Department of Public Health, Food Hygiene and Nutrition Service, AUSL Modena, Italy. firstname.lastname@example.org
Lack of exercise and unhealthy diets are two of the most important risk factors to develop overweight, obesity and other chronic diseases. The school plays a key role in the promotion of lifelong healthy habits in children and their families. Every intervention at school level will need to be matched by changes in the social and cultural context so that the benefits can be sustained and enhanced in the community. We promoted healthy nutrition and a regular physical activity in schools and in local communities, through multifaceted interventions, which involved more than 10,000 children and about 100,000 adults.
In the drafts “Global strategy on diet, physical activity and health” the World Health Organization (WHO) recommended that, to promote a healthy lifestyle in the population, programmes need to be addressed during childhood in order to prevent the long-term effects of poor nutrition and lack of exercise (1).
Nevertheless, several studies show, in industrialized countries, a reduction in the consumption of fruit and vegetables and an increased percentage of sedentary people in the population (2). Therefore, strategies need to be carried out swiftly to promote a healthy diet and lifestyle. Childhood is the critical age for an effective health promotion (3), since children are open-minded and prone to change their habits. Furthermore, healthy habits acquired in childhood are more likely to be held in adulthood. The WHO recommended that to promote a healthy lifestyle since childhood, approaches need to be multi-sectoral and multi-strategic (1). Furthermore, every intervention at local level will need to be matched by support of other stakeholders.
The aim of our interventions is to establish, in various municipalities in the province of Modena, districts’ task forces among schools and the local community to fight obesity and chronic diseases in population.
To this aim our policy is to encourage, mainly through school districts, wellness policies and environment changes to promote access to a healthy lifestyle, in particular, for healthy nutrition habits and an increasing physical activity, for children, adolescent, families and citizens, with the active involvement of the whole local community.
Our methodology is defined in the “Local Health Plan”, a real pact between the stakeholders - institutions, citizens and enterprises – i.e., all the actors involved as partners in attaining the health targets. On this basis, since 2004 we have undergone “Community programs” for the promotion of healthy lifestyles.
Initially, we asessed our children and their families’ behaviours and attitudes as well as their nutritional status (4). Our findings gave light to design subsequent health interventions. We address our interventions to homogenous groups in the community in order to give the participants a confirmation of their good practices, to favour the continuity of interventions over time, and to promote a virtuous cycle of health promotion (Figure 1).
These programmes are based on the financing of community authorities. Our multi-faced interventions are mainly targeted to students (3–14 years old) because in our region the school frequency is mandatory in this age range. These interventions included teacher training, physical activity promotion, nutrition education, printed material distribution among pupils and families, modification of school meals.
In every district, task forces among schools and the local community were created. The workshop included public authorities for coordinated works, teachers, pupil's parents, local representative mass catering sectors, sport clubs and food retailers. We used different strategies for various territory with different social and cultural context. We have provided a system to check results.
The programme is now active in 5 different districts; 10,000 children have been involved in the school educational programme and more than 100,000 adult subjects have been contacted. We have also trained about 350 teachers and in many schools the consumption of snacks fruit has been promoted.
Physical activity courses have been organized in kindergartens and primary schools and the number of hours dedicated has been increased. We are experimenting the “Pedi-bus” and the “Cycle-bus” to also increase the levels of routine physical activity, as walking and cycling as means of daily transport, can be a most effective strategy to achieve these purposes. We are establishing alliance with sport clubs to promote sports and physical activity both in school and outside school (after school) for children and adolescents. We have organized hike excursions for children and their families. We have seen some improvements in fruit and vegetables daily intake during school meals.
Our interventions are based on social cognitive theory (5). Our aims are (i) to promote knowledge for healthy choices about eating and exercise habits, (ii) to increase children's and adults’ self-awareness on the effectiveness of healthy changes. In a Community Program, each member is able to ameliorate his/her own and others’ health by improving capabilities and autonomy as well as social participation of parents and children (6).
Children are the priority population for interventions (7–8), and the school is the best setting (9). In fact, schools have many opportunities to engage children in physical activity and healthy eating and to reinforce healthy diet and physical activity messages. Furthermore, teachers are important in changing lifestyle, because they are reliable and able to involve children and families (9–10). Every intervention at school level will need to be matched by changes in the social and cultural context. Lifestyle behaviours of parents, teachers and community leaders are important to children's perception of community support. So, activity programmes must be tailored to the needs of the local community. These objectives can be achieved more easily with the creation of local task force.
In conclusion, “Community Projects” are shared projects among schools and the local community that stimulate healthy lifestyle in children, adolescents, families and citizens and promote a virtuous circle between school-family and community; so that the benefits can be sustained and enhanced.
This may improve the effectiveness of the interventions also in terms of costs (11).
We thank the children and their parents, the teachers, and all the field-operators who participated in the projects. Local Health Units supported the present work.
Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.