Questions/Answers

An individual’s health over the course of his/her lifetime is closely connected with childhood and adolescence health. Therefore, the health of children and teens must be protected, in a fair manner, regardless of one’s address or socioeconomic status. By preventing obesity and smoking (the two biggest causes of non-infectious disease) among minors, the SMG aimed to give citizens longer and healthier lives. Given that socially vulnerable children/teens can develop permanent health-detrimental habits through not only individual choices but also their socioeconomic environment, services provided at schools was paired with efforts to supplement environmental deficiencies. This project aims to blend participatory education with the creation of healthy local communities in order to enable children/teens to learn how to protect and maintain their health on their own. To achieve this goal, the SMG took a new approach. First, to ensure that no child or teen experiences health inequality because of socioeconomic status or area of residence, the city decided to implement concentrated health-promoting activities for socially vulnerable children/teens. Second, through digital innovation, contactless services will be developed that are appropriate for the post-COVID-19 era. Third, the SMG aims to develop an automatic self-screening system and create a healthy environment so that local communities gain the ability to protect their own children and teens. Fourth, the city aims to forge partnerships with diverse institutions and collect feedback from stakeholders in the process of designing and implementing public services.

The policy was designed to be implemented with digital technologies, including consultations, physical exercise, and nutritional information provided via a mobile app. A system was developed to measure children’s physical fitness, and a remote mediation program was operated for morbidly obese teens. Public services were also made more accessible to vulnerable citizens, and socially underprivileged children were given fruit and access to nutritional education and sports programs. An innovative policy system was introduced, and inter-organizational partnerships were created. In addition, programs on obesity/smoking prevention were carried out through inter-organization collaborations and spearheaded by children/teens and local residents.

This project is related to four Sustainable Development Goals (SDG). First, for Goal 3 (Good health and well-being), children/teens were encouraged to adopt healthy lifestyle habits over their entire lives to prevent obesity and smoking (key causes of decreased lifespan). Second, for Goal 10 (Reduced inequalities), by focusing the project on socially vulnerable children/teens (who are at risk of obesity and nutritional imbalance due to lack of access to safe, healthy foods), the project aimed to prevent inter-regional/class health inequality. Third, for Goal 11 (Sustainable cities and communities), through the cooperation of related institutions on people-centric policies spearheaded by the project’s targets (teens) and local residents, an infrastructure and human resource capabilities were established to enable local communities to maintain health-conducive environments. Fourth, for Goal 16 (Peace, justice and strong institutions), the number of non-smoking areas was increased through the cooperation of local residents and relevant institutions, while a law-abiding basis was established for the project’s implementation through voluntary efforts by residents to protect children/teens.

First, from a social perspective, teens and local residents were persuaded to participate. Second, from an economic perspective, the SMG secured a budget by enacting ordinances and was able to consistently expand the project in the form of a cooperative project with related institutions. Third, from an environmental perspective, governance systems were created with relevant institutions/civic groups, and inspections were conducted of facilities frequently used by teens to create a healthy urban environment for them. Resident associations were also formed to improve districts with health-detrimental environments to ensure that the project’s goals can be implemented without government interference.

First, by establishing a health screening system for preschool-aged children, who are usually excluded from public policies, it is now possible to supervise health per life stage and accumulate health-related information from a young age. Second, a safe environment was created for the protection of children/teens by finding health-detrimental (neglected) areas of vulnerable districts. Despite the fact that children and teens were being exposed to second-hand smoke and other health hazards on a daily basis on their walk to school, there was no way to file a civil complaint. To amend this situation, the SMG encouraged children and teens to search their neighborhoods for health-detrimental areas and apply for those locations to be designated as non-smoking areas. Third, the project was designed and implemented through public-private cooperation rather than unilateral action by administrative bodies. By implementing policies that teens and residents of vulnerable districts agreed with, the project aimed to alleviate inter-regional health inequality and inter-class conflict. Fourth, by providing concentrated health services for childcare facilities that are frequented by vulnerable children and thereby encouraging the project’s targets to voluntarily maintain healthy lifestyles, the project aimed to prevent health inequality for vulnerable children caused by social inequalities.

To increase the physical activity of female students (which is much lower than that of male students) and create an exercise-friendly environment at schools, the SMG worked with the Seoul Metropolitan Office of Education and private companies to host an exercise idea contest especially for female teens. The winning idea was required to be adopted by all middle and high schools in Seoul. To protect women and children in areas with high adult male smoking rates from the effects of second-hand smoke, the project was promoted on buses/in subways and on streets with high floating populations starting in 2018.

The target of this project is children and teens living in Seoul, including vulnerable individuals. They need to eat nutritious food, learn about proper eating habits, experience diverse physical activities, and be protected from health-detrimental actions. Each year, the SMG conducts a health screening and physical exercise programs at approximately 500 childcare facilities. A “walk to school” program (with light snack), classes on nutrition/physical activity, strength tests, and health counseling were provided for approximately 100 schools. For 220 childcare facilities for vulnerable children, seasonal fruit was provided along with nutrition classes and exercise programs. This helped socially vulnerable children improve their eating habits, health issues, and understanding of nutrition (e.g. increased fruit/vegetable consumption and physical activity, decreased fast food/sweetened beverages/instant noodles consumption, and better understanding of nutrition facts labels). To prevent students from smoking, age-appropriate PR campaigns were conducted, while teens were encouraged to create their own anti-smoking environments. This resulted in a decrease in teens in Seoul trying smoking from 18.6 percent in 2014 to 11 percent in 2019 (and this figure continues to decrease each year). Teens in vulnerable districts are protected from cigarette smoke through the designation of smoke-free streets for 304 schools.

Because obesity and smoking are indices that are highly influenced by an individual’s socioeconomic status, the most urgent task was to break the vicious cycle of the parents’ socioeconomic status having a negative impact on their children’s health. Since 2005, the SMG has been offering free health consultations and services through public health clinics and conducting age-appropriate health education at schools. In 2014, a health screening system was developed for preschool-aged children in the format of a platform, through which a child’s strength and physical dimensions can be easily measured, recorded, and viewed via smartphone. Areas within a 50-meter-radius of elementary, middle, and high school entrances (2015) and 10-meter-radius of kindergartens and daycare centers (2018) were legally designated as non-smoking areas. In 2017, the SMG joined an international cooperative system with the WHO, Vital Strategies, and Bloomberg Philanthropies to jointly conduct a sugar consumption-reducing project for teens. It also signed an MOU with the SMOE for the joint conducting of prevention programs on teen obesity and smoking. The teen-designated non-smoking school street program was expanded to include the creation of anti-smoking environments. In 2018, a policy proposal forum, questionnaire/FGI survey, and Delphi survey were conducted of teens, parents, teachers, and policy-making employees to prepare the project’s legal grounds. Since 2015, retail stores have been monitored each year to prevent the sale of cigarettes to teens. Inter-regional health inequalities are regularly monitored to check whether vulnerable children are at a health disadvantage, and a teen health status survey monitors/checks whether children/teens are active smokers. Programs that measure the improvement of physical activity and eating habits assess changes in awareness/knowledge of health. To assess citizen tangibility and the effectiveness of the obesity prevention program, the SMG is conducting a big data-based study with the Seoul Institute of Technology.

The biggest issue that was overcome was encouraging inter-organizational cooperation. Internally, SMG divisions worked together to design programs, encourage children/teens to participate, and expand PR. Externally, the city worked with the SMOE, youth centers, childcare centers, the Seoul Institute of Technology, and citizens/private organizations to maintain discussions on children’s health. The agreement of diverse stakeholders on the goal of protecting the health of children and teens and establishment of a cooperative system based on this shared understanding resulted in the voluntary participation of related parties and the smooth division of tasks and budget areas.

This project is innovative because it was conducted based on various forms of feedback from children and teens. With such feedback, the WHO’s “health-promoting school” model was adapted to the circumstances of children/teens in Seoul. A sustainable operational system was created through collaborations among local residents, parents, and relevant institutions. By designating hazardous areas as smoking-free school streets based on feedback from teens and residents, citizens were motivated to follow the law. The project is being benchmarked by other municipal and provincial governments in Korea as an example of an innovative policy for protecting vulnerable children through public-private cooperation.

The project’s basic principles and structure were based on the WHO’s health-promoting school. The health-promoting school project creates a healthy environment by providing positive, comprehensive experiences of improved health to the entire school community. Ultimately, it provides adequate healthcare services and also encourages healthy habits in the home and local community as a whole. Based on this model, the SMG designed and carried out its project based on feedback on the characteristics of Seoul.

Through its partnership with the Seoul Institute of Technology, the SMG developed projects that utilize technologies such as IoT, big data, and smart devices. An app was created to provide counseling, classes, and various kinds of information in real-time. It was then linked to eating/exercise/anti-smoking services for teens convenience. A health check system was also developed to enable preschool-aged children to easily measure, record, and view their physical dimensions and strength. A remote lifestyle mediation program for obese children/teens makes use of IoT devices to monitor physical changes and the amount of physical activity done by users.

First, by conducting a trial version of the student-led anti-smoking school street project since 2017, the SMG has actively promoted its efforts to the central government as well as the general public (through news coverage, etc.). This resulted in a drastic decrease in smoking-related civil complaints in 2018 and other tangible effects through the creation of a safe environment for socially vulnerable children/teens and anti-smoking education. Accordingly, the Ministry of Health and Welfare recommended that all other regional governments benchmark the SMG’s anti-smoking school street project (which was spread to major metropolitan cities/provinces, including Gyeonggi Province, Busan, and Gwangju). Second, the SMG’s project (since 2015) of monitoring/persuading retail stores to not sell cigarettes to teens is reducing the sale of cigarettes to teens through sellers’ voluntary participation and thorough ID checks. With such efforts, the teen health status survey showed that the ease with which teens can purchase cigarettes is decreasing (2015: 79.4%, 2016: 71.2%, and 2017: 67.9%). Various central ministries are asking the SMG to share its data and cooperate on similar projects. The project is now being increasingly conducted at the small-scale regional level, with strengthened monitoring of illegal cigarette sales at retail stores by local governments.

This project, which utilizes digital technologies, is highly applicable in the post-COVID-19 era and amid the prolonged COVID-19 situation. With only an app, teens can receive remote anti-smoking counseling services and education on exercise/nutrition, measure their physical strength (indication of health), and share health-related information. The remote lifestyle mediation program for obese teens provides systematic support from multiple experts (doctors, clinical psychologists, nutritionists, exercise therapists, etc.). Big data-based machine learning programs have made it possible to find causes of obesity per district and introduce policies that are strategic and based on solid data.

First, the project budget was obtained through investment from private players. Funds were used to operate a health screening system for preschool-aged children and give fruit to socially vulnerable children and teens. The local safety map project didn’t need a budget because it used the SMOE’s system. Second, the personnel required were from various institutions: SMG divisions, SMOE, childcare centers, youth centers, Seoul Institute of Technology, civic groups, and private organizations. The key players were the teachers, students, and local residents of the 407 participating schools, whose cooperation played the biggest part in decision-making and PR campaigns.

First, focus was given to creating a social consensus. Feedback was collected from children, teens, parents, and local residents. PR campaigns were held with civic groups, while citizens were educated about the project’s goals through media coverage. Second, to create a sustainable administrative environment, an inter-organizational cooperative system and joint work process were established. Third, in terms of finances, funding was secured through ordinances, with the project’s multiple aspects carried out through the sharing of resources with other institutions. In this way, the project was made expandable without any significant budget needs (reducing costs by half, etc.).

Yes

In a 2020 assessment conducted by the MOIS, the SMG’s obesity improvement rate was designated as an example of “Outstanding Goal Accomplishment,” and the anti-smoking policy for teens received a ministerial commendation in 2019 from the Ministry of Health and Welfare. Furthermore, the SMG conducted its assessments of the smoking rate among socially vulnerable teens and the smoking rate gap among social classes. To measure physical activity and changes in eating habits, physical strength tests and surveys were conducted.

The assessment indices for the obesity prevention program were: obesity rate, changes in physical size/strength, improvement in eating habits and physical activity levels, strength measurement, completion of physical activity, and change in perception/knowledge of health. The indices for the anti-smoking program were: teen smoking rate, exposure to second-hand smoke at home and school, ease of purchasing cigarettes, rate of illegal cigarette sales, rate at which age is not checked when purchasing cigarettes, and registration rate for anti-smoking classes at local health clinics. Assessments of the establishment of anti-smoking school streets were based on the civil complaint rate and inspection rate.

The rate of physical activity caused by improved nutrition and expanded offering of physical activity programs for socially vulnerable children/teens increased from 13.7% (2018) to 15.0% (2019). Rates of fruit consumption (42.8%→51.8%) and vegetable consumption (57.4%→59.1%) increased as well, while instant noodle consumption (7.0%→6.8%) and fast-food consumption (4.7%→4.3%) decreased. The rate of sweetened beverage consumption declined (12.0%→11.1%), while bowel movement regularity rose (76.2%→78.1%) along with the ability to understand nutrition facts labels (46.7%→61.9%). The results of smoking rate gaps based on parents’ level of education showed that the gap between smoking rates of children with well-educated parents (8.5%) and parents with low education levels (25.0%) decreased from 16.5%p (2015) to 4.4%p (2017). Meanwhile, the teen smoking rate fell from 7.0% (2015) to 5.7% (2019), a marked difference compared to the increase in smoking rates nationwide (national: 6.3% (2016) to 6.7% (2018)). In other words, the concentration of services for obesity/smoking prevention, age-appropriate PR, and environmental improvement for socially vulnerable children and teens is improving the health of children/teens and reducing the class-based health gap.

This project is being implemented through the cooperation of various institutions, including the SMG, SMOE, local health clinics/schools, local communities, youth/childcare centers, Seoul Institute of Technology, civic groups, and private organizations. Policies on protecting the health of children/teens were a driving force that brought about such collaboration among institutions in diverse sectors. In the past, overlapping budget allocation (caused by lack of cooperation and data sharing among institutions) was a problem that had little possibility of being addressed. The SMG, however, spearheaded the effort to bring related institutions to the table, explain the purpose of the project, and bring about a consensus on the need to participate, through which a collaborative network was established for the purpose of protecting the health of socially vulnerable children/teens. Such inter-organizational cooperation at the local government level and creation of citizen-participatory policies (created with input from children/teens) resulted in collaborations among central government ministries. Seoul shared the outcomes of the project with the Ministry of Health and Welfare, Ministry of Education, and Ministry of Gender Equality and Family, and inter-ministry efforts are still being made to create a basis for the application of this project nationwide.

To protect the health of socially vulnerable children/teens, the SMG, SMOE, and local childcare centers jointly provide classes at schools on healthy lifestyles and app-based programs (health counseling, child-appropriate programs, etc.). These programs could only be implemented through effective task and budget division among participating institutions. Avenues for collecting feedback for the project’s design, implementation, and assessment were created (debates, forums, surveys, etc.) to allow children/teens, parents, teachers, and local residents to participate. Cooperation went beyond administrative bodies to include private organizations and civic groups, thus establishing a healthy environment for future generations through funding and PR campaigns. These public-private partnerships made it possible for this project to continue being conducted without efforts having to be spearheaded by administrative bodies. The implementation process and outcomes were shared with central ministries (Ministry of Health and Welfare, Ministry of Gender Equality and Family, etc.), and discussions were held on how to expand the project to other regional governments. The SMG also worked with major foreign institutions (Bloomberg Philanthropies, WHO, etc.) to conduct campaigns and projects on improving the health of vulnerable children/teens. In this way, the SMG cooperated with diverse personnel, institutions, and sectors.

Protecting the health of children and teens is especially important in Korea, which currently has an extremely low birth rate. The SMG focused on providing unique, concentrated services for socially vulnerable children/teens along with universal services so that all children and teens choose to eat healthily and exercise. Efforts were made to get feedback from children/teens and offer health-promoting services that meet their needs as well as create a social foundation for it. A cooperative system was created under a common goal (health of children/teens) through meetings and countless efforts to persuade institutions to set aside their interest in profits. Synergy was created through an efficient system that shares information on the budget and capabilities of each participating institution and divides tasks and budget responsibilities based on that information. Also, the expansion of service provision through digital devices ensured that health-promoting services for socially vulnerable children/teens can be provided continuously even during COVID-19. The SMG will be using feedback from teens and citizens to further structuralize the current system on inter-organizational understanding (clear division of task/budget responsibilities, joint assessment, sharing of data, etc.) and design sustainable policies that allow future generations to enjoy healthy lives without class-based discrimination.