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Part III. Can we turn back the clock or modify the adverse dynamics? Programme and policy issues

Influencing public nutrition for non-communicable disease prevention: from community intervention to national programme – experiences from Finland

Published online by Cambridge University Press:  22 December 2006

Puska Pekka ,
Pietinen Pirjo  and
Uusitalo Ulla
Puska Pekka*
Affiliation:
Department of Noncommunicable Disease Prevention and Health Promotion, World Health Organization, CH-1211 Geneva 27, Switzerland
Pietinen Pirjo
Affiliation:
Department of Noncommunicable Disease Prevention and Health Promotion, World Health Organization, CH-1211 Geneva 27, Switzerland National Public Health Institute, Department of Epidemiology and Health Promotion, Helsinki, Finland
Uusitalo Ulla
Affiliation:
Department of Noncommunicable Disease Prevention and Health Promotion, World Health Organization, CH-1211 Geneva 27, Switzerland Cornell University, Division of Nutritional Sciences, Ithaca, NY, USA
*
*Corresponding author: Email puskap@who.int
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Abstract

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A global health transition is currently underway. The burden of non-communicable diseases (NCDs) is increasing rapidly in the developing world, very much as a result of changes in lifestyles. In addition to changes in tobacco use and physical activity, major changes are taking place in diets, contributing greatly to the growing epidemic of NCD. Thus, a huge global public health challenge is how to influence the trends in diet and nutrition for effective global NCD prevention.

The health transition took place rapidly in Finland after World War II and mortality from cardiovascular disease (CVD) was exceptionally high. The North Karelia Project was launched in 1972 as a community-based, and later as a national, programme to influence diet and other lifestyles that are crucial in the prevention of CVD. The intervention had a strong theory base and it employed comprehensive strategies. Broad community organisation and the strong participation of people were the key elements. Evaluation has shown how the diet (particularly fat consumption) has changed and how these changes have led to a major reduction in population serum cholesterol and blood pressure levels. It has also shown how ischaemic heart disease mortality in a working-age population has declined by 73% in North Karelia and by 65% in the whole country from 1971 to 1995.

Although Finland is an industrialised country, North Karelia was rural, of rather low socio-economic level and with many social problems in the 1970s and 1980s. The project was based on low-cost intervention activities, where people's participation and community organisations played a key role. Comprehensive interventions in the community were eventually supported by national activities – from expert guidelines and media activities to industry collaboration and policy. Similar principles for nutrition intervention programmes could be used in developing countries, obviously tailored to the local conditions. This paper discusses the experiences of the North Karelia Project in the light of needs from the less-industrialised countries and makes some general recommendations.

Keywords

Public nutritionDietInterventionNon-communicable diseasePreventionPolicy planning
Type
Research Article
Information
Public Health Nutrition , Volume 5 , Issue 1a , February 2002 , pp. 245 - 251
Copyright
Copyright © CABI Publishing 2002

References

1Murray, CJL, Lopez, AD. Mortality by cause for eight regions of the world: Global Burden of Disease Study. Lancet 1997; 349: 1269–76.CrossRefGoogle ScholarPubMed
2World Health Organization (WHO). Diet, Nutrition, and the Prevention of Chronic Diseases. Report of a WHO Study Group. Technical Report Series 797. Geneva: WHO, 1990.Google Scholar
3Michaud, CM, Murray, CJL, Bloom, BR. Burden of disease – implications for future research. JAMA 2001; 285: 535–9.Google Scholar
4Tuomilehto, J, Lindström, J, Eriksson, J, Valle, TT, Hämäläinen, H, Ilanne-Parikka, P, Keinänen-Kiukaanmäki, S, Laakso, M, Louheranta, A, Rastas, M, Salminen, V, Uusitupa, M. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N. Engl. J. Med. 2001; 344: 1343–50.CrossRefGoogle ScholarPubMed
5Hu, FB, Manson, JE, Stampfer, MJ, Colditz, G, Liu, S, Solomon, CG, Willett, WC. Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N. Engl. J. Med. 2001; 345: 790–7.Google Scholar
6McCullough, ML, Feskanish, D, Rimm, EB, Giovannucci, EL, Ascherio, A, Variyam, JN, Spiegelman, D, Stampfer, MJ, Willett, WC. Adherence to the Dietary Guidelines for Americans and risk of major chronic disease in men. Am. J. Clin. Nutr. 2000; 72: 1223–31.CrossRefGoogle Scholar
7McCullough, ML, Feskanish, D, Stampfer, MJ, Rosner, BA, Hu, FB, Hunter, DJ, Variyam, JN, Colditz, GA, Willett, WC. Adherence to the Dietary Guidelines for Americans and risk of major chronic disease in women. Am. J. Clin. Nutr. 2000; 72: 1214–22.Google Scholar
8Drewnowski, A, Popkin, BM. The nutrition transition: new trends in the global diet. Nutr. Rev. 1997; 55: 31–43.CrossRefGoogle ScholarPubMed
9Sobal, J, Stunkard, AJ. Socioeconomic status and obesity: a review of the literature. Psychol. Bull. 1989; 105: 260–75.Google Scholar
10Sobal, J. Food system globalization, eating transformations, and nutrition transitions. In: Grew, R, ed. Food in Global History. Boulder, CO: Westview Press, 1999; 171–93.Google Scholar
11Ramalingaswami, V. Diseases of affluence. World Health 1992; (Nov-Dec): 24.Google Scholar
12Puska, P, Vartiainen, E, Tuomilehto, J, Salomaa, V, Nissinen, A. Changes in premature deaths in Finland: successful longterm prevention of cardiovascular diseases. Bull. World Health Org. 1998; 76: 419–25.Google ScholarPubMed
13Ovcarov, V, Bystrova, V. Present trends in mortality in the age group 35–64 in selected developed countries between 1950–73. World Health Stat. Quart. 1978; 31: 208.Google Scholar
14Pietinen, P, Lahti-Koski, M, Vartiainen, E, Puska, P. Nutrition and cardiovascular disease in Finland since the early 1970s: a success story. J. Nutr. Health Aging 2001; 5: 150–9.Google ScholarPubMed
15Puska, P, Tuomilehto, J, Salonen, J, Nissinen, A, Virtamo, J, Björkqvist, S, Koskela, K, Neittaanmäki, L, Takalo, L, Kottke, TE, Mäki, J, Sipilä, P, Varvikko, P. The North Karelia Project: Evaluation of a Comprehensive Community Programme for Control of Cardiovascular Diseases in North Karelia, Finland 1972–1977. Copenhagen: World Health Organization European Office, 1981.Google Scholar
16Puska, P, Tuomilehto, J, Nissinen, A, Vartiainen, E, eds. The North Karelia Project. 20 Year Results and Experiences. Helsinki: University Press, 1995.Google Scholar
17Pietinen, P, Vartiainen, E. Dietary changes. In: Puska, P, Tuomilehto, J, Nissinen, A, Vartiainen, E, eds. The North Karelia Project. 20 Year Results and Experiences. Helsinki: University Press, 1995; 107–17.Google Scholar
18Karvonen, MJ, Punsar, S. Sodium excretion and blood pressure of west and east Finns. Acta Med. Scand. 1977; 202: 501–7.CrossRefGoogle Scholar
19Puska, P. Nutrition and mortality: the Finnish experience. Acta Cardiol. 2000; 55: 213–20.CrossRefGoogle ScholarPubMed
20National Public Health Institute (KTL). Nutrition in Finland. KTL Publication. Helsinki: KTL, 1999.Google Scholar
21Hasunen, K, Pekkarinen, M, Koskinen, E, Seppänen, R, Beckström, LA. The Food Consumption and Nutrient Intake in Finland from 1969 to 1972. Report B8/1998. Helsinki: Social Insurance Institution, 1998 [in Finnish with an English summary].Google Scholar
22Pietinen, P, Uusitalo, U, Vartiainen, E, Tuomilehto, J. Dietary survey of the FINMONICA project in 1982. Acta Med. Scand. Suppl. 1988; 728: 169–77.CrossRefGoogle ScholarPubMed
23Pietinen, P, Vartiainen, E, Seppänen, R, Aro, A, Puska, P. Changes in diet, in Finland from 1972–1992; impact on coronary heart disease. Prev. Med. 1996; 25: 243–50.CrossRefGoogle Scholar
24Helakorpi, S, Puska, P. Health behaviour changes in North Karelia. In: Puska, P, Tuomilehto, J, Nissinen, A, Vartiainen, E, eds. The North Karelia Project. 20 Year Results and Experiences. Helsinki: University Press, 1995; 141–56.Google Scholar
25Helakorpi, S, Uutela, A, Prättälä, R, Puska, P. Health Behaviour Among Finnish Adult Population. Publication B10/1998. Helsinki: National Public Health Institute, 1998.Google Scholar
26Vartiainen, E, Jousilahti, P, Alfthan, G, Sundvall, J, Pietinen, P, Puska, P. Cardiovascular risk factor changes in Finland, 1972–1997. Int. J. Epidemiol. 2000; 29: 49–56.Google Scholar
27Vartiainen, E, Puska, P, Pekkanen, J, Tuomilehto, J, Jousilahti, P. Changes in risk factors explain changes in mortality from ischaemic heart disease in Finland. Br. Med. J. 1994; 309: 23–7.Google Scholar
28Puska, P. Development of public policy on the prevention and control of elevated blood cholesterol. Cardiovascular Risk Factors 1996; 6: 203–10.Google Scholar
29Nissinen, A, Pietinen, P, Tuomilehto, J, Tanskanen, A, Moisio, S, Puska, P. Experiments with dietary intervention in hypertension control – implementation of the North Karelia Salt project. Magnesium 1982; 1: 232–40.Google Scholar
30Tuomilehto, J, Puska, P, Tanskanen, A, Karppanen, H, Pietinen, P, Nissinen, A, Enlund, H, Ruotsalainen, P. A community-based intervention study on the feasibility and effects of the reduction in salt intake in North Karelia. Acta Cardiol. 1981; 36: 83–104.Google ScholarPubMed
31Puska, P, Isokääntä, M, Korpelainen, V, Vartiainen, E. Village competition as an innovative method for lowering population cholesterol. Eur. Heart J. 1999; 1(Suppl. S): S64–S72.Google Scholar
32Kuusipalo, J, Mikkola, M, Moisio, S, Puska, P. The East Finland berry and vegetable project: a health-related structural intervention programme. Health Promotion 1986; 1: 385–91.Google Scholar
33Miettinen, TA, Puska, P, Gylling, H, Vanhanen, H, Vartiainen, E. Reduction of serum cholesterol with sitostanol-ester margarine in a mildly hypercholesterolemic population. N. Engl. J. Med. 1995; 333: 1308–12.CrossRefGoogle Scholar
34Dowse, GK, Gareeboo, H, Alberti, KGMM, Zimmet, P, Tuomilehto, J, Purran, A, Fareed, D, Chitson, P, Collins, VR, Hemraj, F. Changes in population cholesterol concentrations and other cardiovascular risk factor levels after five years of the non-communicable disease intervention programme in Mauritius. Br. Med. J. 1995; 311: 1255–9.CrossRefGoogle ScholarPubMed
35Uusitalo, U, Feskens, EJM, Tuomilehto, J, Dowse, G, Haw, U, Fareed, D, Hemraj, F, Gareeboo, H, Alberti, KGMM, Zimmet, P. Fall in total cholesterol concentration over five years in association with changes in fatty acid composition of cooking oil in Mauritius: cross sectional survey. Br. Med. J. 1996; 313: 1044–6.Google Scholar