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Fixin' Healthcare

Tuesday, January 03, 2012

Some Lessons From Finland

In the 1960s Finland had the world's highest rate of deaths from coronary heart disease and the Province of North Karelia was the highest. The North Karelia Project was launched in 1971 to address this situation. Prevention was chosen as the most effective public health solution. "The general idea was to transform the social and physical environment of North Karelia. After an initial 5-year period, the project was extended locally, and its findings diffused nationwide to promote prevention throughout Finland. An integrated approach to prevention was central to success of the project. The risk factors for cardiovascular disease-unhealthy diet, smoking and physical inactivity-are risk factors for many chronic diseases. Rather than a number of vertical disease specific programs, an integrated approach targets the main common behavioral risk factors." Thinking advanced from a focus on risk factors for individuals into a broader emphasis upon the needs for society, environment and community to be supportive for health and to enable healthy living, i.e. a more comprehensive approach based on health determinants. Social marketing was an important aspect of the North Karelia Project. Dramatic changes were observed in risk-related lifestyles and risk factors in the people of North Karelia and this was associated with substantial reduction in population-wide rates of cardiovascular disease. With the nationwide roll-out of activities, the prevalence of risk factors and death due to cardiovascular disease began falling throughout Finland.

The North Karelia Project was adapted by cardiologists at Mayo Clinic for implementation in Olmsted County, Minnesota and in 2002 it served as a model for initiating Healthy Greenville 2010, which has evolved into LiveWell Greenville. Communities with similar public health projects are New York City, Savanah, Louisville, Oklahoma City and Chicago. A recent report indicated a five percent decline in obesity among school children in New York City.

Education is directly tied to health status and it is interesting that Finland has demonstrated success with reform of its educational system.

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