Christina Rasmussen-Rubæk Healthcare Consultant , Municipality of Favrskov

1. Lifestylediseasesamongchildren and youngpeople – how to empowerthem and their families? Christina Rasmussen-Rubæk Healthcare Consultant, Municipality of Favrskov

2. Crüsli tastes almost too good to be healthy!

3. Health without sacrifices

4. Conceptualising health

5. Framework and overview EU • Health-EU • Shape Up Europe Nationally • Facts on physical activity among children and young people in Denmark • Facts on overweight among children and young people in Denmark Locally • The Municipality of Favrskov: Help the child – empower the family • Aarhus Social and Healthcare College: Exercise and health in the social and healthcare educations

6. EU Health i EUShape up Europe

7. Health-EU CHILDREN AND INFANTS • The aim of the EU’s policies and measures is to ensure a high level of health protection for this particular target group, which is far more exposed to health treaths than adults. • Important health themes are: • Health before birth • Food for infants and toddlers • Healthy food and weight control • Healthcare through the use of special drugs • The social and environmental influences also put focus on themes such as: • Nutrition • Mental health • Physical risks

8. Health YOUNG PEOPLE • Young people’s health is influenced by a number of factors, including social and environmental issues. • The EU supports in particular health promotion and health prevention by addressing a number of health determinants: • Smoking • Nutrition and physical activity • Sexual health • Alcohol and drug abuse • Mental health • Furthermore, there are great challenges connected with social and regional inequalities in health caused by economic, social and cultural factors.

9. Shape Up Europe • A school-community approach to influence the determinants of a healthy and balanced childhood and adolescence. • Shape Up involves the school and the community, including the family, from the start, jointly with the child. To promote healthy habits requires new ideas to convey a broader vision of the benefits of a balanced diet and regular physical activity, focusing on a positive and critical view of food and body movement.

10. Involvement and action • www.shapeupeurope.net • 26 cities in 25 countries and 5 ”competence centres” • Health is ”conceptualised” in everyday language • Children and young people are seen as active participants • Schools/children try to influence health determinants • Cooperation between school and local community concerning supporting children and young people’s actions

11. The IVAC approach

12. The IVAC approach

13. Nationally Facts on physical activity and overweight among children and young people in Denmark

14. Facts on physical inactivity in Denmark • People who are physically inactive have an increased risk of developing type 2 diabetes, cardiovascular diseases, cancer and osteoporosis. They also risk dying earlier. • 30-40% of the adult Danish population are physically inactive. A large part is found among overweight people, immigrants, unemployed, poor, frail elderly people and citizens with lower education. • The differences in health behaviour are established early on. Already among boys and girls aged 15-16, we see a quantitative difference in exercise behaviour. • The children, who are in worst physical shape, have 11 times as high a risk of accumulating risk factors that could end up in lifestyle diseases.

15. Children and physical activity • It is four times more likelythatchildren and youngpeoplewhotake the bike to and from schoolareamong the 25% with the bestphysical fitness seen in relation to thosechildrenwhoaretaken to school by car. • Physicallyactivechildrenare not onlyhealthierthan the inactiveones, theirability to learn is alsobetter. A new study has shownthatchildrenare more focused and involved in the learningprocessafterphysicalactivity. Thisapplies in particular to the more noisychildren. Furthermore, more sport – and therebyalsoless time for the theoreticalsubjects – does not reduce the children’sacademicproficiency in the theoreticalsubjects.

16. Children and physical activity • At 7% of the Danish schools, the children have dailyaccess to a sports centre in theirschool breaks. • Within the field of afterschool centre activities, almost all children have access to skippingropes and ball games everyday. 44% have dailyaccess to a sports centre. In 37% of the afterschool centres, there is oneemployeehiredwho has a movement-relatedorexercise-relatededucation.

17. Facts on overweight in Denmark • Today, almost 50% of the adult population are overweight, at least 11% (400,000 Danes) are suffering from obesity. • An increasing number of those suffering from obesity should be found among children and young people. • 14-20% of the young people aged 14-16 are overweight. • In average – and within the last 18 years - men and women have gained 6 kg in weight. The men have gained 2.2 cm in height and the women 1.2 cm.

18. Children and young people’s diet • Sweets and soft drinks • Fruit and vegetable schemes • Portions • Eating habits

19. Children and young people’s dietSweets and soft drinks • Children and youngpeopleeattoomanysweets and drink to manysoft drinks. The Danish national diet study from 2000/2001 showedthat 15% of the childrenaged 4-14 had soft drinks and 30% had sweetsalmosteveryday. • Boys drink more soft drinks thangirls. • Sugarysoft drinks seem to beinfluential in the development of overweightamongchildren and youngpeople. • The Danish municipalitiesarewellontheirway: The number of afterschool centres offering juice drinks has decreased from 47% in 1999 to 17% in 2004

20. Children and young people’s dietFruit and vegetable schemes • Onaverage, childrenget 40-50% of their total energy in institutions. • In 2006, onethird of the schools had fruit and vegetableschemes for the children. • 68% of the afterschool centres serve food to the childrenafterschool, but freshfruit is served in lessthanonethird of the centres and only 13% serve vegetables. • A Danish studywithchildrenaged 6-10 has shownthatfruit and vegetableschemes at the schoolsincreased the averagedailyintake of fruitconsiderablybothamong the childrenwhotook part in the scheme and thosewho did not.

21. Children and young people’s dietPortions • Large portions increase the risk of eatingtoomuch and canbeone of the factors underlying the development of overweight and obesity. • Small children up to the age of 3 seem to beable to tellwhenthey have had enough to eat. Therefore, let themeatwhattheywant – but serve the food in portions.

22. Children and young people’s dietEating habits • Irregularbreakfast habits areassociatedwithlateroverweight. • Children in kindergartenseat more regularlythanolderchildren. More than 90% eatbreakfast, lunch and dinneronweekdays. • Amongthoseaged 11-14 only 76% and 50%, respectively , eatbreakfast and lunch during the week. • Children and youngpeoplegetalmostonethirddietary fibres lessthanrecommended: Theyeattoolittleryebread, theygettoofewcoarsevegetable – and they do not getenoughfruit.

23. Health behaviour and lifestyleamongchildren and youngpeople • The tendency is that unhealthy habits accumulate. • Those who smoke also drink more often, they exercise less, and fewer of them eat meals regularly. • Not only do the unhealthy habits influence their health, they also incluence the young people’s well-being – 15-16 year old smokers had more symptoms of diseases than their non-smoking peers. • Furthermore, smoking, not eating breakfast, no sports activities and frequent beer-drinking was associated with a worse health condition – both in the opinion of the pupils themselves and of the doctor.

24. The parents’ attitude? Parents’ knowledge, attitude and behaviour means a lot to the healthy or unhealthy habits of their children.

25. How important do parents find the following statements in relation to keeping or promoting their child’s health and well-beeing? That the childdoes not start taking drugs That the cildlearns to cooperate and solveconflicts That the child is able to have closecontactswithotherchildren That the childdoes not start smoking That the childbrushes his/her teeth has his her teethbrushedregularly That the childgetsenoughsleep That the child is physicallyactive (exercise, sport and play) That the childlearns to listen to his/her body That the childwashes his/her handsaftergoing to the bathroom That the childeatsfruit an vegetableseveryday That the childdoes not start drinkingalcohol That the childdoes not getexposed to tobaccosmoke at home That the childdoes not gettoomuchsugar (sweets, soft drinks/ coca cola) That the childdoes not gettoomuchfoodcontaining fat

26. Locally A municipal health promotion project ”Help the child – empower the family”

27. The municipalities have been made responsible for health promotion and prevention

28. A project concerning the effort to help overweight children, young people and their families in the Municipality of Favrskov (2007-2010). The project consists of a generaleffort – a wide range of initiatives available to all children and their families – and a specific effort containing both prevention and treatment elements split up on three intermediate projects. Help the child – empower the family

29. Help the child – empower the family • Intermediate project 1: Effort towards infants and toddlers in families with overweight • Intermediate project 2: Effort towards school children aged 6-8 • Intermediate project 3: Effort towards children aged 9-12 with overweight

30. Intermediate project 1 • Efforttowards infants and toddlers in families withoverweight Children in families, whereoneorbothparentsareoverweight, have an increasedrisk of becomingoverweighttoo. All pregnantwomenwhoareoverweightareoffered a 2½ yearprogramme – as parents to infants and toddlers – wheretheyshouldreceive motivation and inspiration to integratemovement and physicalactivity in the everydaylife of the family and create the framework for healthymeals for the family.

31. Intermediate project 2 Efforttowardsschoolchildrenaged 6-8 As a supplement to the pedagogical plans on motor coordination in the pre-schoolclasses, a course is established for and targettingoverweightchildren. Ten childrenwillbeselected by the healthvisitor. Some of the importantthingsaredailyphysical activity and a healthy and balanced diet. The families areinvolved and arevisited at home by the healthvisitor.

32. Intermediate project 3 Efforttowardschildrenaged 9-12 withoverweight A one-yearcourse is established for overweightchildren. The course starts withoneweek of summer schoolwhere the parentsareinvolved too. The aim is to create the foundation for new friendships and networks, whichcanhelp support the children, and to helptheir parents to a new lifestyle and health habits. Afterwards, therewillbe monthly meetings withteaching, exercises and cooking. Furthermore, the childrenparticipate in 1-2 weeklyactivities.

33. Locally Exercise and health in the social and health care educations

34. Exercise as part of the curriculum • Two hours a week for all social and healthcare helpers and assistants

35. Context • On-the-job injuries • Overweight • Fitness ratings • Stress • Social inequality in health

36. Exercise as part of the curriculum Objective: To improve the students’ state of health, tell them about physical activity and health, keep them healthy at the labour market and reduce the number of on-the-job injuries.

37. Exercise as part of the curriculum Intermediate aims • To make the students want to exercise and use their body • To improve the students’ body-consciousness, coordination, muscle strength, physical fitness and balance • To give the students an understanding of the importance of exercise to receive a general well-being • Make the students capable of starting physical activities

38. Intermediate aims in keywords • Motivation • Physical training • Knowledge • Role model

39. ProjectExercise and health in the social and healthcare educations In 2007, the Minister of the Interior and Health put focuson physicalactivity under the motto ”Gang i Danmark” (i.e. ”Get Denmark going”). www.gangidanmark.dk The aim of the project To increasefocusonphysicalactivity and healthduring the education of the social and healthcare students and thusalso improve the students’ health and physicalabilities as well as theircompetences in connectionwithprovidingguidanceon healthbehaviour.

40. Project outcomes • Model - Best Practice report and implementation model • Tools - teaching material • Dissemination - of the project’s outcomes

41. Best Practice Report ”Mapping and evaluation of experiences made with implementing exercise lessons in the social and healthcare educations at Aarhus Social and Healthcare College.” Student statements in relation to the efforts …

42. ”Exercise is fun; we have fun together, we laugh, it has a positive social effect, and it provides energy for the theoretical stuff”

43. ”They refer to concrete experiences where they feel that exercise is important in relation to the more sedentary learning processes.”

44. ”The students point to the fact that it is important to be a good role model because you know the exercises yourself and know how they work.”

45. The students indirectlyexpress an understanding of the learningprocesswith the following dimensions: • Motivation – the affective dimension of learning • Bettertheorylearningprocess – the cognitive dimension of learning • The employment of new competences – the practice dimension of learning

46. www.mosu.dk For the teaching material please see

47. Thankyouverymuch for your attention Christina Rasmussen-Rubæk