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A Whole Country Ate Better: Lessons From Finland

The lessons of Finland are powerful and point to ability of simple, coordinated, and consistent messages to the public and our families to not smoke, reduce animal fat intake, and increase vegetables and fruits in our diets to avoid unnecessary early deaths.
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In the early 1970s, young men in Finland were dying from heart attacks at the highest rates in the industrialized world. In the North Karelia region of the country, home to 180,000 people, every family knew the pain of watching a young and fit man die young. While the Finns had very little obesity and very few sedentary jobs (factors that should have protected them from heart disease), they had very high blood cholesterol and elevated blood pressure, and smoking was rampant.

In 1972, the Finnish government launched the North Karelia Project with the goal of lowering the quantity and type of fats eaten and to improve smoking rates. They coordinated an education program in schools, medical facilities, media, work sites, supermarkets, and even worked with the food industry to emphasize the health risks of smoking and offer tips to quit.

Residents were asked to switch from butter to vegetable oil-based margarine and replace whole milk with low-fat milk. By 1977, the drop in heart deaths was sufficiently impressive to roll the project out to the entire country and over 30 years of data are available.

Did the residents respond? They sure did. The rate of using butter on bread fell from 90 percent to less than 5 percent and one-third of the population began to drink skim or 1 percent milk, up from zero at the outset. Overall dietary fat intake dropped and saturated fats fell to 16 percent of calories.

Beginning in 1979, the government introduced an additional goal of eating vegetables six to seven times a week. By 2004, about a quarter of the men and one-third of the women of Finland were reaching that goal. Smoking in men fell from 52 percent to 31 percent and remained under 20 percent in women, the lowest in Europe.

What were the results?

The results for dying at a young age were stunning. In North Karelia, men between the ages of 35 and 64 years enjoyed a drop in overall death by 62 percent, heart attack deaths fell 85 percent, all cancers deaths dropped by 65 percent, and lung cancers decreased by 80 percent. For the entire Finnish nation, the chances of dying from a heart attack during working years was reduced by a whopping 80 percent! When researchers looked at what caused the dramatic improvements in health, they found that the most powerful factor was the drop in animal saturated fat.

Has there been any follow-up in terms of the habits and health of the citizens of Finland 40 years after this amazing social experiment? A recent survey showed that the Finnish people continue to reductions in blood pressure and smoking. Of some concern, the average cholesterol in the subjects reached a nadir in 2007 and is climbing some. I suspect this is due to the proliferation of processed foods throughout Europe.

The lessons of Finland are powerful and point to ability of simple, coordinated, and consistent messages to the public and our families to not smoke, reduce animal fat intake, and increase vegetables and fruits in our diets to avoid unnecessary early deaths. The message that butter and animal fat is healthy is often heard and may confuse you, but the health boom in Finland teaches a powerful lesson that cannot be ignored.

My advice as a cardiologist with decades of experience? If anyone recommends you eat a diet high in animal fats like butter and meat, ask them if they have any long-term data on preventing heart disease, the No. 1 killer in the world. Heart attacks are preventable and putting your fork in a plant, green or starchy (instead of an animal) remains your best health decision.