The North Karelia Project

We\’re told that a project in North Karelia did wondrous things for health inequality.

The North Karelia project shows how the geography of inequality can be conquered by engaging the hearts and minds of local people. In the 60s, Finland had the world\’s highest rate of early deaths from coronary heart disease. People died young from largely preventable and treatable conditions, particularly concentrated in the poor eastern province of North Karelia. After much political debate and scientific work, the prevention programme was launched in 1972, co-ordinated by the local university.

The emphasis is very much on how the results were specifically wonderful in that particular area as the community mobilised to beat the problem.

Hmm, yes, well:

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From a quick eyeballing we would probably say that sure, there\’s been a great effect on deaths from coronary heart disease. Just as there has been everywhere over that time span. But that general decrease seems to swamp the relative decrease between the specific locality and the general population.

Perhaps this isn\’t quite as much of a success as it is said to be?

1 thought on “The North Karelia Project”

  1. Tim, perhaps you are missing one thing. The vertical line in 1977 indicates a point of time when the project in North Karelia was expanded to a nation wide activity. Thus, it is conceivable that both the local collapse and the nationwide decrease of coronary heart disease are due to actions adopted in the North Karelia Project.

    Where the article goes wrong IMO is that it repeats some fashionable mantras about inequality. But I think that is mostly just because the author wants to please the potential funders of expanded projects.

    I think the North Karelia project is not without its merits: eating excessive amounts of pig fat probably might not be good for your health. And although many men in North Karelia still have an agreement with the hares (“I don’t eat your food, you don’t eat mine”), the consumption of fresh vegetables has increased.

    This is, of course, not only because of the project: the change is also due to the introduction of refrigeration, international transport and globalized food trade to such an extent that the oranges and bananas these people see are no longer models made of porcelaine displayed in school classes, as they were for my parents’ generation. Rural Finland in 1960’s was vastly different from today.

    There is room for criticism, of course. I haven’t really studied this stuff but if I remember correctly, some researchers have argued that the significant reduction in deaths over CND are not really due to North Karelia project and its nationwide expansion, and people eating more lettuce; it is because the generations that suffered extreme poverty and malnutrition in their childhood have passed away, and the age bracket 35-64 is now filled by people who grew up getting a daily meal at school and enjoyed a generally much better diet in their youth (“better diet” actually meaning “enough calories”) though this was before the North Karelia project. There was true, wide-spread hunger and undernourishment in North Karelia the first half of 20th century, and that was removed for the children of 1950’s.

    The men also changed from back-breaking heavy forestry work (tools: a bucksaw, an axe, and if you’re wealthy, a horse with sled) to use chainsaws and tractors, and then onwards to different jobs (or unemployment benefits). And even if they stayed in forestry, they started to use advanced equipment from the likes of Ponsse ( http://www.ponsse.fi/ ) which, incidentally, is nowadays responsible for the municipality with the greatest amount of income inequality in the country – because in the small town where the company comes from, everyone is relatively poor except the one man who owns a large portion of the stock-listed corporation that he created to make these machines that have liberated thousands of forestry workers both from their jobs and from a need to eat horrific amounts of fat to produce enough energy to survive their jobs.

    And of course professor Pekka Puska, writing for WHO, is keen to highlight the achievements of MD Pekka Puska, who was instrumental in the North Karelia project starting early 1970’s.

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