This section provides an overview of the project and describes its evaluation and national applications, the main results of evaluation studies, and conclusions that can be drawn from the project.
In the decades after World War II, Finland faced serious noncommunicable disease epidemics resulting from increased occurrence of the major chronic diseases—an increase that took place in spite of growth in health services and in the general level of income. In the early 1970s, Finnish men had the highest mortality rate from coronary heart disease in the world (Pisa and Uemura, 1988). The mortality rate from cancer and the rate for all causes of death were also high. Finland undertook several measures to control these new epidemics and to improve the health of the nation. One major action taken was the start of the North Karelia Project.
Faced with the great burden of heart disease and other major chronic diseases, representatives of the population in the province of North Karelia in eastern Finland signed an urgent petition to the Finnish government to start a program aimed at reducing the high mortality from these diseases. In response, Finnish experts, local representatives, and World Health Organization (WHO) representatives designed and formulated a national demonstration project to explore avenues for the prevention of premature mortality, especially from cardiovascular diseases. Under this initiative, North Karelia, which is neighbor to the Russian Republic of Karelia, has been a demonstration area for a comprehensive community-based preventive program since 1972.
The major objective of the North Karelia Project has been to decrease mortality and morbidity rates from cardiovascular and other chronic diseases, as well as to promote general health among the population of the area. Special emphasis has been on the middle-aged male population, which had especially high mortality rates prior to the start of the project.
The basic idea of the project was to reduce levels of well-established lifestyle-related risk factors among the population through a well-conceived and comprehensive community-based intervention. Previous research, such as the Framingham Study (Wilson, 1994; Brand et al., 1992; Kreger, 1991) and the Seven Countries Study (Keys, 1980), had clearly identified the important and likely causal role of a few risk factors, notably smoking, elevated serum cholesterol (related to diet), and elevated blood pressure, and a review of available knowledge on risk factors for heart disease among the Finnish population showed these three to be most important. The latter two factors were probably associated with the local diet, which was very high in saturated fats. Thus the desired major