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National guidelines for prevention and treatment for unhealthy lifestyle
In the national guidelines for prevention and treatment for unhealthy lifestyle from 2018 (Nationella riktlinjer för prevention och behandling vid ohälsosamma levnadsvanor), the National Board of Health and Welfare (Socialstyrelsen) gives recommendations concerning unhealthy lifestyles and habits. The purpose of the guidelines is to stimulate the use of scientifically evaluated and effective measures in this area, and to provide a basis for open and systematic healthcare priorities.
Recommendations for children and adolescents under 18 are presented in a separate chapter. These recommendations include insufficient physical activity, tobacco use and alcohol consumption. Three recommendations affecting children under 12 years of age include unhealthy eating habits and insufficient physical activity.
1. Insufficient physical activity among young people under 18 years
Insufficient physical activity increases the risk of poor physical and mental health and poor physical capacity. It may also affect future health and increase the risk of developing certain chronic diseases of adulthood. The recommendation given in the guidelines is that health care should:
Guidance and support to young people under 18 who are insufficiently physically active.
For young people under 18 years with unhealthy eating habits or inadequate physical activity, there are also recommendations for the following measures:
- Family support programme
2. Tobacco use among young people under 18 years
Many among those who start smoking early in their adolescence become nicotine addicted. The risk of disease and mortality increases with the amount of cigarettes and how long time a person has smoked. It is therefore important that health care supports young smokers to get rid of their tobacco use. Qualified councelling on tobacco use involves healthcare professionals for a person-centered dialogue with a young person in order to support her or him to quit smoking. Web-based intervention to support a behavioral change related to tobacco use includes personalised support, including how to quit smoking, as well as a number of interactive components, such as giving personal support within 24 hours. The intervention can be supplemented with councelling and telephone monitoring. The recommendation given in the guidelines concerning tobacco use is that health care should:
Provide qualified guidance to young people under the age of 18 smoking tobacco.
- Provide web-based interventions for young people under the age of 18 moking tobacco.
There are also recommendations for the following measures:
- Qualified councelling combined with prescription drugs
- Family support programme
3. Alcohol consumtion among young people under 18 years
Use of alcohol is one of the largest individual risk factors for deaths and ill health among young people aged 15-19. Alcohol consumption during the teens has been shown to increase the risk of later problematic alcohol use. For young people under the age of 18, all alcohol consumption is defined as risk-taking, and guidance is identified as the best available measure for this target group. The recommendation given in the guidelines concerning alcohol consumption is therefore that health care should:
Provide guidance to young people under 18 years.
There are also recommendations for the following measures:
Family support programme
- Web-based intervention
The current government document promoting the role of sport, youth fitness and physical activity is the government bill Government support to sport activities (Statens stöd till idrotten) set up in 2009, based on the government bill A sports policy for the 2000s (En idrottspolitik för 2000-talet), set up in 1999. The policy bill addressed the population in general, while children and adolescents are identified as a priority group.
The bill consists of following main elements:
- An overview of the government’s role in relationship to the sports movement.
- A statement that current principle of responsibilities between the government and the sports movement should remain unchanged. That is, the government formulates objectives and guidelines for the subsidy allocation, while the sports movement independently set objectives for their own activities.
- The Swedish Research Centre for sport science (Centrum för idrottsforskning) is tasked to monitor and evaluate the government support.
- A new guideline for the government support, with sharper focus on children and adolescents. In order to receive grants for sports, activities for children and teens must comply with the UN Convention on the Rights of the Child.
The policy consists of a long-term orientation, focusing on high ethical standards, increased participation, volunteering, equity and integration in sports.
The key objectives in the policy bill are:
- Providing opportunities for all girls and boys, women and men to exercise, hence contributing to a lifelong interest in exercise and healthy lifestyle.
- Supporting a free and independent sports movement and providing positive experiences of sport as entertainment.
- Ensuring that all sports activities for children and youth are consistent with the UN Convention on the Rights of the Child.
- Strengthening and developing cooperation between sports associations, schools and others engaged in efforts to promote physical activity and good exercise habits.
Responsible authority and organisation
The National Board of Health and Welfare (Socialstyrelsen) is responsible for giving recommendations concerning unhealthy lifestyles and habits.
Since 2015, the Ministry of Health and Social Affairs deals with issues concerning sports policy. As mentioned above, the government approach comprises mainly of subsidy allocations.
The responsible actor for coordination of the subsidy allocations is the Swedish Sports Confederation (Riksidrottsförbundet), a civil society organisation. The Swedish Sports Confederation is responsible for distribution, administration, organisation and monitoring of the grants.
According to the ordinance on government grants to sports (Förordning om statsbidrag till idrottsverksamhet), the Swedish Sports Confederation has to annually provide a comprehensive accounting of who has received grants, the amounts and purposes. Also, the confederation must each year present a summary to the government on how the allocations have been used and assess the impact of the subsidy, in relation to the objectives set by the government.
Evidence based monitoring
Since 2009, the Swedish Research Council for sport science (Centrum för idrottsforskning) at the Swedish School of Sport and Health Sciences (Gymnastik- och idrottshögskolan), has the government task to follow up the government's support to sports organisations. This is done through regular and long-term monitoring of the government support to sports organisations, based on a number of indicators, in-depth analyses and additional research.
The latest evaluation of government’s support to sports movement was conducted in 2016.
Some findings from the evaluation were:
- The majority of children and adolescents do not meet the daily physical activity recommendations, which, according to the Swedish Medical Society and WHO, is at least 60 minutes per day.
- Girls in upper secondary school were least active. In that group, only 14% met the daily physical recommendations.
- Also, the evaluation showed a polarised image of young people’s participation in sport associations. About 20% do not exercise at all in their spare time. An equal share is very active. Those who are active in a sports association are in general more physically active, less sedentary and have less screen time, compared to those who are not active in a sport association.
Specific target groups within the youth population
A specific target group in the bill 'Government support to sport activities' (Statens stöd till idrotten) is young people with disabilities. The bill states that young people with disabilities are underrepresented within organised sports activities, and that they tend to quit exercising earlier than others do in their age group. For that reason, sports associations need to increase their efforts to create activities that are more inclusive and where even children and young people with disabilities can feel included. This means that children and young people with disabilities, who can exercise and compete with children and young people without disabilities, should be encouraged and supported to do so.
The government’s support to sports amounts in 2019 to roughly 200 million euros (2.1 billion SEK). In 2017, about 56 million euros (585 million SEK) were distributed as local activity support (lokalt aktivitetetstöd) for organised sports activities for children and young people between 7 and 25 years of age. According to the Swedish Sports Confederation, grants can be allocated to sport activities which involve performance and competitive oriented sport, health and fitness oriented sport, and to recreational sport in which a central element of physical activity is included.
Targeted initiatives are a part of the government’s support. One such initiative is the Lift for Sport (Idrottslyftet), launched in 2007. The Swedish Sports Confederation is responsible for the Lift for Sport programme, intended for getting children to try out sports activities, as well as encouraging older youngsters to continue with sports. Lift for Sport has been applied for more than 10 000 clubs and attracted more than 800 000 participants. The government grant in 2019 was about 54 million euros (569 million SEK).
Evaluations have been conducted on a regular basis since the start of the Lift for Sport. The overall picture is that both the Confederation and the associations are experiencing Lift for Sport as a very positive initiative. The support has enabled the associations to develop and renew their activities for children and young people.
According to a summary analysis, education in leadership has been found to be a key factor for raising the quality of the activities. That in turn has led to a higher number of young people that have chosen to remain active in the associations. Another finding is that many sport associations mostly rely on try-it-out activities, in order to open up their activities.
Further, the evaluation shows a lack of common understanding of the objectives for the Lift for Sport. The associations have interpreted the guidelines in different ways. What does the sports movement mean by opening up the doors for more young participants? To encourage youngsters to stay active longer? To work on gender equality? A common interpretation of the main objectives could have served as a basis for formulating goals and development plans for all involved.
Status of physical education in the curriculum
The curriculum states that schools should aim to ensure that learners have opportunity of regularly carrying out physical activities. Physical education and health is one of the upper secondary foundation subjects that are included in all upper secondary education, both general and vocational. All students are obliged to 100 credit points (corresponding about the same number of lessons) in physical education, of the total of 2 500 credits required for a vocational diploma/a diploma for admission to higher education.
Following general courses are offered:
- Physical education and health 1, 100 credits, which building on knowledge from the compulsory school or equivalent.
- Physical education and health 2, 100 credits, which building on the course physical education and health 1.
- Physical education and health 1 – specialisation, 100 credits.
- Physical education and health 2 – specialisation, 100 credits, building on knowledge from the course physical education and health 1 – specialisation.
Introducing daily physical exercise in schools In autumn 2017, the Government introduced an initiative for enhanced possibilites for daily exercising in schools (Samling för daglig rörelse). The background is that, in comparison to other European countries, Sweden has been at the lower level when it comes to the extent of teaching hours in physical education. A report from the European Commission from 2013 showed that only seven out of 31 countries had fewer sports lessons in compulsory education than Sweden.
As a part of the initiative, the government has instructed the National Agency for Education to submit proposals on how to reach the goal of all students being part of physical activity every day. In December 2018, the Agency for Education has sent a proposal for consideration to actors such as central government agencies, special interest groups and local government authorities. The proposals concern an addition in the Curriculum. New area of responsibility is proposed for school principals, and that is for creating good conditions for physical activities during the school day.
The teaching time in the subject of physical education and health was expanded with 100 hours in compulsory education, starting from 2019. If the lessons were concentrated on, for example, grades 7 to 9, this means about one extra lesson per week.
A network of stakeholders, the Swedish Sports Conferederation (Riksidrottsförbundet), the Swedish School of Sport and Health Sciences (Gymnastik och Idrottshögskolan) and Swedish Outdoor Life (Svenskt Friluftsliv), together with the teachers' unions, will hold a continuous dialogue on, among other things, skills development among teachers in physical education and health.
Pedagogical tools and support provided to teachers
The Swedish National Agency for Education (Skolverket) has in collaboration with the National Agency for Special Needs Education and Schools (Specialpedagogiska skolmyndigheten) developed the movie Physical Education and Health on Equal terms(Likvärdig undervisning i ämnet idrott och hälsa).The film describes ways to create opportunities for all students, regardless of ability, to participate in physical education.
In connection to the movie, a study package has been developed containing guidelines and materials to support teachers, work-teams and schools with their efforts to develop physical education for those in need of special support, in order to create equal conditions for all students.
Continuing professional development (CPD)
In Sweden, the ’teachers boost’ programme (Lärarlyftet) is aimed at providing CPD opportunities for compulsory school teachers lacking formally required qualifications for subjects which they already teach as part of their duty. As far as physical education is concerned, this initiative offers several courses intended specifically for general teachers in charge of physical education and health in compulsory education.
Collaboration between schools and sports organisations
There is no clear support or legal framework in Sweden for collaboration and formation of partnerships between authorities, schools, health professionals and youth workers, in order to promote youth fitness and physical activity among young people.
However, the government supports collaboration with schools and sports clubs indirectly through subsidy allocations via the Sport-lift initiative (Idrottslyftet), a government initiative that the Swedish Sports Confederation (Riksidrottsförbundet) is responsible for. The goal for the period 2016-2019 is to develop sports associations so that children and young people between 7 and 25 years of age can choose to take part in activities and be stimulated into lifelong activity in the sports movement.
Although school collaboration is not a priority area within the Sport-lift initiative, a sport association/club may receive support for school-collaboration.
In order to receive support for school-collaboration it is important that:
- the sport association has been approved by the school administration,
- the planned activities do not aim to replace the subject Physical education and health,
- activities are conducted in the school’s district,
- activities are offered to all students in the chosen school/class and that continuing activities within the sports association/club are offered after the project has ended.
In 2017, the Swedish Sports Confederation has been commissioned by the government to make another commitment for increasing psysical activity in the lower grades of compulsory education. The aim is to improve the development of physical literacy, well-being and school results among school children. The Swedish Sports Confederation's efforts are made in connection with the school day and are led by the regional sports federations in collaboration with municipalities and schools.
School sports associations
School sports associations (skolidrottsföreningar) offer activities for learners on their own terms, in connection with the school day. The School Sports Federation (Skolidrottsförbundet) is the national organisation for school sports clubs. Today, there are about 1 300 school sports associations with about 150 000 members.