Chronic diseases and health promotion

Part Three. What works: the evidence for action

Chapter One. A strategy to achieve rapid results

Reducing deaths in Poland and Finland

A dramatic reduction in the death rate in Poland

Between 1960 and 1990, Poland experienced a serious increase in death rates from heart disease among young and middle-aged men and women. Unexpectedly, beginning with political and economic changes in 1991, this trend sharply reversed. In people aged between 20 and 44 years, the decline in death rates averaged 10% annually, while in those aged between 45 and 64 years, the annual rate of decline was 6.7%. This was one of the most dramatic rates of decline ever seen in Europe, although similar declines have since occurred in other countries in eastern Europe.

Poland’s results have been attributed principally to the replacement of dietary saturated fat with polyunsaturated fat. Vegetable fat and oil consumption increased (primarily in the form of rapeseed and soybean oil products), while animal fat consumption, mainly butter, declined. These trends were associated with the removal of price subsidies on butter and the availability of cheaper vegetable oils. Other factors contributing to the decline include increased fruit consumption and decreased tobacco use (but only in men). Improvements in medical treatment contributed little, if at all, to the decline in death rates.

Reducing death rates from heart disease in Finland

In the 1970s, Finland had the world’s highest death rate from cardiovascular disease. This was largely a result of widespread and heavy tobacco use, high-fat diet and low vegetable intake. In response to local concerns, a large-scale community-based intervention was organized, involving consumers, schools, and social and health services. It included legislation banning tobacco advertising, the introduction of low-fat dairy and vegetable oil products, changes in farmers’ payment schemes (linking payment for milk to protein rather than fat content), and incentives for communities achieving the greatest cholesterol reduction. Death rates from heart disease in men have been reduced by at least 65%, and lung cancer death rates in men have also fallen. Greatly reduced cardiovascular and cancer mortality has led to greater life expectancy – approximately seven years for men and six years for women.

Heart disease and lung cancer death rates among men aged 30 years and over in Finland: