The
Future
of the
Health
Care in Europe
Diabetes
and
Heart
London
13, 2011
Meet theMay
experts
August 30 2009
Responding to the challenge:
determining health policy
Introductory remarks
Lars Rydén
Department of Medicine
Karolinska Institutet
Stockholm, Sweden
Health and Disease
The ideal situation
Health and disease
The ideal solution
Lucas Cranach 1546 The Youth Fountain
Preservation of health
Some prerequisites
 Political support
Health and disease

Common
pathways
The ideal solution
 Professional collaboration
 Persistancy and endurance
 Shared view on important steps
 Redirection of available resources
 A long-term view on the total impact
Preservation of health
Important threats
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
Diabetes and
the Heart
Geoffrey
Rose
Meet- the
experts
1926
1993
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.”
Choice and information
Preservation of health
Example - tobacco
Scientific evidence
Urge Member States to
implement and enforce
smoke free legislation
Hospital admissions for
AMI in eight studies 2004 - 2008
Reduction
19% (95% CI 14-24)
Non-smokers  70%
Preservation of health
Blocking common pathways towards disease
Pulmonary
cancer
Myocardial
infarction
Chronic non-communicable diseases (CNCD)
Dimension and common pathways
Behind
86% of deaths in WHO region Europe
Main determinants
Diseases
Cardiovascular
Tobacco
Diabetes
Alcohol
Malignant
Diet
Respiratory
Physical inactivity
Hepatic
Kidney
Preservation of health
Transprofessional collaboration
Policy conference June 2009
Bringing 10 professional
organisations together
Distinguish myths from
evidence based knowledge
Explore the ”climate”
for collaborative efforts
to gain political support
Lars Rydén
Karolinska Institutet
Stockholm, Sweden
The European Chronic Disease Alliance
ECDA
 Recommendations on
Taxation
Agriculture
Food labelling
Urban planning
Education
Sport and recreation
 Paramount legislative principle
Health in all policies
Preservation of health
On the importance of a unified approach
0
3
smoking
km of daily walking
5
<140/90
fruit & vegetables/day
mm Hg blood pressure
<5.0
<3.0
0
mmol/l cholesterol
mmol/l LDL-cholesterol
diabetes
(Gyberg & Rydén Europ J Cardiovasc Prev Rehab 2011. In press)
Preservation
health
Hinderofför
förbättrad folkhälsa
On the importance of a unified approach
Group
Politician
NGO
Health admin
Professionals
The three most important measures to
implement EHHC
Most important
Political
Organisation
Economic
Mediarelated
Awareness
Least important
(Gyberg & Rydén Europ J Cardiovasc Prev Rehab 2011. In press)
Life style
Attitudes
Other
The power of prevention of chronic disease
Explaining the fall in CHD deaths (ex: Sweden)
Risk Factors worse
Diabetes
Obesity
+11%
+8
+3
Risk Factors better
Cholesterol (diet)
Smoking
Population BP fall
Physical activity
- 66%
-39
-20
-9
-3
Treatments
13,180
fewer deaths 2002
1986
- 36%
AMI
-6
Secondary prevention
-12
Heart failure
-7
Angina ASA, CABG & PTCA -3
Hypertension
-4
Primary prevention (statins) -2
Unexplained
2002
(Björk, Rosengren, Bennett, Lappas,Capewell Europ Heart J 2009; 30:1046-56 )
- 9%
Resource allocation
European health care
% 100
97
80
60
40
20
0
3
Treatment
Prevention
From the appeal to the European Commission on the occasion of the
incoming European Commission, February 2010
Preservation of health
A long-term view of the total impact
June 25 2010
www.nice.org.uk/guidance/PH25
www.sph.uq.edu.au/bodce-ace-prevention
Preservation of health
A long-term view of the total impact
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
www.sph.uq.edu.au/bodce-ace-prevention
(Vos et al Assessing Cost-Effectiveness in Prevention. Univ Queensland,
Brisbane and Melbourne 2010)
Preservation of health
Some prerequisites
 Political support
Health and disease

Common
pathways
The ideal solution
 Professional collaboration
 Persistancy and endurance
 Shared view on important steps
 Redirection ofThanks
available resources
 A long-term view on the total impact
for the attention!!!