Pekka Puska

Finnish research scientist, Professor Pekka Puska is the Director General of the National Institute for Health and Welfare (THL). THL is a comprehensive national institute for public health and welfare under Ministry of Health in Finland. It employs some 1300 persons and covers a broad range of health and welfare issues from disease prevention, nutrition, lifestyles and environment, infectious disease control and national vaccination programs to health and social services, health and welfare monitoring and statistics. THL has major national service functions, various surveillance tasks, high level research and numerous international activities. The National Institute for Health and Welfare (THL) was formed after a merger of the National Public Health Institute (KTL) and the National Research and Development Centre for Welfare and Health (Stakes), and started its work in January 2009. Prior to his present position Professor Puska was the Director General of KTL and, before that, the Director for Noncommunicable Disease Prevention and Health Promotion at the World Health Organization Headquarters (WHO HQ) in Geneva. Professor Puska has, for most of his career, worked at the National Public Health Institute. He was, for 25 years, the Director and Principal Investigator of the North Karelia Project: prevention of cardiovascular diseases in North Karelia and later on in all Finland. Within 25 years, over 80% decline in annual heart disease mortality among the working age population and a dramatic general improvement in public health took place. The project is widely seen as a model for successful population based prevention of cardiovascular and other noncommunicable diseases (NCD). At the World Health Organization (WHO), Professor Puska directed the work on integrated prevention of NCD targeting the main risk factors (unhealthy diet, physical inactivity and tobacco) through health promotion, national programs, policy measures and regional networks. Professor Puska's Department was the focal point of this work that culminated in adoption of the Global Strategy on Diet, Physical Activity and Health by the World Health Assembly in 2004. Professor Puska has, internationally and domestically, been involved in a number of scientific, expert and public health functions, WHO's work, multinational projects etc. He has over 500 scientific publications. Professor Puska has served as a Member of the National Parliament of Finland. In his current position as Director General of THL Professor Puska has a central position in Finnish public health work and in health & social policy issues. Internationally, Professor Puska is the immediate Past-President of World Heart Federation and the President of the International Association of National Public Health Institutes (IANPHI) and also the Chair of the Governing Council of the WHO International Agency for Cancer Research (IARC). Professor Puska has M.D and M.Pol.Sc. degrees and PhD in epidemiology and public health. Among several honors are Honorary Doctorate at St. Andrew's University (Scotland) and Academician of Russian Academy of Natural Sciences. He has received, among other things, WHO's annual Health Education Award in 1990, WHO Tobacco Free World Award in 1999, the Nordic Award for Public Health in 2005, and the Rank Prize in 2008. Professor Puska is Director and Principal Investigator of the comprehensive community-based program (North Karelia Project) to substantially reduce extremely high cardiovascular disease mortality in Finland. Finland has, with the North Karelia Project, achieved remarkably good results and provided a model for successful chronic disease prevention and health promotion around the world. Lifestyles are now healthier, risk factor levels are lower, and disease rates have greatly diminished in Finland. Important dietary changes have been substantial decrease in salt and saturated fat intake and an increase in the vegetable consumption. Annual cardiovascular mortality rates among working-age people are now some 80 % lower than at the outset; life-expectancy has much increased and public health has greatly improved. The North Karelia Project was the first comprehensive community-based research exercise with main idea to demonstrate a beneficial impact of dietary changes in the population on cardiovascular death and disability. Professor Puska is the author of the great number of articles, a comprehensive reports and two books, published from 1972 year up today. His studies describes the latest experiences and results, but also at the same time repeat the historical information on the background, principles, methods, early activities and experiences of the North Karelia Project. Professor Puska as a creator of this pioneering project is a founder of the community-based strategies for noncommunicable disease prevention in the world, the one who has motivated hundreds of young researchers to contribute to the knowledge of the public health nutrition and lifestyle interventions to reduce noncommunicable diseases. Annual North Karelia week is arranged for the international research community and health professionals to spread the good experiences how to change life style and decrease noncommunicable disease risk. The North Karelia Project radically adjusted the habits of a whole community of Finnish population and fundamentally changed society itself. The links with many international developments as well as with the WHO have increased during its 40 years of existence. The results and experiences gained in the North Karelia Project give great support to WHO initiatives on chronic, noncommunicable disease prevention. This and other work in Finland paved the way for the Health in All Policies (HiAP) initiative started during the Finnish European Union (EU) presidency in 2006. The initiative and the principles have been linked with related developments within the EU and the WHO. Professor Puska started comprehensive, multi sectoral action to reduce the world's highest mortality from coronary heart disease in North Karelia and lately on in Finland demonstrating in his own country, whether blood concentration of cholesterol and blood pressure levels could be lowered by altering the national diet. A high priority target of the dietary intervention was reduction of highly saturated fat intake and salt and low intake of vegetables. The link between high blood cholesterol level and increased risk of atherosclerotic, obstructive disease of the coronary, cerebral and peripheral arteries has been recognized many years ago. Professor Puska, selecting the most affected Finnish province of North Karelia has drawn attention on the need for inter sectoral work and for considerating the health aspects of different policy proposal on the basis of historical development a framework. The general idea was to transform the social and physical environment of North Karelia. The North Karelia Project is unique example of a whole population intervention, mobilizing government and public support, many sectors such as food manufacturers, farmers, schools, voluntary organizations and others. With their support, he and his team began a well-organized and sustained comprehensive action in North Karelia as a pilot for nationwide prevention throughout Finland. Rather than a number of vertical disease-specific programs, an integrated approach targets main common behavioral risk factors for a range of chronic diseases. In the focus was to change the general risk-related lifestyle including nutrition, physical activity and smoking in the area through community-based action. During the initial 5-years period of the Project marked changes were observed in risk-related lifestyle and risk factors. The incidence of coronary heart disease among working-age man living in North Karelia fell significantly. Within 25 years, a spectacular reduction of about 80% in national coronary mortality rates was achieved among the working population. The major part of coronary risk reduction is statistically attributable to the fall in average blood cholesterol associated to dietary modification along with other measures such as smoking reduction and blood pressure control. The North Karelian and Finnish experience has greatly influenced nutrition policy and behavior over the world and has been responsible for major reductions in mortality and morbidity from cardiovascular disease. The clear demonstration of the protective value of lowering blood cholesterol has also opened the way for powerful new non-pharmacological approach to reinforce the effect of dietary modification. Professor Puska has extensive research activities in nutrition, food science and technology, food composition and utilization in humans. He and his co-workers showed the ability of certain ingredients such as dietary plant sterols, especially sitostanol that reduce serum cholesterol by inhibiting cholesterol absorption. They tested the tolerability and cholesterol-lowering effect of margarine containg sitostanol-ester in a population with mild hypercholesterolemia. Substituing sitostanol-ester margarine for part of the daily fat intake in subjects with mild hypercholesterolemia was effective in lowering serum total cholesterol and LDL cholesterol. The results and experiences of the North Karelia Project give great support to the WHO initiatives such as Global Strategy for prevention and control of noncommunicable diseases, the Framework Convention on Tobacco Control and the Global Strategy on Diet, Physical Activity and Health. Publications: 1. Puska P., Ståhl T.: Health in all policies-the Finnish initiative: background, principles, and current issues. ANNU REV PUBLIC HEALTH 2010;31:315-328. 2. Puska P.: Fat and heart disease: yes we can make a change--the case of North Karelia (Finland). Ann Nutr Metab 2009;54:33-38. 3. Puska P.: The North Karelia Project: 30 years successfully preventing chronic diseases. Diabetes Voice 2008;53:26-29. 4. Miettinen TA., Puska P., Gylling H., Vanhanen H., Vartianen E.: Reduction of serum cholesterol with sitostanol-ester margarine in a mildly hypercholesterolemic population. N Engl J Med 1995;333:1308-1312. 5. Puska P., Iacono JM., Nissinen A., Korhonen HJ., Vartiainen E., Pietinen P., Dougherty R., Leino U., Mutanen M., Moisio S., Huttunen J.: Controlled, randomized trial of the effect of dietary fat on blood pressure. Lancet 1983;1:1-5.