Categories associated with best practice:
Determinants of Health: Personal health practices and coping skills, Physical environment
The North Karelia Project (NKP) aimed to reduce high cardiovascular disease rates in adults by reducing serum cholesterol levels and saturated fat intake, and increasing vegetable, dietary fibre and polyunsaturated fat intake.
The components of the intervention were general information to the public regarding the dietary recommendations, services organization, and environmental changes.
The intervention included passing legislation banning tobacco advertising, the introduction of low-fat dairy and vegetable oil products, changes in farmers’ payment schemes, and incentives for communities achieving the highest reduction in cholesterol levels. The cardiovascular disease related death rates among men have declined by 65%, and the life expectancy among men has increased by 7 years since the intervention began in the 1970s.
Primary Source Document
P Puska, E. Vartiainen, T Laatikainen, P Jousilahti, M Paavola, The north Karelia project: from north Karelia to National action National Institute for Health and Welfare (THL), in collaboration with the North Karelia Project Foundation © Authors and National Institute for Health and Welfare
Contact information of developer(s) and/or implementer(s)
|Intervention Goal / Objective||Level(s) Targeted||Equity Focus|
|To help people buy healthy products at competitive prices||People living in conditions of disadvantage are explicitly stated to be a target population of the intervention.|
|1) initially (1972-82) - to reduce CVD mortality in the local population, 2) Later (1982 onwards) - to reduce major chronic (non-communicable disease) mortality and promote health in the local population.||People living in conditions of disadvantage are explicitly stated to be a target population of the intervention.|
|Intermediate objectives: to reduce the levels in local population of the main risk factors and to promote secondary prevention. Main target risk factors: smoking, elevated serum (LDL) cholesterol and elevated blood pressure. Major emphases on general lifestyle changes (especially smoking and dietary habits)||People living in conditions of disadvantage are explicitly stated to be a target population of the intervention.|
Health Issue(s) that is/are addressed by the Intervention
- Healthy Eating
- Physical Activity
- Prevent/reduce tobacco use
Specific Activities of the Intervention
- Educational health information offered
- Information sessions offered about a risk factor or condition
- Media advocacy
Priority/Target Population for Intervention Delivery
- Adults (age 25-64 years)
|Outcomes and Impact Chart|
|Level of Impact||Description of Outcome||Equity Focus|
|Community Level||Saturated fat consumption used to be very high in Finland. In the late 1960s the Finnish diet was highly atherogenic, with about 23% of energy intake coming from saturated fats. In 1980s there was still about 20% of energy intake from saturated fats, and the use of polyunsaturated fats was very low. In the last survey in 2007 the saturated fats intake had declined to 12% of energy intake and polyunsaturated fats increased. Serum total cholesterol levels have declined significantly in eastern Finland since 1972||Outcomes are reported for people living in conditions of disadvantage, and are not compared to people living in more advantaged conditions.|
|Community Level||In North Karelia cholesterol declined 21% in men and 23% in women. During the first five years the decline was greater in North Karelia than in the reference area in men. A remarkable decline in cholesterol levels was also observed in southwestern Finland after 1982. There was a levelling off in the decline between 1997 and 2002, but in the past five years cholesterol levels have again declined about five percent.||Outcomes are reported for people living in conditions of disadvantage, and are not compared to people living in more advantaged conditions.|
|Community Level||Smoking declined more decisively in North Karelia than Kuopio during the first ten years of the project. (Table 5). In North Karelia, 52 % of men were smokers in 1972 and 31 % in 2007. Until 1997 the prevalence of smoking among men declined significantly in all survey areas.||Outcomes are reported for people living in conditions of disadvantage, and are not compared to people living in more advantaged conditions.|
- Multiple implementations - Different settings/populations/providers - The intervention showed significant adaptability as it has been implemented in different settings or with different populations or by different provider(s). This can include multiple implementations during the same time period. Each implementation of the intervention must have been substantially the same and must have demonstrated positive results for the primary objectives of the intervention.
Expertise Required for Implementation within the Context of the Intervention
- Specialized skills training provided as part of the Intervention - The intervention does not require individuals or groups with highly specialized training, but requires that individuals or groups be trained as part of the implementation of the intervention.
Are there supports available for implementation
Yes. Training seminars on current topics, which have also involved practical activities such as cholesterol measuring, exhibitions, food tastings, were made available. Researchers at the National Public Health Institute have often been invited to present the latest results of the population surveys or smaller studies. The staff of the North Karelia Project have often given lectures and had meetings with school children, voluntary organizations, visitors to the project etc. A variety of treatment guidelines and model programmes to help health service workers understand the important of systematic measurements, counselling, persuasion, and follow-up of peoples health related habits.
Are there resources and/or products associated with the interventions
Yes. Printed materials such as leaflets, books, posters, etc. for developing social contacts and various practical activities.TV programmes. Supportive cards, stickers and posters supplied by the project to support efforts for creating smoke-free areas. Health behaviour monitoring systems (disease registers) as evaluation resources.