Should Ireland do a heart disease intervention?

luckat

Back in 1972 North Karelia in Finland had the worst heart disease in Europe.

This was a society that lived on cream cakes and big fatty steaks, took no exercise and smoked like trains.

The government ran an experiment to see if they could improve the heart health of the area - a poorish area with a big population mix and not a huge education level, so in theory not amenable to eating fruit, stopping smoking, starting exercising.

The result of the project was that the death rate from heart disease plunged. And the rest of Finland benefited too, because they saw the results in North Karelia, and people around Finland also stopped smoking, started exercising, stopped eating hard fats and started eating fruit and vegetables.

Take a look here:

http://www.ktl.fi/portal/english/osiot/research,_people___programs/epidemiology_and_health_promotion/projects/cindi/north__karelia_project/

or google "north karelia project". Take a look at the graph for heart disease deaths, it's pretty jaw-dropping.

I suspect that if we ran the same project in Ireland we'd have the same results, and our population would be way healthier.

What surprises me is that other countries haven't done this. This project, started in 1972, was probably the most successful health intervention ever.

luckat

By the way, here's an interview with the guy who ran the project back in the 1970s.

I hadn't realised that he was the leader of the Finnish Students' Union when he started the project.

He's quite funny - in the interview he says that when women told him their husbands complained at being served low-fat milk, he told them to put the low-fat milk in high-fat containers, and when they did this the husbands stopped complaining! What a cunning stunt!

http://www.newscientist.com/channel/opinion/mg18524861.700

Archeron

Perhaps a first step wouold be to reduce the price of healthy foods in shops in Ireland.
A friend of mine has explained that even though her sisters kids prefer fruit, its cheaper to feed them crap. Go into Spar, an apple costs 90c and a chocolate bar costs 80c. On organic chicken costs, what, €9.00? A box of cheap beef burgers will do the week and cost a third of that.

luckat

Archeron, as far as I remember, government subvention for fruit and vegetables *was* part of the North Karelia Project.

By the way, here's another piece about the North Karelia Project:

http://www.eatingwell.com/news_views/special_report/miracle_up_north.html

daveirl

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InFront

There is a related issue that the government is doing very little about, and that is childhood obesity. When I was in primary school there were very few overweight kids my age, that was only 10 years ago. Today, it's ballooned, literally.

punky

Yep. Up with this sort of thing. After being away for a few years and coming back to Ireland, I realised how fat we're getting as a nation. What's even more disturbing is that it now seems acceptable (in their minds at least) for overweight people to wear revealing clothes such as belly tops or low cut jeans that leave way too little to the imagination.

I'm not just having a go at fat people here. I actually believe it's the beginning of a cultural problem when people start thinking of this as 'normal' and aren't ashamed to show off their flab.

As mentioned above, I think the fact that nasty processed food is way cheaper than the healthy stuff is part of the problem. At the risk of sounding snobby, it seems to me that many of those who make up this new fatty boom are from poor backgrounds or areas. I see over weight inner city kids stuffing their faces with crisps and all that other crap everyday. Is this the glory of the celtic tiger?

luckat

Mm. Though if you read the two articles I posted (ahem!) you'll see that the doctor who ran the North Karelia Project says himself that obesity is a separate issue.

Ireland has a terrifying level of heart disease - it's one of the reasons that our health services are staggering under the load. And this is an illness we can actually do something about.

If we replicated the North Karelia Project we could have a life expectancy like Japan's. We could have a healthy, active old age, and be useful in our 70s and 80s. We could also cut levels of other illnesses, such as strokes and diabetes.

Why not do it?

The project also sounds like fun, if we got Pekka whatsisname over to replicate his project - reality TV shows, involving the ICA, contests between towns, meetings in schools, changes in school lunches - oh wait, we don't give kids school lunches here. Well, all the other stuff.

InFront

Thats true that their seperate issues. Not everyone with heart disease is obese. But most of them are, and there is a definite link between childhood obesity and adult heart disease. I'm not saying we should focus only on obesity prevention, but instead corrective diets and good health all around.

But to ignore children who are suffering obesity, as part of any heart disease eradication plan, would be foolish. Obesity poses a great danger for their health, for the economy, and will add pressure onto the healthcare service in not so distant off years.

I think a programme like this would be very welcome here, and it would work - however im not sure if that most people would be enthusiastic enough to make it work for them.

luckat

I suspect that Ireland would succeed in a replication of the North Karelia Project.

North Karelia in the 1970s was... well, the nearest thing to it might have been Connemara in the 1970s. Poor, conservative, self-indulgent, set in their ways, a patriarchal place, where people loved their lifestyle of cigarettes, spirits, meat, milk, butter and eggs.

Compared to what the project had to confront, Ireland is practically Mediterranean.

WhiteWashMan

from ah

luckat

Humanities? Seems an odd place to put it! Is there a medical forum, or health, or lifestyle? Anyway, I'm not fussy; just making the suggestion that this is a project that should be run.

BuffyBot

daveirl wrote:

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People with lots of time on their hands maybe.

daveirl

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luckat

Ditto stir-frying. Fast, healthy, delicious, cheap.

luckat

But we also have to consider the huge inertia effect of living in a society where fast food, smoking and no exercise are the norm - as was the case in Finland before the North Karelia Project.

In that project:

* A TV show followed the efforts of various people to stop smoking, change their diet, take exercise to a specific level, cut their cholesterol readings and normalise their blood pressure. Hugely popular, this was one of the first (if not *the* first) reality show. Pekku Pusca talks about people stopping him on the street to ask "How's that girl doing on giving up smoking?"

* The Martha organisation - roughly equivalent to the Irish Countrywomen's Association - was brought in, and used to spread information on nutrition - like how to make household favourites with lower-fat ingredients replacing the butter, cream and bear fat beloved of the Finns.

* The farmers - hugely hostile at first, because their dairy products were threatened - were involved, given grants to grow rapeseed for oil, and to revive the Finnish berry industry.

* The team of doctors running the scheme stood in supermarkets giving out leaflets about what they were doing and why, and about how people could cut their heart risk and have a better life.

* Restaurants and cafes were involved - and the salt saved from using less in cooking was piled in huge jars so the customers could see how much healthier the food was. Cafe staff started to press their customers to eat salads, fish and fresh ingredients.

* Food laws were changed - labelling food for fat content and salt was mandated, probably the first in Europe.

* Pescu's team went into food producing companies making things like bread and sausages, asking them (against huge resistance at first) to make lower-salt and lower-fat versions. A sausage maker made sausages from mushrooms instead of pork. A breadmaker lowered the salt content and used vegetable oil instead of animal fat.

* The team worked with local government to make walking, bicycle and skiing trails, and give out free grips for old people's shoes so they wouldn't slip in icy conditions.

* School lunches (which, disgracefully, are not even provided in Ireland) were changed from fat- and salt-laden blobs to healthy, delicious food that builds good bodies.

When Pekka Pescu started the project, telling people "You are eating every day as if it were Sunday", one-third of the kids he talked to had fathers who had died of heart disease.

Now Finland still has a high level of heart disease - but it's on the high edge of normal, not right at the top, the way Ireland's is.

We could do this too. Where's Mary Harney when you need her?

BuffyBot

daveirl wrote:

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I don't know if you have a young family, or not. Those families I know, with one or both parents working, and a couple of kids would agree that it is *not* always possible for people to take the healthy, often time-consuming option. It's not an ideal situation by any means, but it's a realistic one. And they don't get to spend hours watching TV every night.

In an ideal world, perhaps, we would all be eating good things. I like good food, and when the chance presents, I'll cook it too - but sometimes compromises have to be made. It's easy to say "people are full of excuses", when a lot of the time the reality is that the "lazy" way just happens to be the only way around.

daveirl

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luckat

Hmm. But in Ireland, for some reason, we're very good at being punitive, disapproving and angry.

This isn't a lot of use in changing people's behaviour. What we need is a project that *helps* people to eat properly, rather than a lot of scolding and finger-wagging for what they're doing now.

BuffyBot

I guarantee you the majority of people I'll see in Supervalu tonight buying ****e processed meals will be watching a couple of hours of TV tonight.

That may very well be the case, and I wouldn't disagree. But to generalise like you did earlier in the thread isn't helpful in tackling the issue at hand.

luckat

But getting back to the original point - Ireland is quite hands-on in terms of interventions. We have lots of ads scolding us about TV licences and drunk driving and so on.

So why don't we duplicate the one intervention that (a) is the most successful ever attempted, and (b) relates to Ireland's main health problem?

InFront

So why don't we duplicate the one intervention that (a) is the most successful ever attempted, and (b) relates to Ireland's main health problem?

I think we are very close to dublicating this as it is, and have been for quite some time now. As we all know, societies differ from state to state and from province to province. After reading more about this case I personally think that the Fins were, in this case, 'better listeners'.

Pekka Puska simply went to these people, told them what they were doing wrong, he even had to explain the meaning of the word fruit, and that they should be cutting down on things like saturated fats and salt. I dont think there is anyone in Ireland who is at such a low level of understanding as this in relation to healthy eating in 2006.

His policy was merely one of discussion and persuausion. He says he stood in supermarkets handing out leaflets on diet. He organised local recipes involving healthy ingredients, he warned people about the ill effects of bad nutrition.

All of these things are already available, in some form, in Ireland. There is actually quite a strong level of knowledge and resources out there. The shame and waste is that people are choosing not to apply what they know to be 'best practice' to their lives.

Now, maybe, if we could get a nother Pekka Puska to go around like some culinary missionary, to every provincial town, village and backwater across the land, and nag the locals in the local Centra, or guilt trip the men drinking Guinness in the pub... maybe then we would get change. Buit that, unfortunately, would be impractical!

We do have quite a good level of knowledge out there, and a good availability of resources such as testing for cholesterol, etc.
I firmly believe that the issues of society and working culture are what is really setting people back with respect to heart disease here.

luckat

Part of Pekka P's success was that he was obviously an appealing personality, and well able to get publicity. The reality programmes that showed people succeeding in giving up smokes, slimming off and so on helped.

And the government went along with it - I think Finland now has the longest walking and cycling trails in the world, because local councils started designating places as walking areas.

He managed to get restaurants and schools (unlike Ireland, Finland - like most civilised countries - has school meals) to make a big deal of lowering salt and fat and upping fruit and vegetables.

It's probably a "personality is destiny" thing - the Irish Goverment thinks it can get its citizens to do what it wants by scolding and guilting, whereas in Finland they went for a "we're in this together, let's do it for fun" approach and it worked.