Inequalities in young people’s health and wellbeing: UK and international perspectives AYPH Conference, March 1 st 2011 ‘Making a difference: Improving health and wellbeing outcomes for young people’ Professor Candace Currie Child and Adolescent Health Research Unit (CAHRU) University of Edinburgh

Examining the evidence for young people’s health improvement Where is action needed? How do we identify health needs?

Where is action needed? How do we identify health needs? Comparative approaches Detection of inequalities and inequities in health Social determinants of health – production on inequalities

Health inequalities ‘M easurable differences in health experience and health outcomes’ according to characteristics such as: gender age geography socioeconomic status

Report from the Health Behaviour in School-Aged Children (HBSC) 2005/06 Survey in 41 countries Currie et al, WHO, Copenhagen Health Policy for Children and Adolescents, No. 5 Inequalities in Young People’s Health

Gender and Age United Nations has stated there is an international responsibility to achieve equality between the genders Yet very little attention is given to gender differences in most youth health reports Adolescent age group often merged with younger children or with young adults in health statistics Importance of different stages of puberty, physical and emotional development, growing independence and choice neglected Some health risks already established by age 11, others begin and increase during adolescent years

UNICEF ‘State of the World’s Children’ Report (2011) ‘ Where health data on adolescence are available, it is often not disaggregated by sex, age cohort or other factors that could give much- needed details on the situation of adolescents ’.

Socioeconomic status socioeconomic inequalities are related to social status and resources such as material possessions there are a number of ways to measure socioeconomic status of adolescents HBSC report uses family material affluence as a measure of socioeconomic status – HBSC FAMILY AFFLUENCE SCALE (FAS)

Family affluence low medium high Iceland Turkey Chart showing country variation in levels of family affluence

Examining the evidence: for young people’s health improvement how do Scotland, England and Wales compare with each other? how does health of young people in UK compare with Europe and North America? what health inequalities do we observe among young people in UK and internationally? what are the implications for action?

Health fair/ poor (age 15) UK countries all rank high on fair/poor health In all countries, girls report poorer health than boys In most countries, rates of poorer health increase with age especially among girls 6th 7th 8th

family affluence fair/ poor health Family affluence and self–rated health

Daily fruit (age 15) UK variation In UK and all other countries girls > boys Fruit eating declines with age in almost all countries 3rd 20th 21st

family affluence daily fruit Family affluence and daily fruit

Weekly smoking (age 15) England ranks low compared to Wales and Scotland – due to girls In UK girls > boys; same is true in about half of countries; reverse is true in east Europe 29th 19th 16th

family affluence weekly smoking Family affluence and weekly smoking in north (Europe and N America) and western Europe among girls more commonly than boys

Drunk at least twice (age 15) All UK countries have high rates of drunkenness In UK girls are as/ more likely to get drunk than boys, unlike most other countries 3rd 5th 8th

Picture across UK is similar in terms of prevalence and gender patterns for self-reported health and patterns of alcohol use England relatively positive cf Scotland & Wales Food habits Hours spent TV watching Smoking Cannabis use Condom use England relatively negative cf Scotland & Wales Medically attended injury Daily 60 minutes of physical activity Bullying

Explanations for similarities and differences across UK? Cultural similarities – eg youth drinking culture across the UK? Differences found in UK health patterns may be explained by social/demographic factors or differences in policy and practice? Further analysis of HBSC and other data sources required to answer these questions

UNICEF Innocenti Report Card 9: ‘Children left behind’ (2010) Compares the gap in well-being between the median (average) and worst off children in richest (OECD) countries Considers three aspects of well-being: material, educational, health Asks ‘how far are children being allowed to fall behind?’ in each country

Measuring bottom end inequality in health Three indicators are used: –self-reported health complaints –healthy eating –and frequency of vigorous physical activity All three are well-established markers for children’s current and future health - data are derived from the HBSC Survey

Social determinants of health In UK and internationally also observe marked differences in social contextual dimensions which may explain help to explain health inequalities

Easy to talk to their mother (15 year olds) England ranks 26th (Wales is 23rd and Scotland 32nd ) In most countries boys find it easier to talk to their mother than do girls 23rd 26th 32nd

Three or more close friends (at age 15) England ranks 4th (Wales is 6th and Scotland 3rd) No gender difference in UK but in some countries boys > girls 3rd 4th 6th

Like school a lot (age 15) England ranks highest and Scotland ranks lowest No gender difference in England and Wales but girls> boys in around half of countries 13th 20th 28th

Variation in supportive social contexts in UK England is doing well in terms of positive socioeconomic environment and in terms of liking school cf other UK countries All UK countries score high on friendships with peers Family support appears weaker in UK than many other countries

Pressured by schoolwork (age 15) Wales and England more pressured than Scotland In most countries girls more likely to feel pressured 2nd 3rd 24th

4+ evenings out with friends (age 15) Scotland ranks highest and England lowest in UK Boys > girls in most countries 7th 12th 15th

Variation in ‘risky’ social contexts in UK Young people in England & Wales report high level of pressure stemming from schoolwork – can impact on mental health Being out in evening with friends 4+ nights a week is a known factor in risk taking behaviour – less prevalent in England than other UK countries

Inequalities in health of young people across the UK variation in different dimensions of health experience across UK – need to understand more about underlying causes common sources of inequality are seen to prevail related to gender, age and family affluence overall these are similar to inequalities experienced by young people throughout Europe and North America but gender/ socioeconomic patterns do vary

Implications for policy and practice to safeguard and enhance health of adolescents Need to take into account prevailing age, gender and socioeconomic inequalities Evidence vital for priority setting and for developing approaches to prevention/ intervention Identifying areas of need indicates where need to build assets to support health

Investing in health of young people ‘In the global effort to save children’s lives, we hear too little about adolescence’ ‘Surely, we do not want to save children in their first decade of life only to lose them in the second’

INVESTING IN YOUNG PEOPLE TO SECURE SCOTLAND’S FUTURE March 22, 2011 from 9AM until 5PM Speakers include: ► Vivian Barnekow World Health Organisation ► Leonardo Menchini Unicef ► David McQueen IUHPE ► Clive Needle Euro Health Net ► Dominic Richardson OECD ► David Pattison International Devt. Health Scotland ► Gerry McCartney Public Health Observatory ► Louise Warde-Hunter Action for Children Conference Fee: FREE, Please register as soon as possible as places are limited. Venue: John McIntyre Conference Centre, Edinburgh Full programme and registration:

INVESTING IN YOUNG PEOPLE TO SECURE SCOTLAND’S FUTURE March 22, 2011 from 9AM until 5PM Topics include: o Young peoples’ health in international context o Challenges to Scotland’s health o Young peoples’ health over the last 20 years o Sexual health in Scotland o Mental Health, Transitions and Violence o Children left behind o Investment in young people o Social inequalities & creating a healthy community Conference Fee: FREE, Please register as soon as possible as places are limited. Venue: John McIntyre Conference Centre, Edinburgh Full programme and registration:

Thank you Further information on HBSC and its publications at