For lack of vision?

North Karelia

Canada’s leaders aren’t doing their jobs

A recent article in The Atlantic celebrated the success of a decades-long population health improvement campaign in a remote region in northern Finland called North Karelia. The effort reduced male cardiovascular mortality by an unparalleled 80 per cent and confounded academics and public health experts. They called it “shotgun science,” referring to the multitude and diversity of the interventions that comprised the campaign.

The success of the campaign could not be attributed to any one if its elements. Further, it was executed in both a top-down and a bottom-up fashion. Opinion leaders from every sector were targeted, educated and ultimately engaged in everything from teaching people how to cook with vegetables, to freezing and stocking seasonal fruit in grocery stores for year-round consumption and even smoking cessation challenges issued between competing towns. The opinions leaders passed the torch to people in communities all across the region, who implemented and advocated for these changes, and educated their peers.

The campaign began in 1972 and arguably could not be stopped today: the fabric of North Karelia has been woven over more than 40 years to promote healthy lifestyles. The trick, concludes the article’s author, is to “design an environment that helps make the right decisions for us, making the healthy choice not only easy but unavoidable.”

When the Finnish government identified the health crisis in North Karelia and appointed Pekka Puska to fix it, it was committed to significant, multisectoral change over the very long term. It had a vision of longer, healthier lives for its citizens. In retrospect, Puska tells us that “population based prevention is clearly the most cost effective way to improve public health. Furthermore, even limited relative success with major diseases means in absolute numbers thousands of lives saved. Chronic disease prevention is possible and pays off!”

The Canadian government has the scientific evidence, the expert support and the know-how to substantially improve the health of Canadians. So we are left wondering: can they simply not see what is in the best interest of Canadians? Or are they loath to do the work?

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