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1. National strategy(ies)

2. Encouraging healthy lifestyles and healthy nutrition for young people

3. Health education and healthy lifestyles education in schools

4. Peer-to-peer education approaches

5. Collaboration and partnerships

6. Raising awareness on healthy lifestyles and on factors affecting the health and well-being of young people

National strategy(ies)

There is no standalone national strategy dedicated exclusively to nutrition and healthy lifestyles for young people. Instead, these topics are incorporated into broader policy frameworks. The Health Strategy of the Republic of North Macedonia 2021–2030 places strong emphasis on health education for children and youth, including the promotion of balanced nutrition, regular physical activity, prevention of tobacco, alcohol and substance use, sexually transmitted infections, and mental health challenges.

Healthy lifestyles are also a component of the National Youth Strategy 2023–2027, which identifies health as one of its strategic areas. The Strategy sets objectives related to improving young people’s mental well-being, promoting healthy living, ensuring access to sexual and reproductive health services, and encouraging youth to live and create healthier environments.

In addition, the Action Plan on Food and Nutrition 2016–2025 (Акциски план за храна и исхрана 2016–2025) outlines measures to encourage lifelong healthy eating habits among children, adolescents and young people, with a focus on sustainable improvements.

The National Drugs Strategy 2021–2025 (Национална стратегија за дрога 2021–2025) also applies to the entire population, but places a specific emphasis on young people due to their vulnerability. Developed in cooperation with the former Agency of Youth and Sport, the Strategy foresees improved access to early-intervention programmes, particularly for young people experimenting with psychoactive substances.

Encouraging healthy lifestyles and healthy nutrition for young people

Activities supporting healthy lifestyles among young people are mainly implemented through the Public Health Institute (IPH) and the network of Centers for Public Health. North Macedonia participates in the WHO Childhood Obesity Surveillance Initiative (COSI), conducted every three years and funded through the national public health programme. The initiative monitors obesity trends among school children and provides evidence for improving school meals and physical activity standards.

The Law on Subsidised Student Meals, first adopted in 2020 and revised in 2023, provides daily financial support for regular undergraduate students at public and private universities, aiming to ease access to healthier meals and improve student living standards.

Civil society organisations remain important actors in promoting healthy lifestyles. NGOs such as HERA, Youth Can, and Psihesko organise awareness campaigns, school workshops and peer-education initiatives on healthy nutrition, physical activity and sexual and reproductive health. These programmes help fill the gaps where formal public policies are limited.

Health education and healthy lifestyles education in schools

Health promotion is embedded within the national education system. Schools collaborate with the Ministry of Education and Science, the Ministry of Health and the IPH to organise health-education activities. Elements of healthy lifestyle education appear in subjects such as Life Skills, which address nutrition, physical activity, prevention of addictions, reproductive health, HIV/STIs, smoking, hygiene and violence prevention.

Schools also participate in health-promotion projects supported by government institutions, municipalities and international partners. Many schools have improved sport facilities, laboratories and outdoor spaces to support healthier school environments. Teacher training is organised regularly to strengthen the implementation of health-education content.

Comprehensive sexuality education remains limited in formal curricula, but progress has been made through pilot initiatives implemented in partnership with civil society organisations. HERA has trained peer educators and works with selected schools to deliver age-appropriate sexual and reproductive health information.

Peer-to-peer education approaches

Peer-to-peer education remains an important approach to health promotion for young people in North Macedonia and is driven largely by civil-society organisations. HERA (Health Education and Research Association) is the most prominent provider of peer-education on comprehensive sexuality education and has published a national peer-education handbook and positive evaluation results from pilot CSE programmes. Other NGOs — including Youth Can, Psihesko and S.H.A.R.E. — use peer models in school workshops, awareness campaigns and online outreach to reach adolescents, including marginalised groups.

Recent years have seen stronger international support for youth peer-approaches linked to mental-health and child protection. UNICEF and WHO’s joint programmes and trainings have built local capacity for mental-health and psychosocial support (MHPSS), while youth-led digital initiatives — for example youth co-created mediathons and national campaigns on cyberbullying — show how peer approaches are adapting to online spaces.

Evidence from evaluations and national surveys points to real demand: pilot CSE programmes showed clear learning gains among participating pupils, while a UNICEF-supported survey found high levels of anxiety and depression among adolescents and that many young people in need do not seek formal help. These findings underline why peer-to-peer models — school-based, community and digital — are valuable entry points for prevention and early support. 

At the same time, most peer programmes remain project-based and donor-dependent, which limits scalability and long-term monitoring. Stakeholders repeatedly call for the integration of proven peer approaches into school curricula and national programmes, stable public funding, clearer referral pathways to professional services, and systematic monitoring to measure impact beyond individual projects.

Collaboration and partnerships

The Health Strategy of the Republic of North Macedonia 2021 - 2030 stipulates that the pursuit of better health determinants for all will be achieved through the partnership of individuals, groups and organizations from the public and private sectors and civil society.

Furthermore, in the National Youth Strategy 2023-2027, across its eight thematic areas, it anticipates and reinforces intersectoral collaboration at all decision-making levels, aiming to foster interaction, increased youth engagement, and synergy among the measures.

Raising awareness on healthy lifestyles and on factors affecting the health and well-being of young people

In the absence of a National health promotion strategy, there is no systematic way of counseling and information campaigns related to raising awareness on healthy lifestyles and factors affecting the health and well-being of young people.

Awareness raising campaigns are organized usually on the designated day, mainly by CSO sector, in collaboration with line ministries (World Food Day, World AIDS day, etc.). Funding for such events comes from international donors mainly and organization largely depends on availability of funds that defines the scope and timeframe.