In the early 1970s, Pekka Puska, a young public health physician from Helsinki, was dispatched to the remote province of North Karelia, to lead an ambitious campaign to change the population’s eating habits. The reason? Finland had the world’s highest death rate from heart disease. North Karelia‘s rate was 40 percent higher than that.
The North Karelian Experiment was a huge success. From 1970 to 1995, cholesterol and blood pressure levels dropped. More importantly, deaths from heart disease also dropped…by 73 percent for the group most at risk – middle-aged men. The government replicated the North Karelia model across Finland, with similar results.
For our purpose, more interesting than the results themselves, was the way Pekka Puska was able to affect dramatic behavioral changes on a larger scale. And what we can learn from the North Karelia Experiment, as we consider similar large scale behavioral changes in regards to global warming. I found this radio interview from PRI reporter, Patrick Cox, particularly enlightening:
Holttinen: “Pekka Puska came to our house, I think it was 1978.”
Cox: “That was two years after Jukka Holttinen’s father died. What Puska found in the Holttinen kitchen was fairly typical. The family relied on fatty meat, salt, cheese and butter, washed down with pint after pint of whole milk. Some North Karelians had almost never eaten vegetables before Puska’s team told them to.”
Puska: “When they say that we had to drink skim milk, it was horrible.”
Cox:”..but you got used to it?”
Puska: “Yes of course. Nowadays I drink only skim milk.”
Cox: “North Karelia’s problems with heart disease could be traced not just to the food the locals were eating, but to the food they were producing: low-grade pork, and dairy products.”
Puska: “People were used to that, that was local production, and of course there was a strong dairy industry so there were a lot of economic vested interests.”
Cox: “Puska realized that merely urging people to eat healthier foods wasn’t enough. He needed to make healthier foods more available and more affordable. And that meant taking on the pig and dairy farmers – people who viewed him as a health nut from the big city who was trying to run them out of business.”
Puska: “It was so hard, so intense, the opposition, that that period, particularly in the 80s was commonly called as fat war.”
Cox: “To win the fat war, Puska took on government policies. At the time, agricultural subsidies encouraged the production of the very foods that were helping to cause so many heart attacks in North Karelia. Dairy subsidies, for example, were based on fat content. Puska and his colleagues convinced the government to radically change direction. The government began funding research into new low-fat cheeses and non-dairy spreads…that found their way to supermarket shelves. It phased out milk subsidies. And it introduced subsidies for some new products.”
Ruutiainen: “Quite many of the milk producers they changed to berries.”
Cox: “North Karelian farmer Ismo Ruutiainen began growing strawberries and boysenberries. He says he made a handsome profit.”
Ismo Ruutiainen: “It was really good business.”
Cox: “Soon, more than two dozen berry farms were operating – a new micro-industry was born.”
Meanwhile, Puska and his team were encouraging the public to eat more berries – and other fruits and vegetables. They worked with housewives’ groups. And they laced their message with positive incentives, like cash prizes for the winners of town-versus-town cholesterol-lowering showdowns.
What can we learn from the North Karelia Experiment? We could replace ‘heart disease’ with ‘global warming’, ‘better nutrition’ with ‘carbon reducing lifestyle’, and ‘fat war’ with ‘carbon war’, and the same 12 Proven Behavioral Strategies would apply:
- Education alone does not work
- Need to also change the environment that’s causing the problem
- Need to set up the enabling structure that makes it actually possible and easy for people to change
- People do not like to change their habits, but they do get used to it eventually.
- One person needs to lead
- Start small with one pilot program, and then replicate
- Work down at the individuals and families level
- Take systems approach, the individual within its whole environment; make changes in the environment first
- Work on changing defeating policies
- Build in incentives
- Do grass roots work with women
- Make it fun