YHP Bulgaria

Unhealthy diets and insufficient physical activity add to the risk. Only 18% of Bulgarian 15-year-olds reported at least 60 minutes of physical activity each day in 2022.³ Across the wider 5-19 age group, 29.2% were overweight in 2022, up from 27.6% in 2018. UNICEF links this trend to changing food environments, digital marketing and social and economic disadvantage.⁴

The burden is not shared equally. Among Bulgarian 15-year-olds, overweight or obesity affected 41% of those in the least affluent fifth of families, compared with 18% in the most affluent fifth.³ Bulgarian research also links the school environment with adolescent smoking and alcohol use, underlining the importance of prevention during the years when lifelong behaviours take shape.^5,6,7

To reduce young people's future risk of NCDs by strengthening the knowledge, confidence and resilience of adolescents aged 11-15, particularly those in underserved communities, so they can make informed health choices and encourage healthier behaviours among their peers.

YHP Bulgaria focuses on improving health equity by giving adolescents in underserved urban communities equitable access to credible prevention information and support.

By addressing modifiable risk factors before disease develops and strengthening prevention capacity among young people, schools and educators, the Programme aims to build healthier communities and reduce future pressure on health services. It also helps young people understand how active lifestyles, sustainable food choices and environmental factors such as air pollution affect long-term health.

Delivered with Out Loud Foundation, HealthFluencers works through public schools in Sofia and prioritises communities facing social and economic disadvantage.

• Youth insight and design. Baseline surveys, focus groups and consultations explore young people's experiences of nutrition, physical activity, smoking and vaping, sugary and energy drinks, hydration, sleep, peer pressure and health information. Health professionals validate the messages.
• Interactive health learning. Game-based sessions replace traditional lectures. Activities include the Healthy City simulation, an Energy Drink Reality Check and team challenges exploring how everyday behaviours affect heart, lung and brain health.
• Healthy behaviour challenges. Move for Your Heart, Sugar Detective, hydration and healthy snack challenges support young people to test practical changes in their daily lives.
• Digital storytelling. Students use the SCROLL platform to create and share short videos about their experiences. A Health Passport and Creator League help track participation and make healthier choices visible to peers.
• Youth leadership. Students showing strong engagement are invited to become Youth Health Ambassadors, or HealthFluencers. Additional training in health literacy, communication, public speaking, leadership and responsible digital storytelling prepares them to act as Peer Educators.
• Peer and community engagement. Youth HealthFluencers develop peer-led campaigns, discussions, school health days, sports activities and online content. The Programme culminates in a HealthFluencers Festival that shares youth-created work and connects participants with health professionals, athletes and other positive role models.
• Support for schools. Teachers, school psychologists and community stakeholders receive training and resources to reinforce prevention messages and continue activities within the school community.
• Employee participation. AstraZeneca colleagues can support engagement with young people, communications, training and community volunteering.
• Monitoring and learning. Participation records, workshop attendance, surveys, self-reported behaviour and SCROLL analytics are reviewed quarterly. A final assessment examines results, lessons and opportunities for sustainability and scale-up.

Across the two-year Programme, we aim to:

• Directly reach 5,000 young people, with a target of 2,500 each year.
• Train 400 young people as Youth Health Ambassadors and Peer Educators, with a target of 200 each year.
• Train 120 adults, including teachers, school psychologists and community stakeholders, with a target of 60 each year.

Progress is measured through participation records, surveys before and after activities, self-reported behaviour changes and digital engagement data.

References:

1. World Health Organization. Noncommunicable Diseases Country Profiles 2018: Bulgaria; 2016 mortality estimates. View source.

2. OECD. OECD Reviews of Health Systems: Bulgaria 2026; overview of Bulgaria's health system. View source.

3. OECD and European Commission. EU Country Cancer Profile: Bulgaria 2025; adolescent risk-factor data refer to 2022. View source.

4. UNICEF Bulgaria. Bulgaria is among the countries with the highest rates of childhood obesity in Europe, 10 September 2025; country data refer to 2022. View source.

5. Kotzeva T, Dimitrova E. Risk Behaviours: Tracking Youth Health and Well-Being in Bulgaria 2006-2018. Published 2022. View source.

6. Dimitrova E, Kotzeva T, Alexandrova-Karamanova A. Psychosocial school environment and health risk behaviours of adolescents in Bulgaria. International Journal of Public Health. 2020;65:1331-1344. View source.

7. Yustiniyanova B, Koleva M. School policy in relation to smoking and possibilities for prevention. Scripta Scientifica Medica. 2009;41(1):99-101. View source.

8. World Health Organization. Bulgaria country health data overview. View source.