Global health concerns us all
UEF Bulletin 2017
Health threats are no longer somewhere else. From lifestyle diseases to pandemics, they have become global. Solutions are sought from research and cooperation.
Non-communicable diseases, such as cardiovascular diseases, cancers and type 2 diabetes, already kill more people in low and middle income countries than in the wealthier countries these diseases used to be associated with. “They are experiencing the same transition from infectious diseases to chronic lifestyle diseases as countries that developed earlier,” says Jussi Kauhanen, Professor of Public Health at the UEF Institute of Public Health and Clinical Nutrition.
Faced with the world’s highest cardiovascular mortality in the past, Finland has succeeded in reducing deaths from coronary heart disease among working-age adults by 80% in 40 years. A turning point was a comprehensive community-based intervention programme, the North Karelia project, which was launched in the 1970s. UEF’s Kuopio Campus has since been home to many other successful interventions attracting global interest.
“Countries where chronic diseases are now on the increase may be able to tackle the problem much faster, since there are existing models to implement and more health awareness,” Kauhanen says.
According to Kauhanen, the world has taken small steps towards global health equity in terms of child deaths and life expectancy, but inequities persist between and within countries. “If you live long enough to get cancer, your access to care and prognosis depend on which part of the world you live in. In addition, socioeconomic status is a strong determinant of health, even in wealthier countries like Finland.”
One positive global development is the decline in the number of deaths from infectious diseases. “The HIV epidemic has been a tragic exception to this trend, but in recent years there has been a reduction in both AIDS deaths and tuberculosis deaths linked to HIV.”
However, infectious diseases have become more unpredictable. “During the second half of the nineteenth century, it looked like a pandemic could erupt every ten years. In this century, we have seen pandemic threats or outbreaks much more often, from swine flu and avian flu to SARS, MERS, Ebola and the Zika virus.”
“The fact that people travel a lot makes it easier than ever for viruses to spread from one corner of the world to another. The lesson the world has learnt is that global monitoring, preparedness and cooperation are vital.”
Climate change may also spread diseases like malaria to new areas. In addition, extreme weather threatens the availability of clean air, drinking water, food and shelter. “While we were enjoying a record warm summer in Finland in 2010, Pakistan suffered disastrous floods affecting millions of people, both likely caused by climate change. We need to be prepared for more climate-related catastrophes in the future.”
Health in humanitarian crises is a popular topic among students of public health and a growing research area at the institute. An ongoing research project focuses on health professionals’ experiences in the Syrian War. “Our researchers have travelled to the Syrian border to interview doctors who have continued to work in war-torn Aleppo, and we will extend the interviews to Syrian health care professionals seeking asylum in Europe.”
“Systematic violence targeted at health care providers is a new and worrying phenomenon, exemplified by the bombings of hospitals in Aleppo,” Kauhanen says.
He points out that in addition to the immediate victims of war, many more are traumatised by the war. “It’s difficult to predict how it will affect children’s lives and mental health, in particular.”
One of the researchers on the Syria project, Dr Mikko Häkkinen, previously carried out research for his doctoral thesis among Palestinians living in conflict areas. Instead of their psychological distress, he focused on their coping mechanisms. Such knowledge can be used in planning psychosocial support measures in conflict areas.
Some of the research projects the institute is involved in approach another pressing global threat – antibiotic resistance – by looking into the antimicrobial properties of traditional remedies. For example, honey has traditionally been used to treat infections, and these studies have shown that some Finnish honey has antimicrobial activity against a variety of pathogenic bacteria, notably streptococcus pneumoniae, a bacterium causing pneumonia and meningitis, among other things.
“The spreading of bacteria that are resistant to multiple antibiotics calls for a stricter control of antibiotic use, but new alternatives to conventional antibiotics are also needed.”
Finnish success stories
Finland has long been top of the class when it comes to implementing proven measures to prevent chronic diseases. “Starting from the North Karelia project, pioneering research interventions have led to national action,” says Tiina Laatikainen, Professor of Health Promotion at the UEF Institute of Public Health and Clinical Nutrition.
“For example, the Finnish Diabetes Prevention Study showed that type 2 diabetes can be prevented with lifestyle interventions and was followed by national programmes. Lifestyle changes were found to be effective in the prevention of cognitive decline as well in the recent FINGER study, and the findings are already being implemented. We also have the first comprehensive allergy programme in the world, which is based on research and is bringing about a shift from allergen avoidance to strengthening tolerance.”
Finland introduced the world’s first comprehensive tobacco law in 1976. It has been revised several times, alongside with education and careful timing to make changes more acceptable to the general public. Today, only 15% of Finnish adults smoke daily.
Prevention is an integral part of Finnish health care legislation. Laatikainen adds that Finland has also been active in advocating and implementing a Health in all Policies approach, which means that health implications are taken into account in all decision-making, not just in the health sector. “One important aspect are lunches at day care centres, schools and workplaces. They adhere quite well to national nutrition recommendations, and many employers subsidise their employees’ lunch.”
53% fewer child deaths
The global under-five mortality rate dropped 53 per cent between 1990 and 2015. The rate is still highest in sub-Saharan Africa, but progress has been especially rapid in many countries in the area.
In 1955, the average global life expectancy at birth was just 48 years, in 1995 it was 65 years, and in 2025 it is expected to reach 73 years.
Top-level commitment and shared goals
An unprecedented UN summit was held in 2011 to tackle non-communicable diseases, followed by the WHO Global NCD Action Plan, providing policy options for member states. The WHO Framework Convention on Tobacco Control in 2005 was the first global public health treaty, through which countries committed to legislative measures.
Most premature deaths from non-communicable diseases could be prevented. The WHO’s global action plan aims at a 25% relative reduction in premature mortality from NCDs by 2025.
Mobile health for all?
Even in low and middle income countries, most people have a mobile phone or access to one. Mobile health services and health promotion can be especially useful to people with limited access to conventional services.