The health and socio-cultural issues affecting adolescents in the

European Region

Professor Candace CurrieChild and Adolescent Health Research Unit

University of Edinburgh

HBSC International Coordinator

Policy paper on health and well-being of young people (Youth Forum, 2008)

Health rights

All young people regardless of their economic situation or residence status, of their sexual orientation, or ethnic and religious background, marital status, gender, age or disability should be entitled to health and social protection

Access to health care should be free to all young people under the age of 18 and affordable to those above (this age) to ensure universal access

What do we know about the health and socio-cultural issues across the European

Region?

• We have very good data on some groups of young people – systematic cross-national surveys on children attending school

• We have a less clear picture for many others – children not attending school, post-school age groups

• When considering services and policies to enhance adolescent health need to be aware of these gaps in current knowledge

Snapshot of health of Young People in Europe (WHO, 2009)

Commissioned for the EC Conference on Youth Health: ‘Be Healthy, Be Yourself’ July 2009

New report outlining main issues affecting young people’s health in Europe with a special focus on inequalities

• Focuses on health and inequalities in health of 11-25 year olds

• Systematic data for 11-15 year olds mainly from Health Behaviour in School-Aged Children Study

• But children outside mainstream education are missed

• More difficult to access valid, relevant data on health issues among 16+ age group.

• EUROSTAT and WHO Health for All databases, often not age and gender disaggregated

• Other data come from smaller scale studies

Snapshot of health of Young People in Europe

Impact of economic disadvantage on young people: key points

Effects of economic disadvantage:• Social exclusion and lack of opportunity in

activities that promote or support health• Psychological effect of perceived low social and

economic status• Direct effects of material deprivation and poverty

on social and living conditions• Local and global social and economic conditions

impact on aspirations and sense of achievement which affects mental health

School and health: key points

• Socioeconomic inequalities affect young people’s perceived academic performance

• There is a strong association between subjective health and school performance

• School is a crucial setting for the promotion of adolescent health

• It is vital for Governments to gain an understanding of links between health and educational outcomes

Injuries: key points

• Injuries are leading cause of death in young people and prevalence increases with age

• Road traffic accidents are leading cause of death and injury in 10-24 age group

• Injuries are more prevalent in middle income countries and among lower socioeconomic groups

• Need for comparable data on injury mechanisms to prevent injuries and promote safety among young people

Overweight and obesity: key points

• There is an increasing trend in overweight among children and young people

• Overweight is associated with a wide range of physical and mental health risks

• Overweight rates are higher among lower socioeconomic groups in richer countries and reverse is true in poorer countries

• A concerted effort is needed from governments, industry, communities and individuals to tackle overweight trend

Eating habits: key points

• The dietary habits of young people in Europe are not optimal for maintaining health or preventing disease

• Fruit and vegetable consumption below recommended levels; missing breakfast is common; soft drink consumption high

• Europe-wide dietary strategies need to be sensitive to cultural and socioeconomic factors to be successful

Physical activity: key points

• Physical activity decreases during adolescence especially among girls

• Trends are downwards in moderate to vigorous physical activity

• There is a parallel trend with overweight and obesity

• Physical activity, mental well-being and eating habits are interconnected aspects of adolescent health

Health and socio-cultural issues affecting

adolescents

• Examination of data from most recent Health Behaviour in School-Aged Children Study: WHO Collaborative Cross-National Study (HBSC)

• Drawing on survey findings reported in the international report ‘Inequalities in Young People’s Health’ (Currie et al, 2008) published by WHO

Report from the Health BehaviourIn School-Aged Children 2005/06 Survey in 41 countries

Currie et al, 2008. WHO, CopenhagenHealth Policy for Children and Adolescents, No. 5

Inequalities in Young People’s Health

Key social contexts for adolescent health

highlighted in HBSC

• Family structure and relationships• Family affluence and parental

socioeconomic status • Relationships with peers• School environment

Key health issues for adolescents

highlighted in HBSC

• Substance use• Mental well-being• Physical activity, healthy eating and

weight control• Bullying, violence and injuries• Relationships and sexual health

Weekly smoking at age 15

Ranges from 8% to 48%

• For some countries this is a high priority issue to tackle due to high prevalence

• Low rates may indicate that existing policies and services have been successful and that lessons can be learned from these countries

• Or that smoking rates have not yet increased – eg among girls in some eastern European countries – indicating need for preventive strategies

Drunkenness 2+timesage 15

Ranges from 11% to 59%

• For most countries at least 20% of young people have been drunk at least twice by age 15

• In around a quarter of countries levels are much higher

• How do policies and services compare between these countries?

• Are there successful experiences to be shared?

Country profiles

• The HBSC report allows countries to produce a profile of the key health issues for their young people

• Identify areas of concern and areas where doing well

• Draw on experience from other countries in terms of policies and services for young people

Unequal distribution of well-being among young people

• Adolescents popularly considered to be healthy yet they face persistent health challenges that affect their current and future well-being

• Significant variation exists in experience of health and well-being among adolescents across Europe

• Commission on Social Determinants Report (WHO 2008) highlights economic, social, cultural and environmental factors that contribute to inequalities in health and risk

Inequalities in health experience

• Not only do we see differences across Europe but within countries there are inequalities related to age, gender and socioeconomic status

• It is crucial to take note of these inequalities when developing interventions in order to reach most disadvantaged and avoid increasing inequalities

Variation in levels of Family Affluenceacross Europe in 2006

Health challenges

Two areas that pose some of the greatest challenges for youth friendly services and policies:

• Mental health and well-being• Sexual health

Mental health and well-being

• Complex and sensitive aspect of health among adolescents

• HBSC addresses every day experiences, feelings and perceptions:

– Self-rated health– Life satisfaction– Health complaints– Body image

Self rated health poor/fair at age 11 & 15

At age 11 ranges from3% to 37%

At age 15 ranges from4% to 50%

15 year olds who rate their health as POOR/ FAIR

BOYS

GIRLS

Negative association between family affluence

and self rated health

Health complaints

• Somatic symptoms such as headache and psychological symptoms such as nervousness

• Show an even greater gender differences and increasing rates with age than self-rated health

• Higher rates in low affluence families• More commonly reported in southern and

eastern Europe – opposite picture to self-rated health suggesting cultural differences in how well-being and ill-being are expressed

Body image

• Extremely important to young people in relation to self-confidence and psychological well-being

• Changes associated with puberty can be a negative experience and body satisfaction often declines, especially among girls

• Strongly gendered socio-cultural expectations about ‘ideal’ appearance among young people

• High levels of body dissatisfaction linked to depressive mood and eating disorders

Body image: feeltoo fat at age 11 and 15

At age 11 ranges from9% to 39%

At age 15 ranges from8% to 58%

15 year olds who feel too fat

BOYS

GIRLS

Sexual health

• Sensitive topic which can’t be asked about in some countries

• Questions only asked among 15 year olds• Experience of sexual intercourse and condom

use are presented

Sexual Intercourseaged 15

boys

girls

Condom use aged15

boys

girls

Sexual health: complex socio-cultural

influences

• Different patterns exist across European region with respect to prevalence among boys and girls

• Condom use is between 60% and 95% among sexually active so issues of access and cost need to be explored as well as gender issues around acceptability

HBSC research for action

• HBSC has a broad scope and as well as examining health and behaviour, investigates social and developmental contexts of adolescent lives in the region

• Gathers data on family life, school environment and peer relations – all important as contexts for policy development and linked to the provision of services

• Covers many countries in European region and in future hopefully will include all

Growth of HBSC study: countries by survey year

1985/1986 1989/1990 1993/1994 1997/1998 2001/2002 2005/6 2009/2010

1. Finland 2. Norway 3. Austria 4. Denmark 5. Belgium 6. Hungary 7. Israel 8. Scotland 9. Spain10. Sweden11. Switzerland12. Wales13. Netherlands

1. Finland 2. Norway 3. Austria 4. Belgium

(French) 5. Hungary 6. Scotland 7. Spain 8. Sweden 9. Switzerland10. Wales11.Denmark12. Netherlands13. Canada14. Latvia15. N. Ireland16. Poland

1. Finland 2. Norway 3. Austria 4. Belgium (French) 5. Hungary 6. Israel 7. Scotland 8. Spain 9. Sweden10. Switzerland11. Wales12. Denmark13. Canada14. Latvia15. Northern Ireland16. Poland17. Belgium

(Flemish)18. Czech Republic19. Estonia20. France21. Germany22. Greenland23. Lithuania24. Russia25. Slovakia

1. Finland 2. Norway 3. Austria 4. Belgium (French) 5. Hungary 6. Israel 7. Scotland 8. Sweden 9. Switzerland10. Wales11. Denmark12. Canada13. Latvia14. Northern Ireland15. Poland16. Belgium (Flemish)17. Czech Republic18. Estonia19. France20. Germany21. Greenland22. Lithuania23. Russia24. Slovakia25. England26. Greece27. Portugal28. Ireland29. USA

1. Finland 2. Norway 3. Austria 4. Belgium (French) 5. Hungary 6. Israel 7. Scotland 8. Spain 9. Sweden10. Switzerland11. Wales12. Denmark13. Canada14. Latvia15. Poland16. Belgium (Flemish)17. Czech Republic18. Estonia19. France20. Germany21. Greenland22. Lithuania23. Russia24. England25. Greece26. Portugal27. Ireland28. USA29. tfyr Macedonia30. Netherlands31. Italy32. Croatia33. Malta34. Slovenia35. Ukraine

1. Finland 2. Norway 3. Austria 4. Belgium (French) 5. Hungary 6. Israel 7. Scotland 8. Spain 9. Sweden10. Switzerland11. Wales12. Denmark13. Canada14. Latvia15. Poland16. Belgium (Flemish)17. Czech Republic18. Estonia19. France20. Germany21. Greenland22. Lithuania23. Russia24. England25. Greece26. Portugal27. Ireland28. USA29. tfyr Macedonia30. Netherlands31. Italy32. Croatia33. Malta34. Slovenia35. Ukraine36. Luxemburg37. Turkey38. Slovakia39. Romania40. Iceland41. Bulgaria

1. Finland 2. Norway 3. Austria 4. Belgium (French) 5. Hungary 6. Israel 7. Scotland 8. Spain 9. Sweden10. Switzerland11. Wales12. Denmark13. Canada14. Latvia15. Poland16. Belgium

(Flemish)17. Czech Republic18. Estonia19. France20. Germany21. Greenland22. Lithuania23. Russia24. England25. Greece26. Portugal27. Ireland28. USA29. tfyr Macedonia30. Netherlands31. Italy32. Croatia33. Malta34. Slovenia35. Ukraine36. Luxemburg37. Turkey38. Slovakia39. Romania40. Iceland41. Bulgaria42.Albania43.Armenia

2009/2010

Future challenges: building the evidence base on adolescent health

• Services and policies need to reach and be appropriate for all adolescents

• HBSC at present only covers those in mainstream schooling

Future challenges: building the evidence base on adolescent health

• Data on high risk groups missing – children excluded from school, truanting from

school, unable to attend school for personal/ family reasons such as migrants, children who are carers

• Data on groups with special health needs are missing not addressed– Children in non-mainstream schools due to

learning or behavioural problems

Future challenges: building the evidence base on adolescent health

• Including the voices of young people in agenda setting, policy and service development

• ‘Be Healthy – Be yourself’ – a new on-line Youth Health Initiative supported by European Commission - empowering young people to have a real say about their healthy by offering them a space to air their views, gather and share information and influence debate

Acknowledgements

Young people and schools who have taken part in HBSC

HBSC Research Network

HBSC partner WHO Regional Office for Europe

Health Scotland and other funding organisations