Positive society – promoting wellbeing: A whole-of-society approach to promote

health and wellbeing for all

Dr. Dóra Guðrún GuðmundsdóttirPresident, European Network for Positive Psychology

Director, Determinants for health and wellbeing, Directorate of Health in Iceland

Conference for Substance Abuse Prevention in Finland 2018

Overview

• Health and wellbeing promotion– Determinants of health and wellbeing

• Health promoting community – wellbeing for all• What can governments do to increase

wellbeing?• Real examples from Iceland

– learning from the past– heading for the future

Health and wellbeing

„Health is a state of complete physical, mental, and social well-being and not merely the absence

of disease or infirmity.".“WHO (1948)

Mental health• is defined as a state of well-being in which

every individual realizes his or her own potential, can cope with the normal stressesof life, can work productively and fruitfully, and is able to make a contribution to her or his community (WHO, 2004).

Perc

enta

ge o

f Pop

ulat

ion

Common Mental Disorder

Languishing ModerateMental Health

Flourishing

Psychological Resources

Mental well-being

Promotion of health and wellbeing

• Health Promotion actively aims to positively affect determinants of health and wellbeing.

• Health Promotion is a process that enables and empowers people to influence and improve their own health (WHO, 1986)

• Making the healthy choice the easy and accessible choice, irrespective of age, gender or socio-economic status.

Determinants of health and wellbeing

Dahlgren & Whitehead, 1991

Determinants of mental wellbeing

Beddington, J., Cooper, C. L., Field, J., Goswami, U., Huppert, F. A., Jenkins, R., ... & Thomas, S. M. (2008). The mental wealth of nations. Nature, 455(7216), 1057-1060.

Addressing Determinants of health and wellbeing with comprehensive settings approach

A Health Promoting Communityis encouraged to:

• Take into account Health and wellbeing in all policies. • Create healthy environments to facilitate healthier

choices, e.g. through the health promoting school projects.

• Map and promote health equity (reduce health inequalities) within the community.

• Promote health and wellbeing in cooperation with various partners within the municipality.

http://www.healthpromotion2013.org/health-promotion/health-in-all-policieshttp://www.euro.who.int/__data/assets/pdf_file/0020/170093/RC62wd08-Eng.pdf?ua=1

http://www.healthpromotion2013.org/health-promotion/health-in-all-policieshttp://www.euro.who.int/__data/assets/pdf_file/0020/170093/RC62wd08-Eng.pdf?ua=1

ReykjavíkurborgKópavogur

Mosfellsbær

Eyjafjarðarsveit

Hornafjörður

Fljótsdalshérað

Fjarðabyggð

Seyðisfjarðar-kaupstaður

Health Promoting CommunitiesMay 2018

Skútustaðahreppur

Borgarbyggð

Bláskógabyggð

Vestmannaeyjabær

~80%

% of Icelandersliving in HPC

Dalvíkurbyggð

HPC:

In preparation:

18

9

Ísafjarðarbær

Langanesbyggð

Sandgerði Garður

Norðurþing

Hafnarfjarfjarðarbær

Reykjanesbær

Akureyrarbær

Grindavíkurbær

Garðabær

Súðavíkurhreppur

Fjallabyggð

Árborg

Seltjarnarnesbær

http://www.landlaeknir.is/http://www.landlaeknir.is/heilsa-og-lidan/verkefni/item28551/Heilsueflandi-samfelag

What would politics look like if promoting people´s well-being was one of government's main aim?

http://www.neweconomics.org/publications/entry/a-well-being-manifesto-for-a-flourishing-society

What can governments do?

1. Measure what matters2. Create a wellbeing economy3. Reclaim our time4. Create an education system that promotes flourishing5. Refocus the health system to promote complete health6. Invest in the very early years and parenting7. Discourage materialism and promote authentic

advertising8. Strengthen civil society, social wellbeing and active

citizenship

What you measure affects what you do...

…if you don´t measure the right thing, you don´t do the right thing.“ Joseph Stiglitz, 2009

GDP increases with

• Each sale of antidepressant medication• Each divorce pronounced• Each prison built• Air pollution• Cigarette advertising • Alcohol advertising and sales

But NOT with

„the health of our children, the quality of their education, or the joy of their play. It does not get the beauty of our poetry or the strength of our marriages......it measures everything, in short except that which makes life worthwile“

Robert Kennedy, 1968

Measuring wellbeing on a national level

1. Deciding to start measuring wellbeing2. Selecting methods and processes, including

stakeholders, and gathering information3. Ensuring the assessment responds to the

current context4. Presenting and communicating the results

(together with the government)5. Ensuring an impact on policy-makers and policy6. Planning for the future

Case reports from Iceland: 6 steps linking assessment

and interventions to improve wellbeing

Public health indicators

Health Promoting School Projects

Long-term in nature and apply the whole school approach Involves students, parents, school staff and

the surrounding community The main themes are nutrition, physical

activity, mental health promotion and life skills

National Curriculum Guide with emphasis on health and wellbeing

Health and wellbeing is one of six fundamental pillars of education on which the curriculum guidelines are based

The fundamental pillars are meant to accentuate the principle of general education and encourage increased continuity in school activities as a whole.

The Ministry of Education promotes the Health Promoting Schools Projects as a suggested means towards success in the health and wellbeing pillar.

Six fundamental pillars of education: Literacy, Sustainability, Health and wellbeing, Democracy and human rights, Equality, Creativity.

Example of real challenge that required comprehensive response of the whole community

Youth drinking around last turn of the century

http://www.bbc.com/news/av/stories-41973296/how-one-country-persuaded-teens-to-give-up-drink-and-drugs

http://www.bbc.com/news/av/stories-41973296/how-one-country-persuaded-teens-to-give-up-drink-and-drugs

Youth 15-16 years old

42

3532

33

26 28 2622

25

18 19

14

97

5

2319

1615 14 14 12 11 12 10

107

53 3

1715

12 11 12 139 9 9 7 6 6 3

20

5

10

15

20

25

30

35

40

45

50

1998 1999 2000 2001 2002 2003 2004 2005 2006 2008 2009 2010 2011 2012 2013

%

Ölvun sl 30 daga Daglegar reykingar Prófað hassDaily smoking Tried cannabisIntoxicated by alcohol last 30 days

Chart1

199819981998

199919991999

200020002000

200120012001

200220022002

200320032003

200420042004

200520052005

200620062006

200820082008

200920092009

201020102010

201120112011

201220122012

201320132013

Ölvun sl 30 daga

Daglegar reykingar

Prófað hass

%

42

19

23

10

17

6

42

23

17

35

19

15

32

16

12

33.3

14.9

11.4

26.1

14.2

11.7

27.8

13.6

12.8

26

12

9

22

10.7

9.2

25

11.9

8.8

18

10

6.9

19

10

6

14

7

6

9

5

3

7

3

3

5

3

2

Sheet1

Ölvun sl 30 dagaDaglegar reykingarPrófað hass

1998422317

1999351915

2000321612

2001331511

2002261412

2003281413

200426129

200522119

200625129

200818107

200919106

20101476

2011953

2012733

2013532

Comprehensive approach – universal interventions to decrease youth drinking

The State• Act on how long children can stay outside – outdoor time limits.• Age limit, access to places selling alcohol.• High age limit for buying alcohol and alcohol monopoly.

Municipality• Monitoring substance abuse and develop data driven intervention• Information to parents and other stakeholders – magnets with the outdoor hours published

and distributed.• Encourage parents/caregivers to comply with the law.• Organise search in collaboration with Police.• Access to organised sports and other constructive leisure time activities – “The leisure card”.

Schools- youth centres• Alcohol-free gatherings, in line with the outdoor hours law. • Education to parents and students• Support parent-groups (education, provide facilities for their work).

Parents• Parents-walks around neighbourhoods to follow up on the outdoor hours (social capacity, share

information).• Parent contracts on outdoor hours etc.• Joint family time -> encouraged to spend more time with their children.• Support participation in healthy recreational activities like organised sports vis the leisure card.

Youth• Informed about laws and regulations.• Spending more time with parents/family. • Increased participation in organised sports and other organised leisure time activities via the leisure card.

Magnets with outdoor hours for children

www.samanhopurinn.is

Parents let’s work together! During the school period• Children, 12 years old or younger, may not be

outside their home after 20:00 pm.• Children, 13 to 16 years of age, may not be

outside their home after 22:00 pm.During the summer• Children, 12 years old or younger, may not be

outside their home after 22:00 pm.• Children, 13 to 16 years of age, may not be

outside their home after 24:00 pm.• Parents and caregivers have absolute rights to reduce these outdoor hours. These

rules are in accordance with the Icelandic Child Protection laws and forbid children to be in public places after the stated hours without adult supervision. These rules can be exempted if children 13 to 16 years of age are on their way home from an official school, sports, or youth centre’s activity.The child’s birth year rather than its birthday applies.

Frístundakortið - The leisure card

The leisure card is a grant for all childreen age 6-18 with a legal residence in Reykjavik. The grant is in the amount of 50.000 ISK per year and the leisure card can be applied for on e-Reykjavik as well as on the homepage www.reykjavik.is

http://www.reykjavik.is/

The prevention-day lead by the president of Iceland – since 2006

Encouraging children and parents to spend more time togetherhttp://www.forvarnardagur.is

http://www.forvarnardagur.is/

Adolescent´s happiness

Gudmundsdóttir, D., Ásgeirsdóttir, B., Huppert, F., Sigfúsdóttir, I., Valdimarsdóttir, U., & Hauksdóttir, A. (2015). How Does theEconomic Crisis Influence Adolescents’ Happiness? Population-Based Surveys in Iceland in 2000–2010. Journal of Happiness Studies,

Time spent with parents

Gudmundsdóttir, D., Ásgeirsdóttir, B., Huppert, F., Sigfúsdóttir, I., Valdimarsdóttir, U., & Hauksdóttir, A. (2015). How Does the Economic CrisInfluence Adolescents’ Happiness? Population-Based Surveys in Iceland in 2000–2010. Journal of Happiness Studies,

Chart1

20002000

20062006

20092009

20102010

Girls

Boys

%

26

31

30.9

26.7

34

32

40

37

52

48

Sheet1

2000200620092010

Girls31344052

Boys27323748

Category 31.855

Category 42.855

Adolescent’s happiness 2000-2016

85%86%

87%

89%

84%

75%

77%

79%

81%

83%

85%

87%

89%

91%

93%

95%

2000 2006 2009 2010 2016

Conclusion: We need to:1. Measure what matters2. Create a wellbeing economy3. Reclaim our time4. Create an education system that promotes flourishing5. Refocus the health system to promote complete

health6. Invest in the very early years and parenting7. Discourage materialism and promote authentic

advertising8. Strengthen civil society, social wellbeing and active

citizenship

….if we measure the right thing, we might end up doing the right thing

THANKSdora@landlaeknir.is

Thanksdora@publichealth.is

Positive society – promoting wellbeing: �A whole-of-society approach to promote �health and wellbeing for all �OverviewHealth and wellbeingMental healthSlide Number 5Slide Number 6Promotion of health and wellbeingDeterminants of health and wellbeingDeterminants of mental wellbeingSlide Number 10Addressing Determinants of health and wellbeing with comprehensive settings approachA Health Promoting Community �is encouraged to:Slide Number 13Slide Number 14What would politics look like if promoting people´s well-being was one of government's main aim?What can governments do?What you measure affects what you do...GDP increases withBut NOT withMeasuring wellbeing on a national levelPublic health indicatorsHealth Promoting School Projects�National Curriculum Guide with emphasis on health and wellbeing�Health and wellbeing is one of six fundamental pillars of education on which the curriculum guidelines are basedExample of real challenge that required comprehensive response of the whole communityYouth 15-16 years oldComprehensive approach – universal interventions to decrease youth drinkingMagnets with outdoor hours for childrenFrístundakortið - The leisure cardThe prevention-day �lead by the president of Iceland – since 2006Adolescent´s happinessTime spent with parentsAdolescent’s happiness 2000-2016 � Conclusion: We need to:….if we measure the right thing, we might end up doing the right thingThanks�dora@publichealth.is