THE NORTH KARELIA PROJECT

The North Karelia Project began in 1972 as a project to prevent cardiovascular disease among residents of this province of Eastern Finland. The Finnish Heart Association coordinated the initial discussions, which included community representatives, national experts, and several representatives of the World Health Organization (WHO). Later, the program expanded to include other noncommunicable diseases. The project has shown that high rates of heart disease are not inevitable; community-based projects guided by experts can reduce rates dramatically.

The project began following a petition from provincial representatives who had learned their province had extremely high rates of cardiovascular disease; several earlier epidemiological studies also stimulated creation of the project. The project had a board of directors (which ensured broad community support), a steering committee led by the county medical officer of North Karelia, and various working groups (e.g., on health education, smoking, nutrition) that included a large number of community representatives. Staff at the North Karelia Project office have defined program objec-tives, trained participants, coordinated and promoted activities, and assessed results, but community members have done most of the project work. Originally, the steering committee managed and executed the program; the various working groups func-tioned under the board of directors and the steering committee. In later years, project administration became more centralized, with much of the work carried out in the project office (in the provincial capital).

Still, the project keeps close ties with many community organizations. County medical officers, physician chiefs at local health centers, public health nurses, voluntary organizations, and many other individuals and groups (e.g., sports organizations, berry and vegetable farmers) have become involved. Every public health nurse and physician has been asked to help modify risk factors of their patients and clients; opinion leaders in various villages have become project assis-tants; many health promotion efforts have taken place at worksites; national television broadcasts have targeted smoking and guidance about health; and national "quit and win" contests have been held to reduce smoking. Other initiatives have included cholesterol-lowering competitions between villages and youth and school projects. The North Karelia Project has become affiliated with and has contributed to development of WHO's InterHealth and Countrywide Integrated Noncommunicable Diseases Intervention (CINDI) projects, and has been involved in health promotion training and outreach worldwide.

Surveys have been conducted every 5 years (from 1972 to 1992). Results show that over the long term, the project has been very successful. For example, cardiovascular mortality rates for men aged 35-64 decreased 57 percent from 1970 to 1992. The pro-ject also contributed to policy changes in health, agriculture, and commerce within Finland as a whole. For example, the food industry collaborated with the project to promote low-fat dairy products and sausage as well as salt reduction in several foods. The project shows that major change is possible in behaviors associated with heart dis-ease. In 1972, some 90 percent of the population used butter on their bread; in 1992 only 15 percent did so. Fruit and vegetable consumption increased from about 20 kg per person annually in 1972 to 50 kg in 1992. Smoking dropped dramatically among men but actually increased among women. The North Karelia Project has provided examples of approaches to training and dissemination for other groups interested in community-based health promotion.

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