How to influence the risk profile of a nation

Geoffrey Rose Lecture on Population Science, 704003.

Austria, Vienna, 4 September 2007:

Professor Geoffrey Rose was a pioneer in the field of prevention of coronary heart disease (CHD). He emphasized in his works how CHD prevention calls for general reduction in risk factor levels in the population, i.e. population based approach. Geoffrey Rose wrote: “It makes little sense to expect individuals to behave differently form their peers, it is more appropriate to seek a general change in behavioural norms and in the circumstances which facilitate their adoption.”

The historical experience from Finland, the North Karelia Project, demonstrates beautifully the wisdoms of professor Rose’s ideas. Finland had in the early 1970’s the highest mortality rates of CHD in the world. Comprehensive community and population-based intervention first in the province of North Karelia and later in the whole nation led to major positive changes in diet and smoking, and in reduction of CHD risk factor levels of the whole population. This was associated with dramatic reduction in age adjusted CHD mortality rates and with a major improvement in national public health.

The Finnish experience gives many valuable experiences on the question, how to influence national risk factor levels, which – in spite of all the progress with clinical treatments – is the key issue from public health point of view.

There is no magic bullet to influence risk related lifestyles in the population. Successful national programmes need to involve good research and monitoring, health services (especially primary health care), educational institutions, private sector, civic society, media and political decision makers. Good health information is the basis, but successful programmes should help people to make healthy changes and ultimately promote such societal changes that make the “healthy choices the easy ones”.

During the last few years numerous documents have been developed by WHO and by national and international bodies on the strategies needed to change lifestyles and risk factors in the population, in order to prevent cardiovascular diseases or chronic noncommunicable diseases in general. While they usually outline well the needed strategies, a greater problem usually lies in the implementation. For successful national prevention, it is important not only to do the right things, but also to do enough of it. Another critical issue is strong, dedicated and credible leadership that should be combined with broad collaboration.

The issue of permanent changes of risk related lifestyles in the population is ultimately question of social change. While governments and private sector are in key position for needed environmental and social changes, they are basically influenced by people, i.e. by voters and consumers. Thus for any health action for national change, the big challenge is mobilization of people for the needed change.