Professor Pekka Puska, President of the International Association of National Public Health Institutes (IANPHI) has been one of the most prominent figures in the global battle against chronic and cardiovascular diseases. He was the former Director-General of the National Institute of Health and Welfare in Finland as well as the President of the World Heart Federation. Currently advising the Hong Kong SAR government on its public health policies, he visits Hong Kong twice a year.
During his last visit in Hong Kong, he gave a presentation entitled “Sugar and Health – A Global Concern”. Through the World Health Organisation (WHO) where he was the Director for NCD (Non-Communicable Diseases) Prevention and Health Promotion, the Finnish model was borrowed by many countries to analyse thoroughly when they were devising national strategies against NCDs. The Finnish experience constituted one of the most successful national models in the global battle against chronic and cardiovascular diseases in many different fronts thank to the then 27-year old young researcher with a Master’s degree in Social Sciences in 1972 who spearheaded the North Karelia Project. The North Karelia Project rendered Finland one of the pioneering countries in modern public health.
Reflecting on the project which was started by the group of young doctors that firmly believed that they could change the world, Prof. Puska was still quite surprised with the actual outcome. “When we tried to confront this heart disease epidemic in North Karelia, it was our opportunity to change public health. We had this strong idea that building hospitals would not solve the problem as we needed to go to the basics, ie, the causes and the roots. We certainly believed that we could achieve this outcome, but I must tell you that I had never believed that the chronic disease epidemic in which the cardiovascular diseases and cancer would change so much. After 30 years in the working population there was an 80% decrease in the mortality rates of coronary heart disease,” he said.
In the article entitled “The Finnish Town that Went on a Diet”, it is explained that in the early 70s, the North Karelian men suffered from the highest rate of heart attacks in the entire Finland which was hit particularly hard by cardiovascular diseases after World War II. While very little information on the situation was available at that time, men young barely reached the age of 50. It was a race against time and a long haul battle against heart diseases.
According to Prof. Puska, certain risk factors had been identified that linked the heart diseases up to lifestyle. “High blood pressure; high blood cholesterol and smoking are all related to lifestyle. Therefore, we said we had better change the community rather than selecting a handful few.” The impact of attacking the chronic and cardiovascular diseases with the gradual change in lifestyles soon spread across the region. He commented that the lesson in North Karelia was very important to Finland which was considered a risk country back then. The actions translated into the understanding that prevention is better than cure, which was as well the driving force behind the project.
To this day, the project still serves as a model in promoting healthy lifestyles, as suggested by the Institut National de Santé Publique du Québec. As the world’s major community-based study in the field of cardiovascular diseases prevention, the project was built upon the balance between leadership and partnership, seeking to work with the existing social structures, organisations and networks in North Karelia. How this project was able to bring about the changes in the food products related to the more health conscious public in Finland was another valuable Finnish experience to learn from.
With the increasing awareness of the region of eating more healthily by consuming less salt and fat, Prof. Puska lobbied the food producers, encountering initially stiff resistance against the alteration in the ingredients. However, he succeeded in arousing the interest of the regional sausage producer to lower the fat and salt content in their meat products progressively without the public realising the change in the taste. “It is not just about informing the people, but changing the recipes. We have had in Finland very substantial reduction in salt intake. The taste of salt is something you acquire and you can get used to a lower content little by little. If a company reduces salt by 1% each year, nobody notices. You end up reducing a big bulk just like in Finland.” For example, Benecol products produced from plant sterols came to the market based on a study conducted in North Karelia.
At the International Symposium on Reduction of Salt and Sugar in Food, he drew upon the North Karelian experience to explain the essential balance between regulations and voluntary changes in formulating public health policies. He regards consumer behaviour as the source of change that would in turn, incite the product change. “I think that the difficulties with the private sector also relate to the catering industry. You can have certain legislations but it is as well a matter of voluntary collaboration and mobilisation of the consumers. Another question is the availability of information that customers can access on how much salt, sugar and calories there is in the products.” Food labeling helps to make healthy food options more easily identified, yet the demand that these options become more transparent would have to gain strength amongst the general public.
Within Finland, the North Karelian experience is still vivid in the lives of many. On a city bus in Helsinki, he was stopped by the driver who fetched his pack of cigarettes and said to him,”When I saw you I realised that now it is time to stop smoking. Can you together with me crush this so I do not smoke again?” Prof. Puska was born in Vaasa but he knows North Karelia the best as he spent 25 years in the region paving the way for the international role that Finland would later play in the global battle against chronic and cardiovascular diseases.
Written by Annie Wang, Author of the D’Evénitif blog covering Finnish stories in Asia