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.
When these strategies do not specifically concern young people, they most often include measures or actions in favour of young people's health, in particular prevention programmes, including peer-to-peer programmes, such as the national health strategy (2018-2022).
The national health strategy (2018-2022) includes measures to improve the health of young people such as:
- Generalising "student ambassadors" for health promotion and prevention in schools and secondary schools;
- Preventing hearing risks among young people (health check-up between 15 and 16 years old, awareness campaign for young people);
- Strengthen consultations for young consumers aged 11-25 concerning addictive behaviour;
- Train 80% of the population in first aid and train students in mental health first aid.
National programme for reducing smoking 2018-2022
Coordinated by the Ministry for Solidarity and Health, this programme is primarily aimed at: reducing daily smoking rates and creating a smoke-free generation by 2032.
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 civil society bodies.
The programme's actions are structured around four priority areas of intervention:
- protecting our children and preventing them from taking up smoking
- "Encourage and support smokers to quit";
- "Acting on the tobacco economy to protect public health"; and
- "Monitoring, evaluating, researching and disseminating knowledge about tobacco".
Each axis is associated with various actions, e.g. for axis 1: Protecting our children and preventing them from taking up smoking:
- Promote validated life skills and peer support programmes;
- Implement a sustainable youth-friendly communication strategy on tobacco;
- Extend the "smoke-free administration" charter to all workplaces;
- Mobilise local and regional authorities in the fight against tobacco;
- Create a "cinema, fashion and media independent of tobacco" charter in order to raise awareness in these areas of the challenges of tobacco control;
- Protect young people from commercial incentives aimed at promoting tobacco (confectionery, toys).
Plan regarding cancer prevention
Each year, the public authorities launch a plan dedicated to this disease, which affects around 400 000 people each year. The plan emphasises the importance of screening and prevention, as well as the fight against inequalities in access to care. The Cancer Plan is a government initiative, led by the Ministry of Health in partnership with a number of health institutions including the National Cancer Institute.
The plan sets objectives that concern young people:
- Adapting the care of children, adolescents and young adults;
- To enable the continuation of schooling and studies;
- Respond to the needs of children, adolescents and young adults with cancer.
The 2021-2030 cancer control strategy includes 234 actions based on four axes.
1. Improving prevention ;
2. Limiting the after-effects and improving quality of life;
3. To fight against misdiagnosed cancers;
4. Ensuring that progress benefits everyone.
The multi-year plan includes measures aimed at the youngest children, adolescents and young adults with cancer by adapting their care and enabling them to continue their schooling and studies.
The Ten-Year Cancer Control Strategy 2021-2030 also contains an action to promote vaccination against human papillomavirus (HPV), extended from 2021 to boys aged 11 and 14.
Roadmap on sexual and reproductive health 2017-2030
The Ministry in charge of Health has launched a comprehensive roadmap to improve and promote the sexual health of the French. This roadmap also concerns young people.
The measures in the Sexual Health Roadmap aim, by 2030, to:
- Place education on sexuality and sexual health for young people at the heart of their health education. Biological knowledge, but also psycho-social skills (reflection on mutual respect, equality between girls and boys, reciprocity and consent in relationships with others) must be transmitted to young people. Particular attention will be paid to adolescents under 15, 20% of whom have already begun to have sex;
- Strengthen the prevention, screening and treatment offer in sexual health around primary care professionals". In particular, this involves promoting contraception and sexually transmitted infection (STI) prevention consultations for young girls and boys;
- Maintain a special focus on vulnerable populations or those exposed to HIV;
- Strengthen and diversify STI and HIV prevention;
- Promote research in sexual health".
In September 2021, free contraception for young women under 25 was announced. In addition, the experimentation of a "Condom Pass" for people under 26 was launched.
Since the decree of 18 February 2019, the prevention missions of university health services have been extended to include the prescription of contraception, vaccinations, screening and therapeutic management of uncomplicated STIs
In addition, since 1 January 2022, access to a long-term sexual health consultation has been possible for all men and women under the age of 26. This consultation, which is covered at 100% by the health insurance system, allows all general practitioners, gynaecologists and midwives to discuss sexual health in its entirety during a dedicated time: combined prevention (condoms, PrEP, TPE) in the context of an infectious risk, abortion and contraception, consent and sexual violence...
Finally, the development of the "onsexprime.fr" website for young people aged 11 to 18 helps to promote a positive approach to sexuality among adolescents and the adoption of long-term behaviour that is favourable to sexual health. Developments are underway, in particular on the creation of content on social networks.
Since 2020, the cost of contraception for all underage girls (including those under 15) has been fully covered by prescription. In 2022, this 100% coverage without advance payment was extended to all women up to the age of 26. It should be noted that since January 2023, emergency contraception is now covered at 100% and available without a medical prescription in pharmacies, for everyone, adults and minors.
Since December 2018, two references of external condoms are also reimbursed at 60% on prescription from a doctor or midwife. This reimbursement has been extended to 100% for all young people under 26, without a medical prescription, in January 2023.
Finally, the time limits for performing an abortion have been extended in 2022: from 5 to 7 weeks of pregnancy for medically induced abortion performed in the city and from 12 to 14 weeks of pregnancy for instrumental abortion, with an extension of competences for midwives who can now perform instrumental abortion.
Fight against endometriosis national strategy
The Strategy of fight against endometriosis aims to improve the early detection of endometriosis. This includes screening for gynaecological pain and cycle disorders during the various compulsory consultations in childhood and adolescence, the inclusion of endometriosis in the health record and training school nurses to recognise and refer endometriosis.
Fight against addictions affecting young people through the implementation of the national mobilisation plan against addictions 2018 -2022 (alcohol, tobacco, drugs, screens)
In order to prevent high risk behaviour such as drug use, the public authorities, in partnership with associations, have set up various schemes for young people:
The policy to combat addictive behaviour aims in particular to provide young people with clear information on the risks associated with the consumption of alcohol, tobacco and cannabis, as well as on the excessive use of screens and video games.
Adults who supervise young people in the context of leisure activities (e.g. youth workers) are also invited by the public authorities to create protective environments for young people (compliance with the ban on the sale of alcohol, tobacco and gambling to minors, distancing them from incentives to use). The young people themselves are supported in establishing new forms of conviviality and reducing the risks associated with drug use.
For example, a guide to festive and integration events for students has been drawn up by the Ministry of Higher Education and Research, student representatives from representative student organisations, associations and the Ministry of Health and the MILDECA (see 7.2 Intersectoral cooperation).
In addition, prevention programmes are now being implemented in schools in all regions, mainly through partnerships developed between the administrative departments that oversee universities (rectorates) and regional health agencies.
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). All addiction issues can be addressed in these places: alcohol use, cannabis...
Some 30,000 people a year attend these consultations, three quarters of whom are substance consumers and a quarter are family members or friends of consumers. In 2022, the young consumers' consultations were consolidated and can be organised in places where young people are present.
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, that respond to the needs of young people.
For example, in 2022, the Corsican regional health agency set up actions to prevent psychological disorders during the COVID-19 health crisis for young people in its region.
The Ministry in charge of 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. This pathway is supported, in the national Priority Prevention plan, by the "Health Promoting School" approach. Initiated in 2020, this approach enhances the actions and projects already implemented in the area of health in order to link them with other approaches (school climate, education on sexuality and nutrition, etc.). The aim of this approach is to develop a common culture around health in order to make visible what enables health and well-being in a school.
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 currently defined by the circular n°2018-111 of September 12, 2018.
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.
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 chapters 1 "Youth policy governance" and 4 "Social inclusion") 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 SSEs (- university health services - services de santé étudiante), 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.
The Youth Compass (boussole des jeunes)
The Youth compass is a digital service for 15-30 year olds set up by the Ministry in charge of Youth.
This service aims to combat the lack of access to social rights and services for young people by listing the services that can be used by young people in their place of life and facilitating the connection of young people with the right professional.
La Boussole includes a section dedicated to health, which enables young people to meet professionals to obtain information on topics as varied as social protection, sexuality, unhappiness, addictions and nutrition, for example.
Campaigns geared towards young people
Santé publique France is tasked with launching national risk behaviour prevention campaigns and screening campaigns.
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). This campaign involves 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).
Social network: https://www.facebook.com/samleconducteurdesigne/
The Month without tobacco
The Month Without Tobacco campaign has been held every year in November since 2016. It is a national "challenge" to encourage people to stop smoking.
The European vaccination week
The European Vaccination Week, created in 2005, takes place every year from the end of April to the beginning of May to raise awareness of the role of vaccination in health issues and, in particular, to remind parents and young adults of the right time of life for vaccination.
The sexual health week
The Sexual Health Week is held annually from the end of May to the beginning of June to bring more visibility to sexual health issues. The 2022 edition focused on LGBTQ+ audiences and discourses of discrimination in this regard.
The 2022 campaign « Getting teenagers to move is not easy. But encouraging them is important »
In 2022, Santé Publique France implemented the campaign "Getting teenagers to move is not easy. But encouraging them is important", noting a lack of physical activity and sport among teenagers and targeting the adults around them (parents, teachers, etc.).
The 2022 campaign on mental health of young people #Ispeakto (#Jenparleà)
Since 2021, Santé Publique France has launched an annual digital campaign #Jenparleà aimed at freeing young people's speech on mental health. It is based on the Fil Santé Jeunes online listening service.
The campaign « speaking is already recovering » This campaign, implemented by Santé Publique France, encourages French people whose lives have been affected, personally or otherwise, by the Covid-19 pandemic to speak out. Since the pandemic, Santé Publique France has noted the appearance of an environment (stress, fatigue, etc.) conducive to the appearance of anxiety and depressive symptoms.