Health Education as a stand-alone School Subject to improve Health Literacy of Future Generations: Lessons to learn from Finland

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1 Health Education as a stand-alone School Subject to improve Health Literacy of Future Generations: Lessons to learn from Finland Lasse Kannas, Professor of Health Education University of Jyväskylä, Finland Improving people s health literacy (HL) across the lifespan has become an important health promotion approach in order to support healthy development in childhood and healthy ageing. At the same time, there is the need for evidence of good practice to meet expectations that health literacy has positive health impacts and outcomes. Health literacy describes the degree to which people have capacity to access, obtain, process, understand, appraise and communicate information in order to promote and maintain good health across the life-course. This individual focused definition needs widening to take into consideration other agents that are responsible for providing education. A shift towards the attention to the capacity of professionals as well as health and educational institutions is needed. These agents provide education, guidance and access to information as well as support to active engagement. Schools are a pre-eminent arena in the teaching and learning of health literacy skills in young generations. Thus, it is surprising that learning in the health area has a history of being on the periphery, lacking in coherence and generally without real importance in the hierarchy of school subjects. The school curriculum acts as mirror that stages a nation s health awareness. The curriculum reveals political will and readiness to take into account the health values and goals utilized in defining the core of the most important learning outcomes in schools. Finland is one of the few countries in which Health Education (HE) is taught as a separate, stand- alone school subject. In this presentation the Finnish model of health curriculum development and the last ten years experiences of HE as a unique stand-alone school subject will be described and discussed. The following topics are brought into focus; why HE is worthy to develop as a stand-alone school subject, what is the content of the HE curriculum, what is a comprehensive HE teacher training programme like at Universities in Finland and how national assessment of HL learning outcomes are organized. Research findings about pupils and teachers perceptions of HE lessons will be introduced, too.

2 The development of health promotion in practice and research: comprehensive socio-bio-ecological models and challenges in implementation Bente Wold Department of Health Promotion and Development, University of Bergen, Norway Inspired by the five core principles for health promotion action outlined in the Ottawa Health Promotion Charter, the paper will focus on recent advances in actions related to creating supportive environments, strengthening community action and developing personal skills. Acknowledging the complexity of health processes and the impact of modernization processes, taking a systems view has become increasingly more important, paving the way for comprehensive socio-bio-ecological approaches and models in health promotion research. Applying these models in practice has brought about several major challenges with regard to implementation. The health promotion ideology with its emphasis on empowerment and participation may cause a conflict with the need for rigorous implementation. As an example of such challenges, lessons learned from research with health promoting schools (such as Schools for Health in Europe) during the past 20 years will be discussed. Since such interventions could be ineffective if not implemented with clarity, intensity and fidelity, recommendations for ways in which whole-school interventions based on socio-bio-ecological models can be completely and accurately implemented will be proposed.

3 The Marmot review adopted to local and national Swedish level Lessons learned Mrs. Anna Balkfors City of Malmö Anna Balkfors will talk about the Commission for s socially sustainable Malmö, one of the first local Marmot reviews. This two year policy process was finalized in 2013 with the report; Malmö s path towards a sustainable future, health welfare and justice and is now being implemented. Anna will report on the two year follow-up and reflect on lessons learned and future challenges. Anna will also give an overview of the action going on in Sweden addressing health inequalities. Sweden differs from the other Nordic countries with several local and regional initiatives with commissions to address health inequalities. In May 2015 the Swedish government appointed a national Commission for Equity in Health and as Anna is now working with the commission she will give an update on the work so far. Anna will also reflect on an increasing need from the public sectors for research measuring social impact and for researchers to be more involved in designing policy action.

4 Changing behaviour to improve health: frameworks for developing interventions Susan Michie, Professor of Health Psychology, and Director of the Centre for Behaviour Change, University College London, UK. Behaviour is key to promoting health and well-being, preventing illness and disability, efficient delivery of services, a productive economy and a sustainable environment. Whilst there have been some notable successes, interventions to change behaviour have generally had modest and variable effects. To some extent, this reflects limitations in the scientific methods used to study and change behaviour. Interventions are complex in that they are usually made up of several interacting component behaviour change techniques. To develop more effective interventions, we need systematic methods for analysing problems in terms of behaviour and developing interventions on the basis of that analysis. This talk will present 1. a model of behaviour for understanding the target behaviour in its context (COM-B), 2. a method for specifying interventions in terms of their behaviour change techniques using standardised terms and definitions (BCT Taxonomy v1; and 3. a framework for designing interventions to change behaviour (the Behaviour Change Wheel; The talk will outline a method for developing effective interventions, starting with a model of behaviour (COM-B) to guide an analysis of the target behaviour in context. This model forms the hub of the Behaviour Change Wheel, which integrates 19 frameworks of behaviour change into nine intervention functions and seven policy categories. These are selected according to the behavioural analysis and delivered by selecting from the appropriate behaviour change techniques. Interventions are most likely to be effective if they draw on evidence and are tailored to the local contexts. To inform this, the following criteria are helpful, referred to as APEASE: Affordability, Practicability, Effectiveness and cost-effectiveness, Acceptability, Sideeffects and safety; Equity. Keywords: Health behaviour, Behaviour change, behaviour change techniques, Behaviour Change Wheel, theory

5 Has physical activity anything to do with health promotion? Ph.D. Lone Friis Thing, Associate Professor Department of Nutrition, Exercise and Sports, Copenhagen University Within academic discussions of health promotion related to physical activity an Eliasian perspective is seldom used. Based on a central theoretical theme within Norbert Elias sociology of sport (Elias and Dunning 1986), namely the quest for excitement, this article explores the health orientation of Danish society as an expression of a continued civilizing of the body. In national governmental health messages sports participation and general physical activity are presented as an essential health-promoting instrument that keeps illness and disease away, thereby prolong life. But the all-pervading guide to physical activity and sport - often with a focus on quantitative dimensions like frequency, duration and intensity - as measurable effects and risks, has resulted in a rationalisation of many movement cultures for large selections of the population. Health messages are then presented using narratives of risk rationality (Lupton 1995; Beck 1997), which prioritizes a biomedical perspective and excludes emotional dimensions like pleasure and desire. Norbert Elias' conceptualizing of the emotions, specifically within his work on the sociology of sport, can provide a fresh perspective from which to view the risk orientation of public health. In maintaining a central theoretical space for the emotions an Eliasian framing of physical activity can contribute new ways of thinking about and engaging in public health. As such, it presents an interesting way in which we might seek to tackle continued issues connected to physical inactivity. References Michie S, Atkins L, West R. (2014) The Behaviour Change Wheel: A Guide to Designing Interventions. London: Silverback Publishing.

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