Denmark: A multi-sector approach to boosting physical activity

Around the world, decreasing levels of physical activity have had a significant impact on health and well-being. In the WHO European Region, one third of adults and two thirds of adolescents are insufficiently active, with an estimated 1 million deaths per year attributable to physical inactivity. Moreover, physical inactivity is a major risk factor for diabetes, estimated to account for 7% of the burden of type 2 diabetes in the Region.

Physical inactivity, however, is a modifiable behavioral risk factor, one that countries have set a global target to reduce by 10%. The WHO Regional Office for Europe's recently endorsed Physical Activity Strategy for the European Region 2016-2025 aims to inspire governments to facilitate and remove barriers to physical activity. Denmark offers a good example of how policy actions can help raise levels of physical activity, thereby helping to reduce the risk of diabetes. The Danish Health and Medicines Authority has adopted national recommendations on physical activity for children and adolescents, adults, older people and pregnant women. But the Danish government's work on physical inactivity goes far beyond setting guidelines.

In its efforts to boost physical activity, Denmark has taken a multi-sector approach. For example, the Ministry of Culture entered into a multi-party agreement in May 2014 entitled the Political Agreement on Sports (Politisk stemmeaftale om idræt), which outlines a commitment to sports policy initiatives across ministries that govern a wide range of fields such as culture, environment, health and prevention, children, equality, integration and social affairs, and education. Also in 2014, the Danish government funded the establishment of several partnerships focused on promoting physical activity and reducing overweight among children. The partnerships involve collaboration between municipalities, local organizations, and companies. In 2015, the Ministry of the Environment implemented Denmark's first outdoor recreation policy, serving as a guideline for the development of outdoor recreation activities and future collaboration in the field of outdoor activities. While this policy targets all population groups, there is a special focus on low socioeconomic groups, among whom there is often lower uptake of outdoor recreational activities.

In particular, two main strategies have been launched in Denmark to further improve physical activity. The first focuses specifically on children and adolescents. In Denmark, by age 15 only 11% of boys and 7% of girls met the WHO recommended physical activity levels in 2013/2014. To help combat this worrying level of inactivity, the Danish Parliament updated The Folkeskole (Consolidation) Act in 2014 (originally passed 1993), which makes it compulsory for schools to offer an average of 45 minutes of physical activity per school day in primary and lower-secondary education. The act also adds an extra physical education (PE) lesson per school week in grade 1 and mandates an exit examination in PE when students reach grade 9 in the Danish education system, around age 15. The Day-care Facilities Act states that all day care facilities must prepare a pedagogical curriculum with one of six themes focused on "body and motion."

The second strategy capitalizes on the fact that Denmark has one of the most vibrant biking cultures in the Region. Since 2009, Denmark has invested at least €350 million in cycling projects. The Capital Region of Denmark estimates that one million fewer sick days are now recorded, owing to the fact that 45% of people who study or work in Copenhagen cycle to their place of study or work. Furthermore, Denmark has implemented a national bike strategy – entitled "Denmark — on your bike!" – with three main pillars: everyday cycling, active holidays and recreation, and new and safe cyclists. Aarhus Cycling City is one of many projects that have received financial support from the Cycling Fund (Cykelpuljen). These funds were used for awareness campaigns and to improve infrastructure, such as new cycle paths, bicycle-friendly streets and new bicycle parking solutions. Aarhus has experienced a 19% increase in cycling in recent years, as a result of these projects.

Within Denmark, municipalities and regions generally play an important role in efforts to increase physical activity. For example, the Healthy Cities Network (Sund By Netværk), which includes two-thirds of all municipalities in the country, underpins national policy by working systematically and intersectorally in tackling the main risk factors and reducing inequalities in health.

While work still remains to raise physical activity levels, Denmark has made good progress through taking policy actions. Estimates from the WHO Global Health Observatory show that 73.4% of adults in Denmark reach the WHO physical activity recommendations.