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WHO/HBSC FORUM 2006 Addressing the socioeconomic determinants of healthy eating habits and physical activity levels among adolescents Tuscany Region, Italy Health Behaviour in School-aged Children A World Health Organization Cross-national Study WHO Collaborating Centre for Health Promotion Capacity Building in Child and Adolescent Health WHO Collaborating Centre for Health Promotion and Public Health Development   Addressing the socioeconomic determinants of healthy eating habits and physical activity levels among adolescents  © World Health Organization 2006 All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. 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Report writers/editors: Alex Mathieson1, [email protected] and Theadora Koller, Technical Officer, WHO European Office for Investment for Health and Development, [email protected] Design: Marta Pasqualato, [email protected] Coverphoto: Andrea Bertola Keywords ADOLESCENT CHILD HEALTH PROMOTION OBESITY – prevention and control NUTRITION EXERCISE PHYSICAL FITNESS SOCIOECONOMIC FACTORS HEALTH BEHAVIOUR HEALTH POLICY CASE REPORTS EUROPE 1 The WHO European Office for Investment for Health and Development wishes to thank the WHO Collaborating Centre for Health Promotion and Public Health Development (NHS Health Scotland) for supporting Mr Mathieson’s contribution to the report. ISBN 92 890 2180 2  Addressing the socioeconomic determinants of healthy eating habits and physical activity levels among adolescents  Disclaimer: This publication is based upon the report writers/editors’ interpretations of verbal presentations and group discussions at the WHO/HBSC Forum meeting held in Florence, Italy, on 10–11 March 2006, and written papers prepared as part of the Forum process. The publication does not necessarily represent the views of the World Health Organization, meeting co-organizers, or participants in the Forum 2006 process (including presenters, case study authors and break-out group facilitators). The WHO Regional Office for Europe is one of six regional offices throughout the world, each with its own programme geared to the particular health problems of the countries it serves. The European Region embraces some 870 million people living in an area stretching from Greenland in the north and the Mediterranean in the south to the Pacific shores of the Russian Federation. The European programme of WHO therefore concentrates both on the problems associated with industrial and post-industrial society and on those faced by the emerging democracies of central and eastern Europe and the former USSR. To ensure the widest possible availability of authoritative information and guidance on health matters, WHO secures broad international distribution of its publications and encourages their translation and adaptation. By helping to promote and protect health and prevent and control disease, WHO’s publications contribute to achieving the Organization’s principal objective – the attainment by all people of the highest possible level of health. The WHO European Office for Investment for Health and Development, which coordinated – in conjunction with a dedicated Task Force (see Annex 4) – the activities leading to this publication, was set up by the WHO Regional Office for Europe, with cooperation and support from the Ministry of Health and the Veneto Region of Italy. Its key responsibility is to provide evidence, and support Member States in acting on the socioeconomic determinants of health. For more information regarding the contents of this report and the WHO/HBSC Forum process, please write to the WHO European Office for Investment for Health and Development at [email protected]  Contents Abbreviations and acronyms Section 1 Foreword About the WHO/HBSC Forum process Why address the socioeconomic determinants of young people’s health? Forum 2006: addressing the socioeconomic determinants of healthy eating habits and physical activity levels among adolescents Section 2 Summary of outcomes: WHO/HBSC Forum 2006 Why address the socioeconomic determinants of healthy eating habits and physical activity levels among young people in the WHO European Region? 1. What is the problem? 2. How do we know about this problem? 3. How has the problem of obesity in children and adolescents arisen? 4. Why does this matter? 5. Why act now? 6. What would help tackle this problem? 7. What would we like policy-makers to consider? 8. What immediate steps can policy-makers take? Section 3 The HBSC background paper Overweight in school-aged children in 35 countries: associations with eating habits, physical activity, socioeconomic status and perceived health 1. Introduction 2. Prevalence of overweight Socioeconomic differences in overweight 3. Eating habits Socioeconomic differences in eating habits Associations between eating habits and overweight 4. Physical activity Sedentary behaviours Associations between physical activity, sedentary behaviour and overweight TV viewing and consumption of foods Psychological well-being References Section 4 Case studies Case studies: an introduction Croatia: developing guidelines for children and youth health care – can we tackle inequalities and well-being? 1. Introduction 2. Policy framework 3. Organizational framework 4. Research X 1 2 2 3 3 7 8 8 8 8 9 10 10 11 11 13 14 14 15 16 17 17 18 18 18 19 19 19 21 25 26 27 27 27 29 30  VI Addressing the socioeconomic determinants of healthy eating habits and physical activity levels among adolescents 5. Practice issues 6. Aim of the international guidelines The project timeframe 7. Conclusion Collaboration among the three countries Bringing together practice and science Organizing health care for schoolchildren Reference France: the French nutrition policy framework 1. Introduction 2. The socioeconomic determinants of health in French adolescents Data from the 2001/2002 HBSC survey 3. Policy framework in France: the National Nutritional Health Programme 4. Initiatives promoting healthy eating and physical activity in the school setting Actions implemented as part of the interministerial partnership Other national and local actions 5. Conclusion References Germany: preventive care for obese children and adolescents - quality and deficiencies of programmes and interventions 1. Introduction 2. Background: health promotion and education in Germany 3. The study Methods: a representative survey and quality assessment of institutions and programmes Findings: obesity prevention for children and adolescents in Germany Discussion and recommendations 4. Conclusion References Italy (Piedmont Region): health services, schools and local communities allied in promoting healthy eating habits and regular physical activity 1. Introduction 2. Local and political context 3. The project: main strategies used Training educators in the school setting Involvement of parents 4. Other key initiatives Building alliances School meals 5. Conclusion References Norway: physical activity and healthy eating in schools 1. Introduction 2. The Norwegian situation 3. Intervention programme: “Physical Activity and Healthy Meals in School” 32 32 33 34 34 35 35 35 36 36 36 36 38 40 40 41 41 42 43 43 43 43 44 46 47 48 49 50 50 51 52 52 54 55 55 56 57 58 59 59 60 62  VII Contents Participating schools and principles for planning and implementing actions Network approach Evaluating the intervention programme 4. Conclusion References Slovenia: confronting the problem – the adoption of the Food and Nutrition Action Plan for Slovenia 1. Introduction 2. Health status of children and adolescents in Slovenia 3. Nutritional status of Slovenian children and adolescents 4. Using HBSC data in developing policies and designing programmes 5. Policy context in Slovenia in relation to health and nutrition of children and adolescents The National School Nutrition Programme Inequalities in health 6. Confronting the problem: the adoption of the Food and Nutrition Action Plan for Slovenia 7. Response to the problem: health promotion activities, activities involved in the national action plan and other activities in the field of nutrition 8. Unique themes 9. Conclusion References Spain (Canary Islands): tackling obesity among young people 1. Introduction 2. Social determinants of health in the Canary Islands 3. Obesity in Spain The prevalence of obesity in the Canary Islands Physical activity and sedentary lifestyle Food and diet 4. The political context for the prevention of obesity in Spain Intersectoral action on the socioeconomic determinants of health in the Canary Islands Obesity prevention and the Proyecto Delta The experience of Radio ECCA Foundation 5. Conclusion References United Kingdom (Scotland): from research to policies, practice and partnerships – a case study on health promotion and young people 1. Introduction 2. Introduction to Scotland Scotland’s health 3. Case study The policy context in Scotland in relation to young people and the Health Behaviour in School-aged Children study (HBSC) A cross-sectoral approach: health and education in partnership The mental health and well-being of young people in Scotland Physical activity, healthy eating and healthy weight Training and capacity building–“Growing through adolescence” Developing policy at government level – the example of “Hungry for success” 63 63 64 64 65 66 66 66 67 69 69 70 70 71 74 75 76 77 78 78 78 78 79 79 80 81 82 82 83 84 85 86 86 86 87 88 88 88 89 90 91 91  VIII Addressing the socioeconomic determinants of healthy eating habits and physical activity levels among adolescents 4. Conclusion Main strengths in Scotland Issues that require further development References United Kingdom (Wales): summary of HBSC data to inform policy on nutrition and physical activity for children and young people 1. Introduction 2. Background Addressing inequalities 3. The HBSC study in Wales 4. Influence of HBSC on policy development The National Service Framework for Children, Young People and Maternity Services in Wales (Children’s NSF) Food and Fitness Action Plan for Children and Young People Current action Nutrition Physical activity Other research New action 5. Conclusion References “Young Minds”: children’s and young people’s voices in health matters – learning by making a difference 1. Introduction 2. Health-promoting schools and the many faces of participation 3. Case study: “Young Minds” – exploring food, culture and health Pupil action Pupil involvement IVAC instructional design Teacher guidance International collaboration “Real life” action Nutrition, food and health – pupils’ thoughts Knowledge about health and pupils’ capacity to make a difference 4. Conclusion References Annexes Annex 1 - Agenda Annex 2 - Case study contributors Annex 3 - Resources Annex 4 - WHO/HBSC Forum 2006 Task Force and Organizers 92 92 93 94 96 96 97 97 98 99 99 100 100 100 101 101 101 103 104 105 105 106 108 108 108 109 109 109 109 109 110 114 116 119 120 123 129 130   X Addressing the socioeconomic determinants of healthy eating habits and physical activity levels among adolescents Abbreviations and acronyms AESA Agencia Española de Seguridad Alimentaria (the Spanish food safety agency) ASL Azienda Sanitaria Locale (local health unit) BMI body mass index BzgA Bundeszentrale für gesundheitliche Aufklärung (German federal centre for health education) CAHRU The Child and Adolescent Health Research Unit CES Consejo Económico y Social de Canarias (social and economic council of the Canary Islands) Children’s NSF National Service Framework for Children, Young People and Maternity Services in Wales CINDI Countrywide Integrated Non-communicable Diseases Intervention Código PAOS Código de autorregulación de la publicidad de alimentos dirigida a menores, prevención de la obesidad y salud (the PAOS Code: code of self-regulation of the advertisement of food products directed to minors, prevention of obesity and health) CORELA Laboratoire de Recherche sur la Consommation (laboratory on research and consumption) COSLA Convention of Scottish Local Authorities DAFNE Data Food Networking ENCA Encuesta nutricional de Canarias (nutritional survey of the Canary Islands) ENHPS European Network of Health Promoting Schools ESC Encuesta de salud de Canarias (health survey of the Canary Islands) ESSSCAN Escuela de Servicios Sanitarios y Sociales de Canarias (Canary Islands school of medical and social services) Estrategia NAOS Estrategia para la Nutrición, Actividad Física y prevención de la Obesidad (strategy for nutrition, physical activity and obesity prevention) EU The European Union EUSUHM European Union for School and University Health and Medicine FAO Food and Agriculture Organization of the United Nations FAS family affluence scale GES Gruppo di Educazione alla Salute (health education group) GTA Growing through adolescence HBSC Health Behaviour in School-aged Children HEBS Health Education Board for Scotland HPE Health Promotion and Education HPS Health Promoting Schools ICAPS Intervention centred on adolescents’ physical activity and sedentary behaviour ICT Information and Communications Technology INCA Enquête individuelle et nationale sur les consommations alimentaires (individual and national survey on food consumption) INPES Institut National de Prévention et d’Education pour la Santé (national institute for presention and health education)  XI Abbreviations and acronyms INRA Institut National de la Recherche Agronomique (French National Institute for Agricultural Research) IOTF International Obesity Task Force IVAC Investigation-Visions-Action-Change LEA Local Education Authority MANOVA multivariate analysis of variance MD [Degree of] Doctor of Medicine NGO nongovernmental organization NHS National Health Service ObEpi Enquête épidémiologique nationale sur l’obésité et le surpoids en France (national epidemiological survey on obesity and overweight in France) ONPES Observatoire National de la Pauvreté et de l’Exclusion Sociale (national observatory on poverty and social exclusion) OR odds ratio P P-value PASS Physical Activity in Scottish Schoolchildren PESS Physical Education and School Sport PNNS Programme National Nutrition–Santé (national nutritional health programme) QA quality assurance QA-P quality assurance for prevention r Spearman’s rank correlation coefficient Radio ECCA Emisora Cultural de Canarias y África Occidental Española (Canary Islands radio station cultural network) REHIS Royal Environmental Health Institute of Scotland Elementary Food and Health ReNNPP The resolution on the [Slovenian] national programme of food and nutrition policy SCW Sports Council for Wales SEEDO Sociedad Española para el estudio de la obesidad (Spanish society for the study of obesity) SES socioeconomic status SHPSU The Scottish Health Promoting Schools Unit SIAN Servizio Igiene Alimenti e Nutrizione (food hygiene and nutrition service) SMT School Management Team SNHPS Slovenian Network of Health Promoting Schools UKE Universitätsklinikum Hamburg–Eppendorf (Hamburg University Hospital) WHO World Health Organization WNHSS Welsh Network of Healthy School Schemes   Section 1: Foreword