7.4 Healthy lifestyles and healthy nutrition
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National strategy to promote breastfeeding
The federal government has set itself the task of making Germany a more breastfeeding-friendly country. It aims to improve general conditions for breastfeeding, increase acceptance of breastfeeding, and encourage and help women to breastfeed. Scientific studies show that breast milk offers babies optimal nutrition and that breastfeeding benefits the health of both mother and child. Breastfed children become overweight or develop type 2 diabetes later in childhood or adulthood much more rarely than non-breastfed babies. Mothers have a reduced long-term risk of developing breast, ovarian and endometrial cancer and type 2 diabetes. Breastfeeding promotion has an important part to play in healthy growth and development. Presented in August 2021, the National Strategy to Promote Breastfeeding (Nationale Strategie zur Stillförderung) laid the foundation for the long-term improvement in breastfeeding promotion in Germany. The strategy describes the vision of and path towards a breastfeeding-friendly Germany. The Department for Child Nutrition at the Max Rubner Institute (Institut für Kinderernährung am Max Rubner-Institut, MRI) coordinates implementation of the national strategy to promote breastfeeding on behalf of the Federal Ministry of Food and Agriculture (Bundesministeriums für Ernährung und Landwirtschaft, BMEL). The Healthy Start – Young Family Network ("Gesund ins Leben"), which is part of the Federal Centre for Nutrition (Bundeszentrum für Ernährung, BZfE), is responsible for the communication measures. The national strategy is divided into seven fields: evidence-based guidelines, education, professional training and continued professional development, prevention and care structures, community-based breastfeeding promotion, breastfeeding and working life, marketing of human milk substitutes and a systematic breastfeeding monitoring system.
National Action Plan IN FORM
The central nationwide strategy to improve the eating habits of children and young people is the IN FORM Action Plan, which is described in the Youth Wiki chapter Health and well-being – sport, youth fitness and physical activity: National strategies. Measures to intensify nutrition education and strengthen nutrition skills in all age groups, especially children and adolescents, include developing the quality standards for school meals of the German Nutrition Society (Deutsche Ernährungsgesellschaft, DGE), setting up school networks with the Länder to help school authorities and schools offer balanced meals, developing resources to help educators teach nutrition, and promoting pilot projects in schools.
National Strategy on Drug and Addiction Policy
Addiction prevention is one of four levels in the federal government's National Strategy on Drug and Addiction Policy (Nationale Strategie zur Drogen- und Suchtpolitik). The strategy was adopted in February 2012. Its main goals are to reduce the consumption of legal and illegal addictive substances and to prevent drug and addiction-related problems. The Drug Commissioner of the Federal Government (Drogenbeauftragte der Bundesregierung, part of the Federal Ministry of Health (Bundesministerium für Gesundheit), coordinates drug and addiction policy. Addiction prevention measures are aimed at the entire population, but some activities and campaigns target children and young people specifically.
National strategy to reduce sugar, unsaturated fatty acids and salt in processed food
The coalition agreement for the 19th legislative period tasks the Federal Ministry of Food and Agriculture (Bundesministerium für Ernährung und Landwirtschaft, BMEL) with the development of a scientifically based strategy as part of a participatory process to reduce sugar, unsaturated fatty acids and salt in processed foods. Adopted on 19 December 2018, the strategy is the result of intensive debates with representatives of the federal government, federal states (Länder) and associations and institutions from the fields of nutrition, health, the food industry, consumer protection and science.
The overarching goal is to promote healthy lifestyles and reduce the number of overweight and obese people in the population, especially children and adolescents, and the frequency of diet-related diseases.
The food industry pledges, on a voluntary basis, to reduce sugar, unsaturated fatty acids and salt in processed foods as part of a process spanning several years. Implementation of the strategy is flanked by science-based product monitoring measures and a monitoring committee.
Funding initiative “Healthy for life” (Förderinitiative “Gesund - ein Leben lang”)
Funded by the Federal Ministry of Education and Research (Fördermaßnahme vom Bundesministerium für Bildung und Forschung, BMBF), this measure aims to create a basis that will allow children and young people to remain healthy or recover more quickly. It focuses on child-oriented approaches to preventing and treating chronic diseases and mental problems, health maintenance and prevention concepts for vulnerable people as well as biological and molecular mechanisms that have an effect on health and illness. Research networks cover a broad spectrum of subjects. They are examining ways to improve the diagnosis, prevention and treatment of mental problems and physical disorders, and they are studying the impact of early life events on physical and mental health.
Alliance for Health Literacy (Allianz für Gesundheitskompetenz)
Since 2017, the federal government has been intensifying efforts to strengthen health literacy. Together with the umbrella organisations of Germany’s self-governed health care system, it has set up the Health Literacy Alliance (Allianz für Gesundheitskompetenz) under the patronage of the Federal Ministry of Health (Bundesgesundheitsministerium). All partners are committed to strengthening the general health literacy of the population through health education. Health literacy should be taught at an early age and be part of the teaching plan and curricula of childcare facilities, general education schools as well as at institutions of advanced training and education. The Alliance’s goals also include gathering scientifically validated information – especially from the Internet -, making it generally understandable and promoting communication skills in the training and further education of doctors and health care professionals.
Campaign: STAY HEALTHY move, relax, eat!
The aim of the federal (national) campaign STAY HEALTHY move, relax, eat! (GUT DRAUF bewegen, entspannen, essen – aber wie!) of the BZgA) is to bring about long-term improvements to the health of 12-to-18-years-olds. It is based on an integrated, well-founded concept for nutrition, physical activity and stress regulation. The website also includes plenty of resources on health and nutrition for young people.
Preventing overweight as a funding priority
Preventing overweightness among children and young people (Prävention von Übergewicht bei Kindern und Jugendlichen)is a key funding priority in the policy work of the Federal Ministry of Health (Bundesministerium für Gesundheit, BMG). BMG has three aims:
- Identify success factors to ensure the long-term effectiveness of measures
- Improve project quality and effectiveness
- Develop needs-based and target group-oriented information and education materials
Since 2015, BMG has backed various programmes to meet these targets. The Federal Ministry of Health website contains more information and a list of funded projects.
Sex education and family planning measures
In accordance with the Act on Assistance to Avoid and Cope with Conflicts in Pregnancy (Schwangerschaftskonfliktgesetz, SchKG), the Federal Centre for Health Education (Bundeszentrale für gesundheitliche Aufklärung, BZgA) together with the federal states (Bundesländer) and representatives of all types of family advice clinics, has developed concepts and communicated uniform national measures on sexual education and family planning. This legal mandate is specified in more detail in a framework concept on sexual education agreed with the federal states. BZgA has created several related Internet services.
www.sexualaufklaerung.de: Information for multipliers of information on sex education and family planning, including study and survey findings, the latest data and a description and presentation of media.
www.loveline.de: Youth homepage on love, partnerships, sexuality and contraception. An interactive learning tool for young people with chats, dictionary of terms, trivia games, FAQs, polls, news and monthly focus topics.
www.schule.loveline.de: Offers registered teachers comprehensive information, insights from science and real-life practice and materials and methods for interdisciplinary sex education.
www.familienplanung.de: An online service with information on contraception, family planning, pregnancy and early parenthood. Basic, background and current information is available via a range of channels. Lots of information on selected topics, including accounts of personal experiences, interviews with experts and statistical data. Individuals in need of advice can use the large database of information on pregnancy advice centres across Germany to find their nearest centre quickly and easily.
www.schwanger-unter-20.de: This online service provides a lot of information and guidance for pregnant minors, young women and their partners. Includes information on financial assistance and key points of contact along with answers to frequently asked questions. Young people are encouraged to accept help and, as parents-to-be, have their own say in personal accounts of their experiences.
www.komm-auf-tour.de: The project “Come on tour – my strengths, my future” (Komm auf Tour – meine Stärken, meine Zukunft) aims to help pupils in years 7 and 8 at secondary schools, comprehensives and similar schools to discover their strengths and interests at an early stage. Young people are given guidance and help with making decisions on upcoming practical training and can find out about possible career prospects. Personal topics such as friendship, sexuality and contraception are integrated age-appropriately. A project description, tour data for ongoing state projects, project resources and results of the ongoing evaluation are available on the website.
www.forum.sexualaufklaerung.de: The regularly updated information service provides an overview of media, projects and measures on the subjects of sex education and family planning. It also presents findings from recent scientific studies and evaluations. This is one of the largest full-text services on sex education and family planning.
www.forschung.sexualaufklaerung.de: Activities include research projects, selected studies, results, data, facts and trends relating to sex education, contraception and family planning.
Participatory campaign for early addiction prevention "Make children strong"
The “Make children strong” campaign (Kinder stark machen) of the Federal Centre for Health Education (Bundeszentrale für gesundheitliche Aufklärung, BZgA) aims to give children aged four and over, young people and adult contact persons bio-psychosocial skills they need to lead addiction-free lives. The campaign mainly works in the leisure and sports area and with parents. It is run in close cooperation with the big sports associations and organisations involved in child and youth services and addiction prevention.
National competition for addiction prevention in the community
The theme of the eighth national competition for addiction prevention in the community (Kommunale Suchtprävention) was "effective addition prevention – locally". By the deadline on 15 January 2020, 51 cities, local communities and districts had submitted their entries. The competition was funded by the Federal Centre for Health Education (Bundeszentrale für gesundheitliche Aufklärung, BZgA) and the Drug Commissioner of the Federal Government Drug (Drogenbeauftragte der Bundesregierung) and held with the support of the National Association of Statutory Health Insurance Funds (Spitzenverband der gesetzlichen Kranken- und Pflegekassen, GKV) and local umbrella associations. The prize totalled of 60,000 euros.
Action Programme on Environment and Health (APUG)
Several federal ministries (Environment, Nature Conservation, Building and Nuclear Safety (Umwelt, Naturschutz und nukleare Sicherheit), Health (Gesundheit), Food and Agriculture (Ernährung und Landwirtschaft)) and various top-level federal agencies (Federal Office for Radiation Protection, Federal Institute for Risk Assessment, Robert Koch Institute, and the German Environment Agency (Bundesamt für Strahlenschutz, Bundesinstitut für Risikobewertung, Robert-Koch-Institut, Umweltbundesamt)) cooperate as part of the Action Programme on Environment and Health (Aktionsprogramm Umwelt und Gesundheit, APUG) to support healthy living environments. The action programme funds research projects and information campaigns relating to environmental, health and consumer protection. Children and young people are its key target group. It aims to protect the health of children and young people against harmful environmental factors and enable research into the effect of hazardous substances on children. For example, it supports activities designed to create child-friendly residential areas and healthy environmental and living conditions. It encourages the public – especially children and young people – to actively help shape their environment.
Road safety programme and the action alliance “Federal Working Group for More Safety for Children"
In 2021, the Federal Ministry of Transport and Digital Infrastructure (Bundesministerium für Verkehr und digitale Infrastruktur, BMVI) published the Road Safety Programme (Verkehrssicherheitsprogramm) which provides guidance for the federal government's road safety policy until 2030. The programme’s measures are based on scientific findings. It is a reference framework for the programmatic approaches of the federal states (Länder) and private sector institutions and it invites all road safety stakeholders to actively participate in this important ongoing social task. One aspect of these guidelines also concerns children and young people.
The Federal Working Group for More Safety for Children (Bundesarbeitsgemeinschaft Mehr Sicherheit für Kinder e.V., BAG) is the only nationwide association dedicated to the prevention of accidents that happen to children in the home and during leisure time. It is backed by the Federal Centre for Health Education (Bundeszentrale für gesundheitliche Aufkärung, BZgA) and the Federal Ministry of Transport, Building and Urban Affairs (BMVI), among others. As an umbrella organisation, it campaigns to prevent childhood accidents and raises public awareness of the issue of childhood accidents.
Youth hostels' health promotion programme
According to the motto “Feel Fit|Youth Hostels” (Aktiv und Fit | Jugendherbergen), the German Youth Hostel Association (Deutscher Jugendherbergsverband, DJH) offers youth-friendly programmes to promote health. The campaign slogan is "Experience the good – fit for life". It refers to a modern approach to health that includes healthy eating, stress regulation and exercise as well as the teaching of social and life skills to promote socio-ecological orientation, or "education on sustainable development".
The concept links activities relating to healthy eating, physical activity, relaxation and social learning in a health-promoting environment. Activities range from food festivals, cooking courses, picnics, sporting events, popular sports, fun olympics, beauty salons, body talk sessions and dream holidays to cooperation games, educational experiences, job application training, media workshops and dealing with stress, drugs and conflict.
These experience-based personal development programmes encourage positive attitudes to health in a child and youth-friendly way. Participation and self-determination by young people is vital to triggering big enough changes in attitudes and integrating behaviour into daily life.
Other counselling and information campaigns and programmes are described in the following section "Raising awareness of healthy lifestyles and factors affecting the health and well-being of young people”.
In its Recommendation on health promotion and prevention in schools (Empfehlung zur Gesundheitsförderung und Prävention in der Schule PDF, 40.6 KB), dated 15 November 2012, the federal states (Bundesländer) made their most recent joint statement at the level of the Standing Conference of the Ministers of Education and Cultural Affairs. The recommendation sets out the following basic objectives: “Health promotion and prevention are integral parts of school development. Far from being additional responsibilities for schools, they are at the core of all school development processes." The individual federal states are responsible for implementing the recommendation.
Health promotion and prevention – example from the Federal State of Rhineland-Palatinate
The “good, healthy school” group (Gute Gesunde Schule) helps schools to implement health promotion and prevention steps and networks them regionally. Schools are encouraged to develop health-enhancing structures and ensure the long-term integration of health promotion in their profiles.
The basis for sex education in schools in the Federal State of Rhineland-Palatinate is Section 1 of the Rhineland-Palatinate state education act (Schulgesetz (SchulG) (PDF, 527 KB), Section 1(3) says: "The mandate of schools includes sex education. It comprises an integral element of general education and is implemented on an interdisciplinary basis to teach responsible sexual behaviour. Pupils are to be familiarised with the topic of sexuality and taught human, social and equal partnership skills in an age-appropriate way with the necessary discretion. Sex education must comply with the value judgements with respect to marriage and family enshrined in the Basic Law for the Federal Republic of Germany (Grundgesetz) and the constitution of the Federal State of Rhineland-Palatinate and take into account the requirement for tolerance. The school shall inform parents in good time about the aims, content and form of sex education."
School regulations cover medical care in schools and protection against infectious diseases, steps to take when the health of other pupils is at risk, smoke and alcohol-free schools and commercial activity/the sale of items.
- Sections 91, 92, 93 and 105 of the General school regulations for state secondary comprehensives, integrated comprehensives, grammar schools, colleges and night schools (Schulordnung für die öffentlichen Realschulen plus, Integrierten Gesamtschulen, Gymnasien, Kollegs und Abendgymnasien [Übergreifende Schulordnung] dated 12 June 2009 ).
- Sections 57, 58, 59 and 70 of the School regulations for state vocational colleges (Schulordnung für die öffentlichen berufsbildenden Schulen) dated 9 May 1990.
Lesson resources for teachers
- Chronic diseases
- Nutrition and exercise
- Vaccinations and personal immunisation
- Communication and social skills
- Noise prevention
- Help with the learning process
- Media skills
- Organ donation
- Sex education
- Addiction prevention
The central element of the BZgA’s peer-to-peer approach is the prevention campaign “Alcohol? Know your limits”(Alkohol? Kenn dein Limit). Every year, 50 peer educators aged between 18 and 24 tour around Germany. They approach young people to talk about alcohol and educate them about potential risks. Their focus is on young people aged between about 14 and 24.
Continuation of the youth alcohol prevention campaign OH GREAT! (NA TOLL!) by the Federal Centre for Health Education (Bundeszentrale für gesundheitliche Aufkärung, BZgA), launched in 2009. Since 2012, it has run under the name “Zero alcohol – full power” (Null Alkohol − Voll Power). This is an education initiative under the federal government's alcohol policy. It provides young people with information about alcohol and encourages them to take a critical view of their own alcohol consumption, as well as helping them to change damaging consumption behaviour. Target group: young people aged 12 to 16.
The National Prevention Conference
The Act to strengthen health promotion and prevention (Präventionsgesetz), which came into effect on 25 July 2015, strengthens the basis for greater collaboration between social security agencies, federal states (Bundesländer) and local communities in the area of prevention and health promotion. Statutory health insurers, statutory pension insurance providers, statutory accident insurers, social care insurance agencies and private health insurers are all involved. At a national prevention conference, the social security agencies set joint goals together with the federal government, the federal states, local communities, the Federal Employment Agency (Bundesagentur für Arbeit) and social partners and agree a uniform approach. A national prevention strategy has emerged from the National Prevention Conference. The National Prevention Conference produced a national prevention strategy (nationale Präventionsstrategie).
Examples of partnerships between health insurers and child day-care centres or schools
The aim of the Berlin state programme to promote “good, healthy schools” (Gute gesunde Schule) is to help participating regions and schools improve the quality of teaching and education by investing in health-promoting enhancing measures. Pupils, parents, teachers, school staff and professional youth workers involved in the programme have access to numerous measures in the areas of exercise, nutrition, stress management to implement the “good, healthy school” concept.
Partners of the good, healthy schools programme are Berlin’s Department for Education, Youth and Family (Senatsverwaltung für Bildung, Jugend und Familie), AOK Nordost – Die Gesundheitskasse, BARMER, BKK Landesverband Mitte, DAK-Gesundheit, IKK Brandenburg and Berlin, KNAPPSCHAFT – Regionaldirektion Berlin, Techniker Krankenkasse (TK), Unfallkasse and the ARGORA Klinik Berlin.
Accident insurance provider Unfallkasse Nordrhein-Westfalen in North Rhine-Westphalia awards a school development prize called 'Good, healthy school' (Gute gesunde Schule).
A project exists in Lower Saxony called Healthy life and learning– Health management in schools (Gesund Leben Lernen – Gesundheitsmanagement in Schulen). It is a cooperation project between the state statutory health insurance provider associations and the Association for Health Promotion and Academy for Social Medicine in Lower Saxony (Landesvereinigung für Gesundheit und Akademie für Sozialmedizin Niedersachsen e. V.). The project aims to develop the school organisation into a healthy place to grow up and work for teachers and pupils alike.
From 2014 to 2016, accident insurance provider Unfallkasse Sachsen-Anhalt in Saxony-Anhalt supported the implementation of occupational health management in child day care and schools with a special focus on mental health in cooperation with the Association for Health in Saxony-Anhalt (Landesvereinigung für Gesundheit Sachsen-Anhalt e.V.).
Stakeholders in child day care and schools were offered help to develop and strengthen health skills. The project aimed to establish holistic occupational health management in child day care and schools, with the focus of the backing on mental health.
Raising awareness on healthy lifestyles and on factors affecting the health and well-being of young people
During childhood and adolescence, important behavioural patterns are formed that are decisive for adult health. Health problems that develop in the early years often become risk factors for serious diseases later in life. Promoting the health of children and young people is therefore a priority task of paramount importance.
The Federal Centre for Health Education (Bundeszentrale für gesundheitliche Aufklärung, BZgA) is a specialist authority in the portfolio of the Federal Ministry of Health. With its information and materials on children’s and young people’s health, it addresses parents as well as professionals in health care institutions, early childhood education and pedagogy and child and youth services, but also children and adolescents themselves. The BZgA develops materials and projects according to latest findings in research, preparing them for specific target groups and regularly evaluating, adapting or redeveloping them when necessary.
Information portals of the Federal Centre for Health Education (Bundeszentrale für gesundheitliche Aufklärung, BZgA) on addiction prevention:
- www.rauch-frei.info– Internet service with information for young people on the effects, risks and damage to health caused by smoking. The non-smoking page for young people is mainly made up of the elements: information, communication (smoke-free community) and a personal programme to quit smoking.
- www.spielen-mit-verantwortung.de– Portal with information on and help with gambling addiction. Includes information on the potential dangers of different games, how gambling addiction arises and its impact on those affected and their loved ones. There is also a self-test function to test personal gambling behaviour, an online help programme for people trying to quit and information on local advisory centres.
- www.kenn-dein-limit.info– Portal for young people. Includes information about risks and dangers to health of heavy and harmful alcohol consumption.
- www.Drugcom.de – A low-threshold internet project in the recreational sector aimed at young people taking or likely to take drugs. It aims to promote communication with young people with experience of drugs. Internet-based, anonymous information and counselling services help to motivate young drug users to critically reflect on and modify their consumption.
- https://www.inforo.online/prevnet – Cooperation project between the Federal Centre for Health Education (Bundeszentrale für gesundheitliche Aufklärung, BZgA) and the state addiction prevention coordinators from twelve federal states (Hamburg, Brandenburg, Bremen, Lower Saxony, Mecklenburg-Western Pomerania, Berlin, North Rhine-Westphalia, Hesse, Rhineland-Palatinate, Saarland, Saxony, Bavaria). The portal presents addiction prevention programmes by the federal government and the federal states (Bundesländer) and connects experts with one another. Information on facilities, activities, supporters, studies and resources relating to addiction prevention is bundled together in one portal. The interactive section of the portal, with forums, mailing lists and work groups, including a virtual office function, allows experts to share knowledge and cooperate across state borders.