51 Figure 16: Screenshot website ‘Gezonde Inspiratie’ Source: http://www.gezondeinspiratie.be
Figure 17: Screenshot website ‘Fitte School’ Source: http://www.fitteschool.be Evaluation: If the local organisations involved have evaluation data, these are
listed in the files. The use of the website and its impact on local health promotion efforts targeted at at-risk groups will be assessed one year after its launch. Contact Details:
Bruno Buytaert VIGeZ
+32 2 422 49 42
Since 2004 the classic educational model for healthy nutrition in Flanders (the food triangle) was changed into the ‘active food triangle’. From then off a strong combination is made between nutrition and physical activity.
With ‘Fit School’ the educational model of the active food triangle is translated into school policy. The action is the first in Belgium that combines nutrition and physical activity in one methodology for schools. The action is organised by a joint venture between the National Institute for Health Promotion and Disease Prevention (VIGeZ), Nutrition Information Center (a non-profit organisation to provide scientifically founded and educational information about nutrition) (NICE) and the Flemish Institute for School Sports (SVS).
School in good condition
“Fitte School” | http://www.fitteschool.be52 Aim & Objectives: Building on the actualised concept of healthy school (see:
www.gezondeschool.be), the project aims to give schools the opportunity to fill
in their school policy on nutrition and physical activity with concrete interventions, activities, programmes and projects.
Design: For this aim ‘Fitte School’ offers schools:
A global methodology to work on school policy on healthy nutrition and physical activities, with 3 important components:
1. Education: the construction of a curriculum through the different grades for food- and physical education, linking the educational contents of both themes.
2. Structural interventions: a concrete offer of activities on school level to take part of a healthy catering (school meals, drinks, snacks) and to work on a stimulating environment for physical activities (play yard, active transport, use of the sport infrastructure,...); a practical offer of school projects to work on healthy food (project week, healthy breakfast, school fruit,...) and actions to organize physical activities in the lessons, between the lessons and after school day (physical breaks, competitions between schools,...).
3. Agreements: a practical methodology to work on agreements with school teams, pupils and parents on nutrition and physical activity. A collection of concrete programmes and activities organised by different national and local organisations from health, education and sports. Now we are working on a package for organising a day at the school where healthy food and movement are crucial (Fit School Day). The point is not to disturb the usual school day, but by taking simple actions schools can learn which actions they can take in their policy. It must be a primary step to motivate the schools to work at the food and movement policy.
Instruments for schools to explore their needs and to evaluate their school policy.
At the end of the school year the schools can choose to be evaluated (the instrument of evaluation can also be used for self-evaluation) and in a large meeting the good practices get nominated and interaction between schools is organised.
The process consultancy for schools is organised in 2 ways:
1. Formation: a various offer of formation for school policy makers, teachers and local health professionals
2. Process consultancy for schools by the local field workers on school sports and the local health counsels.
Support: The project is an initiative of three organizations:
1. SVS – Stichting Vlaamse Schoolsport (Flemish Institute for School Sports) 2. VIGeZ – Flemish Institute for Health Promotion and Disease Prevention 3. NICE – Nutrition Information Centre
The project was initially financed by VLAM (Flemish Institute for Fisheries and Agro-marketing). From 2006 until 2009 it was also financed by the Flemish Government (department of Education, department of Health, department of Sports and department of Agriculture).
The project won the WHO Counteracting Obesity Award in 2006.
Trigger: With the introduction of the active food triangle SVS thought it would be interesting to link the same two themes and reach out more actions and methodologies to schools. Finding the right partners lead to a qualitative and good project.
Targeted Communities: The project focuses on the schools. Through the schools it is possible to reach the children and youngsters. When schools pay attention to a good health policy, the pupils learn to make the right choices and this for the rest of their life.
53 Figure 18: Posters used during the ‘Fitte School project’. Left side: Poster used at primary
schools, Right side: Poster used at secondary schools
Source: http://www.fitteschool.be
Evaluation: The evaluation is planned to be carried out in 2010. This will be done by the instrument of VIGeZ: a survey that is conducted every three years and which will assess the impact of the programme on the health of the participants in terms of nutrition, exercise and tobacco.
Contact Details:
Herman van Driessche
SVS – Flemish Institute for School Sports +32 (0)2 420 06 80
Bulgaria
(Extra information was provided by the National Centre of Public Health Protection - EuroHealthNet member)
National Strategy:
The National Food and Nutrition Action Plan (NFNAP) waslaunched in December 2004 and adopted by the Council of Ministers in August 2005. Its strategic goal is to improve the health of the Bulgarian population by improving nutrition and the reduction of the risk of food-borne and diet-related chronic diseases [57].
The action plan covers three strategic areas: nutrition, food safety and food security. It aims at a multi-sectoral approach involving the private sector and nongovernmental organizations, and includes activities addressing people of low socio-economic status. Other activities targeting overweight and obesity relate to the development of new standards for the nutritional content, labelling and marketing of foods, incentives to encourage the production and sale of healthier foods, and the training of health professionals.
The action plan describes a significant difference in the availability of food products depending on population income and a lower availability of the majority of foodstuffs in low income households, in households with 6 and more members, those with 3 and more children and households where the head is unemployed is established, comparing to the average availability per capita in the country.
Since 1997, six national surveys have been conducted on the diet and nutritional status of the population older than one year, as well as of specific risk groups. Special software was developed to monitor foods consumed and calculate intake of energy and nutrients at individual and population levels. The results of this survey have been used as a basis for the development of the above mentioned National Food and Nutrition Action Plan.
54 The 2004 National Nutrition Survey revealed that among those aged 19-60 years,
22% of the males and 17% of the females were obese. For women aged 60-75 years, the percentages were even higher: 39% were overweight and 32% were obese. In addition, 25.6% of 13 years old boys living in Bulgaria are overweight and 6.9% are obese.
National Support:
Bulgaria is involved in several programmes – most of thembeing international programmes set up by the WHO. An overview and description can be found in the EuroHealthNet and WHO report [2, 53].
Apart from the campaigns mentioned in these documents, the National Centre of Public Health Protection is currently developing nutrition manuals and recipes collection on healthy nutrition for different age groups (3-6 yrs, 7-19 yrs), and it is developing nutrition standards for foods in school.
National Programmes:
At the moment there are no ongoing obesityprevention programmes in Bulgaria that specifically target disadvantaged communities.
Croatia
(Extra information was provided by the Human Nutrition Department of the Croatian Institute of Public health)
National Strategy:
At the national level, the Ministry of Health and theCroatian National Institute of Public Health issued in 1999 the Croatian Food and Nutrition Policy [58]. This policy document has a multi-sectored approach
(agriculture, ecology, education and food industry are all included) and aims to promote (healthy) diet, physical activity and healthy lifestyle. It has a special focus on obesity in children and adolescents as it opts for a 20% reduction by increasing the consumption of healthy foods amongst general population. In regard to overweight and obesity, strategies of the policy are to provide a proper education for professionals in the field of nutrition at all levels, to collaborate with the food industry in implementing different programs (e.g. production of healthier foodstuffs, such as decrease in saturated fats), and to take care of the socio-economically disadvantaged and nutritionally vulnerable groups by:
Providing them with an adequate diet;
Ensure an adequate nutrition for school children through organized catering and delivery of school lunch programs;
Improve workers nutrition via organized meal catering at work places; Promote the healthy diet and ensure consumer information about the nutritional value of served meals in hotels and restaurants;
Implement the National breastfeeding strategy;
Continue monitoring the nutritional status and diets of different population groups and continuous conduct of public health nutrition education and promotion of healthy lifestyles (healthy nutrition, physical activity, non- smoking, etc.).
A draft version of the National Food and Nutrition Action Plan 2006-2010 (FNAP) also addresses the problems of socio-economical development, nutrition, food
55 production, food safety and health care. Areas covered in FNAP are food labeling,
marketing of foods, overweight and obesity activities, problems of special groups (pregnant women, school, kindergarten and working population), surveillance of dietary habits and patterns, and nutritional status of general population – especially the vulnerable groups.
FNAP encourages production and sale of healthier foods, plans provision of food to socially handicapped and vulnerable groups, fighting deficits, public health programs for healthy diet and physical activity, collaboration with food industry and training of health professionals.
The National Action Plan for Overweight Prevention and Treatment (APOPT) [59]
was published in 2008 by the Ministry of Health and Social Welfare in cooperation with the Croatian National Institute of Public Health. It targets the main problems of overweight and obesity through nutrition, physical activity, education and collaboration with food industry. Main goals of this action plan are to promote a healthier lifestyle and health in general and to raise awareness about the importance of achieving and/or maintaining a healthy weight, on both national and local levels, through prevention of obesity, promotion of optimal healthy nutrition and physical activity (promotion of cycling, walking and sport facilities, urban planning for PA-friendly environments, etc.) and reducing marketing pressure on children. Important roles are given to the community and to the public sector through the plans multi-sectored approach.
The Law for Health Protection and Plan and Program of Health Protection Measures [60] clearly state the need for nutrition counseling for pregnant women,
which is partly implemented at national level, and availability of low cost or free nutrition counseling in primary care level at local level.
The State Pedagogy Standard for elementary School Education [61] opts for
provision of free or subsidized school meals, the removal of energy-dense nutrient-poor foods and beverages from school vending machines, regulations on marketing of unhealthy foods and non-alcoholic beverages to children, which are
partly implemented at national level, and mandatory inclusion of nutrition education, which is entirely implemented on a national level.
The National Action Plan for Physical Activity (draft version) focuses on physical activity, sport, recreation and education. More specifically, it focuses on the role of physical activity in obesity prevention, urban planning for PA-friendly environments, improvement of road safety, promotion of cycling and/or walking, improvement and promotion of sporting and leisure facilities and improvement of physical activity in general. Responsible bodies for this action plan are Ministry of Health and Social Welfare together with Faculty of Physical Education.
Dietary guidelines for children were published by the Croatian National Institute of Public Health and Ministry of Health and Social Welfare. They were written a format which is interesting and easy to understand for children of all ages. The aim of this brochure is to educate children about healthy foods and dietary habits. It is also intended to be used as a teaching aid for school teachers. Dietary guidelines for adults were published in 2002 by the Croatian National Institute for Public Health. Printed in the form of a brochure, the aim of the document is to educate the adult population of Croatia about healthy nutrition and the impacts of healthy nutrition on preservation of health, especially the importance of healthy nutrition and maintaining of healthy weight.
Guidelines for whole school approach to healthy eating were first published in 2004 by Ministry of Health and Social Welfare together with Croatian National Institute of Public Health. The second edition was published in 2008. These whole school approach guidelines not only focus on healthy eating in schools, but also at home, and put emphasis on the importance of a proper theoretical knowledge about nutrition as well as eating habits.
The whole school approach guidelines focus on collaboration between parents and schools, as well as with school medicine, food suppliers, local community and other participants outside the field of education. Objectives of the guidelines
56 include improving and implementing the food policy in schools. A special focus is
put on the school's role in education about the importance of food and nutrition in everyday life. These guidelines are based on the analysis of the current nutritional status, dietary and life habits, experience and scientific results in the field of nutrition and health of school age children, to insure the optimal development and growth of children and to preserve their health.
National Programmes:
The Nutrition Friendly Schools Initiative (NFSI) [62] –pilot project was conducted from 2006 to 2008, in 8 schools throughout Croatia. The project had an impact on the school nutrition policy at the national level, and results from the project were included in the FNAP. The Ministry of Health and Social Welfare and the Ministry of Science, Education and Sport both supported the NFSI Project. One of the results of the project (currently in process) is the revision of nutritional standards for kindergartens and elementary schools (collaboration between MHSW, MSES and CNIPH).
There are several support systems regarding prevention of obesity in place at the regional and local level. In some regions, school health centers organize counseling for overweight/obese children, and in the city of Zagreb, the Association for prevention of obesity (http://uppt.hr) has a free counseling centre for overweight and obese individuals, which was set up in cooperation with the city authorities. The Center’s main priority is to help people who are overweight or obese.
For more information, please contact: Sanja Perkovac
Croatian Institute of Public Health +385 1 46 83 006
[email protected] Katica Antonic Degac
Croatian Institute of Public Health +385 1 46 83 006