from 2003 to 2005 The results boast good external validity because of the steady 80% response rate – and the fact that non-native Finns a few in the age bracket In short about pensioners lifestyle

45 What lies ahead regarding lifestyle?

46 Tobacco, alcohol, drugs involve challenges Smoking is in general well-controlled and will probably be even more so in the near future. Low SES smoking is the biggest problem – and it really is a sizeable problem. Resources should be directed to tackle smoking initiation and cessation in low SES groups. Increasing alcohol consumption is a rising public health problem in general and in high consumption populations in particular, especially in low SES & high consumption populations. Illegal drugs experimentation is in low tide. There is a heavier than ever population of drug addicts though and since we live in a global world there is always a possibility of sudden worsening of the situation.

47 Nutrition and physical activity include challenges, too Healthy food, right amount of intake of energy in relation to the consumption of energy should be aimed at. Physical activity should be increased because it has health enhancing effects of its own right and because it helps in the maintenance of right weight. Eating unhealthy food and maintaining sedentary lifestyle are again more often a problem in the low SES groups.

48 Do public health researchers need to be rocket scientists?

49 Challenges for public health research Continuous research of the mechanisms of major diseases needs to be upheld basic and applied social & behavioral sciences need to be imported into creation, evaluation and development of instruments to tackle the mechanisms - as they often involve changing lifestyle Resources for implementation research – needed to evaluate the instruments and develop them into forms that are efficient in everyday use – should be provided in planning and funding of projects Message of health promotion research/behavioral medicine needs to be taken seriously – different levels of mechanisms need to be examined and programs for them created, evaluated, developed and implemented …..

50 UPSTREAM (MACRO) FACTORS MIDSTREAM (INTERMEDIATE) FACTORS DOWNSTREAM (MICRO) FACTORS Global Forces Policies Determinants of Health (social, physical, economic, environmental) Health Care System Health Behaviours Physiological Systems Health Biological Reactions Priority Groups Life Stages Settings & Contexts Government Culture Psychosocial Factors ©Queensland University of Technology, School of Public Health, Centre for Public Health Research

51 Health discrepancies need special attention global, regional, national, regional and local perspectives should be employed in studies the whole spectrum of population groups including immigrants should be examined in addition to SES and gender groups health inequalities should be studied from the perspective of moral philosophy/ethics research in health economics should be given a serious input because it should together with ethical research to aim at looking how much emphasis on different forms of prevention should be given methodological research into what really passes as evidence based information in public health should be done – this involves especially the different forms of interventions in health promotion

52 Thank you!

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