7.4 Healthy lifestyles and healthy nutrition
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National Health Plan 2009–2020 (Rahvatervise arengukava 2009-2020) was approved by the Government in 2008 and renewed in 20.12.2012. As the strategy ends in 2020, a new development plan has been compiled and sent to the Parliament to be confirmed by the end of 2020.
The general objectives of the new (yet unconfirmed) National Health Plan 2020-2030 arw as following:
- The average life expectancy increases amongst both men and women.
- The years while living heathly will increase faster than the life expectancy and people live most of their lives without health-related limitations.
- Health unequality decreases (within genders, areas, and education levels).
The sub-goals in order to achieve the general objectives are divided into three main areas:
- Options supporting health.
- Environment supporting health.
- Human-centred healthcare.
Concerning young people, there are also several aspects and goals brought out. For example, mental health and drug use of young people are big concerns and some prevention activities will be taken in order to solve the issues.
The youth-specific target groups identified in the plan are children and young people in general (i.e. from 0 to 26 years old), children up to 18 years old, students in general education, young people with special needs and young people with behaviour that puts their health at risk.
The Ministry of Social Affairs is the main responsible authority for the implementation of the Plan.
The document will be confirmed by the Parliament by the end of 2020.
The Network of Health Promoting Kindergartens and Schools
Estonia is a member of the Schools for Health in Europe network since 1993. In Estonia, the health-promoting schools' movement started in 1993, when 16 schools became members of the European Network of Health Promoting Schools. Since 2000, the movement was broadened to kindergartens. By the end of 2020, more than 500 educational institutions are members of the Health Promoting Kindergartens and Schools network in Estonia. The network is coordinated by the National Institute for Health Development.
Health-promoting educational institutions are defined as institutions that implement a structured and systematic plan for the health and well-being of all children and of teaching and non-teaching staff. This is characterised as a whole school approach and contains - healthy policies, physical and social environment, individual health skills and action competencies, links within the community and health and well-being services.
At the county level, there is a network of coordinators, who usually work in school or kindergarten and the coordination is additional work for them. There are coordinators in all 15 counties and also the 4 largest cities.
The coordination in state and county level was financed by the state through the National Health Plan 2009-2020 and Estonian Health Insurance Fund. Kindergartens and schools finance their activities itself and/or through different projects. In the new national health plan for the years 2020-2030 the programme is not mentioned, but as the available document is still not confirmed and the implementation programme as well, then this might be one action to be funded through the new development plan as well.
VEPA is an environmental intervention used in the classroom to create a nurturing environment that is conducive to learning. The intervention is designed to reduce off-task behaviour; increase attentiveness; decrease aggressive and disruptive behaviour, as well as shy and withdrawn behaviour. PAX GBG has also shown improvements with academic success, and mental health well-being and reduces substance abuse later in life.
Since 2014, more than 11.000 students and 600 teachers have participated from more than 160 schools all over Estonia.
PAX game is implemented by the National Institute for Health Development in cooperation with the Ministry of Interior and funded by the European Social Fund.
During the years 2016-2018, a 2-year-research was conducted in Estonian schools in order to assess the impact of VEPA methodology. 42 schools and 708 first grade students participated in the research. The data was collected three times - before intervention in the beginning of a school year and at the end of first and second school years from teachers, parents, and children. The study showed that in the classes where VEPA was used, there was a dicrease of difficulties with children's behaviour, attention, and attention. Also, there was a trend in improving emotional difficulties (such as feeling worried or scared) and communication with peers. The VEPA methodology was most useful for children who had more mental health issues in the beginning of the first grade.
KiVa is a research-based anti-bullying program that has been developed in the University of Turku, Finland. The effectiveness of KiVa has been shown in a large randomized controlled trial. Since 2014, 77 schools have been implemented KIVA in Estonia. The programme in Estonia is supported by the Ministry of Education and Research. In Spring 2020, a report was published, which shows that the methodology is more effective in schools that use it regurarly than in the schools that just begun participating in the program. In the schools that use KiVa during a longer period, there is much less long-time bullying.
The research group of physical activity for health in Institute of Sport Sciences and Physiotherapy in the University of Tartu is designing school-based interventions and their aim is to promote physical activity in the whole community, as sufficient physical activity supports mental, physical and social well-being.
Current shortcomings in promoting active lifestyle lie in the lack of focus on environmental factors and the over-concentration on sports. The objective measurements show that children involved in organised sports activities do not necessarily have higher physical activity. The pilot project by Tartu University showed that it is far too frequent in Estonian schools to discourage the physical activity of children during the school day.
The research group is a permanent research unit in the structure of the University of Tartu.
The aim of the good school model is to describe different aspects of a good school and to find the criteria that indicate that a school actually deals with these aspects.
The focus of the model is on evaluation. The ultimate aim of the project is to achieve a situation where all schools are evaluated fairly and feel motivated to improve.
The Estonian Union for Child Welfare has been leading a project called “Kiusamisest vaba lasteaed ja kool” (Kindergartens and schools free of bullying) since 2010, currently ongoing.
The mission of Free of Bullying is:
- To reduce the number of children subjected to bullying in preschools and primary schools
- To create a safe, positive and healthy environment for children attending preschool or primary school
The mission is to be achieved by:
- Teaching children how to be a good friend
- Giving children the courage to say no if they experience bullying
- Supporting the children to act based on the values of tolerance, respect, care and courage
- Strengthening group spirit among children and thus preventing bullying
Programme is supported by the Ministry of Education and Research.
Health education and healthy lifestyles education in schools is part of national curricula subject Human Study in Basic school and in addition, the subject Personal, Social and Health Education in upper secondary school. Human studies were included in all levels of the school curriculum as a compulsory subject in 1996. The main topics are physical activity, nutrition, social and life skills training (preventing risky behaviour and substance (e.g. drug, tobacco and alcohol abuse), injury prevention and safety skills, mental health, etc.
One of eight cross-curricular topics is health and safety – the aim is for the pupil to develop into a mentally, emotionally, socially and physically healthy member of society who is capable of following healthful lifestyles, act in a safe manner and take part in developing a health-promoting environment.
There is a different kind of supporting materials and training for teachers both in Estonian and Russian languages (teacher or trainer guidelines; web resources such as Toitumine, Tubakainfo; Alkoinfo; Narko, etc.; films at the Terviseinfo website etc.
Sex education and personal relationships education
In Estonia, human studies were included in all levels of the school curriculum as a compulsory subject in 1996 and sex education and personal relationships education is part of it.
Sexual education and personal relationships education are based on „Standards for Sexuality Education in Europe. A framework for policymakers, educational and health authorities and specialists“. These standards are translated to Estonian language and are freely available.
Apart from the standards, there are different kind of tools and training in sexual health field created and available for teachers both in Estonian and Russian language (teacher or trainer guidelines; web resources: Amor, HIV; films: Räägi Asjast website etc.
There is no central framework policy or guidelines established to develop peer-to-peer educational approaches aiming to enhance young people's knowledge and understanding of factors related to their health and well-being.
TORE is a youth organisation that promotes movement of support students in general education schools and vocational education schools. The organisation developing the programme in Estonia started in 1996 and is ongoing.
The main goal of the organisation is to increase the number of schools and people in schools, who support and develop a friendly learning atmosphere, social skills and the anti-bullying standpoint. The network is based on training students to be support-students for peers and training adults in schools to be able to cooperate better with youth. TORE is also a member of the anti-bullying coalition (see below). TORE targets general education and vocational education school students and adults in schools. The organisation is supported by the state budget through the Ministry of Education and Research. Mechanisms for monitoring and evaluation of the activities in the organisation are not available.
There is no obligatory or policy framework for partnerships between formal education providers, youth workers and health professionals. Cooperation between different stakeholders may occur at the local, regional or national level, however, it is not guided centrally.
Local governments are obliged to analyse the public health and security situation and prepare health and well-being profile, and the format of the profile analyses foresees cooperation between the specialists in different areas. This cooperation is however not formed as a permanent cooperation body in general.
In 2014, a Bullying Free Education Coalition was created. This coalition has been recognised and supported by the Ministry of Education and Research. The number of partners has been increased and in 2016 the coalition under the leadership of the Ministry of Education and Research developed a “Concept for education path without bullying” – a document stating the main understanding of bullying, its prevention and interventions in Estonia. It lists the main programmes available to address bullying through all levels of education. The concept does not ensure public funding for the programmes.
Raising awareness on healthy lifestyles and on factors affecting the health and well-being of young people
In general, well-being and healthy lifestyle issues are considered to be part of youth information, youth information is defined as one area of youth work in Estonia. The Ministry of Education and Research is the responsible governmental authority in charge of youth information.
There are 16 centralised public regional youth guidance and information centres, called Pathfinder centres (Rajaleidja), which provide studying counselling, psychological, socio-pedagogical, special education counselling and speech therapy. Please see chapter 3.4. for more information on guidance and counselling in Rajaleidja Centres.
Estonian Youth Work Centre (starting from 01.08.2020 Education and Youth Board) organised yearly for 24 years an information fair for youth called Teeviit, which was attended by thousands of young people in Estonia. Teeviit 2017 was the last youth information fair. Now the brand "Teeviit" is being used only web-based as a youth information platform that gives young people different kind of information, including health-related, created by young people targeted to young people.
In addition, local and regional information for youth is available through local youth information portals such as:
Estonian Union for Sexual Health coordinates the work of centres for youth counselling on sexual health, relationships and violence issues. The target group for the centres is young people up to 24 years of age. There is also a web-portal Amor to provide online information and counselling on sexual health issues. There are 17 centres in the network and most of them are based in clinics or medical centres.
The service is financed by the Health Board and National Institute for Health Development
Youth information campaigns
There are different kind of web and social media-based materials in campaigns for youth:
- Tobacco prevention
- Alcohol prevention
- Sexual health
- Mental health
- Drug prevention
- HIV prevention
- Nutrition - Fiidikaru, Toitumine
- Traffic Safety Education
Regular national campaigns have been held in the areas of safe sex, nutrition, tobacco and alcohol prevention, oral health etc. In general, the target group of the youth campaign is general youth age 7-26.
The programme “Protect yourself and help the other” for 6-8 class year students and 15 youth camps (one in each county). The aim of the camp is to develop a way of thinking that would support and promote the health of children. In the camps, specialists in their fields teach how to foresee risks and cope with emergency situations. The programme is organised by cooperation of the Estonian Road Administration, Rescue Board, Estonian Health Insurance Fund, Police and Border Guard Board, county governments, local governments etc.