Skip to main content
    • Aa
    • Aa
  • Access
  • Cited by 21
  • Cited by
    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.

    Afshin, Ashkan Penalvo, Jose Del Gobbo, Liana Kashaf, Michael Micha, Renata Morrish, Kurtis Pearson-Stuttard, Jonathan Rehm, Colin Shangguan, Siyi Smith, Jessica D. and Mozaffarian, Dariush 2015. CVD Prevention Through Policy: a Review of Mass Media, Food/Menu Labeling, Taxation/Subsidies, Built Environment, School Procurement, Worksite Wellness, and Marketing Standards to Improve Diet. Current Cardiology Reports, Vol. 17, Issue. 11,

    Borodulin, K. Vartiainen, E. Peltonen, M. Jousilahti, P. Juolevi, A. Laatikainen, T. Mannisto, S. Salomaa, V. Sundvall, J. and Puska, P. 2015. Forty-year trends in cardiovascular risk factors in Finland. The European Journal of Public Health, Vol. 25, Issue. 3, p. 539.

    Golay, A. Brock, E. Gabriel, R. Konrad, T. Lalic, N. Laville, M. Mingrone, G. Petrie, J. Phan, T.-M. Pietiläinen, K. H. and Anderwald, C.-H. 2013. Taking small steps towards targets - perspectives for clinical practice in diabetes, cardiometabolic disorders and beyond. International Journal of Clinical Practice, Vol. 67, Issue. 4, p. 322.

    White, Sarah 2013. Is it time for a lifestyle approach to the burden of chronic kidney disease?. Hypertension Research, Vol. 36, Issue. 4, p. 295.

    Sachithananthan, Vedavalli Buzgeia, Mohammed Awad, Fadwa Omran, Rema and Faraj, Amna 2012. Impact of nutrition education on the nutritional status. Nutrition & Food Science, Vol. 42, Issue. 3, p. 173.

    Thow, A. M. Quested, C. Juventin, L. Kun, R. Khan, A. N. and Swinburn, B. 2011. Taxing soft drinks in the Pacific: implementation lessons for improving health. Health Promotion International, Vol. 26, Issue. 1, p. 55.

    Boddington, Paula 2010. Dietary Choices, Health, and Freedom: Hidden Fats, Hidden Choices, Hidden Constraints. The American Journal of Bioethics, Vol. 10, Issue. 3, p. 43.

    Mason, P. Porter, S. C. Berry, S. E. Stillman, P. Steele, C. Kirby, A. Griffin, B. A. and Minihane, A. M. 2009. Saturated fatty acid consumption: outlining the scale of the problem and assessing the solutions. Nutrition Bulletin, Vol. 34, Issue. 1, p. 74.

    Grant, W. B 2008. Commentary: Ecologic studies in identifying dietary risk factors for coronary heart disease and cancer. International Journal of Epidemiology, Vol. 37, Issue. 6, p. 1209.

    Lachat, Carl Roberfroid, Dominique Huybregts, Lieven Van Camp, John and Kolsteren, Patrick 2008. Incorporating the catering sector in nutrition policies of WHO European Region: is there a good recipe?. Public Health Nutrition, p. 1.

    Witkos, Maciej Uttaburanont, Michelle Lang, Christopher D. and Arora, Rohit 2008. Costs of and Reasons for Obesity. Journal of the CardioMetabolic Syndrome, Vol. 3, Issue. 3, p. 173.

    Duthie, Garry G. 2007. Berry Fruits. Molecular Nutrition & Food Research, Vol. 51, Issue. 6, p. 643.

    Jilcott, Stephanie Ammerman, Alice Sommers, Janice and Glasgow, Russell E. 2007. Applying the RE-AIM framework to assess the public health impact of policy change. Annals of Behavioral Medicine, Vol. 34, Issue. 2, p. 105.

    Popkin, Barry M. 2007. Understanding global nutrition dynamics as a step towards controlling cancer incidence. Nature Reviews Cancer, Vol. 7, Issue. 1, p. 61.

    Garrett, James and Ruel, Marie T. 2005. The coexistence of child undernutrition and maternal overweight: prevalence, hypotheses, and programme and policy implications. Maternal and Child Nutrition, Vol. 1, Issue. 3, p. 185.

    Petersen, Poul Erik and Yamamoto, Tatsuo 2005. Improving the oral health of older people: the approach of the WHO Global Oral Health Programme. Community Dentistry and Oral Epidemiology, Vol. 33, Issue. 2, p. 81.

    Uusitalo, U Sobal, J Moothoosamy, L Chitson, P Shaw, J Zimmet, P and Tuomilehto, J 2005. Dietary Westernisation: conceptualisation and measurement in Mauritius. Public Health Nutrition, Vol. 8, Issue. 06,

    Marshall, Debra A. Walizer, Elaine and Vernalis, Marina N. 2004. Optimal Healing Environments for Chronic Cardiovascular Disease. The Journal of Alternative and Complementary Medicine, Vol. 10, Issue. supplement 1, p. S-147.

    De Backer, Guy Ambrosioni, Ettore Broch-Johnsen, Knut Brotons, Carlos Cifkova, Renata Dallongeville, Jean Ebrahim, Shah Faergeman, Ole Graham, Ian Mancia, Guiseppe Cats, Volkert Manger Orth-Gom??r, Kristina Perk, Joep Py??r??l??, Kalevi Rodicio, Jos?? L. Sans, Susana Sansoy, Vedat Sechtem, Udo Silber, Sigmund Thomsen, Troels and Wood, David 2003. European guidelines on cardiovascular disease prevention in clinical practice Third Joint Task Force of European and other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of eight societies and by invited experts). European Journal of Cardiovascular Prevention and Rehabilitation, Vol. 10, Issue. Supplement 1, p. S1.

    Hsairi, Mohamed Fekih, H. Fakhfakh, R. Kassis, M. Achour, Noureddine and Dammak, J. 2003. Années de vie perdues et transition épidémiologique dans le Gouvernorat de Sfax (Tunisie). Santé Publique, Vol. 15, Issue. 1, p. 25.


Part III. Can we turn back the clock or modify the adverse dynamics? Programme and policy issues: Influencing public nutrition for non-communicable disease prevention: from community intervention to national programme – experiences from Finland

  • Puska Pekka (a1), Pietinen Pirjo (a1) (a2) and Uusitalo Ulla (a1) (a3)
  • DOI:
  • Published online: 22 December 2006

A global health transition is currently underway. The burden of non-communicable diseases (NCDs) is increasing rapidly in the developing world, very much as a result of changes in lifestyles. In addition to changes in tobacco use and physical activity, major changes are taking place in diets, contributing greatly to the growing epidemic of NCD. Thus, a huge global public health challenge is how to influence the trends in diet and nutrition for effective global NCD prevention.

The health transition took place rapidly in Finland after World War II and mortality from cardiovascular disease (CVD) was exceptionally high. The North Karelia Project was launched in 1972 as a community-based, and later as a national, programme to influence diet and other lifestyles that are crucial in the prevention of CVD. The intervention had a strong theory base and it employed comprehensive strategies. Broad community organisation and the strong participation of people were the key elements. Evaluation has shown how the diet (particularly fat consumption) has changed and how these changes have led to a major reduction in population serum cholesterol and blood pressure levels. It has also shown how ischaemic heart disease mortality in a working-age population has declined by 73% in North Karelia and by 65% in the whole country from 1971 to 1995.

Although Finland is an industrialised country, North Karelia was rural, of rather low socio-economic level and with many social problems in the 1970s and 1980s. The project was based on low-cost intervention activities, where people's participation and community organisations played a key role. Comprehensive interventions in the community were eventually supported by national activities – from expert guidelines and media activities to industry collaboration and policy. Similar principles for nutrition intervention programmes could be used in developing countries, obviously tailored to the local conditions. This paper discusses the experiences of the North Karelia Project in the light of needs from the less-industrialised countries and makes some general recommendations.

    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Part III. Can we turn back the clock or modify the adverse dynamics? Programme and policy issues
      Available formats
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about sending content to Dropbox.

      Part III. Can we turn back the clock or modify the adverse dynamics? Programme and policy issues
      Available formats
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about sending content to Google Drive.

      Part III. Can we turn back the clock or modify the adverse dynamics? Programme and policy issues
      Available formats
Corresponding author
*Corresponding author: Email
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

1CJL Murray , AD Lopez . Mortality by cause for eight regions of the world: Global Burden of Disease Study. Lancet 1997; 349: 1269–76.

3CM Michaud , CJL Murray , BR Bloom . Burden of disease – implications for future research. JAMA 2001; 285: 535–9.

4J Tuomilehto , J Lindström , J Eriksson , TT Valle , H Hämäläinen , P Ilanne-Parikka , S Keinänen-Kiukaanmäki , M Laakso , A Louheranta , M Rastas , V Salminen , M Uusitupa . Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N. Engl. J. Med. 2001; 344: 1343–50.

5FB Hu , JE Manson , MJ Stampfer , G Colditz , S Liu , CG Solomon , WC Willett . Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N. Engl. J. Med. 2001; 345: 790–7.

8A Drewnowski , BM Popkin . The nutrition transition: new trends in the global diet. Nutr. Rev. 1997; 55: 3143.

9J Sobal , AJ Stunkard . Socioeconomic status and obesity: a review of the literature. Psychol. Bull. 1989; 105: 260–75.

18MJ Karvonen , S Punsar . Sodium excretion and blood pressure of west and east Finns. Acta Med. Scand. 1977; 202: 501–7.

19P Puska . Nutrition and mortality: the Finnish experience. Acta Cardiol. 2000; 55: 213–20.

23P Pietinen , E Vartiainen , R Seppänen , A Aro , P Puska . Changes in diet, in Finland from 1972–1992; impact on coronary heart disease. Prev. Med. 1996; 25: 243–50.

26E Vartiainen , P Jousilahti , G Alfthan , J Sundvall , P Pietinen , P Puska . Cardiovascular risk factor changes in Finland, 1972–1997. Int. J. Epidemiol. 2000; 29: 4956.

27E Vartiainen , P Puska , J Pekkanen , J Tuomilehto , P Jousilahti . Changes in risk factors explain changes in mortality from ischaemic heart disease in Finland. Br. Med. J. 1994; 309: 23–7.

32J Kuusipalo , M Mikkola , S Moisio , P Puska . The East Finland berry and vegetable project: a health-related structural intervention programme. Health Promotion 1986; 1: 385–91.

33TA Miettinen , P Puska , H Gylling , H Vanhanen , E Vartiainen . Reduction of serum cholesterol with sitostanol-ester margarine in a mildly hypercholesterolemic population. N. Engl. J. Med. 1995; 333: 1308–12.

34GK Dowse , H Gareeboo , KGMM Alberti , P Zimmet , J Tuomilehto , A Purran , D Fareed , P Chitson , VR Collins , F Hemraj . Changes in population cholesterol concentrations and other cardiovascular risk factor levels after five years of the non-communicable disease intervention programme in Mauritius. Br. Med. J. 1995; 311: 1255–9.

35U Uusitalo , EJM Feskens , J Tuomilehto , G Dowse , U Haw , D Fareed , F Hemraj , H Gareeboo , KGMM Alberti , P Zimmet . Fall in total cholesterol concentration over five years in association with changes in fatty acid composition of cooking oil in Mauritius: cross sectional survey. Br. Med. J. 1996; 313: 1044–6.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Public Health Nutrition
  • ISSN: 1368-9800
  • EISSN: 1475-2727
  • URL: /core/journals/public-health-nutrition
Please enter your name
Please enter a valid email address
Who would you like to send this to? *