A Gallic Village that Bucked the Trend of Childhood Obesity: Report on a Study Trip to Seinäjoki (Finland)

Von Benjamin Ewert

Childhood obesity has become a worldwide epidemic that threatens the health of future generations. Around the world, despite theoretical insights and empirical investigations that call for multi-stakeholder interventions, health policymakers struggle to effectively contain childhood obesity. Recently, however, the Finnish city of Seinäjoki has become a global role model with regard to its significant reduction of the number of overweight and obese children. Hailed as a sort of Gallic village that bucked the trend of childhood obesity  (WHO, 2015), Seinäjoki has raised the attention of public-health researchers wondering what the recipe is of the magic potion ‘that makes the children thin’  (Der Spiegel, 2016). After interviewing 15 local stakeholders (i.e. public administrators, school principals, teachers, parents, school nurses, food managers and representatives of third-sector organizations) that are – in one way or another – involved in Seinäjoki’s anti-obesity programme, I will briefly summarise my impressions without having analysed the data in depth yet. Above all, Seinäjoki’s efforts to curb childhood obesity have turned out a remarkable success due to the combination of local autonomy, multi-professional teamwork and a change-ready mindset. Moreover, the sum of many small- and medium-scale measures such as new school yards and an activity-friendly infrastructure has contributed to making health promotion ‘centre stage’ within the city’s various settings.

A local example of cross-sectoral health policy

Activity-friendly school yards are one feature of Seinäjoki’s anti-obesity programme (photo: Benjamin Ewert).

Seinäjoki’s anti-obesity programme  is a particularly successful example of integrating Health in All Policies (HiAP) at the local level by ‘systematically taking into account the health implications of decisions’ and ‘seeking synergies across sectors’ (Ståhl et al., 2006). Nevertheless, what has made HiAP effective in Seinäjoki is the combination of supportive background and favourable context factors. First of all, the city has used its great amount of local autonomy (e.g. to raise municipal taxes), as granted by the Finnish constitution to municipalities, to make health promotion a top priority. With the aid of its coordinator of health and welfare promotion, for example, the city strategically bundles and overviews local actions against childhood obesity. Thus, Seinäjoki succeeded to create a bigger picture by relating a number of single health-promoting measures such as early-childhood prevention, close monitoring of children’s health by school nurses, the construction of activity-friendly school yards, the extension of cycle paths, the provision of heart-health-certified school meals and the integration of physical exercise into regular school lessons. Without any additional financial means at its disposal, the programme strongly depends on ideational resources like, first and foremost, the trust and cooperation among stakeholders, i.e. day-care centres, schools, caterers, health services, sports clubs, non-profit organisations and the city-development and -planning departments. As reported in many interviews, local stakeholders’ unagitated ‘we-are-just-doing-our-job mentality’ was extremely helpful to implement the programme. Everyone has played its little part to reduce the number of overweight and obese children. This policy of small steps has been orchestrated through various thematic working groups (e.g. school-yard boards or nutrition units) that facilitate multi-professional cooperation and joint action.

However, in order to understand the programme’s promising results, further enabling factors have to be taken into account. In this respect, there are a number of structural features unique to Finland: firstly, the Finnish institution of Maternity and Child Health Clinic, called Neuvola, has been providing systematic lifestyle counselling for children and families free of charge for more than 100 years; it represents a strong foundation for fighting childhood obesity. School nurses, a further advantage of the Finnish case, continue the work of Neuvola by regularly checking students’ health parameters (i.e. weight, amount of physical exercise, eating habits, mental health). In addition, the provision of free school meals ensures that almost all children receive health-conscious nutrition at schools, which prevents them from buying snacks or fast food beyond the school gate. Finally, the Finnish school system has proved to be very helpful concerning activities for obesity prevention. Most importantly, teachers are free to conduct health-promoting pedagogical experiments such as integrating elements of physical exercise in regular classes, teaching outdoors or banning tables and chairs from classrooms. Moreover, the Finnish Schools’ on the Move Programme , which is carried out by the Finnish National Board of Education and the Ministry of Education and Culture, reinforces these efforts. Also, schools can decide on the schedule of the school day autonomously, which allows them to establish so-called physical-activity breaks (up to 90 minutes).

Lessons to be learned from the case of Seinäjoki

Students take the bicycle to school and back home – in spite of snow and ice (photo: Benjamin Ewert).

These favourable conditions for implementing Seinäjoki’s anti-obesity programme are once again strengthened at the local level. The city and its very homogenous population benefit from a relatively positive socio-economic situation with an unemployment rate of 10,7% (nationwide: 12,6%), a vivid local civil society with more than 70 sports clubs and an active cultural life. In short, having been spared by other social challenges (e.g. youth unemployment or the integration of a vast number of migrants), Seinäjoki’s local administration is able to give full commitment to the prevention of childhood obesity. Would the same strategy and set of measurements also work in another city or even in another country? Certainly, the programme cannot be considered a best-practice example to combat obesity, since a one-to-one implementation is not possible due to local particularities (e.g. involved stakeholders and available resources) and context factors (e.g. administrational and cultural systems). However, key pillars of the programme – multi-sectorial cooperation, thematic working groups and a combination of small-scale measurements – may be adapted to other settings and stakeholder constellations. Altogether, it is the health-minded attitude of Seinäjoki’s people and their joint commitment to end childhood obesity that serve as a stunning and inspiring model for health promoters across the world.

Benjamin Ewert
Heidelberg School of Education

References

Der Spiegel (2016): The Fit Children of Seinäjoki. Retrieved on 11th of June, 2017 from http://www.spiegel.de/international/tomorrow/nutrition-how-finland-has-solved-the-problem-of-obese-children-a-1088256.html
Ståhl T et al., eds. (2006): Health in All Policies: prospects and potentials. Helsinki, Ministry of Social Affairs and Health.
World Health Organization (2015): Finland curbs childhood obesity by integrating health in all policies. Retrieved on 11th of June, 2017 from http://www.who.int/features/2015/finland-health-in-all-policies/en/


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