Lifestyle & Lifestyle & Public HealthPublic Health

Antti UutelaAntti UutelaNational Public Health InstituteNational Public Health Institute

(KTL)(KTL)

Lecture at Exploratory Workshop: Responding Lecture at Exploratory Workshop: Responding to Public Health Challenges, January 11, 2007to Public Health Challenges, January 11, 2007

Hotel Arthur, HelsinkiHotel Arthur, Helsinki

Impact of ill Impact of ill healthhealth

Major causes for death in 2002; and pensions due to inability to work in 2000

Deaths in 2002

number % number %

Cardiovascular 21 133 43 Mental disorders 62 500 55 Neoplasms 10 522 21 Musculo-skeletal 16 300 14 Injuries and poisonings 4 077 8 Nervous and sense organs 11 900 10 Respiratory 3 865 8 Injuries and poisonings 6 000 5 Mental disorders 3 246 7 Cardiovascular 5 400 5 Nervous and sense organs 2 165 4 Neoplasms 2 400 2 Digestive 2 036 4 Metabolic 2 000 2 Metabolic 641 1 Infectious 500 0 Infectious 381 1 Others 7 700 7 Musculo-skeletal 285 1 Others 1 035 2

Total 49 389 100 Total 114 700 100

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 tobe used at the Regional Health Promotion Meeting Round in 2005-2006

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

1971453

Direct costs of care and imputed value of lost labor by disease group in 1995

Direct costs 1995

1000 e % 1000 e %

Cardiovascular 918353 17 Cardiovascular 1104132 12 Neoplasms 334302 6 Neoplasms 607692 6 Injuries and poisonings 316885 6 Injuries and poisonings 1494932 16 Respiratory 589062 11 Respiratory 279333 3 Mental disorders 692074 7 Mental disorders 2542149 26 Nervous and sense organs 446211 8 Nervous and sense organs 589150 6 Digestive 301446 6 Digestive 225015 2 Metabolic 178106 3 Metabolic 166849 2 Infectious 75390 1 Infectious 795098 1 Musculo-skeletal 582968 11 Others 967985 22

Total 5402782 100 Total 9597203 100

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-skeletalOthers

21

821400 4

What impacts What impacts health?health?

Factors affecting health

Social, economic,cultural &environmental

conditions

HealthLifestyle

Health and medicalservices

Geneticinfluences

(Source: Tones and Tilford: Health Promotion, 2001, Figure 1.1)

Lifestyle of Lifestyle of youthyouth

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 SystemSources of lifestyle information on youth

Lifestyle of 14-18 yrs old boys

Source: Fig 45 in A. Rimpelä’s chapter in Koskinen & al (eds): Health in Finland 2006

Lifestyle of 14-18 yrs old girls

Source: Fig 45 in A. Rimpelä’s chapter in Koskinen & al (eds): Health in Finland 2006

Youth’s 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)

Lifestyle of Lifestyle of working-age working-age populationpopulation

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 www.ktl.fi/julkaisuja 2006 version coming out soon

Health Monitoring SystemSource of lifestyle information on working age population

Health Monitoring System

SmokingSmoking

0

10

20

30

40

50

%

men women

year

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

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

0

20

40

60

80

year

%Men, daily smokers

Women, daily smokers

Men, the others

Women, the others

Men Women

Education

Proportion of daily smokers by educational Proportion of daily smokers by educational group, 25-64 yrsgroup, 25-64 yrs

0

10

20

30

40

50

78-81 82-85 86-90 91-95 96-2000

2001-2005

%

Low Middle High

0

10

20

30

40

50

78-81 82-85 86-90 91-95 96-2000

2001-2005

%

Food choicesFood choices

Food choices, Food choices, 1978-20051978-2005

0

20

40

60

80

%

0

20

40

60

80%

Butter on bread Vegetables daily

Skimmed or 1 %-milk

Men Women

Healthy food choices* by educational group

Men Women

0

20

40

60

80

100

79-81 82-85 86-90 91-95 96-2000

2001-2005

%

0

20

40

60

80

100

79-81 82-85 86-90 91-95 96-2000

2001-2005

%

Low Middle High

*Person indicates used of at least 3 out the next four usual choices: Eating vegetables daily, Doesn’t 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

Consumption Consumption of alcoholof alcohol

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

Men Women

0

20

40

60

80

100

%

Used any alcohol during the past yearBeer (during the past week)Spirits (during the past week)Wine (during the last week)Long drinks (during the past week)Cider (during the past week)

0

20

40

60

80

100

82-8

4

85-8

6

87-8

8

89-9

0

91-9

2

93-9

4

95-9

6

97-9

8

99-2

000

2001

2002

2003

2004

2005

%

0

20

40

60

80%

Men

Women

Percentage of men reporting at least 8 units and women reporting at least 5 units alcohol consumption during the

previous 7 days

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

0

20

40

60

80

82-86 87-91 92-95 96-99 2000-03

2004-05

%

0

20

40

60

80

82-86 87-91 92-95 96-99 2000-03

2004-05

%

Low Middle High

Physical activityPhysical activity

0

20

40

60

80

78 80 82 84 86 88 90 92 94 96 98

2000

2002

2004

%

Men, leisure timephysical exercise atleast twice a week

Women, leisure timephysical exercise atleast twice a week

Men, walking orcycling to and fromwork every day (atleast 15 min.)

Women, walking orcycling to and fromwork every day (atleast 15 min.)

Physical activity, 1978-2005Physical 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

Leisure-time physical activity at least 2-3 times Leisure-time physical activity at least 2-3 times a week by educational groupa week by educational group

MenWomen

0

20

40

60

80

78-81 82-85 86-90 91-95 96-2000

2001-2005

%

Low Middle High

0

20

40

60

80

78-81 82-85 86-90 91-95 96-2000

2001-2005

%

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

Response rate in the lifestyle survey ofthe working age population

0

10

20

30

40

50

60

70

80

90

100

year

%

Men

Women

Total

two reminders

three reminders

one reminder

Lifestyle of Lifestyle of pensionerspensioners

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

www.ktl.fi/julkaisuja.

Health Monitoring SystemSource of lifestyle information on pensioners

Health Monitoring System

0

5

10

15

20

25

30

1993 1995 1997 1999 2001 2003 2005

%

Miehet Naiset

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

Miehet

0

10

20

30

40

50

60

70

1985 1987 1989 1993 1995 1997 1999 2001 2003 2005

%

Kasviöljyä ruoanlaitossa Voita leivällä Rasvatonta maitoa

Naiset

0

10

20

30

40

50

60

70

1985 1987 1989 1993 1995 1997 1999 2001 2003 2005

%

Kasviöljyä ruoanlaitossa Voita leivällä Rasvatonta maitoa

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

(red) at meals

Miehet

0

5

10

15

20

25

30

35

40

1985 1987 1989 1993 1995 1997 1999 2001 2003 2005

%

Kasviksia Hedelmiä ja marjoja

Naiset

0

5

10

15

20

25

30

35

40

1985 1987 1989 1993 1995 1997 1999 2001 2003 2005

%

Kasviksia Hedelmiä ja marjoja

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

0

10

20

30

40

50

60

70

80

1993 1995 1997 1999 2001 2003 2005

%

Miehet Naiset

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

0

2

4

6

8

10

1993 1995 1997 1999 2001 2003 2005

Alk

ohol

iann

oksi

a

Miehet Naiset

Reported average weekly consumption of alcohol units among 65-84 yrs old men

and women (red)

0

5

10

15

20

25

1993 1995 1997 1999 2001 2003 2005

%

Miehet Naiset

Reported consumption of at least 8 units (men) or at least 5 units (women) of alcohol

weekly, 65-84 yrs old (%)

Trend of food choices positive, and follows that of working age persons

Men’s daily smoking has decreased, women’s 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

What lies ahead What lies ahead regarding regarding lifestyle?lifestyle?

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.

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.

Do public health researchers need to be rocket scientists?

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 …..

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 Culture

Psychosocial Factors

©Queensland University of Technology, School of Public Health , Centre for Public Health Research

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

Thank you!Thank you!Thank you!