The North Karelia Project

One of the bloggers that I follow regularly, Tim Worstall, wrote about the North Karelia Project, quoting The Guardian.

I can see his point, but I think he missed a thing when pointing out that there was nation-wide decrease in coronary heart disease at the same time with the local project. As is visible in the WHO article, the vertical line in 1977 indicates a point of time when the project in North Karelia was expanded to a nation wide activity. Thus, it is conceivable that both the local collapse and the nationwide decrease of coronary heart disease in Finland are partially due to actions adopted in the North Karelia Project. The nation-wide trend had its reasons.

Regarding Guardian, it isworth noting (though not very surprising, given that it's The Guardian) to see how the North Karelia project is used for arguing for income redistribution, when the actual findings are about something quite different. Professor Puska writing for WHO may of course want to highlight the achievements of a young MD Pekka Puska who happened to be in charge of the project, and one way to ensure funding for future projects is to preach for "equality" which means redistribution, which means taxes and related projects, which means tax money funding for his projects.

However, as far as I remember, the actual point of the North Karelia project wasn't income distribution at all; it was teaching better diet practices to people. If we start to talk about distribution of information instead of redistribution of wealth, then things start to make sense. The inequality is not about income, it is about how much people know and understand their own behaviour.

So, to get back to the WHO article, in my opinion, it goes wrong when it repeats fashionable mantras about inequality. But I think that is mostly just because the author wants to please the potential funders of expanded projects.

The North Karelia project is not without its merits: eating excessive amounts of pig fat probably might not be good for your health. And although many men in North Karelia still have an agreement with the hares (“I don’t eat your food, you don’t eat mine”), the consumption of fresh vegetables has increased.

This is, of course, not only because of the project: the change is also due to the introduction of refrigeration, international transport and globalized food trade to such an extent that the oranges and bananas these people see are no longer models made of porcelaine displayed in school classes, as they were for my parents’ generation. Rural Finland in 1940’s was vastly different from today.

Some researchers have argued that the significant reduction in deaths over CHD are not really due to North Karelia project and its nationwide expansion, and people eating more lettuce; it is because the generations that suffered extreme poverty and malnutrition in their childhood have passed away, and the age bracket 35-64 is now filled by people who grew up getting a daily meal at school and enjoyed a generally much better diet in their youth (“better diet” actually meaning “enough calories”) and this change was achieved already before the North Karelia project.

There was true, wide-spread hunger and undernourishment in North Karelia the first half of 20th century, and that was removed for the children of 1950’s.

Note that North Karealia of 1960's was a very different place from North Karelia of 2010, not to mention any British place of 2010. It is argued that much of the health problems that middle-agers of 1972 suffered - resulted from malnutrition and hunger experienced in their childhood, 1920's to 1940's, some of this caused by war. Malnutrition was solved, more than adequately. But that solution is irrelevant and possibly counter-productive if applied to modern British or Finnish cities, where the health problems are caused by too much pizza and carbonated sugar water - not lack of calories for children.

Starting in 1970's, the men in North Karelia also changed from back-breaking heavy forestry work (tools: a bucksaw, an axe, and if you’re wealthy, a horse with sled) to use chainsaws and tractors, and then onwards to different jobs (or unemployment benefits). And even if they stayed in forestry, they started to use advanced equipment from the likes of Ponsse ( http://www.ponsse.fi/ ) which, incidentally, is nowadays responsible for the municipality with the greatest amount of income inequality in the country – because in the small town where the company comes from, everyone is relatively poor except the one man who owns a large portion of the stock-listed corporation that he created to make these machines that have liberated thousands of forestry workers both from their jobs and from a need to eat horrific amounts of fat to produce enough energy to survive their jobs.

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