University of Minnesota
http://www.umn.edu/
612-625-5000
Menu

Pekka Puska

Year: December 12th, 2005
Location: Helsinki, Finland
Interviewed by: Labarthe, Darwin

Abstract

This fine interview between a director of CVD policy in the US (Labarthe) and a director of policy in Finland and formerly of WHO (Puska) ranges over the epidemiologic base of prevention strategy, the history of the North Karelia demonstration, and its role in the social changes in Finland. It describes the origins of community studies, their opposition by academics and industry and the evolution of health behavior with socioeconomic determinants, negative and positive components.

The interaction between science, economics, and health policy is elaborated, showing how the growth of social concern for public health and non-material matters, as in globalization, follows cycles and requires ongoing policy intervention with a strong research base. (Henry Blackburn)

Quotes

I feel epidemiology has been absolutely the foundation and crucial for the successful control of the cardiovascular epidemic. Of course there are different perspectives. You know, the people in biomedicine they kind of say that you should understand the mechanism of the disease before you can prevent it. But, of course, we feel that is not the case. I think the reality is that epidemiology has really identified the very likely risk factors and then biomedical research has come in and explained more and more about the mechanisms. I’m saying this also particularly because when we started in North Karelia I heard a lot of comments saying that… And you know the International Journal of Epidemiology had an editorial in 1973 called “Shotgun Prevention,” which criticized the start of the North Karelia Project, that we are starting such a large project with insufficient evidence. Do you remember that editorial?

I think the whole issue of cardiovascular prevention, heart health because it is not just one magic bullet, but it is a fairly broad concept. So ultimately I think this is really a fairly broad issue… I mean, basically we are talking about social change. That’s the bottom line. I never believed in a kind of social engineering that you can really engineer the society for beautiful, nice prevention. Although we can have nice frameworks and so on and they are useful in the background, but ultimately, I think that it is broad social change and it takes time. So a demonstration project, a pilot project like the North Karelia Project it is just one part of pushing the social change. Having said all this in background, on the one hand I am quite pleased. I think the whole concept is changing the world. It started from Framingham and so on and with the North Karelia Project and many other things – CINDI and so on – they are all bricks in something which profoundly leads to the second public health revolution. I mean, the first public health revolution was prevention and control of infectious diseases and now the second public health revolution is prevention and control of chronic diseases, which are not bacterial or viruses, but it is a question of certain behaviors. And from behavior we go to aspects in the society as you describe – environments and social. So I think in that way I am pleased.

The only change is when people start changing. The instrument, the vehicle of change really goes from this more direct health behavior and so on. People stop buying butter in this country and that had to change the agriculture. There would have been no way for us to go to the Minister of Agriculture and say, “Stop the dairy industry.” But when people stop, the dairy industry had to change. So to go back a little bit to what I said, this is a question of social change and how do you engineer social change and it is not just by any theory that health people draw a nice box and we go up there and change that. The question is how do you run? That has been all my life and you know I have been a little bit in politics as well. Nobody more than me would like to see broad political change in society for health, but it is not just because we have nice conferences and say, “Do it.” The question is how do you do that? And the only way is through the people and through the more practical changes when people start to make change.

The other aspect is that, of course, it is quite clear that good progress does not continue by itself. I mean there has to be some push for that, there must be health work behind that and so on. So we cannot take for granted that health work continues in good directions. They have to be supported. I am a bit optimistic in the way that I think there is a very basic law of human nature that where standard of living increases there is more attention to immaterial aspects. I mean, in primitive societies the interest is food and housing and a job. The more the standard of living increases the more that people are interested in immaterial things like quality of life, environment, health, and so on. So I am a bit optimistic that in the long run we have certain good things on our side.

Full Transcript Access

Full transcripts of interviews may be made available to those engaged with original materials for scholarly studies by contacting us.