Can we leave industry to lead efforts to improve population health ?

Food Public Health

No – but the food industry can cooperate if government is sufficiently committed. The best example being the North Karelia Project in Finland, Finland which when rolled out as a national program reduced the incidence of ischaemic heart disease over 24 years by 65%. (Ref).

This was a result of the realisation in the 1960s that Finland had an exceptionally high rate of heart disease with high levels of risk factors – high fat diet, smoking and hypertension. There was a national consensus that action was required which involved education through the media, identification and management of risk factors  by health professionals and community initiatives.

The community initiatives involved identifying opinion leaders in every community and collaboration with voluntary organisations e.g. the national housewives’ organisation.

The report states that ‘In response to the evolving consciousness among its customers the Finnish food industry has pursued the development of new low –fat products with great diligence and creativity’

The government liberalized regulations on food production to allow mixing dairy fats and vegetable oils and low fat spreads. Explicit labeling enabled consumers to select genuinely low fat products.

In 1985 a major collaborative project to change diet was financed by the Ministry of Agriculture and Ministry of Commerce to help farmers change from dairy to berry production and development of a domestic rape seed oil. Collaboration with the baking industry lead to a change from butter use to vegetable oil margarine.

Karelian lunch

The healthy eating message was reinforced through children being given a free school lunch and children’s weight was monitored at school.

Results were that high fat milk consumption dropped from 70% to 14% among men and 60% to 10%  among women with reduced consumption of other fat sources. Total cholesterol fell by 16% in men and 18.4% in women; the proportion of men with levels over 6.5mmol/L  ( i.e. very high) fell from 60% to 28% and for women it fell from 57% to 17% in keeping with dietary modification being a major cause in the reduction of heart disease.

This project covered other aspects of health promotion including smoking cessation and increased exercise. Over 21 years there was a drop in all cause mortality of 39% with a 42% reduction in cerebrovascular disease, a 17% reduction in cancer deaths and an improvement in perceived health status.

The report illustrates that food industries can respond to a concerted program to improve health.

In the USA the federally sponsored National Cholesterol Education Program achieved a reduction of less than 10% in cholesterol levels and the authors reported that during that time the food industry consumed more resources than the community study to promote high fat foods.

The superior results from Finland could indicate that the cooperation of the food industry in changing dietary habits made a difference and that national action in other countries or combined international action could lead to more people eating healthier diets.

Ref: Successful prevention of non-communicable diseases: 25 year experiences with North Karelia Project in Finland, Pekka Puska, National Public Health Institute, Finland,