One of the best known population-level prevention programmes took place in the North Karelia region of Finland: around 40 years ago the area’s population suffered from very high rates of non-communicable disease (NCD), even compared to Finland’s very high levels of the time.
In 1972, an initiative involving local and public health officials as well as academic experts took aim at the region’s underlying NCD risks. This North Karelia Project adopted a whole population approach that included not just education but also efforts to change the social and physical environment in ways conducive to health.
The five-year trial proved so successful that its lessons were rolled out across Finland and the country continues to benefit. An integral feature was the successful co-ordination of a wide number of stakeholders, including health professionals, media, schools, supermarkets, food producers and local housewives. This was a marked innovation.
“We were young, enthusiastic, and a bit heretical,” recalls Dr Pekka Puska, director general of Finland’s National Institute for Health and Welfare, who helped create and lead the project. “We saw that lifestyle change could not be solved by health service methods. Information is not enough. You need to involve and work with the whole community.”
But it was not easy. Every community, he says, has advantages and disadvantages for encouraging joint action. In North Karelia’s case, the population was fairly homogeneous but, typical of rural communities, innovation could excite cultural resistance. “We had big fights,” Dr Puska recalls. Looking back, he sees two widely applicable lessons on stakeholder co-operation from the North Karelia Project.
First, “Identify the practical things you want people to do that will give win-win situations.” While participating in such a project, private sector companies still have to do business and government administrators also need to see benefits for their own jobs.
Food companies and supermarkets in North Karelia were involved in the effort to encourage consumer demand towards healthier products. This allowed them to prepare for, and subsequently benefit commercially from, these shifting habits.
The second lesson, says Dr Puska, is the importance of personal contact. “You have to go around, meet people, and get their respect and friendship,” he says.
The project’s wider lessons are still being studied and applied around the world.
