Finland had one of the worst health profiles on the globe 30 years ago. Richard Hannaford outlines how it's becoming the picture of wellness.
Finland is slowly losing its reputation for ill health - as years of assertive health campaigning are slowly paying off. Its unhealthiness was not dissimilar to Ireland's but we have a lot of catching up to do to match Finland's transformation.
Talk to Dr Pekka Pushka, the director general of the National Public Health Institute, for just a few minutes and you come to realise just how big a crisis was facing Finland back in the 70s.
"I think the reality of the situation hit home for me when I went to an elementary school, asked if anyone had lost a father to heart disease and a third of the children raised their hands."
According to the statistics at that time, Finland had the worst record in the world for cardiovascular disease. And North Karelia, a region on the border with Russia, had the worst record in Finland.
Such was the concern that by 1971 the population there had raised a petition calling on the Finnish parliament to do something to halt the epidemic. And that was how Dr Pushka and his colleagues found themselves at the start of a 30-year project which is still bearing fruit.
In the 1970s Finland was a poor agricultural country, with less than five million people, struggling to survive next to the Cold War superpower of the Soviet Union. More than half the adult male population smoked, hardly anyone ate vegetables, and in a country with a thriving dairy industry virtually everyone ate butter.
"People loved their butter and milk but didn't like vegetables - they would say vegetables are fit only for animals not for men," says Dr Pushka. Now less than a quarter of the population smoke, 80 per cent of people eat vegetables daily, and only 7 per cent of the population use butter on bread.
How this has happened has been intriguing the world's public health doctors for some time. Conferences have been held and scores of physicians and politicians from all over the globe have visited and studied what Finland has done.
To understand that you have to return to Karelia in the 1970s and Dr Pushka and his team. Realising they had few resources they decided to concentrate their efforts on changing a few key indicators: blood pressure, cholesterol and smoking.
They began with a poster and leaflet campaign offering practical advice. Slogans were simple and direct like "to prevent heart disease eat more vegetables", and "Smoking causes Heart Disease".
They also realised that this crusade would fail if it was simply a "health" initiative. So as well as involving the local doctors and nurses, they also sought help from other groups, like the local Finnish housewives' organisation and the chamber of commerce, to get their message across.
In schools they began a programme of annual health checks on children, which included measuring their weight, blood pressure, and in some cases their cholesterol levels. Children with problems were identified and given help and support. In the dinner hall the free school meal was also changed to provide a more healthy diet, while sugary drinks were banned from the buildings.
"There were some extremely strong commercial pressures against this work," says Dr Pushka, "the dairy industry, a mainstay of Finland, was particularly affected - but people knew we couldn't go on the same old way."
In fact, food manufacturers have adapted, many by reducing their salt and fat content. A labelling scheme - in which a healthy heart sticker is placed on particular products - is now seen by producers as giving them a commercial advantage.
Within a short period the benefits began to be seen (see graph) and the government agreed to roll out the North Karelia project across the whole country.
Nowadays fewer people are smoking, and there has been a significant reduction in peoples' blood pressure and cholesterol levels. The results of those changes have been nothing short of extraordinary. Over the past 30 years the number of men dying prematurely each year has dropped by 82 per cent, while there has also been a 70 per cent reduction in deaths from cancer. Finland has moved from being top of the world league of deaths from heart to fifth, and in some indexes even lower.
However, Dr Pushka warns against complacency. "There are no simple answers," he says. "There is still plenty to do." And that's particularly true when it comes to dealing with obesity. Surprisingly back in the 70s the number of people who were overweight was relatively small. "Farmers and lumberjacks who worked in the area were already very active," he notes, "They weren't fat but they had high blood pressure and cholesterol levels."
But more recently people in Finland, like many other western countries, have become less active. As a result there has been an increase in obesity.
"We have had to repeat the earlier messages on diet again," says Dr Hannu Vanhanen, medical director of the Finnish Heart Association, "but also we have to get people to take more exercise."
One of the latest initiatives involves family doctors "prescribing exercise". Patients are given a slip which they can take to local sports facilities, which are subsidised, and offered a range of activities from swimming to volleyball. One of the most popular is Nordic Walking - a sort of fast walking with ski poles, but without the snow or skis.
"I know one middle-aged man with elevated blood pressure," says Dr Vanhanen. "I prescribed medicine and exercise - he was a good footballer and has taken up the sport again. Now he has normal blood pressure and has lost 10 kilos."
Sporting chance
One of the problems about encouraging people to become active is that many of those who would benefit most, are also the most difficult to reach.
In the City of Turku in the west of Finland Deputy Mayor Kaija Hartiala, herself a doctor, has backed a project which specifically seeks out these groups. "We have for some time given money to local sports boards and supporting sporting facilities, but we realised that a big proportion of the population, particularly women, was not active - so our main goal was to these people and get them active."
Under the scheme, called Ladies in Motion, people from the community were recruited and given training. They were then sent back into the social welfare offices, pubs, and even on to the doorsteps to find people who were not exercising at all, and persuade them to come and use the sports facilities.
Currently more than 500 people, who were persuaded to become active, now themselves run a number of local groups involved in jogging, soccer, and volleyball. These groups have become part of the daily life of the community.
Another project, "Power Action" targets teenagers. The City now offers every teenager a free tryout for all sorts of sports - from snowboarding to Kung Fu - so they can see if they like it.