Nutrition Mikko Vienonen M D Ph D Finland

Nutrition Mikko Vienonen, M. D. , Ph. D. / Finland Coordinating Chair of Expert Group SIHLWA/ NDPHS Social Inclusion, Healthy Lifestyles & Work Ability

Hello! Buorre paeve! Kanawapee! (Sámi –Inari) (Inuit) Vidzya ölan! Qanuq ippit! (Komi) (Inupiak) Кепсиэ! Kepsie! Wăciyě! (Woods Cree) Etc. ……………. . (Yakut)

What I am going to talk about: q SIHLWA (Social Inclusion, Healthy Lifestyles and Work Ability)/ NDPHS in short: what it is and what it is not? q Public health challenges in nutrition: Nordic & Sámi viewpoint. How does the future look like? Strengths and threats. q What should/could be done about nutritional problems among indigenous and remote populations? q What should/ could be the role of NDPHS/ SIHLWA and other actors?

EG on ”SIHLWA” (50 members) (Social Inclusion, Healthy Lifestyles and Work Ability) Established in Nov. 2005 since then has held 6 meetings 3 sub-groups: 1. 2. 3. Alcohol (ADO) Adolescents and Socially- Rewarding Lifestyles (ALC) Occupational Safety and Health (OSH) Please visit our website at www. ndphs. org

Average life-expectancy is mainly a reflection of unhealthy lifestyles. In Europe the estimated number of deaths (2005) from noncommunicable diseases was 8. 2 million people (all deaths were 9. 6 million). NCDs make 77% of all deaths (source WHO-EURO 2006).

The main causes are known

NUTRITION as underlying determinant (obesity, low veg. -fruit intake, low unsat. fat, low fish, high salt)

Effective interventions are known

Age-adjusted mortality rates of coronary heart disease in North Karelia 700 start of the North Karelia Project and the whole of Finland among 600 males aged extension of the Project nationally 35– 64 years 500 from 1969 North Karelia 400 to 2002. Mortality per 100 000 population 300 200 100 Year All Finland - 82% - 75% 69 72 75 78 81 84 87 90 93 96 99 2002

Type-2 Diabetes in Finland 500 000 Lukumäärä 400 000 Estimated T 2 D 300 000 15 Prevalence 1970 1980 1990 Kelan erityiskorvattavuus (lukumäärä) 2000 D 2 D 2004 0 1960 Finrisk 2002 5 Health 2000 100 000 Finrisk 92 10 Finrisk 87 200 000 2010 0 2020 Prevalenssi väestötutkimuksissa, % Tyyppi 2 diabetes Suomessa KTL: n väestötutkimusten perusteella 600 000 7

Type-2 Diabetes is expensive*! (5 – 11 % of total health care expenditure in European countries) • Basic medical treatment of T 2 diabetes c. 570 €/patient/year. • With complication T 2 -diabetes becomes 19 times more expensive c. 11. 000 €/ patient/ year. • How high is the expense of human, independent life? *Expenses calculated for Finland

Type-2 Diabetes is preventable! (Int. J. Circumpolar Health 66: 2 2007) Cumulative incidence of T 2 D, % 50 Control 40 30 20 Intervention 10 Intervention ceased 0 0 1 2 3 4 5 Follow-up time, years 6 7 8 Lindström et al, Lancet 2006: 368; 1673 -79 10

BMI North. KKarelia/ Finland Pitkaranta/ Karelia-Russia

Total Cholesterol in N-Karelia/Finland (1982 -2002) and Pitkäranta/ RUS-Karelia (1992 -2002), age-group 25 -64 NK-F men (blue diamond) NK-F women (red square) PR-R mem (green triange PR-R women (pink ball) Data: Risk factor surveys

VEGETABLES North-Karelia/ Finland Pitkaranta/ Karelia-Russia

Finland 2000: Vegetable , fruit and berries intake at least 400 gr / day (Map left: women) Recommendation: Over 400 grams / day (Map right men)

Finland 2000: Berries intake grams / day (Map left: women) (Map right: men)

Finland 2000: Fish intake grams / day (Map left: women) Recommendation : 2 -3 times fish per week) (Map right: men)

Finland 2000: Fish intake over 200 grams / week (Map left: women) (Map right: men) Recommendation : 2 -3 times fish per week)

Finland 2000: Saturated fat % of total energy intake (Map left: women) (Map right: men) Recommendation under 10 % of total energy intake

Finland 2000: Salt intake grams / day (Map left: women) (Map left: men) Recommendation: women| under 6 g/day, men under 7 gr/day

Finland 2000: Health promoting diet INDEX (vegetables, fruit, berries, fish, rye-bread, unsaturated fat, salt)/ max 25 points (Map left: women) (Map right: men)

Finland 2000: Body Mass Index (BMI) (Map left: women) (Map right: men) Normal BMI should be under 25

Finland 2000: Body Mass Index (BMI) 30 and over = obesity (Map left: women) (Map right: men)

Finland 2000: Sugar (% of total energy intake) (Map left: women) (Map right: men) Recommendation: Sugar intake max 10 % of total energy intake

Finland 2000: Total Cholesterol (mmol/l) (Map left: women) (Map right: men) Recommendation: < 5 mmol/l

Finland 2000: Waist obesity (waist-pelvis ratio over 0. 85 women and over 1. 0 men) (Map left: women) (Map right: men)

Mortality of the Sami in Northern Finland 1979 -2005 Leena Soininen & Eero Pukkala. Int, J. Circumpolar Health 67: 1: 2008. ) Cohort study N= 2091 Disease mortality 1979 – 2005 among Sami men and non-Sami Lapplander men (SMR= deaths/year/100. 000 standard popul. ) Selected indicator (disease) Sami men SMR non-Sami men SMR ALL DISEASES* 0. 88 1. 07 Cancers (malign. neopl. )** 0. 69 1. 29 Dementia* 1. 89 1. 68 Alcohol related (incl. alc. poisoning) 0. 62 0. 83 Circulatory system (all) 0. 92 1. 03 * p<0. 5, **p<0. 05, ***p<0. 005 (category of statistical significance)

Mortality of the Sami in Northern Finland 1979 -2005 Leena Soininen & Eero Pukkala. Int, J. Circumpolar Health 67: 1: 2008. ) Cohort study N= 2091 Disease mortality 1979 – 2005 among Sami women and non-Sami Laplander women (SMR= deaths/year/100. 000 standard popul. ) Selected indicator (disease) Sami women SMR non-Sami women SMR ALL DISEASES 1. 00 1. 02 Cancers (malign. neopl. ) 0. 95 0. 74 Dementia 1. 16 1. 80 Alcohol related (incl. alc. poisoning) 0. 00 1. 03 Circulatory system (all) 0. 91 1. 07 * p<0. 5, **p<0. 05, ***p<0. 005 (category of statistical significance) NONE!

Mortality of the Sami in Northern Finland 1979 -2005 Leena Soininen & Eero Pukkala. Int, J. Circumpolar Health 67: 1: 2008. ) Cohort study N= 2091 Accidents & violence mortality 1979 – 2005 among Sami and non-Sami Lapplanders (men and women together) (SMR= deaths/year/100. 000 standard popul. Selected indicator (disease) Sami SMR non-Sami SMR ALL ACCIDENTS & VIOLENCE*** 1. 67 1. 29 Land traffic accidents 1. 65 1. 41 Other land traffic acc. (snowmobile)*** 12. 7 7. 83 Water transport accidents*** 8. 40 2. 31 Drownings 2. 94 1. 83 Suicide 1. 55 0. 88 * p<0. 5, **p<0. 05, ***p<0. 005 (category of statistical significance)

Mortality of the Sami in Northern Finland 1979 -2005 Leena Soininen & Eero Pukkala. Int, J. Circumpolar Health 67: 1: 2008. ) Cohort study N= 2091 Conclusions: The Sami men had lower disease mortality as compared with Finnish population generally and their non-Sami neighbors, although their life habits would suggest a higher mortality rate. Reasons for this may be related to their diet that is rich in reindeer meat and fish, their physically active way of life and their genetic background.

Inuit women’s health in Nunavut, Canada (Gwen K. Healey& Lynn M. Meadows. Int. J. Circumpolar Health 66: 3: 2007. ) Inuit women’s nutritional status in Nunavut, Canada Indicator Nunavik women S. -Quebec women BMI greater than 30 23. 9 % 12. 3 % Physically inactive 47. 9 % 26. 4 %

Obesity and metabolic correlates among the Inuit and general Danish Population Margit E. Jørgensen, Circumpolar Health 2003, Nuuk. ) Greenlandic Inuit population obesity status 2003 - 2004 Indicator BMI greater than 30 Abdominal obesity Inuit men (Danish men) Inuit women Danish women) 18. 4 % (17. 7 %) 24. 9 % (17. 8 %) 15. 9 % (8. 3 %) 58. 1 % (17. 7 %)

Dietary patterns in the population living in the Sámi core areas of Norway the SAMINOR study (M. Brustad, C. L. Parr, M. Melhus, E. Lund Int. J. Circumpolar Health 67: 1: 2008. ) Sami core areas population obesity status 2003 -2004, Norway Indicator BMI greater than 30 BMI 25 - 29. 9 Sami men & women 26 % 45. 5 %

What should/could be done about nutritional problems among indigenous and remote populations? • The dangerous trend of obesity and T-2 diabetes epidemic must and can be stopped. • Primary, secondary and tertiary level prevention is cost effective. • Indigenous people by their culture have an advantage. • More knowledge and advocacy on nutrition and healthy lifestyles in general is needed.

What should/ could be the role of NDPHS/ SIHLWA and other actors? • Make an analysis based on PYLL (potential years of life lost) on indigenous peoples’ NCD determinants and their impact on health. • SIHLWA sub-group on indigenous remote peoples’ health & social inclusion. • Advocate for intervetion project(s) in selected topical and geographical areas.

Thank you! Quyanaq! (Inupiak) Tahka (Sámi) Atti! (Komi) Махтал! Makhtal!(Yakut) Mikwêc! (Woods Cree)