The Institute of Public Health and Clinical Nutrition in one of the four institutes in the School of Medicine. Our main research fields are public health, nutrition and health care & health services. The focus of our research is on the strategic profile area of UEF: Ageing, lifestyle and health.
Public health research
Ageing, lifestyles, and health are global challenges at the core of our university’s strategy. These are exactly the issues our public health research is looking research-based understanding for. We conduct scientific studies on people, populations, communities, and environments, and from multiple health viewpoints. Ageing is of our interest, and so is the health and wellbeing of working age people and of those young ones who still go to school. The list of research questions is endless. Can we identify novel risk factors for worse health? What about less established factors that might strengthen our health? Any new ways to promote health and its various dimensions? What role has the person herself to play? And what about the impact on our health that comes from the social, cultural and physical environment? All of this gives an idea of the central content of our public health research programs. The same theme extends itself to the other research lines at the Institute of Public Health and Clinical Nutrition as well, like studies on health care and health services, and to the broad field of nutritional research.
Non-communicable diseases (NCDs), including heart disease, stroke, various cancers, diabetes, chronic lung disease, mental disorders and neurodegenerative conditions, have become an enormous global burden of disease. The global rise of NCDs has been driven strongly by certain major risk factors, such as tobacco use, unhealthy diet, lack of physical, and harmful use of alcohol. Yet there is still a multitude of questions regarding less established risk factors and the whole complexity of etiologic mechanisms that remain to be answered.
In past decades, we have all seen this happen in Finland. Nowadays, NCDs are a global menace of unforeseen proportions. As the death toll due to infectious diseases has been on clear decline, even when we count recent pandemics, NCDs now account for more than two thirds of all deaths worldwide. Furthermore, 3 out of 4 NCD deaths occur in low- and middle-income countries. The burden weighs even heavier against lower income populations, if we focus on those roughly 16 million people who annually die prematurely before reaching 70 years of age.
In the light of those trends, the Institute of Public Health and Clinical Nutrition recognizes its global responsibility. Our epidemiologic and public health research projects on NCDs are internationally well known. The line of research on this field starts from the North Karelia Project in Eastern Finland in early 1970s and goes through many important research programs, such as CAIDE and IMPRO, not to forget the scientifically productive flagship project, the population-based longitudinal KIHD Study. We are also increasingly participating in major international research consortia, with an idea to pool valuable epidemiologic data from millions of people.
Sociocultural determinants of health are part of the big picture of public health research. In this research area, we seek answers to how social, political and cultural forces shape human health at multiple levels of life. We are interested in understanding the complex relationships between sociocultural, macroeconomic, policy-related, and psychosocial factors on one hand, and individual and public health on the other. The determinants of health extend themselves far beyond individual biology and health behavior, which justifies this line of health research.
In the social domain of this research area, we investigate social inequalities in health that may originate in childhood social disadvantages, in conditions of work life, access to care, or difficulties created by economic or financial circumstances such as the grave 1990s economic depression in Finland.
In the cultural dimensions our projects have included, for example, ethnographic research on cultural beliefs on health issues, spiritual aspects of health, cultural and political conflicts with public health implications, and possible health effects of fine arts and dancing.
The multidisciplinary psychosocial facet of the program covers such research questions as the interplay between personality characteristics and health outcomes, links between mental health and physiological processes, loneliness, addictions and, by applying life course epidemiology approach, childhood psychosocial predictors of health in later life.
This line of research is inherently international. For example, we have been running research projects in the middle of the humanitarian catastrophe in Syria, in areas of Western Kenya that are alternatively ravaged by droughts and floods, among Palestinians experiencing generations-long disenfranchisement, in communities of Pakistan still fighting endemic polio, and in Central Asia looking into the access to and affordability of health care within a transitional Mongolian health policy system.
Sociocultural health and wellbeing is our motto.
A longer life expectancy is one of the greatest achievements of our society. However, financial and health policy challenges are attached to the ageing of the population structure to such an extent that the positive sides of the development and the resources of older people are not entirely recognised. There is, therefore, great demand for research on ageing. We need current epidemiological data on factors related to the health of older people, the occurrence and forecast of long-term illnesses, the need for services and the functionality of service systems, and above all, fresh and functional interventions in order to promote the health and well-being of older people.
Research on ageing at the macro level is, to a great extent, a multidisciplinary cooperation. Our unit and the University of Eastern Finland offer good possibilities for this cooperation. Besides health sciences, there are important domestic and international cooperation partners in many disciplines. Our task is to identify the effects of an individual’s properties, way of life, factors related to the environment and work, and more extensively the effects of current conditions on the health, ability to function and well-being of older people. This requires both a research approach based on a long-term life-cycle and very time-specific intervention research.
Join our multidisciplinary team to look for answers to the following questions, for example:
- How can we turn our ageing workforce into a success factor?
- How can we develop the service system of social welfare and health care in such a way that its operation would continue to be cost-effective and humane also for older people?
- What happens when health and ability to function waver – what is meant by optimised treatment, nutrition and rehabilitation?
Life worth living until the end – promoting good ageing and old age as a health researcher.
The Institute of Public Health and Clinical Nutrition is engaged in broad-based, multi-methodical, and interdisciplinary health promotion research. The main thematic areas of health promotion research are the well-being, health, and health behaviour of children and young people, and health inequalities. We also do research on health promotion in schools and school communities, with a research approach covering pupils, staff members, and parents. Based on these research themes, we have joined the Schools for Health in Europe (SHE) network. Health promotion research offers the means to influence the environments in which children and young people grow up and develop, and various social and societal factors connected to their health.
Nutrition plays a key role in promoting the health and well-being of the elderly. The Institute is one of the participants in the LENTO study (LifE style, Nutrition and Oral health in Care Givers). The study is carried out in collaboration between the Institute of Public Health and Clinical Nutrition, the Institute of Dentistry and the Department of Nursing Science in the University of Eastern Finland, and the Department of Endocrinology and Clinical Nutrition in Kuopio University Hospital.
Living environment affects human health in many ways. At best, it promotes health and healthy lifestyle, but we are also regularly exposed to harmful environmental factors. Many current megatrends modify the health effects of environment, including urbanisation, climate change and environment change in general, and aging of populations in the developed countries.
We conduct environmental health research in cooperation with the Department of Environmental and Biological Sciences and the Finnish Institute for Health and Welfare. Environmental health research is typically multidisciplinary, and therefore we carry out exposure studies and epidemiological studies, as well as health impact assessment. Exposure is typically assessed with measurements and modeling, health effects using questionnaires and register data.
Central topic areas are urban health and the health effects of climate change and its mitigation measures on. These cover research on the health effects of air pollution from traffic and wood combustion, environmental noise from traffic and wind turbines, summertime heat, and urban green space.
Our ongoing work includes e.g. a study on the health effects of heat and adaptation to the changing climate. The project is coordinated by UEF and funded by the Academy of Finland. In another large study, funded by NordForsk, health effects of environmental noise are studied in the Nordic studies.
Nutrition research
Nutrition has a significant impact on health and well-being. The nutrition research at the Institute covers a wide range of investigations, taking into account also the social and psychological aspects related to diet and eating behavior and development of healthy and safe foods. The research methods range from large population studies to genomic- and epigenomic-level investigations and include all ages from newborns to elderly.
This line of research was established in early 1990s. It has been based on controlled dietary interventions to examine the impact of health promoting diet on metabolic responses. The Finnish Diabetes Prevention Study (FDPS) was the first controlled long-term intervention trial to show that type 2 diabetes is preventable by changing lifestyle. Research has focused on the quality of dietary fat, dietary fiber and food patterns and recently more on the interactions of genetic background and diet.
Research groups
We mainly do observational research, but also run clinical trials. Our main study population is the Kuopio Ischaemic Heart Disease Risk Factor Study (KIHD), one of the most extensively examined study populations in the world. An important clinical trial is the Finnish Vitamin D Trial (FIND), a 5-y study of the effects of vitamin D supplementation on disease prevention. We are also involved in the Kuopio Birth Cohort study (KuBiCo), which investigates the effects of genetics and environmental and lifestyle factors during pregnancy on health status of the mother and the child. With our studies we are involved in several international networks, such as NCD Risk Factor Collaboration, the Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group, and Fatty Acids and Outcomes Pooling Project. In order to reduce costs and save time in data collection, we have also created an internet-based and automated food frequency questionnaire (FFQ) to collect nutrition data in large study populations.
Research group
Lifestyle habits form a fundamental basis for health and wellbeing in all phases of life. In our current research projects we have concentrated especially on the promotion of health and wellbeing among children and adolescents as well as those young and older adults with increased risk for type 2 diabetes or marginalization. We aim to find new effective ways and models to promote health and wellbeing through lifestyle counselling and food- and nutrition education within early childhood education and care, primary schools and social and health care. The current projects are Ruokakunta, Maistuva koulu, RuokaTutka, Putting knowledge to use: School meals today and tomorrow, Kehonkuva hyvinvoinnin perustana (KEHUVA) and Stop Diabetes (StopDia).
Research groups
Our research areas cover widely the impacts of food on our health and well-being. Our research laboratories offer facilities to study the digestion of food constituents, gut health and permeability, and relationships between food items and other ingredients with the host and the gut microbiota. Especially we aim to study new protein sources, their structure, safety, bioavailability, and health effects in vitro and in vivo; existing and new probiotics, prebiotics, and other functional foods and ingredients, their identification, safety and availability, and related technologies. Furthermore, we carry out short- and long-term clinical intervention studies as well as organoleptic evaluations. In food safety research, we are currently working on new technological solutions that can increase food quality and extend the shelf life of food products. We work openly with stakeholders and strive to promote open science in the food sector.
Research groups
Health care and health services research
Health care research is a combination of clinical and epidemiological studies, action research, and service system analysis. The key research topics include the use of services, the content, quality and appropriateness of work, and the organisation of services and treatment practices. Using diverse research methods, we identify problems, describe phenomena, evaluate policies and procedures, analyse risk factors and forecasts, do diagnostic tests, and assess the quality and impact of treatment.
Health services research seeks to promote impactful health services. The research approach may be:
- Disease- or problem-oriented – e.g. how to optimise the treatment of cardiovascular diseases
- Patient- or population-oriented – e.g. the burden of illness on an individual, the population as a whole, or the health care system
- Treatment and method-oriented – e.g. ways of implementing the screening and treatment of depression
- Service system oriented – e.g. the impact of service system changes on the use of services and the quality of treatment
Our primary care research addresses, for example, successful treatment of hypertension, the impact of participatory plans of care, the burden of chronic diseases, and the incidence and importance of depression and depressive symptoms in primary care patients. We also study the patient flows of health centre hospitals, the impact of multi-professional medication evaluation, and the role of pre-hospital emergency care in supporting terminal care at home.
Our research in service systems focuses on topics such as the accessibility and availability of services; the optimisation of hospital and emergency services; care paths; effective treatments; assessing the cost-effectiveness of social and health care services; and, optimising the structure and costs of social and health care services through web-based applications.
We are engaged in research collaboration with many other disciplines and research institutes, health centres and hospital districts, and social and health care units. Our research is aimed at creating the conditions for offering good quality, impactful, and equal treatment to patients, and for promoting the health of the population as a whole.
The inequality of occupational health care in Finland is not socially sustainable. While the Finnish occupational health care system functions well, all through the 2010s, the sickness absence rate in the municipal sector varied between professional groups, with up to four-fold gaps between certain professions. For instance, home care nurses, practical nurses, teaching assistants, cleaners, and hospital assistants were absent from work due to being ill 24–31 days a year, while directors, specialists, doctors, and teachers were annually absent from work only 6–9 days. In addition, the causes of burden at work and work ability risks associated with lifestyle choices in the municipal sector accumulate within certain occupational groups, such as home care and practical nurses, and ever more frequently within younger age groups. Another reason for concern is that the health and well-being of these employees is connected to the health and well-being of patients and customers, in other words, to the quality of services.
Work has an important role to play in the promotion of health and well-being. The majority of employees spend approximately 1,600 hours a year at work. Work itself promotes health, but workplaces can also implement health promotion measures. For example, banning smoking in hospitals and eating candy in schools help people make healthy choices. Workplaces could play an even greater role in promoting healthy lifestyles. Social support from the work community is underutilised as a health promotion resource. Would a couch potato be motivated to go for a walk if we all went as a group?
The traditional way of motivating people to make lifestyle changes has been with the aim of preventing future diseases. For example, encouraging people to lose weight this year so that they will not get type 2 diabetes years or decades from now. Could better results be achieved among the working age population if the aim of lifestyle changes was to improve people’s work ability and recovery from work today? For example, to prevent a truck driver from falling asleep at the wheel; to help a specialist stay alert when attending remote meetings all day long; or a nanny who is not too overweight to care for the children. All health promotion efforts in the workplace should be mindful of the requirements and impact of each job and profession. The results will not be the same with office workers and firemen.
Research in occupational health care is multidisciplinary, combining the branches of (social) epidemiology, (social) medicine, psychology, ergonomics, nursing science, health economics, social sciences, and service system analysis.
The thematic areas of research include risk factors for sickness absence and disability pension, and factors supporting returning to work. Our research addresses the health effects of work-related stress and other psychosocial risks associated with work, and the impact of social capital and other resources on health. Other focus areas for research in occupational heal care include shift work and working time arrangements in the social and health care sector, for example in home care; continuing in working life when a person has a chronic disease, such as type 1 diabetes; and health disparities between occupational groups and the means for closing the gap.
Our research also addresses the history of occupational health care physicians; the impact of medical specialist training in occupational health care and the virtual university in occupational health care; and the integration of occupational health care in other health care.
We carry out extensive research with the Finnish Institute of Occupational Health and many other actors in Finland and abroad.
A longer life expectancy is one of the greatest achievements of our society. However, financial and health policy challenges are attached to the ageing of the population structure to such an extent that the positive sides of the development and the resources of older people are not entirely recognised. There is, therefore, great demand for research on ageing. We need current epidemiological data on factors related to the health of older people, the occurrence and forecast of long-term illnesses, the need for services and the functionality of service systems, and above all, fresh and functional interventions in order to promote the health and well-being of older people.
Research on ageing at the macro level is, to a great extent, a multidisciplinary cooperation. Our unit and the University of Eastern Finland offer good possibilities for this cooperation. Besides health sciences, there are important domestic and international cooperation partners in many disciplines. Our task is to identify the effects of an individual’s properties, way of life, factors related to the environment and work, and more extensively the effects of current conditions on the health, ability to function and well-being of older people. This requires both a research approach based on a long-term life-cycle and very time-specific intervention research.
Join our multidisciplinary team to look for answers to the following questions, for example:
- How can we turn our ageing workforce into a success factor?
- How can we develop the service system of social welfare and health care in such a way that its operation would continue to be cost-effective and humane also for older people?
- What happens when health and ability to function waver – what is meant by optimised treatment, nutrition and rehabilitation?
Life worth living until the end – promoting good ageing and old age as a health researcher.