7.4 Healthy lifestyles and healthy nutrition
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The elaboration of the Strategy on the Rights of the Child in health (2017-2025) (Στρατηγική για τα Δικαιώματα του Παιδιού στην Υγεία) is part of the Ministry of Health's priorities included in its Strategic Plan for the years 2017-2025, and is specifically targeting young people up to the age of 18 years old. This National Strategy aims to be a "guide" emphasizing the promotion and protection of the health rights of children residing in Cyprus, providing a clear framework for action to improve the current structures and, through interdisciplinary collaboration methods, provide holistic health care to the child, with their own active involvement. The content of the strategy sets the guidelines for all stakeholders on their issues of competence. It also includes specific objectives and defined actions to be promoted by those involved.
The Strategy is founded on eight pillars as follows:
- Health Services for the Child
- Non-Communicable Diseases (NCDs)
- Nutrition and Maternal Breastfeeding
- Infectious Diseases - Vaccinations
- Prevention of violence and accidents
- Alcohol, Substances, Tobacco
- Sexual and Reproductive Health and Rights
The National Strategy on the Sexual and Reproductive Health of Youth (2018-2025) (Εθνική Στρατηγική για τη σεξουαλική και αναπαραγωγική υγεία των νέων) is also part of the Ministry of Health's priorities included in its Strategic Plan and was prepared with the assistance of executives from various ministries and other public and private sector bodies, non-governmental organizations and representatives of the young people themselves who participated in a two-day workshop of the Ministry of Health, which was organized on 13-14 of June 2017 in Nicosia, in cooperation and with the participation of a World Health Organization (WHO) representative for the Region of Europe. The Strategy targets young people from 15-29 years old, who amount to 188 375 people representing 22% of the total population in the government-controlled areas of Cyprus. The Key Action Pillars of the Strategy are the following:
- Parental Health
- Family Planning - Infertility - Birth Control, Adverse Pregnancy - Abortion
- Sexually Transmitted Diseases (STIs) - HIV / AIDS - Reproductive System Infections
- Prevention of Cancer of the Reproductive System
- Preventing and Managing Cases of Sexual Violence
The National Strategy for the Prevention and Management of Violence in School (Εθνική Στρατηγική για την Πρόληψη και Διαχείριση της Βίας στο Σχολείο) runs between 2018-2022 under the supervision of the Ministry of Education,Sport and Youth, and specifically the Cyprus Observatory on School Violence (COSV). It is envisioned that through the implementation of the National Strategy, schools are safe, democratic and child-friendly spaces where all children are actively involved, enjoy their rights, co-opt, acquire knowledge and skills, cultivate values and attitudes that lead them to develop their full potential.
The key action pillars of the strategy are:
- Creation of information systems
- Legal and administrative measures to prevent and manage violence at school
- Strengthening structures
- Enriching knowledge and enhancing skills for developing peaceful attitudes and behaviours by students
- Involvement of children
- Empowering parents / guardians, teachers, management teams
A Monitoring Committee (Επιτροπή Παρακολούθησης) has been appointed on the decision of the Council of Ministers to monitor the implementation of the Strategy. The Committee consists of representatives from the Ministry of Education,Sport and Youth, the Ministry of Justice and Public Order, the Ministry of Health, the Deputy Ministry of Social Welfare (Υφυπουργείο Κοινωνικής Πρόνοιας), and any actor undertaking actions in the field. Responsibilities of the Monitoring Committee are:
a. Monitoring the implementation of the actions of the National Strategy;
b. The dissemination of valid and timely information to the public through various means;
c. The approval of material which will be used during the actions of the National Strategy. So far, no monitoring results have been made publicly available.
The National Strategy for Addressing Addictions 2021-2028 (Εθνική Στρατηγική για την Αντιμετώπιση των Εξαρτήσεων 2021- 2028) succeeds the National Strategy on Illicit Substances Dependence and the Harmful Use 2013-2020 which was produced by the Cyprus National Addictions Authority (NAAC) . The purpose of the Strategy is for children, young people, and all citizens of the Cypriot society to have access to prevention, treatment, reduction of harm, and social support services in a protective environment from all kinds of addictions. The Strategy will be implemented/divided in two Action Plans: 2021-2024 and 2025-2028. The first Action Plan 2021-2024 (Σχέδιο Δράσης 2021-2024) is already available in Greek and it is based on six pillars:
- Social Support
- Reduction of harm
- Reduction of supply
- Research – Evaluation – Education
- International Cooperation
The NAAC is responsible for the overall coordination, implementation, supervision and monitoring of the national strategy and its action plans. It is important to mention that the previous National Strategy 2013-2020 received an external evaluation in September 2020. The outcomes of the evaluation are presented in an extensive report named “Evaluation of the National Strategy on Illicit Substance Dependence and the Harmful Use of Alcohol 2013 - 2020 of the Republic of Cyprus”. Some of its main outcomes reveal that there is a need for more targeted prevention for minors and early school leavers, there is little provision of objective information about the effects and risks of different drugs and alcohol in Cyprus, the collaboration between stakeholders appears to be limited, there is a need for targeted treatment programs for migrants and stimulant users, and there are few structures for social reintegration. For extensive information about the evaluation of the previous National Strategy, please read the detailed report.
Action Plan for Child injuries and poisoning 2016-2020 (Εθνικό Σχέδιο Δράσης για τα Ατυχήματα και τις Δηλητηριάσεις στα Παιδιά 2016-2020): The Ministry of Health, recognizing the need for a coordinated approach for addressing the problem of childhood injuries and poisonings, began in 2002 the first coordinated actions with the establishment of the Advisory Committee for the Prevention of Childhood Injuries and Poisonings, with a key mandate to develop an action plan on childhood injuries and poisoning. Cyprus was the first country on a European level to develop and adopt a Strategic Action Plan to Prevent Accidents and Poisoning in Children.
The Action Plan aims to substantially reduce morbidity and mortality from unintentional injuries (road crashes, drawing and suffocation, falls, poisoning and burns and scalds) by setting realistic goals and taking advantage of the good practices of other countries. For each type of accident, the basic principles of prevention that have been repeatedly tested in many countries with a great success have been also adopted in this action plan. These principles are as follows:
- programming and educational intervention to ensure greater safety for children
- enforcement /legislation
- environmental and product modification
The National Strategy for the Protection, Promotion and Support of Breastfeeding (Στρατηγική Προστασίας, Προαγωγής και Υποστήριξης του Μητρικού Θηλασμού στην Κύπρο) (2011) seeks to increase both the initiation of breastfeeding rates at hospital discharge and its exclusive continuation for the first six months. Based on the demographic statistics of 2019 (δημογραφικές στατιστικές 2019), the mean age of women at the birth of their first child was 29,6 years in 2019, while the mean age at birth irrespective of the order of the child was 31,2 years. Therefore, this strategy is particularly relevant for young mothers. The Strategy is based on four main pillars:
- Policy, Planning, Management and Funding
- Information, Training, Education
- Data Recording and Monitoring System
Each of the pillars is analysed in objectives that constitute the basis for the development of concrete actions. The overall coordination of the Strategy is under the Ministry of Health.
The National Strategy of Cyprus against Diabetes (2016-2020) (Εθνική Στρατηγική για τον Σακχαρώδη Διαβήτη) is the result of the consultations conducted among representatives of the International Diabetes Federation (IDF), patients' organizations, universities, scientific societies and ministerial departments with the Ministry of Health. The Strategy is based on five pillars:
- Prevention and health promotion
- Diagnosis and treatment
- Rehabilitation services
- Documentation/diabetes registry
The key objectives of the strategy are to prevent diabetes and its complications, to ensure the quality of services at low cost, and provide effective care according to the needs of each individual (vulnerable groups) through a holistic approach. The strategy is particularly relevant for youth, because as noted in the strategy, research data shows an increasing rate of Type 1 and 2 diabetes among young people and children.
Finally, the National Strategy for a better Internet for Children in Cyprus (2018-2023) (Εθνική στρατηγική για ένα καλύτερο διαδίκτυο για τα παιδιά στην Κύπρο) prioritises sensible and responsible use of the internet by young people. For more information about this Strategy, please read the 6.8 Media literacy and safe use of new media .
The Mental Health Services of the Ministry of Health provide free smoking cessation programs that incorporate a combination of interventions, counselling (evidence-based protocol that supports cognitive behavioural interventions) and pharmaceutical use (implementation of nicotine patches step 1: 25 mg, step 2: 15 mg, step 3: 10 mg). These programs are free of charge and are provided throughout the country in all the cities (Nicosia, Limassol, Paphos, Larnaca, and the Famagusta area). Individuals who are interested in quitting smoking can contact the Smoking Cessation Programs on a toll-free number (1431), available throughout the country. Then, their information is recorded, such as their name, phone number and town where they live, and they are contacted by officers of the SCP to arrange a group or individual meeting or just become informed about the program. The programs are usually short-term and include one hour long weekly meeting for about 6 to 8 weeks. The counsellors assist the individuals to be motivated for a smoking cessation, to choose when to quit, form a rationale behind quitting, to become psycho-educated in regards to the physical and psychological addiction from nicotine and guidance towards the steps for maintaining the cessation. Throughout this process, the individuals are supported during their attempts to quit, and are encouraged to discuss difficulties and positive consequences from smoking cessation with their counsellors. Their relapses are addressed, and assistance is provided on how to face them. Individuals have their carbon monoxide calculated with smokelryzers (breath carbon monoxide monitors intended for multi-patient use), a method which appears to be a useful tool for motivation and increases goal engagement. The SCP, however, does not assist young people under the age of 18.
Pharmaceutical aids - each person receives counselling intervention as well as free nicotine patches based on each individual’s personalized needs, so that the smoking cessation process is more effective.
Treatment programmes in Cyprus (Θεραπευτικά προγράμματα στην Κύπρο)
There is a number of treatment services for illicit substances, alcohol and pathological gambling / gambling disorder that are available in Cyprus and approved by the Cyprus National Addictions Authority (NAAC). The treatment services address to minors and their families, but also adults above the age of 18, and they include – among others – counselling, individual and group therapeutic interventions, detoxification and psychological support. The relevant guide of the provided services is available only in Greek (Οδηγός Υπηρεσιών Θεραπείας για τις Παράνομες Ουσίες, το Αλκοόλ και την παθολογική ενασχόληση με τυχερά παιχνίδια).
Safer Gambling Week: The National Betting Authority was established in 2012, following the Betting Law of 2012, 106(I)/2012. Every year is implementing the Safer Gambling Week that is a safe space where specialists and ordinary people co-exist. A platform hosting information exchange and meaningful dialogue, a meeting point for involved bodies, Gambling Sector professionals and players and their families and friends.
Health Education Programmes organised in schools of all educational levels
- Funding the school unit actions. The funded actions are designed to strengthen the factors that serve the goals of Health Education as they have emerged both for the Cypriot and international reality: Development of personal and social skills, effective management of emotions and development of communication skills, promotion of self-esteem, improvement of the psychosocial climate at school, support of the family self-sufficiency. The request for a grant is made to the Health Education and Citizenship Coordinating Committee.
- Supporting schools for the holistic treatment of serious delinquency cases. The School Violence Intervention Team (SVIT) supports schools in Secondary General, and Secondary Technical and Vocational Education to deal with serious incidents and/or phenomena of extreme delinquency. The main role of SVIT is to support schools in the development and implementation of action plans based on a holistic and systemic approach. This process involves the collaboration between the school and several government and community services and organisations, and other key players, based on the needs of each case.
- Grant of non-school related actions to support pupils belonging to vulnerable groups. The program is operational since 2012 and is part of the MOEC’s commitments to the National Strategy of the Cyprus National Addictions Authority to address the National Strategy on Illicit Substances Dependence and the Harmful Use 2013-2020. The MOEC with the Committee of Health Education and Citizenship favour the development of actions by schools aiming at involving these children in non-school activities, to make creative use of their free time. The actions aim at offering substantial support (learning, emotional, social, self-empowerment, highlighting and fostering talent, developing a safe lifestyle) to pupils who belong to vulnerable groups.
- “Well-being” Health Education Program (Πρόγραμμα «ΕΥ ΖΗΝ»): the program is the result of an inter-state agreement between Greece and Cyprus. Within the framework of this programme, each participating school from Cyprus cooperates with a school from Greece for two years and explores an issue related to health (smoking, alcohol, drugs, food, etc.).
- Sex education Program: This program is the result of collaboration between the Ministry of Education, Sport and Youth and the Medical Association. It deals with the sexuality of the individual and aims to develop interpersonal relations, respect, and mutual understanding between the two sexes.
- School without tobacco: All schools from all levels of education are expected to implement actions against smoking for pupils, teachers, parents and guardians. An outline of a policy that can be adopted by the schools as well as activities that can be carried out both at school and in the classroom are attached with the circulars. Moreover, information is given about the negative effects of smoking on a person’s health and statistics about teenage smokers in Cyprus. Details about private and state stakeholders that can support anti-smoking plans of action are supplied.
- The Anti-HIV/AIDS educational program course for Lyceum students is being applied by the School Health Service of the Ministry of Health. The scope of this course, which is carried out by means of dialogue, games and through role-playing, offers the students some knowledge on AIDS and the sexually transmitted diseases, and aims at the development of a healthy attitude and behaviour and the acquisition of ways of resistance through various exercises as well as to increase children’s sensitivity to the consequences of AIDS.
Health Education: Based on the MOEC’s official website, within the context of the implementation of the New Curricula in the Cypriot Education System, Health Education has been introduced since 2011 in the syllabuses of Upper Secondary General Education Schools as a cross-curricular program. The students not only have the chance to get informed about the physical consequences of certain behaviours but also to consider the factors that affect their behaviour, to practice communication and cooperation skills, to manage conflicts and cope with peer pressure, to deal with social stereotypes, to manage issues such as security, education consumer rights and responsibilities, road safety, obesity, etc. The purpose of the Health Education Curriculum (Αναλυτικό Πρόγραμμα Αγωγής Υγείας) is to promote the mental, physical and social well-being of students as a means of life through the development of personal and social skills and through collective action that will upgrade their social and physical environment. There are four main topics addressed through Health Education:
- Development and empowerment of self
- Develop a safe and healthy lifestyle
- Creating and improving the social self
- Formation of an active citizen
The Health Education Program does not seek to cover only the teaching process within the classroom but also ensure that students can live and operate in an environment that promotes the adoption of healthy lifestyle choices. Within this framework, all schools are encouraged, starting in 2009 on an annual basis, to develop a Health Education and Crime Prevention Action Plan aiming at taking initiatives and actions locally in the school unit for addressing timely social problems and in particular delinquency and security environment, tolerance, cooperation. The Health Education Course supports schools in the holistic approach to serious offending incidents through the Rapid Response Team. There is a large number of pedagogical tools and resources provided to teachers responsible for health education, including seminars for teachers, access to printed and online material as well as promotion of good practices on Health Education. Some of the available resources and seminars for the educators can be found on the Cyprus Pedagogical Institute (Παιδαγωγικό Ινστιτούτο Κύπρου) website (Αγωγή Υγείας – Βιβλίο, Εγχειρίδια, Υλικό).
Sex education and personal relationships education: Issues related to sexual education are mainly integrated into the curriculum of Health Education in the thematic sub-section “Family Programming, Sexual and Reproductive Health”. The sub-section contains topics that are directly related to a holistic understanding of sexual and reproductive health such as national and European legal framework, stereotypes, domestic violence, dangerous sexual behaviour, homophobia, the role of religion and the media, etc. These themes are approached in relation to the role of pressure friends, values of life, sex stereotypes, self-confidence, her security, rights and obligations as well as abuse substances. The topic of sexual education is also embedded in the school subjects of Physics and Biology as a cross-curricular program.
Grant of non-school related actions to support pupils belonging to vulnerable groups. The program is operational since 2012 and is part of the MOEC’s commitments to the National Strategy of the Cyprus National Addictions Authority to address the National Strategy on Illicit Substances Dependence and the Harmful Use 2013-2020. The MOEC with the Committee of Health Education and Citizenship favour the development of actions by schools aiming at involving these children in non-school activities, to make creative use of their free time. The actions aim at offering substantial support (learning, emotional, social, self-empowerment, highlighting and fostering talent, developing a safe lifestyle) to pupils who belong to vulnerable groups.
Currently, there are no top-level guidelines, programmes projects or initiatives facilitating or relying on peer-to-peer education.
At the end of 2021, the Ministry of Education, Sport and Youth (MOEC) in collaboration with the Cyprus National Addictions Authority (NAAC) signed a cooperation agreement (Συνεργασία μεταξύ Αρχής Αντιμετώπισης Εξαρτήσεων Κύπρου και Υπουργείου Παιδείας, Πολιτισμού, Αθλητισμού και Νεολαίας για την πρόληψη και αντιμετώπιση παράνομων ουσιών εξάρτησης στο σχολείο), which consists of 3 annexes:
- The “Cooperation Protocol for the Prevention and Treatment of Illicit Substance Abuse in Schools” (Πρωτόκολλο Συνεργασίας για την πρόληψη και αντιμετώπιση των παράνομων ουσιών εξάρτησης στο σχολείο μεταξύ του Υπουργείου Δικαιοσύνης και Δημοσίας Τάξεως (Αστυνομία Κύπρου – Υπηρεσία Καταπολέμησης Ναρκωτικών), του Υπουργείου Παιδείας, Πολιτισμού, Αθλητισμού και Νεολαίας (Διευθύνσεις Σχολείων) και της Αρχής Αντιμετώπισης Εξαρτήσεων Κύπρου). The Cooperation Protocol sets the objectives of the collaboration, the various actors who participate in the Protocol, the framework and guidelines under which they collaborate for the prevention and treatment of illicit substances abuse in schools as well as other important parameters.
- New Protocol for referring students who display addictive behaviours in treatment programs (Νέο Πρωτόκολλο για την Παραπομπή Μαθητών/ Μαθητριών που παρουσιάζουν/εμφανίζουν εξαρτητικές συμπεριφορές σε θεραπευτικά προγράμματα). The Protocol refers to students of Secondary General and Secondary Technical and Vocational Education who display addictive behaviours in the school environment.
- A list of programmes funded and approved by the Cyprus National Addictions Authority (Επιχορηγημένα και Αδειοδοτημένα Προγράμματα της Αρχής Αντιμετώπισης Εξαρτήσεων Κύπρου) in which students can participate after they have followed the referral procedure.
The collaboration between the MOEC and the health professionals-visitors is vital for promoting healthy lifestyles to students of all ages in schools. Their operation began with a Ministerial Decision in 1976. In particular, School Health Services (SHS) are provided to all children attending Primary, Middle, Secondary General and Secondary Technical and Vocational Education schools. School Health Services staff is comprised by health professionals that can help all students within the school environment. As the contribution of the health professionals for encouraging healthy lifestyles and health nutrition falls largely into the category of information and counselling structures, it will be discussed in the following section.
Raising awareness on healthy lifestyles and on factors affecting the health and well-being of young people
Information providers / counselling structures:
- Lectures for future parents and pregnant women are provided by the Health Visitors of the Ministry of Health. These lectures are targeting future parents and pregnant women for informing, educating and preparing them for their new role. Contact points are the respective general hospitals of the districts of Nicosia, Limassol, Larnaca, Paphos and Famagusta area.
- Lectures on the implications of smoking again by the Health Visitors of the Ministry of Health for young people to be informed on the implications of smoking in their life.
- Lectures on the Prevention of HIV/AIDS and sexually transmitted diseases aim at providing students the necessary knowledge and competencies for the development of healthy lifestyles of students. These programmes are provided by Health Visitors, in cooperation with the administration and teaching personnel of the public schools.
- The program “TARGET” for Drug Harm Reduction and Drop –in Center coordinated by the Nursing Service Administration of the Ministry of Health in cooperation with the Cyprus Anti-Drugs Council contributes to a multidimensional field in Drug Addiction ranging from measures to protect vulnerable populations with difficulties in accessing health services to measures of broader beneficial public health interventions to society as a whole. Contact point of the programme is the Cyprus Anti-Drugs Council.
- Protection and Health Promotion Programs for special groups - Health Visitors in collaboration with other agencies and services provide preventive health care services (ex. immunizations, tuberculosis tests, health promotion programs) to special groups of people, such as enslaved persons, prisoners, immigrants, asylum seekers.
- Information and awareness-raising campaigns on reducing the exposure of children to second-hand smoke (Εκστρατείες Ενημέρωσης και Ευαισθητοποίησης για τη μείωση της έκθεσης των παιδιών στο παθητικό κάπνισμα) – The campaigns are organised since 2005 by the Cyprus National Committee on ''Environment and Children’s Health'' and they include lectures, pilot surveys, development of audio-visual materials and participation in radio and television broadcasts as well as in other media channels. Each year, the Committee also organises a one-day conference on different topics on children’s health. Information material can be found also on the official website of the organisation.
Youth-targeted information campaigns:
The K.Y.F.A (HIV/AIDS Supporting Center) organizes information campaigns (Πρόγραμμα ενημέρωσης μαθητών δευτεροβάθμιας και τριτοβάθμιας εκπαίδευσης) to secondary and tertiary education students on the topic of HIV and its prevention. The Centre has also a mobile check-point (Κ.Υ.Φ.Α. CheckPoint) that provides information and on-spot free anonymous HIV test to the public. The mobile check-point visits several universities – especially during the HIV International Day – in order to sensitise young people on the topic of HIV. In addition, the Ministry of Health organises several informational campaigns about smoking targeting young people of the island. However, there are no major, large-scale, youth-targeted information campaigns on healthy lifestyles and factors affecting the health and well-being of young people in Cyprus. Informational campaigns normally target the general population of the island.