1. Diabetes and the Heart Meet the experts August 30 2009 Responding to the challenge: determining health policy Introductory remarks Lars Rydén Department of Medicine Karolinska Institutet Stockholm, Sweden The Future of Health Care in Europe London May 13, 2011

2. Health and disease The ideal solution Lucas Cranach 1546 The Youth Fountain Health and Disease The ideal situation

3. Health and disease The ideal solution Preservation of health Some prerequisites  Political support  Common pathways  Professional collaboration  Persistancy and endurance  Shared view on important steps  Redirection of available resources  A long-term view on the total impact

4. Presently established factors Life style Physical inactivity, obesity, food habits, stress, smoking Medical Hypertension, dyslipidemia diabetes……. Fundamental reasons Agricultural politics Social disintegration Climate changes Tax politics (e.g. tobacco) Industrialisation/urbanisation Preservation of health Important threats

5. Diabetes and the Heart Meet the experts August 30 2009 1992 ”The primary determinants of disease are mainly economic and social. Therefore its remedies must also be economic and social. Medicine and politics cannot and should not be kept apart.” Geoffrey Rose 1926 - 1993

6. Choice and information Scientific evidence Urge Member States to implement and enforce smoke free legislation Preservation of health Example - tobacco Hospital admissions for AMI in eight studies 2004 - 2008 Reduction 19% (95% CI 14-24) Non-smokers  70%

7. Preservation of health Blocking common pathways towards diseasePulmonarycancerMyocardialinfarction

8. Behind 86% of deaths in WHO region Europe DiseasesMain determinants Cardiovascular Kidney Hepatic Respiratory Malignant Diabetes Chronic non-communicable diseases (CNCD) Dimension and common pathways Tobacco Alcohol Diet Physical inactivity

9. Lars Rydén Karolinska Institutet Stockholm, Sweden Policy conference June 2009 Preservation of health Transprofessional collaboration Distinguish myths from evidence based knowledge Explore the ”climate” for collaborative efforts to gain political support Bringing 10 professional organisations together

10.  Recommendations on Taxation Agriculture Food labelling Urban planning Education Sport and recreation  Paramount legislative principle Health in all policies The European Chronic Disease Alliance ECDA

11. (Gyberg & Rydén Europ J Cardiovasc Prev Rehab 2011. In press) 0 smoking 3 km of daily walking 5 fruit & vegetables/day <140/90mm Hg blood pressure <5.0mmol/l cholesterol <3.0mmol/l LDL-cholesterol 0 diabetes Preservation of health On the importance of a unified approach

12. The three most important measures to implement EHHC Hinder för förbättrad folkhälsa Most important Least important Political Economic Organisation Mediarelated Awareness Attitudes Life style Other (Gyberg & Rydén Europ J Cardiovasc Prev Rehab 2011. In press) Group Politician NGO Health admin Professionals Preservation of health On the importance of a unified approach

13. 13,180 fewer deaths 2002 20021986 Risk Factors worse+11% Diabetes +8 Obesity +3 Risk Factors better- 66% Cholesterol (diet)-39 Smoking-20 Population BP fall -9 Physical activity-3 Treatments- 36% AMI-6 Secondary prevention -12 Heart failure-7 Angina ASA, CABG & PTCA -3 Hypertension -4 Primary prevention (statins)-2 Unexplained- 9% (Björk, Rosengren, Bennett, Lappas,Capewell Europ Heart J 2009; 30:1046-56 ) The power of prevention of chronic disease Explaining the fall in CHD deaths (ex: Sweden)

14. 100 80 60 40 20 0 % Treatment Prevention 97 3 From the appeal to the European Commission on the occasion of the incoming European Commission, February 2010 Resource allocation European health care

15. www.sph.uq.edu.au/bodce-ace-preventionwww.nice.org.uk/guidance/PH25 June 25 2010 Preservation of health A long-term view of the total impact

16. www.sph.uq.edu.au/bodce-ace-prevention Cost-saving interventions in 2003 Australian population Taxation and regulation and interventions on salt, alcohol and tobacco Polypill for CVD prevention (ACE-i+Ca-antag+ diuretic+statin) Investment cost A$4.6 billion Averted expenses A$ 11 billions (Vos et al Assessing Cost-Effectiveness in Prevention. Univ Queensland, Brisbane and Melbourne 2010) Preservation of health A long-term view of the total impact

17. Health and disease The ideal solution Preservation of health Some prerequisites  Political support  Common pathways  Professional collaboration  Persistancy and endurance  Shared view on important steps  Redirection of available resources  A long-term view on the total impact Thanks for the attention!!!