How do I enable Survival Mode?

Isn't it just in the difficulty settings?

After doing some googling apparently you have to leave Helgen before you can activate it and it shows up above the difficulty settings.

According to one of comments in a forum about feedback for Survival mode (beta) in bethesda.net, Survival mode is activated once you leave cave after Helgen alongside Hadvar which can be disable or enable through Settings - Gameplay in menu

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It's kinda weird. One of my characters was able to access it right away(they were in the middle of a dungeon) but my new guy who i made for survival started in the thieves guild(live another life mod start) didn't have the option show up until i left the thieves guild base. As soon as entered the town of Riften proper, it finally popped up.

I had the same problem yesterday, enabled the beta in Steam, made it to Riverwood, no survival mode setting anywhere.

Turns out you have to log into Bethesda.net under 'Mods' first as well, otherwise Skyrim can't install it for you.

Hope that helps!