7.4 Healthy lifestyles and healthy nutrition
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National Action Plan on Children and Young People’s Smoking in Denmark (National handleplan mod børn og unges rygning)
In December 2019, the Danish government and a majority of the political parties in parliament agreed on a national action plan targeting tobacco use among children and young people.
The bill implementing the national action plan was adopted in December 2020. Some of the initiatives in the action plan are:
- Ban on displaying cigarettes, tobacco surrogates, etc. in shops
- Plain packaging of tobacco products, electronic cigarettes, etc.
- Further restrictions on advertising and sponsorship
- Further restrictions on the use of tobacco, etc. in institutions and schools for children and adolescents. Ban on any form of tobacco use and suchlike during school hours – the ban also applies to pupils leaving the property of the institution during school hours, for instance during excursions, etc. Ban on sale of tobacco, etc. in these schools and institutions
- Ban on distinctive flavours except menthol and tobacco in electronic cigarettes
- Regulation of non-tobacco nicotine products (referred to as ‘tobacco surrogates‘ in the bill)
- Strengthened control of sales of tobacco products to minors and increased fines
- Increased fines for violations of the Smoke-Free Environments Act
The objective is to reduce the number of smokers – especially that fewer adolescents start smoking or become addicted to other nicotine products. It is also the intention to ensure that smoking or the use of other nicotine products does not appeal to children and adolescents, and that children and adolescents are not confronted with these products (e.g. during their schooling).
Strategy for promoting healthy and sustainable diets among young people in Denmark
As part of the Danish government’s commitment to reducing the nation’s climate footprint, the Ministry of Food, Agriculture and Fisheries is working with a strong focus on promoting healthy and sustainable diets and food systems.
The Danish Veterinary and Food Administration will, in line with the Ministry of Food, Agriculture and Fisheries, and as part of a 2021-2023 strategy, provide Danish consumers with information and tools for a more healthy and sustainable living from a dietary point of view. Consumer engagement is a vital aspect in ensuring a more sustainable future, and many Danish consumers wish to make a personal effort in this respect. This also applies to the younger generations.
The Official Dietary Guidelines – good for health and climate
The Danish Veterinary and Food Administration advises and issues recommendations to consumers and enterprises about nutrition, healthy eating and food production. In January 2021, the Danish Veterinary and Food Administration updated Denmark’s food-based dietary guidelines. The new guidelines provide advice on how to eat in a healthy and at the same time climate-friendly way. For example, the new guidelines advise the Danish population to eat more vegetables and legumes and less meat (among other recommendations).
The Official Dietary Guidelines are applicable to the population aged 2-65. They also function as the basis for all nutrition activities issued by the Danish Veterinary and Food Administration, such as the Keyhole Label and guidelines for healthy meals in professional kitchens, including kitchens in nurseries, schools, educational institutions and workplaces.
The Official Dietary Guidelines are based on scientific reports from the Technical University of Denmark (DTU) and comply with the Nordic Nutrition Recommendations. The development was financed by the Danish government. The guidelines are conveyed through a series of communication materials and in cooperation with a wide range of stakeholders, including a Food Partnership for Health and Climate and the Danish Healthy Food Council.
Read more about the Official Dietary Guidelines at altomkost.dk.
In Denmark, several national authorities are responsible for encouraging healthy lifestyles and healthy nutrition among young people. The Danish Veterinary and Food Administration (Fødevarestyrelsen), under the authority of the Ministry of Food, Agriculture and Fisheries, and the Danish Health Authority (Sundhedsstyrelsen), under the Ministry of the Interior and Health of Denmark, provide information and guidelines that encourage people to live a healthy life.
Initiatives under the Danish Veterinary and Food Administration:
The Danish Veterinary and Food Administration are responsible for the following three initiatives related to healthy lifestyles and healthy nutrition for young people.
Dietary guidelines in Denmark
The Danish Veterinary and Food Administration are responsible for the dietary guidelines for meals and food offerings served in nurseries, schools, education institutions and workplaces. The various guidelines can be found on the Danish Veterinary and Food Administration’s website ‘All about food’ (Alt om kost). The guidelines aim to increase the availability of food and meals that are in line with the Official Dietary Guidelines. This includes meals and food offerings served at schools and education institutions where young people attend.
Based on the new ‘Official Dietary Guidelines – good for health and climate’, published in January 2021. Dietary guidelines for foods and meals in nurseries, schools, education institutions and workplaces are available.. The guidelines focus on not only healthy but also climate-friendly food and meals (including, for example, foods and meals containing more legumes and less meat). The guidelines focus on different types of food and meal offerings such as lunch dishes, sandwiches, breakfast, snacks and drinks.
To complement the dietary guidelines for meals in nurseries and schools, the Danish Veterinary and Food Administration provide guidelines for meal settings and environments related to the meal. The goal of this is to encourage the development of healthy food and meal habits among especially children and youngsters.
National study of the Danes’ dietary habits and physical activity
To gain insight into the Danes’ dietary habits, the National Food Institute at the Technical University of Denmark (DTU) has, since 1985, conducted national dietary surveys among Danish children and adults (4-75 years). The data is categorised by gender and age groups. Since 2000, the institute has also collected detailed data on the Danes’ physical activity and weight. The most recent survey was published in 2015.
In 2021, DTU initiated a survey with a focus on the degree to which the Danes are eating according to the Official Dietary Guidelines from January 2021. The key indicators of the study will, among other things, include the average intake of fruits, vegetables, legumes, wholegrains, nuts, seeds, vegetable oils, fish, meat and dairy products, as well as the intake of less healthy foods (i.e. foods that are energy dense, low-nutrient, high in sugar, unhealthy fats and salt). The results are used for counselling and for research in the field of nutrition, for example on the assessment of new ingredients, in relation to dietary advice and the targeting of nutritional information towards the population.
The ‘Keyhole’ label
The Keyhole is a Nordic nutrition label that was launched in Denmark in 2009. The label is a positive voluntary labelling scheme with 32 food categories. The conditions for use of the label are based on the Nordic Nutrition Recommendations and are set to increase the intake of fruit and vegetables, wholegrain and dietary fibre and decrease the intake of fat, especially saturated fat and added sugar and salt. Today, the Keyhole can be found on more than 4000 pre-packed foods, with most consumers recognising the label.
Initiatives under the Danish Health Authority
The Danish Health Authority is responsible for the following initiatives encouraging healthy lifestyles and healthy nutrition for young people:
Pool for health promotion and prevention of disease
The Danish Health Authority administers a pool for health promotion and sickness prevention. Organisations and NGOs can apply for funding of projects within the following areas:
- Alcohol prevention
- Mental health
- Sexual health
- Asthma and allergy
- Physical activities
- Tobacco prevention
- Cross-municipal networks for health promotion and prevention
- Monitoring of the health-related activities
- Prevention of doping
Preventive guidelines for food and meals for municipalities
The purpose of the preventive guidelines for food and meals is to support the municipalities’ work with promoting healthy food and meal habits. The recommendations are based on Danish and international evidence, supplemented with knowledge of good practice and experiences from, for instance, municipalities. The target group is municipal employees. The guidelines were updated and relaunched in 2018 in a collaboration between the Danish Health Authority and the Danish Veterinary and Food Administration. The use of the guidelines is monitored regularly by an independent research institute.
Health education in primary and lower secondary education in Denmark
In Denmark, health education is primarily a topic covered in primary and lower secondary education. In 2021, the Danish Veterinary and Food Administration joined forces with the non-profit organisation Madkulturen (The Food Culture) to develop a new course on the Official Dietary Guidelines for primary and lower secondary schools. The course is called ‘From dietary guidelines to food culture’ and will both provide theoretical knowledge about the Official Dietary Guidelines and develop students’ self-confidence in the kitchen. The teachers are given a basis for conducting exciting and involving teaching about the relationship between food, health and climate. One of the ambitions is that students will be able to reflect critically on the connection between food production and climate. The aim is to enable students to make reflective choices about food, nutrition, health and climate, and thus translate the Official Dietary Guidelines into everyday practice. The teaching material is available from the beginning of 2022.
Furthermore, education institutions are obliged to provide healthy education environments that contribute to students’ well-being. The physical surroundings and the study environment affect students’ well-being. The décor of the classrooms and the education institution in general may contribute to the students’ well-being and their motivation to learn. Furthermore, according to the Act on Pupils’ and Students’ Teaching Environment (Undervisningsmiljøloven, LBK nr 316 af 05/04/2017), it is the responsibility of the education institution to ensure that the teaching environment is completely safely with regard to health and safety.
Health education in general upper secondary education in Denmark
The health topics addresses in Biology C level are:
- Physiology: overview over the human organ system, the structure and functioning of one organ, reproduction, and hormonal regulation
- Health, sickness, and medicine
Since 2007, a ban on smoking covering, for instance, education institutions has been implemented. In 2021, the smoking ban (Lov om røgfrie miljøer, LBK nr 1632 af 18/06/2021) has been expanded, making it illegal to smoke and use tobacco products, tobacco surrogates or herbal smoking products on the premises of child-care institutions, schools, boarding schools, secondary residential schools, institutions with upper secondary education and other premises for children and adolescents under the age of 18. The objective of the act is to prevent the harmful effects of passive smoking and to ensure that children and adolescents are not confronted with smoking or the use of other tobacco products, tobacco surrogates or herbal products for smoking.
Since the reform of general upper secondary education in 2016, upper secondary education institutions are obliged to conduct an annual survey on students’ well-being. The survey contributes to uncovering areas in relation to students’ professional and social well-being that are in need of special measures and follow-up.
In 2019, the Danish Evaluation Institute (EVA) published a report on students’ well-being in upper secondary education programmes. The report emphasised that it is a core task of the upper secondary education institutions to develop teaching environments and teacher–student relations that promote and support professional and social well-being of the students.
In order to support students’ mental health, upper secondary education institutions must offer support and guidance to students who fail to thrive and who are at risk of dropping out. The support can be in the form of mentoring, coaching, contact teacher, psychologist, etc. The person in charge of the support must have insight into guidance and measures to promote desirable behaviour and well-being among young people. The target group is young people who address staff/teachers directly or students who teachers identify as having problems in relation to well-being or retention.
Health education in vocational upper secondary education in Denmark
Education in healthy lifestyles is part of the subject Society and Health in the first-year basic programme in the VET programmes. The students learn about healthy work processes, healthy lifestyles, hygiene, sexual health, including contraception, the body, gender, and identity. The subject is included in some VET programmes.
In preparatory basic education and training (FGU), the education is organised so that health, nutrition, and exercise are an integral part of all parts of the student’s education. The institution must provide one or more daily meals free of charge.
Vocational upper secondary education institutions are obliged to conduct an annual survey on students’ well-being. The survey contributes to ensuring and improving the students’ well-being and motivation to complete an education – and thereby reduce dropouts.
In 2007, a smoking ban was implemented. VET colleges and production schools that are not merged with a three-year general upper secondary education institution are not covered by the same rules as the three-year general upper secondary institutions. In VET colleges, it is not allowed to smoke inside the education institution. However, smoking outside is legal, and VET colleges can decide to arrange a smoking room where students are allowed to smoke.
The Ministry of Children and Education manages a digital learning platform, emu.dk, which provides teaching material and inspiration for teachers in primary to upper secondary level, as well as in adult education and continuing training.
Sex education for young people in Denmark
Sex education is mandatory in primary and lower secondary education (folkeskole) but not at upper secondary education level. Some vocational education and training (VET) education programmes include the subject Society and Health (see above).
Sex education in primary and lower secondary education covers themes such as sexuality, gender, the body, and health can be included in the teaching in the following subjects: Biology, Social Science, Danish, History, Psychology, Philosophy, Physical Education and Sport, Culture and Society.
The NGO Danish Family Planning Association (Sex & Samfund) has developed free teaching material aimed at upper secondary education programmes. Furthermore, at the digital learning portal emu.dk, teachers can find inspiration and teaching material for sex education.
The Danish Family Planning Association runs a young-to-younger corps that offers sex education to primary, lower secondary, upper secondary, and special needs education programmes. The teaching covers the body, gender, sexuality, reproduction, contraception, etc. The teaching can take place at the Danish Family Planning Association’s locations or at the school. There is self-payment for schools using the Danish family Planning Association’s services, unless the municipality has entered into an agreement with the association.
The approach in the teaching is norm-critical and based on dialogue.
The Danish Health Authority and the Danish Veterinary and Food Administration collaborate with a range of public authorities and private partners to promote healthy lifestyles and healthy nutrition.
The Ministry of the Interior and Health of Denmark has overall responsibility for the promotion of healthy lifestyles and healthy nutrition in Denmark, and the role of the Danish Health Authority includes offering advice to the Danish Ministry of the Interior and Health and other governmental, regional, and municipal authorities in the area of healthcare, such as the Ministry of Children and Education, which is a top-level authority within the area of formal health and sex education in Danish primary and secondary schools. The Danish Health Authority also cooperates with the municipalities, who have overall responsibility for the prevention of diseases for all citizens in Denmark.
In relation to this, the National Board of Health has prepared a prevention package for sexual health in which recommendations for initiatives and special target groups are described. The purpose of the prevention package on sexual health is to support the municipalities’ work to increase sexual health and well-being among all citizens.
The Ministry of the Interior and Health of Denmark funds private organisations with expertise within different health areas.
The Ministry of Food, Agriculture and Fisheries has the responsibility for administrative and research tasks in the areas of farming, fisheries and food production. Supporting sustainable and innovative food production and consumer protection and information are some of the core concerns of the ministry.
In relation to this, the Danish Veterinary and Food Administration has, for example, in 2021 published the new Official Dietary Guidelines, which is aimed at the Danish population between 2-65 years. To implement the dietary guidelines, the Danish Veterinary and Food Administration work together with a wide range of stakeholders as well as in public–private partnerships. The aim of the collaboration and engagement in partnerships is to promote awareness and knowledge of the Official Dietary Guidelines and to make the healthy and climate-friendly choices the easy choices.
Examples of public–private partnerships promoting healthy lifestyles and healthy nutrition in Denmark
The following initiatives are examples of public-private partnerships promoting healthy lifestyles and healthy nutrition. They receive at least 50% public funding.
Danish Family Planning Association: Sex education in schools.
The Aids Foundation: Counselling and checkpoints.
Danish School Sports: Healthy children move the school. A programme with six measures to promote physical activities among children and young people in primary and secondary schools.
The Danish Healthy Food Council: The Danish Healthy Food Council is a partnership established in 2018 where partners collaborate with the purpose of getting everyone in Denmark to eat healthier. The council currently (2023) consists of 32 members, including public authorities, private companies, universities, research institutions, health NGOs, etc. The council seeks to gather all relevant stakeholders and initiatives for healthy food and healthier meals across sectors in a joint effort to realise the vision of everyone eating healthier food.
The council coordinates its long-term initiatives through three programmes: ‘Danish eating habits’, ‘Generation healthy’ (with a focus on children and young people) and ‘Meals as well-being’. The council has a particular focus on reaching vulnerable citizens.
The Danish Food Partnership for Health and Climate: The Danish Food Partnership for Health and Climate was founded in May 2019. The objective of the partnership is to increase the supply, demand and distribution of healthier products and meals. The focus is to increase the intake of wholegrains, fish and vegetables and decrease the intake of salt, sugar and fat through, for example, reformulation, downsizing, etc. The initiative also includes marketing and communication about healthy eating and foods. The target group is the entire Danish population, including children and young people. The Danish Veterinary and Food Administration holds the chair, and 150 member organizations participate (e.g. retail, food service, food producers, health organisations and education and research institutions).
Raising awareness on healthy lifestyles and on factors affecting the health and well-being of young people
According to the Danish Act on Health (Sundhedsloven, LBK nr 210 af 27/01/2022) the Danish Health Authority (Sundhedsstyrelsen) has an information obligation to the public, the Ministry of the Interior and Health of Denmark, and to the healthcare authorities in general.
The task is to impart knowledge to the population and the authorities on the population’s health status, risk factors, and prevention (e.g. an unhealthy lifestyle), and to promote structural, preventive interventions that can support healthy choices.
The Health Authority formulates health promotion packages within several areas, for instance food and meals, tobacco, alcohol, physical activity, and sexual and mental health. The material presents evidence-informed risk factors and recommendations.
The organisation the Danish Family Planning Association (Sex & Samfund) runs two counselling services on sexual health:
- Private Talk: A counselling service for young people in the 10–15-year age group. The service consists of both a telephone line and a chat forum.
- Sex Line: A counselling service for young people in the 15–25-year age group. The service consists of both a telephone line, a chat forum, and a problem page.
The organisation provides online information aimed at children, young people, and adults about sexually transmitted diseases, contraception, sexuality, puberty, social media, the body, and boundaries. The organisation also runs a contraception and counselling clinic in Copenhagen. Trained nurses and medical specialists advise young people and provide free treatments. The organisation the Aids Foundation also provides information on sexual health. It has three checkpoints in the three largest cities in Denmark: Copenhagen, Aarhus, and Odense. At these checkpoints, specific target groups can be tested anonymously and freely for sexually transmitted diseases, for instance HIV. The target groups are:
- Young people in the age group 15-29 years
- Women who have sex with women
- Men who have sex with men
- Migrants from countries with a high prevalence of HIV
- Persons with HIV
The target groups can also receive counselling sessions provided by the checkpoints. The counselling can be in the form of face-to-face consultations or over the phone by the use of the checkpoints’ hotline.
Furthermore, some municipalities in Denmark have established special ‘youth clinics’ (UngMod) that offer advice and guidance on sexual health and psychosocial well-being to young people aged 12-25 years. Danish youth-targeted information campaigns raising awareness on healthy lifestyles
Every year, the Danish Health Authority conducts a number of information campaigns to focus on some of the most common risk factors having a major impact on public health, for example alcohol, physical activity, tobacco, and sexual health.
The Danish Health Authority also runs information campaigns aimed at more specific target groups.
The purpose of these information campaigns is to provide the citizens with a basis for making decisions about their own health behaviour and offer them directions for action, for example to stop smoking. The campaigns also contribute to a change in attitudes and behavioural changes.
The Danish Health Authority co-funds a number of private organisations with expertise within the area of health. In relation to young people, the organisations the Danish Family Planning Association and the Aids Foundation often run campaigns about sexual health.
The Danish Health Authority also runs ad hoc and recurrent campaigns such as the following:
Much More Presence (Meget mere med), 2018. The campaign focuses on alcohol consumption among 16–20-year-olds. The Danish Health Authority produced posters, PowerPoints, films, and material that could be used on Facebook, and municipalities could use the material in local campaigns. Besides the campaign material, the Danish Health Authority formulated different promotion strategies that the municipalities could make use of. The campaign’s website is still in effect in 2022.
Music Against Drugs and Less drinking – More Partying. Since 2003, the Danish Health Authority has cooperated with festivals and the interest organisation of Danish music venues Danish Live. The campaign focuses on regulations of serving of alcohol and limiting the use of alcohol. Each year, the campaign is evaluated. The campaign’s website is still in effect in 2022.