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Pekka Puska

Pekka Puska 130x180Born in 1945, since 2009 I have been the director-general of the Finnish National Institute for Health and Welfare, part of the national Ministry of Health. It employs some 1,300 people, and has responsibility for disease prevention, nutrition, healthy ways of life and environment, infectious disease control, and national vaccination programmes; and also health and social services, health and welfare monitoring, and statistics. Before then I was director-general of the Finnish Public Health Institute.

Between 2001 and 2003 I was director for Noncommunicable Disease Prevention and Health Promotion at WHO Geneva, with lead responsibility for the 2004 WHO Global Strategy on Diet, Physical Activity and Health

For most of my career, I have worked at the National Public Health Institute. For 25 years, I was the director and principal investigator of the North Karelia Project for prevention of cardiovascular diseases in North Karelia which later on became national. The project is widely seen as a model for successful population-based prevention of cardiovascular and other non-communicable diseases.

The story of the project began in the sparsely populated frontier region of North Karelia which is in eastern Finland, the part of the province that remained Finnish during the Soviet occupation in the Second World War. In 1972 North Karelia became the focus of what was to become the whole country’s path to recovery.

In the 1970s Finland held the world record for rates of heart disease. The idea then was that a good life was a sedentary life. Everybody was smoking and eating a lot of fat. Finnish men used to say vegetables were for rabbits, not real men, so people simply did not eat vegetables. Staples included butter on bread, full-fat milk and fatty meat.

The biggest innovation was massive community-based intervention. We tried to change entire communities. Instead of a mass campaign telling people what not to do, we blitzed the population with positive incentives. Villages held ‘quit and win’ competitions for smokers, where those who quit for a month won prizes. Entire towns were set against each other in cholesterol-cutting contests. We would go in, measure everyone’s cholesterol, then return two months later. The towns that cut cholesterol the most would win a collective prize. We didn’t tell people how to cut cholesterol, they knew how to do that. It wasn’t education they needed, it was motivation.

All this was combined with sweeping nationwide changes in legislation. All forms of tobacco advertising were banned outright. Farmers were given strong incentives to produce low-fat milk or grow a new variety of oilseed rape bred just for the region that would make domestic plant oil widely available for the first time. Previously, farmers had been paid for meat and dairy on the basis of the product’s fat content; this was changed to link payment instead to how much protein the produce contained. Often, our moves were attacked for being unpatriotic. When we said the population must start eating fruit, protests poured in that fruit would have to be imported. So the scheme was revised to encourage the growing of berries that thrive in a Baltic climate. Now Finland has a healthy industry producing all sorts of berries.

In time, working as always within government, and also within communities, we succeeded in forcing down salt intake, a crucial move for cutting blood pressure, and blood cholesterol has fallen along with fat intake and smoking. In 1972, more than half the middle-aged men of North Karelia smoked. Now the country has one of the lowest smoking rates in the world. In 30 years the number of men dying from cardiovascular heart disease dropped by at least 65 per cent, with deaths from lung cancer being slashed by a similar margin. Physical activity has risen and now, Finnish men can expect to live seven years longer and women six years longer than before the North Karelia and then Finnish national project.

I hold MD and MPolSci degrees and a PhD in epidemiology and public health. In 1974 I qualified as doctor of medicine and surgery, at the University of Kuopio, and in 1985 became adjunct professor of public health at the same university. In 1983 I was visiting scholar at Stanford University, California, US. Between 1972-1978 I was principal investigator of the North Karelia Project. Between 1992-2000 was director, division of health and chronic diseases, at the National Public Health Institute of Finland, becoming director-general in 2000. From 2001-2003 I was at WHO Geneva. I resumed at the National Public Health Institute in 2003, and then took up my present post as director-general of the National Institute for Health and Welfare in 2009.

I have served as a member of the Finnish parliament. Am a former president of the World Heart Federation and former vice-president of the International Association of National Public Health Institute. I have been chair of the governing council of the WHO International Agency for Cancer Research (IARC) based in Lyon, France.

I have over 500 scientific publications. Among various honours are an honorary doctorate at St. Andrew’s University in Scotland) and an academician of the Russian Academy of Natural Sciences. I received the WHO annual health education award in 1990, the WHO tobacco-free world award in 1999, the Nordic award for public health in 2005, and the Rank Prize for nutrition in 2008. Past President of the World Heart Federation, Vice President, International Association of National Public Health Institute. Chair, Scientific Committee of the 8th Global WHO Conference on Health Promotion (being held in June 2013, Helsinki, Association founder member.