Cardiovascular disease is a big killer in Finland, as it is in most Western societies. Yet the Finns have pulled down the death rate by a dramatic 75 per cent with a concerted and ongoing information campaign.
The programme began in 1972, when Finland had the world's highest death rate from cardiovascular disease. In turn, the eastern border province of North Karelia had the country's highest death rate from the disease, so it became the focus of a cardiovascular-disease reduction programme that became known as the North Karelia Project.
The Finnish Heart Association joined with the ministry of social affairs and health and the World Health Organisation to see whether a national programme of talks, competitions, education and legal changes could reduce rates of cardiovascular disease. The focus was on bringing about lifestyle changes in the North Karelian population in relation to health, smoking and nutrition.
The region's health status was surveyed in 1972, then examined at five-year intervals. Information programmes began and health-education meetings took place in schools and workplaces. Tough anti-smoking legislation was passed and "cholesterol lowering" competitions were run between villages and schools.
The first follow-up survey, in 1977, revealed that there had been significant changes in risk factors. Smoking levels, cholesterol levels and the prevalence of high blood pressure had dropped in North Karelia compared with the rest of Finland.
By 1981, the programme had been extended to the entire country, and as diets changed, rates of smoking fell and levels of exercise rose, so the incidence of cardiovascular disease declined steadily. By 1994, the number of middle-aged male smokers had dropped from 52 per cent of the population to 32 per cent, although, perversely, the number of women smokers had increased from 10 per cent to 20 per cent.
Cholesterol levels in men and women had fallen by 10 per cent by 1994, and blood pressure levels had dropped by 4.8 per cent for men and 11.3 per cent for women. The bottom line was seen in the death rate. By 1995, annual mortality from cardiovascular disease in North Karelia's working-age population had fallen by about 75 per cent.
Finland has not rested on its laurels and is looking for further improvement in the figures. With the ministry of social affairs and health, the Finnish Heart Association organised a consensus meeting in 1997 that led to the launch of a fresh crusade against cardiovascular disease. Its ambitious goal is to reduce Finland's age-standardised incidence of and mortality from cardiovascular disease by a startling 50 per cent, compared with the 1997 figures, which would bring it into line with the southern-European levels.
The goal is to achieve this well within a generation, according to Mika Pyykk÷ of the Finnish Heart Association. "We estimated that it would take 10 to 15 years to cut down to that rate, so we should have results by 2015."
The association has no illusions about what it must achieve. Its statistics show that cardiovascular disease causes nearly half of all deaths in Finland, and fully half of its population of five million suffers from hypertension, heart attack or stroke, despite the success of the North Karelia Project.
Each year, 20,000 people have heart attacks and another 10,000 have strokes. High blood pressure affects 40,000 a year. As much of this can be attributed to lifestyle, this is the area the association and the ministry plan to target.