From pilot project to national implementation: experiences from the North Karelia Project.

The North Karelia Project started in 1972 as a response to the request of the local people. It was aimed at reducing the exceptionally high mortality and morbidity from cardiovascular diseases in the area. The Project's activities have been directed towards inducing behavioural changes amongst the entire population. Equally, the care of those already sick (such as hypertensives) has also simultaneously been reorganized. The Project has involved the whole of that society, in addition to the health care system, and has collaborated with the food industry, schools and various voluntary organizations. The most recent new activity is a programme to promote marketing of local vegetables and berries to have a substitution for dairy farming, as consumption of dairy products reduce with new dietary habits. The results are encouraging. The individually reported health behavioural changes are reflected by a clear net reduction in biological risk factors (serum cholesterol, blood pressure) compared to the reference community. Also statistics show that mortality from ischaemic heart disease has been reduced more significantly in North Karelia (-22%) than in the rest of Finland (-11%) during the period 1974-1979. The activities tested in North Karelia, and found to be feasible, have been recommended for implementation nationwide in Finland. For instance, anti-smoking activities were first tested in North Karelia before the introduction of national legislation, and experiences obtained in health education have been conveyed to other sectors of the Finnish population through national television in several programmes. The county of North Karelia continues to be a demonstration area in Finland, at present for the Integrated Programme for the Prevention of Noncommunicable Diseases.