7.4 Healthy lifestyles and healthy nutrition
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The national strategies drawn up by the Government and, more specifically, the health authorities, address health issues or problems that concern all French citizens: sexual health, smoking, nutrition and chronic illnesses. Whilst they are not specifically aimed at young people, more often than not they comprise measures or actions in favour of youth health. Several multiannual strategies or programmes seeking to improve the health of the general population, young people in particular, are under way. These deal with tobacco control, sexual health and cancer.
National programme for reducing smoking 2014-2019
Coordinated by the Ministry for Solidarity and Health, this programme is primarily aimed at: reducing daily smoking rates and creating a smoke-free generation.
The programme is rolled out by the ARS - regional health agencies on the basis of scientific studies and datasets provided by the MILDECA - Cross-government mission for combating drugs and addictive behaviours (mission interministérielle de lutte contre les drogues et les conduites addictives), Santé publique France agency and OFDT - French Monitoring Centre for Drugs and Drug Addiction (Observatoire Français des Drogues et des Toxicomanies).
The programme's actions are organised around three key priorities:
- "Protecting young people";
- "Helping smokers to stop";
- "Acting on the tobacco economy".
The national programme for reducing smoking sets out a number of measures aimed at protecting young people, including:
- Creation of a plain pack with larger health warnings. Since 1 January 2017, sales of cigarettes and roll-your-own tobacco have only been authorised in plain packaging;
- Certain additives and flavours are banned;
- Tobacco product advertising at sales outlets is now prohibited;
- All customers must now be asked to show a form of ID that proves their age before buying tobacco;
- Prohibition on establishing new tobacconists around public and private schools alike, training centres and leisure centres for young people;
- Increase in the price of tobacco.
National sexual health strategy 2017-2030
The Ministry for Solidarity and Health has launched a comprehensive strategy to improve and promote the sexual health of French citizens, young people among them.
Between now and 2030, the measures outlined in the National sexual health strategy (Stratégie nationale de santé sexuelle) are aimed at:
- “Making sexual health and sexuality education of the youngest generations a central feature of their health education pathways”. Knowledge about biology as well as psychosocial skills (giving thought to mutual respect, gender equality between girls and boys, reciprocity and consent in relations with others) must be passed on to young people. Particular attention should be paid to under 15 year olds, 20% of whom are already sexually active;
- "Strengthening the provision of prevention, screening and treatment services regarding sexual health around primary care professionals”. This especially entails promoting the consultation on contraception and prevention of sexually transmitted infections (STIs) for underage girls and boys;
- "Keeping a particularly close eye on vulnerable groups of people or those more exposed to HIV”
- "Improving and diversifying the prevention of STIs and HIV";
- "Promoting research in sexual health".
Cancer plan 2014-2019
The Cancer plan 2014-2019 is the third plan to be devoted to this disease which affects some 355,000 people every year. The plan focuses on the importance of screening and prevention as well as the fight against inequalities in terms of treatment. The Cancer plan is a governmental initiative, coordinated by the Ministry for Solidarity and Health in partnership with a number of other health institutions including the National Cancer Institute (Institut national du cancer).
The plan sets out objectives bearing on young people:
- Adapt treatments for children, adolescents and young adults;
- Allow sufferers to continue their schooling and education;
- Meet the needs of children, adolescents and young adults suffering from cancer.
Young consumer consultations
Since 2005, a network of consultations has been set up across all French départements on the initiative of the Ministry for Solidarity and Health as part of the fight against drug addiction. These consultations are free and anonymous. They are intended for young consumers of psychoactive substances (such as cannabis, alcohol, tobacco, synthetic drugs and cocaine) as well as those showing signs of substance-free addictive behaviour (video games for example).
Some 30,000 people a year attend these consultations, three quarters (23,000) of whom are substance consumers and a quarter are family members or friends of consumers.
ARS – Regional Health Agency programmes
Apart from the initiatives making up national and comprehensive health strategies (nutrition, healthy lifestyles, etc.), health programmes specifically geared towards young people are set up at regional level by Regional Health Agencies, which can take action on a multiannual basis.
In 2016, in partnership with the Regional Health Agency, the Alsace Champagne-Ardenne Lorraine Region supported health prevention and education schemes for young people by launching a call for proposals called "Work on your health” (Travaille ta santé). The purpose of this was to improve quality of life for under 25s – not least their knowledge of sexually transmitted infections (STIs) and diseases.
The Ministry for Solidarity and Health grants appropriations to the FIR – Regional Intervention Fund (Fonds d’Intervention Régional) for financing measures and trials that have been approved by the Regional Health Agencies. The FIRs are the latters’ financial management instruments. Their resources come from an endowment provided by:
- the State;
- Basic compulsory health insurance schemes;
- the CNSA – National Solidarity Fund for Independent Living (Caisse Nationale de Solidarité pour l’Autonomie).
Schools have a twofold mission: surveillance, monitoring of pupils' health as well as providing them with health education and teaching them to take responsibility in light of the risks.
Citizenship and health education committee
In secondary schools, the CESC - citizenship and health education committee (comité d’éducation à la santé et à la citoyenneté) implements health education and measures on preventing violence in schools. This committee form part of the overall governance of each secondary school institution pursuant to the provisions of Articles R 421-46 and 421-47 of the Education Code (Code de l’éducation). It is chaired by the school head or principal and can be made up of a number of different members: representatives of teaching staff, parents and pupils, representatives of the municipality and local authority, institutional partners (police or gendarmerie for example) and partner associations.
Health education at school is also achieved through the health education pathway.
The PES - health education pathway (parcours éducatif de santé)
This initiative is part of the legislation for restructuring French schools and has been reaffirmed by the legislation for modernising the French health service. It has been implemented since the beginning of the 2016/2017 academic year and is explained in a "brief document that can be understood by all stakeholders" indicating what steps are being taken as regards pupils' health from primary school right through to sixth-form college (lycée). This document is also shared with families.
The PES is a three-pronged approach:
- Health education;
- Prevention, which bears on the risks and situations which children and adolescents might encounter depending on their age (addictive behaviours, diet, exercise, sexuality education, sexist and sexual violence, etc.);
- Protection, in order to create an environment that is conducive to well-being.
A Support Guide for the Health Education Pathway has been drawn up by the Ministry of National Education for schools.
Health education is organised around priority themes:
- A healthy lifestyle, education in healthy eating and sport;
- Sexuality education, access to contraception and prevention of STIs and AIDS.
- Prevention of addictive behaviours;
- Prevention of "dangerous games" and contribution to the prevention and tackling of bullying at school;
- Prevention of mental health problems;
- Sexuality education in light of the risks.
Health education forms part of the Common Base of Knowledge and Skills and must be officially documented in the school's strategic plan. National health education guidelines are defined by Circular no. 2011-216 of 2 December 2011, published in the BOEN - National Education Official Bulletin (Bulletin officiel de l'éducation nationale) no.46 of 15 December 2011.
Sex and relationship education
Sexuality education in secondary schools and sixth-form colleges (lycées) is defined by Circular no. 2003-027 of 17 February 2003 entitled "Éducation à la sexualité dans les écoles, les collèges et les lycées” [education in primary schools, secondary schools and sixth-form colleges]
At lower and upper secondary level
At least three annual sexuality education sessions are organised in secondary schools and sixth-form colleges (lycées). These tie in with and round off the various subjects taught in lessons, biology in particular.
Their learning outcomes are as follows:
- "Provide pupils with objective information and scientific knowledge;
- Identify the different dimensions of sexuality: biological, emotional, cultural, ethical, social and legal;
- Develop critical thinking skills;
- Encourage responsible individual and collective behaviour (prevention, protection of yourself and others, the right to privacy and private life);
- Raise awareness of the specific information, aids and guidance available in and outside the school".
This education forms part of a public health approach:
- To prevent and reduce risks: unwanted early pregnancies, forced marriages, sexually transmitted infections, HIV/AIDS;
- To crack down on homophobic and sexist behaviour as well as sexual violence;
- To promote gender equality.
Preventing sexually transmitted infections (STIs) is a key priority of sexuality education.
Prevention of STIs, HIV/AIDS in particular, involves informing adolescents about the risks they run and what they can do to protect themselves.
It can be addressed during:
- Earth and Life Science lessons;
- the annual sexuality education sessions;
- educational actions enabling a cross-cutting approach to be taken to AIDS prevention.
Partnerships with associations are set up with a view to running information campaigns, for example with the association Sidaction. 1 December, World AIDS Day is another opportunity for staging prevention initiatives. What is more, there is at least one condom vending machine in every sixth-form college (lycée).
Initiatives to protect young people against sexual violence may also be organised in the context of this sexuality education, through awareness-raising actions.
There is a range of resources to help teachers plan their sexuality education lessons: the Sexuality Education portal on Éduscol.
The peer-to-peer approach to health prevention is gradually gaining ground in France. It not only concerns young people but also the elderly and disadvantaged groups of people. It is an approach favoured by the voluntary organisation sector, but public actions aimed at promoting it have been carried out.
The "student-Health relay" (étudiant-relais Santé) scheme
This peer-to-peer approach has been materialised through the "student-Health relay" scheme introduced by the SUMPPS - University Health Promotion and Preventive Medicine Services (Services Universitaires de Médecine Préventive et de Promotion de la Santé) in higher education institutions. The "student-health relay" is involved in prevention measures at university level. It provides information about health issues and refers its peers to the relevant points of contact. It represents the interface between the health and social workers, university institutions and students.
The "Onsexprime" website
In addition to the "student-Health relay" scheme, the website "Onsexprime", run by the agency Santé publique France (a public institution supervised by the Ministry for Solidarity and Health), has been designed on the basis of this peer-to-peer prevention approach. Onsexprime.fr seeks to paint a reassuring picture of sexuality for adolescents and enable them to grasp the importance of prevention.
The website publishes testimonies and retranscriptions of other adolescents' experiences. This content is supervised and approved by the website administrators, and some content is fictional. The website also has a forum where young people can chat and post comments on the subject of sexuality (these discussions are also moderated by the hosting website).
Assessing the peer-to-peer health education approach
The peer-to-peer education approach and initiatives using this practice are not systematic. But its impact and merits have been analysed by scientific research for all that. The INJEP - National Institute for Youth and Non-Formal Education (Institut national de la jeunesse et de l’éducation populaire) has written up studies and reports on the subject: "L’éducation pour la santé par les pairs : une autre façon de prendre sa place dans la société" [Peer-to-peer health education: another way of finding one's place in society], supervised by Yaëlle Amsellem-Mainguy and Éric Le Grand. These studies show that the key to successful peer-to-peer health education is the "complementary" combination of peer education (between young people) and more "traditional" education involving health professionals (adults). Other studies look into the role and importance of the Internet in peer-to-peer education.
Health policies within schools rely on collaboration between multiple partners: teaching staff, institutions and associations as well as pupils' parents. Health and social workers (school doctors or nurses for example) are also called on to help deliver these projects. The citizenship and health education committee is tasked with organising these partnerships.
External professionals can also share their expertise by developing initiatives in schools and producing educational resources: the Agency Santé publique France, MGEN - General Mutual Health Insurance Fund for National Education (Mutuelle générale de l’éducation nationale), the Red Cross, Planning familial, National Anti-Smoking Committee (Comité national contre le tabagisme), Crips - Regional AIDS prevention and information centres (Centres régionaux d’information et de prévention du sida), CPAM - Primary Health Insurance Fund (Caisse primaire d’assurance maladie), Anpaa - National Association for the Prevention of Alcoholism and Addictions (Association nationale de prévention en alcoologie et addictologie), Sidaction (HIV prevention, etc.
When such experts are to hold regular sessions in school settings, an agreement must be signed. These partnerships are formally established, perhaps through a framework agreement. To give an example, in 2010 the agency Santé publique France signed a five-year framework agreement with the Ministry of National Education.
Raising awareness on healthy lifestyles and on factors affecting the health and well-being of young people
With a view to raising young people's awareness of risk factors and behaviours for health, the public authorities use a variety of tools to promote physical and mental well-being. This advocacy work can be carried out via structures dedicated to informing young people and national or local campaigns.
Information providers/counselling structures
Information providers and counselling structures belonging to the Youth Information Network (Réseau Information Jeunesse) (See 5.8 Information providers/counselling structures) help to raise young people's awareness of addictive and risk behaviour. These community structures are located in municipalities where youngsters can go directly without needing an appointment.They are coordinated at regional level by the CRIJ - regional youth information centres (centres régionaux de l’Information Jeunesse), which are subsidised by the devolved departments of the ministry in charge of youth and by the Regional Councils.
Some of the network's resources can be accessed on the website of the Youth Documentation and Information Centre (Centre d'information et de documentation Jeunesse), the central resource centre for the whole of the Youth Information network as well as the CRIJ for the Ile-de-France (Parisian) region.
All of the organisations working in favour of youth health (See 7.2 Governance), such as the associations partnered up with public authorities (maisons des adolescents, missions locales) as well as SUMPPS, placed under the authority of the Ministry of Higher Education, play a part in raising young people's awareness.
These structures pass on and disseminate information about the health schemes available to young people and promote access to rights to health.
In some municipalities there is a Youth health centre (Espace santé Jeunes). This is somewhere 11 to 25 year olds can come for advice and guidance on health and well-being issues. It is free of charge, freely accessible and guarantees confidentiality and anonymity for the young people who come. It is also a resource centre where young people can get information about nutrition, contraception methods, infectious diseases (STIs), addictive substance consumption and suicide prevention. Youth health centres can be set up by local authorities (Municipalities, Département) in partnership with associations.
Campaigns geared towards young people
Santé publique France is tasked with launching national risk behaviour prevention campaigns and screening campaigns. In 2015, the Agency and the Ministry for Solidarity and Health decided to launch their HIV and STI screening campaign "Screening is a way of taking care of your future" (Se faire dépister, c’est prendre soin de son avenir) on World AIDS Day. This message, which was as much for the wider community as it was for young people, was broadcast across several types of media: television, posters (seven visuals) and web banner ads. Events were also organised in connection with the campaign at eight busy train stations.
The Ministry of the Interior put together a road safety campaign to tackle drink driving: Sam, "whoever's driving doesn't drink" (Sam, celui qui conduit c’est celui qui ne boit pas). Launched in 2016 for the attention of young people, this campaign involved the production and broadcasting of the short film "Samvenger" about Sam (which stands for No Fatal Accidents/Sans Accident Mortel), a recurring character created in 2006 symbolising the young driver who decides not to drink on a night out and commits to driving his or her friends back home. This film was released on 3 August 2016 and shown at more than 2,600 cinemas as well as on the YouTube channel "Sam, the designated driver" (Sam, le conducteur désigné).
In 2018, this campaign was renewed.
Social network: https://www.facebook.com/samleconducteurdesigne/