Inspiration tour to North Karelia: 45 successful years of reducing coronary heart disease mortality the community way

Photo story - WHO organizes study tour to North Karelia, Finland

In 1972, Finland had the highest rate of coronary heart disease (CHD) mortality in the world, and the region of North Karelia in eastern Finland had the highest rate in the country. To address this issue, the region initiated what is known as the North Karelia Project, a far-reaching, community-based intervention that aims to reduce CHD mortality by encouraging healthier habits and cutting down on risk factors such as high cholesterol intake and smoking.

The project is still active today and has produced remarkable results. During the 40-year period from 1972 to 2012, CHD mortality in North Karelia decreased by 82% among working-age men and 84% among women.

“The project has 2 slogans: ‘Face-to-face communication’ and ‘Find common interests’,” explains Vesa Korpelainen, who was until recently the long-term manager of the North Karelia Centre for Public Health. These slogans reflect the project’s approach, namely, to involve as many different sectors in the community as possible and to communicate healthier habits in a simple, straightforward fashion.

Lessons learned from the experience of North Karelia

A group of 28 health professionals and health authorities from countries in eastern Europe and central Asia recently participated in a study tour to North Karelia. Over the course of a full 2-day tour, the group visited businesses, schools, health services locations and nongovernmental organizations, all of which play an important role in the success of the North Karelia Project.

“I am taking many new ideas home with me from this trip,” says Roza Dzhakipova, national coordinator of non-communicable diseases in Bishkek, Kyrgyzstan. “The importance of collaboration between different sectors is perhaps the most essential.”

The project’s emphasis on prevention impressed Dzhakipova. When she returns to Bishkek, she intends to set up a cross-sector working group with a focus on prevention. “At home we focus only on treatment, and all available funds go to treatment. We need activities that direct attention to risk factors,” she says.

Iryna Rudenko from Ukraine found the discussion with a school nurse at a local secondary school particularly interesting. “In Ukraine the school nurses mostly distribute headache or stomach ache pills to the students,” she said. “The nurse here is very active; she talks to all the students and is easy to reach for anyone not feeling well.”

Banu Ekinci from Turkey was fascinated by the sheer sustainability of the project in North Karelia. “It has been functioning for close to 50 years; I find that very impressive. The fact that everything is so simple, yet of such high quality, is also important,” she says.

Vesa Korpelainen, the former manager of the project, agrees with this assessment: “I’ve always told my staff that we have to have the courage to be simple and not worry about how we might look in the eyes of our colleagues.”

Cooperation makes anything possible

Nino Kiknadze, associate professor at the Department of Family Medicine at the Tbilisi State Medical University in Georgia, notes that the general level of trust in the North Karelia population plays an important role. “People count on the authorities here and trust they mean well, which naturally contributes to the success of the project,” she says.

She believes that parts of the North Karelia Project could be successfully implemented in her own country, based on a whole-of-society and whole-of-government approach. “The results of the project show that you can do anything, if all levels cooperate.”

WHO/Europe organized the study trip in the context of the European Office on the Prevention and Control of Noncommunicable Diseases, financed by the Ministry of Health of the Russian Federation.