7.4 Healthy lifestyles and healthy nutrition
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The current Swedish governing document for healthy lifestyles and healthy nutrition policy is the government’s bill 'A renewed public health policy' (En förnyad folkhälsopolitik). Key parts of the bill were decided by the parliament in 2009.
Specific target groups in the bill are children, young people and parents. Particular focus is on strengthening and supporting parents in their parenting, in order to intensify suicide prevention, promote good eating habits and physical activity and reduce the use of tobacco.
In order to achieve the overall public health objective – creating social conditions for a good health on equal terms for the entire population – the government has identified that a long-term and cross-sectorial approach is needed in all sectors that affect the development of the public health. To facilitate this work, a combined target structure with eleven target domains has been developed. One of the target domains is eating habits and food.
According to the Public Health Agency, unhealthy eating habits are one of the biggest risk factors for ill-health and premature death in Sweden. The eating habits among adults in Sweden have improved in many ways since 1990s, but the intake of vegetables, fruit, whole grains and vegetable oils, as well as seafood, is still too low. At the same time, intake of sweet drinks, pastries, fat dairy and salt is too high, as well as consumption of red meat. The daily physical activity level is also low and has remained unchanged in the last decade.
Based on facts like these, the government instructed in 2016 the Public Health Agency of Sweden (Folkhälsomyndigheten) and the Swedish National Food Agency (Livsmedelsverket) to develop support for health-related activities related to eating habits and physical activity.
In 2017, the agencies gave a proposal describing an overall structure at national level. The authorities consider that national goals and broad collaborations are needed to reduce ill-health and to reduce health gaps related to eating habits and physical activity. According to the proposal, the Public Health Agency should be assigned the task of establishing a structure for national coordination of public health work related to healthy nutrition and physical activity.
The Public Health Agency of Sweden (Folkhälsomyndigheten) is an expert authority with responsibility for public health issues at a national level. Among other responsibilities, the agency monitors the development of and knowledge on the eating habits of the population, including different factors which can affect this.
The Swedish National Food Agency (Livsmedelsverket) is an expert authority with responsibility for the food sector. The agency works towards the following goals: healthy dietary habits, safe foods and fair practices in the food trade. The main tools are regulations, recommendations and communication.
Sweden has a comprehensive and service-oriented welfare system, where all citizens are to have equal opportunities for good and equitable health. Meals served in public institutions such as schools, nursing homes and hospitals are considered an important part of the task.
The safety of all public meals is regulated by European and national food legislation. National nutritional guidelines are developed in Nordic collaboration, and these guidelines set the standards for the nutritional quality of public meals.
School lunches are served in many countries, but the Swedish school meal model is unique in offering free meals to all children between 7 and 16 years of age, and to most students between 16 and 19 years of age, on an everyday basis. The meals are hot and several alternatives are often available. Salad, bread, butter, milk and water are also on the menu.
Since 2011, the Education Act stipulates that school lunches must be nutritious, thus equal a third of the recommended daily intake of energy and nutrients. In November 2011, the National Food Agency was commissioned to work in cooperation with the Swedish National Agency for Education, supporting work with nutritious school meals. One element of this work involved revising the guidelines Good school meals (Bra måltider i skolan). These guidelines are intended to provide support for efforts to produce good school meals.
Health education in upper secondary education
In Sweden, health education is included in the subject of physical education and health. At upper secondary level, as described in section 7.3, Sport, youth fitness and physical activity, the subject is mandatory both for vocational and academic study programmes.
Physical education and health
The subject of physical education and health aims at helping students at upper secondary level to develop their physical ability, and the ability to plan, carry out and assess a variety of physical activities that promote all-round physical capacity. Teaching should also lead to students developing knowledge of how their own bodies function, and the importance of lifestyle and the consequences of physical activity and inactivity.
In addition, teaching should also help students to develop their health and environmental awareness, and gain general interest in health issues.
Teaching should raise awareness and challenge stereotypes of what is considered to be masculine and feminine, and inform about the consequences of different body ideals. It should also give students opportunities to develop knowledge of the importance of physical activities and nature experiences for physical ability and health.
The subject of health is a programme specific subject for Child and recreation programme and Health and social care programme, both being vocational programmes at upper secondary level. The subject covers health and health promotion from individual, group and societal perspectives. The subject is based on a holistic view of people as biological, psychological and social beings.
Teaching should aim at helping students to develop knowledge of people's health, and of different kinds of health promotion measures. Students should be given opportunities to develop knowledge about public health goals and the content of public health work. Teaching should help students to develop their abilities to work in a health promoting way using a salutogenic approach, thus reinforcing what is healthy and seeing people as a resource for their own well-being.
In Sweden, sex education became mandatory as early as in 1955. Terms such as sexuality, relationships, gender, gender equality and norms have been included since 2011 in several of the course and subject syllabuses for compulsory and upper secondary school and adult education. This means that the responsibility for this subject falls on several teachers, and that it will be brought up within the scope of multiple courses and subjects (Skolverket).
The major part of sex education is conducted in years five, eight and nine of compulsory school. In year five, when the pupils are 11 years old, topics like puberty, body development and masturbation are covered. In year eight, at the age of 14, many schools focus on topics like bodily functions and STIs. In year nine, the focus is often on relationships.
The upper secondary school's subject syllabus sets out a central content for sex and relationships teaching. The subject has been integrated primarily in other subjects such as history, physical education and health, natural science, social sciences and religion.
Sex education in Sweden conveys facts about sexual and reproductive health such as anatomy, sexual functions, sexual orientations, STIs, HIV/AIDS, abortion and contraceptives. Moreover, the possibility to discuss, reflect and work on attitudes, norms and values regarding for example the use of condoms, gender, harassments and expressing love is also an important part of sex and relationships education. Here, different methods such as value clarification games and group talks are used.
At many schools, condoms are distributed within the context of sexuality education. Many schools also provide condoms at the school nurse’s reception. If there is a youth clinic located nearby, many schools include a visit.
Gender perspective is an important part of the Swedish policy in relation to sex education. Currently in Sweden, there are on-going discussions about the possibility of linking sex education and gender equality education more closely. In 2018, the Government allocated SEK 50 million (about 4,8 million euros) for better coordination of sex and relationship education and preventioning sexualt assoult in school environment.
The National Agency for Education (Skolverket) offers both pedagogical tools and support to teachers responsible for sex and relationships education. All tools – films and other support materials – are free for downloading for teachers. The films, together with related discussion questions, are meant to provide a basis for discussion in the work team or the subject group, on how gender equality, sex patterns, sexuality and relationships can be integrated into teaching.
Today, there are films aimed at teachers in natural science, physical education and health, religion, social sciences, history, biology, art, English, Swedish and music.
Local associations of RFSU (the Swedish Association for Sexuality Education, see Collaboration and partnerships below for more information) offer specialised school informers. School informers work with information about sexuality issues, based on a positive sexual opinion. RFSU informers meet learners between 13 and 20 years of age, for discussions about feelings, sexuality and the body, consent, norms and rights. The school informers are between 20 and 30 years of age, and have received informant training.
At present, there is no clear support or legal framework in Sweden when it comes to collaboration between authorities, schools, health professionals and youth workers for promoting physical activity among young people.
However, the government supports collaboration with schools and sport organisations indirectly through subsidy allocations via the Sport-lift initiative (Idrottslyftet), which the Swedish Sport Confederation (Riksidrottsförbundet) is responsible for (see section 7.3 for more information).
RFSU (the Swedish Association for Sexuality Education) is the leading organisation in Sweden in the field of sexual and reproductive health and rights (SRHR). RFSU works locally (e.g. with information provision in schools), nationally (e.g. by influencing policies) and internationally (e.g. in the form of development projects in Africa). RFSU sees openness on sexuality as the point of entry of health promotion and STIs and HIV/AIDS prevention.
Raising awareness on healthy lifestyles and on factors affecting the health and well-being of young people
A Healthier Sweden
On behalf of the government, an annual campaign week giving attention to healthy eating habits and physical activity – A Healthier Sweden (Ett friskare Sverige) – was arranged during 2010-2012. Particular attention was paid to children, teens, elderly people and people with intellectual impairment.
A Healthier Sweden aimed to provide inspiration and knowledge on how to eat healthy and how to exercise, by paying attention to concrete examples from all over the country. The mission was carried out in collaboration with municipalities, county councils/regions, civil society organisations as well as private actors. The final year of the campaign, 2012, in total 2 800 activities were organised throughout the country and 1 000 different actors contributed to highlighting the importance of good eating habits and physical activity.
The campaign was evaluated by two external evaluators. The first of the two independent reports (Bakhsi 2013) highlighted the appropriateness of the mission. That is, has the campaign week been successful and has the Public Health Agency as coordinator succeeded. The second independent report (PA Consulting Group 2013) examined whether initiatives like a Healthier Sweden actually contribute to increased public awareness about the benefits of good eating habits and physical activity.
Some of the conclusions were the following:
- the campaign week A Healthier Sweden generated good media attention and a wide range of activities has been offered to the public and the priority target groups, with regard to the financial resources available.
- Social disparities in health have been highlighted in particular over all three years. Despite of that, this effort did not have a significant impact on organisers' choices for activities. Only about 10% of the activities were targeted for teens, while about 45% of the activities were of open character.
- There is some scientific support for that activity and information-based campaigns, such as A Healthier Sweden, may have some effect on public awareness and knowledge.
- There is stronger scientific support for that theory-based campaigns, based on health science theory and communication strategic knowledge, have greater potential for effect.
- In conclusion, it should be noted that there is no evidence that campaigns such as A Healthier Sweden actually cause behavioral changes, such as healthier eating habits or increased physical activity.