Managing the allergy and asthma epidemic in 2020s-Lessons from the Finnish experience

Abstract

In Finland, a systematic public health programme was implemented from 2008 to 2018 to mitigate the burden of allergic disorders by revisiting the prevention strategy. Allergy health and contacts with natural environment were emphasized to promote immunological and psychological resilience instead of poorly justified avoidance. Allergy management practices were improved and low-valued recommendations for care, for example for food allergy, were revised. Patients and families were empowered to use guided self-management to proactively stop symptom exacerbations. A professional non-governmental organization implemented the nationwide education for healthcare and patient NGOs for patients, families and lay public. In healthcare, the work supporting allergic patients and families was organized towards common goals and integrated into everyday work without extra costs. Reaching the predefined goals was followed by employing the national healthcare registers and questionnaire surveys. Governmental bodies contributed with kick-off funding, which was supplemented by private funding. International collaboration, for example with the European patient organization (EFA), increased awareness of the Finnish action and predisposed it for peer review. The 10-year results are favourable, patients are less disabled, practices and attitudes in healthcare have changed, and major cost savings have been obtained. Views of the lay public and patients are slow to move, however. Local multidisciplinary allergy teams were set up to continue the activities also after the Programme. Changes in environment and lifestyle in the last 50 years are the main reasons for the allergy rise. The Finnish experience may help to manage allergic diseases, improve nature relatedness in the fast-urbanizing world, combat nature loss and reduce the disease burden.

Keywords: allergy campaign; allergy epidemic; allergy prevention; allergy programme; biodiversity; public health.

FIGURE 1

The strategic planning of the programme (Ref. [17,19,22], modified)

FIGURE 2

Steering of the programme was kept simple

FIGURE 3

Goals for healthcare with specific tasks, tools and outcomes for follow‐up. Indicators for goals were quantitative. Key messages were set up for all citizens (Ref. [25], modified)

FIGURE 4

Practical advice was given for building and improving tolerance/resilience (primary prevention) as well as preventing symptoms and exacerbations (secondary and tertiary prevention) (Ref. [27], modified, Table S2)

FIGURE 5

The stepwise education of healthcare professionals

FIGURE 6

(A) Healthcare professionals taking part in the educational sessions in 2015. (B) Unmet educational needs of 557 responders, who responded to an email survey in 2018. Other topics included indoor air problems, anaphylaxis, asthma diagnostics, reimbursement of medication, allergy to pollens, animals and moulds, food allergy in adults and allergens in cosmetics

FIGURE 7

Allergy in children. Unmet needs for education as reported by 40 healthcare professionals working in the Western part of Finland in 2012

FIGURE 8

Annual cost savings during the programme 2008‒2018 (€ million) as compared to the year 2007. The direct (outpatient visits, hospital days, drugs, other) and indirect costs (sickness allowances, disability pensions, according to SII) (Ref. [18], modified)