A recent survey shows that participation in leisure-time physical activity is highest in Finland among the European Union countries. About two thirds of both women and men engage in various activities for at least three hours per week. This proportion has been continuously increasing since 1978, when the annual surveys of the Public Health Institute began. However, non-recreational physical activity, e.g. walking and cycling to work, has decreased. The interest and increasing participation in leisure-time physical activity among the Finns is based on several factors. The environmental conditions have forced, but also stimulated and enabled people to be physically active. Physical education in primary school has been compulsory for both girls and boys for more than 130 years. Exercise and sports have been emphasized in the young nation for nationalistic and defense reasons. This interest created strong sport organizations with local associations, open to all and with nominal fees, in nearly every village. The local municipalities have had the responsibility to offer sites and services for sport and recreational activities. The state has supported both the voluntary organizations and municipalities, especially since the establishment of the national lottery system in 1940. The high participation of women is largely explained by their equal rights with men, e.g. the right to vote since 1906.

Successful physical activity promotion programs

Until the beginning of the 1960’s the emphasis was on sports, and in the 1960’s – 1980’s increasingly on exercise for fitness. During the 1990’s there has been a shift to emphasize exercise and non-structured physical activity for health. Several measures have strengthened this development: 1. the report of the State Committee on Exercise and Sport in 1990 that emphasized health and local action as the key elements of exercise and sport policy, 2. publication of a thorough scientific review in 1994 of all aspects of social justification for physical activity and sport, and its attractive lay version for the policy makers. Promotion of health-enhancing physical activity was included as part of Finnish health policy and program in 1992. This ground work led to the launching of two successive physical activity promotion programs, "Finland on the Move" and "Fit for Life". Both programs were favorably received, with interim results showing a reasonable increase in participation of previously sedentary individuals. This led to the continuation of the first 5-year Fit for Life program for a second 5-year period. In addition to the Ministries of Education and Health, the Ministries of Transport, Environment and Labor will also provide state funding and participate in coordination during this second period. In the health sector, a potentially important measure has been the development of national consensus and a corresponding action program for the prevention of cardiovascular diseases. The action program includes the promotion of physical activity, and comprehensive recommendations have been launched to facilitate the promotion of physical activity by various sectors and actors, particularly on the local level.

Legislation is the most powerful policy tool

Legislation is in principle the most powerful policy tool to reach the set goals. In Finland two new laws are important to increase opportunities for physical activity. The Finnish local government includes the right to participate in physical activity. This means that the municipalities have legal obligations in this area in the same way as they have obligations regarding the provision of education. The other new law is the Sports Act. The purpose of the Act is to promote physical activity and sports and related civic activity to promote the population’s health and well-being, and to support children’s and young people’s growth and development through exercise and sports. According to the Act, general conditions for sports and physical activity shall be created by the government and the local (municipal) authorities, and the responsibility for arranging sports rests with the sports organizations.

In summary, during the past 10 years substantial positive development has occurred in promoting physical activity in Finland. Physical activity has been increasingly included in public policies of various sectors. This has led to the launching of sizeable and innovative promotion programs and other measures. They have received substantial state funding, but they have created several times more resources from local sources, both public and private. There is also a definite reorientation of the societal funding and services from competitive sports to physical activity. In all these changes the health-enhancing potential of physical activity has been a key underlying factor and selling argument. This development as a whole, demonstrates the significance of the availability and use of evidence-based knowledge for societal development.

Ilkka Vuori, M.D., is professor and Director of the UKK Institute for Health Promotion Research, WHO Collaborating Center in Tampere, Finland and can be reached at tel: 358-31-2829111, fax: 358-31-2829-200, or email: ukilvu@uta.fi

The Norwegian lifestyle and identity is strongly connected to water, mountains, trees, and weather, in spite of Norway being one of the richest and most developed countries in the world. In other words: the lifestyle is connected to nature. Nature is regarded as a partner, and movement within nature is one of the most important principals in the modern society of Norway. The term used in the Norwegian language for this approach and mentality is "Friluftsliv". "Friluftsliv" is based on experience and built around the principals of primary information (receiving direct information through nature) and primary learning ("learning by doing"). It is also an essential part of the school curriculum. The same principals apply to the "AEØA – Do you know Norway" project, which was developed by the Institut für Prävention (IPN) in Köln and supported by the Norwegian Foreign Office. The successful project (10,000 overnight lodgings) was developed for the German secondary school and offers guidelines on the principals, contents and examples for class excursions and teacher seminars. The past experiences with the project show:

1. Nature is still a fascinating and fantastic teacher and finds an exceptionally high acceptance amongst students and teachers, even in 1999.
2. Even people living in urban areas have a strong affinity for nature. The explanation for this must be the genetic predisposition regarding lifestyles which we used to follow for over 100,000 years, i.e., living in nature.

"Friluftsliv" is not a sport and cannot be compared to conventional outdoor activities. It rather is a lifestyle in which body and soul are in balance through the activities in and the experience of nature. It is also a "new" way to fight against physical inactivity and to support an active, health-oriented, and "normal" lifestyle. "Friluftsliv" is a great chance for health promotion in the 21st century!

Dr. Lagerstrøm is the president of IPN and can be reached at tel: 49-2234-9465711, fax: 49-2234-946576, or email:ipn@uumail.de

"Health promotion is the science and art of helping people change their lifestyle to move toward a state of optimal health. Optimal health is defined as a balance of physical, emotional, social, spiritual and intellectual health. Lifestyle change can be facilitated through a combination of efforts to enhance awareness, change behavior and create environments that support good health practices. Of the three, supportive environments will probably have the greatest impact in producing lasting change." (American Journal of Health Promotion, 1989, 3, 3, 5.)

Currently, few Japanese people engage in regular physical activity. The Sasakawa Sports Foundation (SSF) has conducted national sports surveys every other year since 1992 to get an understanding of the situation of sports and physical activity among people in Japan. According to the "The 1998 SSF National Sport-Life Survey", 13 percent of Japanese people aged 20 and older are active sports participants, who exercise somewhat moderate to hard for at least 30 minutes more than twice per week to maintain and improve their health. However, this result shows a continuous increase since 1992, when the survey started (6.5% in 1992, 7.6% in 1994, and 9.6% in 1996). Concerning popular sports and physical activity for "sports enthusiasts" who exercise more than once a week (42.9% of adult population1), walking ranked first (15.6%) followed by bowling, calisthenics, weight training, jogging, cycling and swimming. When comparing these numbers to other countries, Canada and Australia fared the best. However, caution should be exercised when comparing countries as the classification of active sports participants differs.

The Ministry of Health and Welfare has been developing the national objectives of health promotion and disease prevention, which is called Healthy Japan 21. It is the product of a national effort involving professionals, citizens and public agencies from all parts of Japan. Healthy Japan 21 offers a vision for the 21st century aiming at reducing premature deaths and disability, and at enhancing quality of life for all Japanese. It is scheduled to be published in January of 2000. The report presents many opportunities for prevention in the form of measurable targets or objectives to be achieved by the year 2010, and is organized into nine priority areas which include physical activity and exercise, nutrition, tobacco, alcohol, mental health, dental health, heart disease, cancer and diabetes.

The year 2010 objectives place an emphasis on increasing light to moderate physical activity in everyday life. There are three objectives in the area of physical activity:

1. Increase the proportion of people who engage in vigorous physical activity that enhances their health status (baseline: 52.6% for male, 52.8% for female in 1996).
2. Increase the proportion of people who practice brisk walking or walk instead of taking vehicles or escalator (baseline: 25.7% for male, 32.5% for female in 1996).
3. Increase by at least 1,000 steps the amount of walking per day. (baseline: 8,202 for male, 7,282 for female. The target was 9,200 for male, 8,300 for female in 1997).

¹This is a different classification from the 13%: here all activities are included, even if for less than 30 minutes and low intensity, like for example bowling.

Dr. Toshio Yamazaki can be reached at the National Institute of Fitness & Sports in Kanoya, Kagoshima under tel & fax: 81-994-46-4962, or email:yamazaki@mail-sv.nifs-k.ac.jp . For more information on the SSF survey please send an e-mail to einfo@ssf.or.jp , fax to 81-3-3580-5968, or check the website at http://www.ssf.or.jp

Seventy percent of the people in the state of São Paulo are sedentary, and 300,000 deaths per year in Brazil can be attributed to cardiovascular disease. Taking this scenario into account, the State Secretary for Health in São Paulo asked the CELAFISCS Research Center in São Caetano do Sul to develop a program to promote health though physical activity. "Agita São Paulo" was launched in December of 1996 with the following goals:

1. To increase the population’s knowledge of the benefits of physical activity and
2. To increase the amount of positive involvement in physical activity.

The basic premise is to upgrade everyone’s physical activity level by one level, i.e., to persuade the sedentary to be at least occasionally active, the occasionally active to be regularly active, the regularly active to be very active, and the very active to maintain that level. The program targets three groups: school children and students, workers, and the elderly. The name "Agita" was recommended by marketing experts as the term in the Portuguese language reflects more than merely moving but also a social and mental approach (like "active citizenship").

A large number of influential governmental and non-governmental organizations are participating program partners. Posters, flyers, manuals, logos (the most eye-catching is the "half hour man", the mascot which recommends the accumulation of at least 30 minutes of moderate physical activity per day), and slide and video presentations have been developed to educate the public on 23 topics relating to physical activity and health. More recently, nutritional topics have been added with the inclusion of the food pyramid. The media has been heavily involved resulting in an estimated 21 million people being reached through the campaign. Special attention has been given to assessing the physical activity of the target population. A questionnaire adapted from international models is being used to determine any changes in behavior. Even the stages of change (e.g., starting to consider getting involved in exercise) are being monitored as these are considered important signs of improvement. The program has been expanded to other Brazilian cities, e.g., Bahia, and is planned to be adopted by other Latin American countries (e.g., "Muevete Bogotá" in Colombia).

For more information please contact Dr. Victor Matsudo at the Physical Fitness Research Center of São Caetano do Sul – CELAFISCS in Brazil at tel/fax: 55-11-4538980 or 55-11-4539643, or e-mail at lafiscs@mandic.com.br

Guatemala is a Central American country with a population of 11.5 million, which is the largest population in the region. About half of Guatemala’s population is mestizo (known in Guatemala as ladino), people of mixed European and indigenous ancestry. Ladino culture is dominant in urban areas, and is heavily influenced by European and North American trends. But unlike many Latin American countries, Guatemala still has a large indigenous population (44%), the Maya, that has retained a distinct identity. The two cultures have made Guatemala a complex society that is deeply divided between rich and poor. This division has produced much of the tension and violence that have marked Guatemala’s history. Although a significant middle class has developed in urban areas, more than 75% of Guatemalans live below the poverty level.

Guatemala has a young population, with 44% under age 15 in 1999. The birth rate of almost 37 per 1000 population is five times the death rate (7 per 1000). Guatemala’s people suffer from one of the highest infant mortality rates in Central America, 46 deaths per 1000 live births (1998), but that represents a significant improvement from 125 per 1000 births in 1960. Life expectancy at birth is 64 years (61 years for males and 67 for females).

About 35.8% of all Guatemalans over the age of 15 are illiterate (42.7 percent of females, 28.3 of males), with these among the highest rates in Central America. Although elementary education is free and compulsory, lack of enforcement and inadequate resources leave many Guatemalans without a formal education.

Guatemala established a social security program and labor code in 1946. Although the law provides for an extensive program of health care, old age pensions, disability and accident insurance, in practice the shortage of health-care personnel and other resources has meant that social services for the poor are very inadequate. The country has about 7 doctors for every 10,000 inhabitants, and most doctors work in the Guatemala City area. In 1995 only 754,100 people, less than a quarter of the workforce, were registered for social security.

INCAP – An Institute to Tackle Nutritional Problems

In 1949, the health ministries of the region formally created the Institute of Nutrition of Central America and Panama (INCAP). INCAP was founded to determine the nutritional problems of the region, find practical solutions to these problems through technical assistance services, education, skills development and dissemination of information. The reasons to establish INCAP were well justified, since nutrition deficiencies, that mainly affected preschool children and women in reproductive age, were highly prevalent in the region and their causes and management were still not known. Since then, to date, many advances have been made in the knowledge of the nature, magnitude, distribution, determinants and solutions of dietary and nutritional problems. INCAP has assumed the leadership in promoting food and nutrition security in Guatemala and the rest of Central American countries.

Some of the solutions recommended have been food fortification with vitamin A, iron and iodine; elaboration of analytical models and national policies and programs on food and nutrition, such as Guatemalan nutrition guidelines; development of technology and methodologies, such as production of low-cost, nutritious foods (Incaparina, fortified cookies), better cereal varieties and better post-harvest technologies; and definition of the treatment of the malnourished children. As an example of the impact of food fortification programs, sugar provides about 50% of vitamin A recommended dietary intake in Guatemala. Vitamin A deficiency has been reduced from 27% in 1987 to 16% in 1995. In 1996, the Guatemalan sugar agroindustry received an award from the Pan American Health Organization (PAHO) for being the first country in the world that achieved 100% fortification of sugar production with vitamin A, and Guatemala was a pioneer in implementing the legislation of sugar fortification.

Need For Health Promotion Programs

The health and education ministries, with INCAP’s technical support, are working together to promote healthy schools. Forty thousand teachers and 15 thousand health workers are being taught to develop skills on healthy diet and lifestyles. The components of healthy schools in Guatemala include: education in and promotion of food and nutrition security, disease prevention and management, immunization programs, improvement of sanitary conditions, school security, oral health, psychological and social protection, and environmental issues.

In recent years, Guatemala, as most of the developing world, has gone through an epidemiological transition, characterized by a decrease in food deficiency and infectious diseases and an increase in non-communicable diseases. At present, nutritional deficiencies co-exist with obesity in many Guatemalan communities. A decade ago, INCAP initiated several activities addressed to reduce the risk and frequency of non-communicable disease related with diet and lifestyles. Few studies have been conducted in urban communities and different strategies have been proposed to diminish the risk of chronic diseases.

For more information on Guatemala please contact Manuel Ramirez Zea, M.D., PhD., at INCAP, tel: 502-4723762, fax: 502-4736529, or e-mail: mramirez@incap.org.gt

Race/Ethnicity and Social class and Physical Activity

A recent study by Dr. Carlos Crespo of American University in Washington, DC et al., examined the relation of physical activity during leisure time and race/ethnicity and social class. Physical inactivity is more prevalent among racial and ethnic minorities than among Caucasians. It is not known if differences in participation in leisure-time physical activity are due to differences in social class. Thus, this paper provides estimates of the prevalence of physical inactivity during leisure-time and its relationship to race/ethnicity and social class.

Between 1988 and 1994, 18,885 adults aged 20 years or older, responded to the household adult and family questionnaires as part of the Third National Health and Nutrition Examination Survey (national representative cross-sectional survey). Mexican Americans and African Americans were over-sampled to produce reliable estimates for these groups. Multiple assessment of social class included education, family income, occupation, poverty status, employment status and marital status.

The age-adjusted prevalence (per 100) of adults reporting leisure-time inactivity is lower among Caucasians (18%) than among African Americans (35%) and Mexican Americans (40%). African American and Mexican American men and women reported higher prevalence of leisure-time inactivity than their Caucasian counterparts in almost every category of education, family income, occupation, employment, poverty and marital status.

The authors concluded that current indicators of social class do not seem to explain the higher prevalence of physical inactivity during leisure-time among African American and Mexican American. More research is needed to examine the effect of other constructs of social class such as acculturation, safety, social support and environmental barriers in promoting successful interventions to increase physical activity in these populations.

Dr. Crespo is a professor in the Department of Health and Fitness at American University, Washington, DC. He can be reached at tel: 202-885-6259, fax: 202-885-6288, or e-mail: crespoc@american.edu

Participants of the 4th Annual
IIHP Meeting in Curitiba, Brazil

The 5th Annual IIHP Meeting will be held at American University in Washington, DC, from October 18-21 of 2000.

The International Institute for Health Promotion (IIHP) is a global center for the development and advancement of health promotion policies, programs, services, and research that maximizes multiple efforts across the globe. It was established in 1994 as an addition to the National Center for Health Fitness at American University in Washington, DC, to assist in leading, facilitating, and coordinating the efforts of many international individuals and organizations. More than 50 cooperating members from 25 nations form an extensive interdisciplinary health promotion network that includes ongoing dialogue, information exchange and project participation. E-mail the IIHP at iihpaa@american.edu . The IIHP website is http://www.healthy.american. edu/iihp.html

Conference Dates

Permission to Reprint