This document summarizes a research project called Good Ageing in Lahti Region (GOAL), which aimed to promote health and well-being among the aging population in the Päijät-Häme region of Finland. The project involved researchers from multiple universities and organizations collaborating over 10 years to conduct a cohort study, implement community-based interventions, and perform community diagnoses. Interventions focused on prevention of type 2 diabetes and cardiovascular disease through lifestyle counseling, as well as identifying and assisting those with impaired physical functioning. Results showed some interventions were effective at helping participants achieve health goals. The project also shifted emphasis over time from individuals to influencing social and healthcare systems and policies.

1. Improving public health - does research
have an influence?
Mikael Fogelholm, Professor in Nutrition
Department of Food and Environmental Sciences
Faculty of Agriculture and Forestry
Department of Food and Environmental Sciences www.helsinki.fi/yliopisto 4.10.2011 1

2. Health-related grand challenges for
European research: age distribution
100 %
80 %
80+
65-79
60 %
50-64
25-49
40 %
15-24
0-14
20 %
0%
1950 1975 2000 2025 2050
www.helsinki.fi/yliopisto

3. Health-related grand challenges for
European research: dementia
40
30 Dementia
20
%
Stroke
10
Parkinson
0
60 70 80 90 100
Age (years)
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4. Health-related grand challenges for
European research: obesity
25
20
15
% with
overweight
10
5
0
67 71 74 77 80 84 85 86 94 95 98 99 2 3
Overweight among adolescents (12-18 y) in Nordic
countries between years 1967 and 2003.
www.helsinki.fi/yliopisto 4.10.2011

5. Health-related grand challenges for
European research: type 2 diabetes
Non-obese Obese
35
Type 2 diabetes 30
in Finland 25
• 1970: 50 000 20
• 2010: 200 000 %
• 2030: 400 000? 15
10
5
0
46-50 36-40 26-30 46-50 36-40 26-30
Birth year (19..)
The proportion (%) of type 2 diabetics among obese
(BMI>30) and non-obese (BMI<30) in Päijät-Häme
(Lahti region), South Finland. www.helsinki.fi/yliopisto 4.10.2011 5

6. Joint programming perspectives and
motivation
l Harmonizing strategic research approaches within countries to
tackle more efficiently societal challenges
l Synergistic use of shrinking research budgets in a difficult
economic climate
l Grouping calls for grants at the level of several member states on
a voluntary basis will reinforce the potential for scientific
collaboration in Europe
l Accountability to stakeholders in pooling research efforts
addressing common social issues in Europe
l Simplifying European procedures governing scientific collaboration
(and its administration)
www.helsinki.fi/yliopisto 4.10.2011 6

7. Health-related Joint Programming topics
Neurodegenerative diseases, in particular Alzheimer’s
disease
More Years, Better Lives - The Potential and
Challenges of Demographic Change
A healthy diet for a healthy life
The microbial challenge – an emerging threat to
human health
www.helsinki.fi/yliopisto 4.10.2011 7

8. A healthy diet for a healthy life
Policy and societal challenges
• Social inequalities
• Young generation & elderly
• Obesity, type 2 diabetes
• Determinants of choices & health
• Food supply
• Sustainable & reasonable price
• Competitiveness of food industry
www.helsinki.fi/yliopisto 4.10.2011 8

9. A healthy diet for a healthy life
How to change?
Understanding of
• Individual differences
• Relationships between habits-onset disease
• Mechanisms
• Genetic basis
• Needs due to social inequalities
‒ Minority groups
• Social environments
www.helsinki.fi/yliopisto 4.10.2011 9

10. A healthy diet for a healthy life
Research needs identified
• Validation of health claims
• Share databases and large intervention studies
• European Food Research Institute?
• European network on Food-omics
• Long-term European multi-centre intervention
studies
• Standardization of investigation procedures and
designs
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11. Good Ageing in Lahti Region (GOAL),
Finnish research project on ageing and
well-being
www.helsinki.fi/yliopisto 4.10.2011 11

12. The province of Paijat-Hame in the
beginning of GOAL (y. 2000)
Low-tech industry characteristic for town of Lahti,
agriculture for the rural areas
High unemployment rate
Ageing rapidly
Relatively poor health status
Unhealthy lifestyles, high BMI
Municipalities having great economic difficulties,
pressure to organizational changes
Health care sector operating with lowest costs in
the country; and with rapidly ageing personnel
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13. Proportion of 65-74 –y old in Päijät-Häme, yr. 2000
(pink) and 2015 (light blue, predicted)
Hollola
Pukkila
Lahti
Nastola
Orimattila
Iiitti
Hämeenkoski
Artjärvi
Kärkölä
Heinola
Asikkala
Sysmä
Padasjoki
Hartola
0 5 10 15 20
22.6.2006
Finland, 2000 Finland, 2015

14. Good Ageing in Lahti Region (GOAL),
Finnish research project on ageing and
well-being
Collaborators
University of Helsinki, Palmenia
University of Helsinki, Dept. of
Social Policy
University of Helsinki, Division of
Nutrition
National Institute for Health and
Welfare
Lahti Polytechnic (University of
Applied Sciences)
Päijat-Hame Hospital District and
its 15 municipalities
www.helsinki.fi/yliopisto 4.10.2011 14

15. Good Ageing in Lahti Region (GOAL),
Finnish research project on ageing and
well-being: goals
To empower both the population
and the professionals in health
promotion
And as a consequence
To increase welfare, diminish
morbidity, and improve quality
of life among ageing population
in Lahti Region
www.helsinki.fi/yliopisto 4.10.2011 15

16. Good Ageing in Lahti Region (GOAL),
Finnish research project on ageing and
well-being: the three parts
1) 10-year cohort study (2002-2012)
three birth cohorts (baseline n=2815) will be followed,
those born in 1946-50, 1936-40 and 1926-30
needs assessment
general program evaluation
2) Community-based interventions (2002-2012)
evidence-based
implementation studies
development of policies and practicies
3) Community Diagnoses (2002)
combining data from cohort study, statistical reports and
policy documens from each municipality
www.helsinki.fi/yliopisto 4.10.2011 16

17. Self-reported health compared to 1 year earlier
(GOAL cohort, 2005)
100 %
80 %
60 % Worse
Similar
40 % Better
20 %
0%
46-50 36-40 26-30 46-50 36-40 26-30
Year of birth (19..)
Ikihyvä Päijät-Häme, interim report 2005 (Fogelholm et al. 2007)
www.helsinki.fi/yliopisto 4.10.2011 17

18. Self-reported difficulties in performing activities
related to daily living in women, born 1926-30,
1936-40 and 1946-50.
0 10 20 30 40 50 60 70 80 90 100 %
Bathing/dressing
Walk 100 m
Walk 500 m
Stairs 1 floor up
Walk 2 km 1946-50
Carrying food-bag 1936-40
1926-30
Moderate exertions
Kneeing/bending
Stairs several floors
Vigorous activities
Ikihyvä Päijät-Häme, interim report 2005 (Fogelholm et al. 2007)

19. Proportion of individuals with severe
restrictions in walking 500 m or bending,
according to local community type. Results are
adjusted for age and sex.
20
18 * *
* = p<0.001
16 vs. other
14
% 12 Urban
10 Semi-urban
8 Rural
6
4
2
0
Walking 500 m Bending
Fogelholm et al. Scand J Publ Health, 2006
www.helsinki.fi/yliopisto 4.10.2011 19

20. Intervention I: Group-counselling for
prevention of T2D and CVD, based on The
Health Action Process Approach. 1-y results.
Intervention goals GOAL, % DPS, %
N=352 N=265
Total fat < 30E% 48 47
Those achieving 4-
5 goals had SFA < 10E% * 34 26
significantly more
often normal Fibre > 15g/1000 kcal*** 52 25
glucose tolerance at
1-y follow-up Exercise > 30 min / d*** 66 86
(χ2 = 7.120, p < 0.05)
Weight loss > 5% *** 12 43
4-5 goals achieved 20 18
Absetz et al. Diabetes Care 2007, 30, 2465-2470.
www.helsinki.fi/yliopisto

21. Intervention II: Identification and
counselling for individuals with impaired
physical functioning
3rd sector Community health-care
Interventions
Identification of
• Social networking Health Action Process Approach
individuals with
• Strength and Motivation mobility
balance training Empowerment problems
• Nutrition
To the intervention
Back to health care for follow-up measurements
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22. Lessons learned from GOAL
Emphasis shifted from individual towards social and
health care sector and municipal administration as
primary targets
Sensitivity to emerging intervention needs
Interventions support each other ideologically,
structurally and methodologically
During its brief history, GOAL has established itself
as a developmental resource in Päijät-Häme – but it
takes time to overcome resistance!
Maatalous-metsä tieteellinen tiedekunta / Henkilön
nimi / Esityksen nimi www.helsinki.fi/yliopisto 4.10.2011 22