1. The health and socio-cultural issues affecting adolescents in the European Region Professor Candace Currie Child and Adolescent Health Research Unit University of Edinburgh HBSC International Coordinator

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. Report from the Health Behaviour In School-Aged Children 2005/06 Survey in 41 countries Currie et al, 2008. WHO, Copenhagen Health Policy for Children and Adolescents, No. 5 Inequalities in Young People’s Health

14. Key social contexts for adolescent health highlighted in HBSC Family structure and relationships Family affluence and parental socioeconomic status Relationships with peers School environment

15. 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

16. 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

17. Drunkenness 2+times age 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?

18. 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

19. 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

20. 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

21. Variation in levels of Family Affluence across Europe in 2006

22. Health challenges Two areas that pose some of the greatest challenges for youth friendly services and policies: Mental health and well-being Sexual health

23. 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

24. Self rated health poor/fair at age 11 & 15 At age 11 ranges from 3% to 37% At age 15 ranges from 4% to 50%

25. 15 year olds who rate their health as POOR/ FAIR BOYS GIRLS

26. Negative association between family affluence and self rated health

27. 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

28. 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

29. Body image: feel too fat at age 11 and 15 At age 11 ranges from 9% to 39% At age 15 ranges from 8% to 58%

30. 15 year olds who feel too fat BOYS GIRLS

31. 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

32. Sexual Intercourse aged 15 boys girls

33. Condom use aged 15 boys girls

34. 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

35. 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

36. Growth of HBSC study: countries by survey year 1985/19861989/19901993/19941997/19982001/20022005/62009/2010 1. Finland 2. Norway 3. Austria 4. Denmark 5. Belgium 6. Hungary 7. Israel 8. Scotland 9. Spain 10. Sweden 11. Switzerland 12. Wales 13. Netherlands 1. Finland 2. Norway 3. Austria 4. Belgium (French) 5. Hungary 6. Scotland 7. Spain 8. Sweden 9. Switzerland 10. Wales 11.Denmark 12. Netherlands 13. Canada 14. Latvia 15. N. Ireland 16. Poland 1. Finland 2. Norway 3. Austria 4. Belgium (French) 5. Hungary 6. Israel 7. Scotland 8. Spain 9. Sweden 10. Switzerland 11. Wales 12. Denmark 13. Canada 14. Latvia 15. Northern Ireland 16. Poland 17. Belgium (Flemish) 18. Czech Republic 19. Estonia 20. France 21. Germany 22. Greenland 23. Lithuania 24. Russia 25. Slovakia 1. Finland 2. Norway 3. Austria 4. Belgium (French) 5. Hungary 6. Israel 7. Scotland 8. Sweden 9. Switzerland 10. Wales 11. Denmark 12. Canada 13. Latvia 14. Northern Ireland 15. Poland 16. Belgium (Flemish) 17. Czech Republic 18. Estonia 19. France 20. Germany 21. Greenland 22. Lithuania 23. Russia 24. Slovakia 25. England 26. Greece 27. Portugal 28. Ireland 29. USA 1. Finland 2. Norway 3. Austria 4. Belgium (French) 5. Hungary 6. Israel 7. Scotland 8. Spain 9. Sweden 10. Switzerland 11. Wales 12. Denmark 13. Canada 14. Latvia 15. Poland 16. Belgium (Flemish) 17. Czech Republic 18. Estonia 19. France 20. Germany 21. Greenland 22. Lithuania 23. Russia 24. England 25. Greece 26. Portugal 27. Ireland 28. USA 29. tfyr Macedonia 30. Netherlands 31. Italy 32. Croatia 33. Malta 34. Slovenia 35. Ukraine 1. Finland 2. Norway 3. Austria 4. Belgium (French) 5. Hungary 6. Israel 7. Scotland 8. Spain 9. Sweden 10. Switzerland 11. Wales 12. Denmark 13. Canada 14. Latvia 15. Poland 16. Belgium (Flemish) 17. Czech Republic 18. Estonia 19. France 20. Germany 21. Greenland 22. Lithuania 23. Russia 24. England 25. Greece 26. Portugal 27. Ireland 28. USA 29. tfyr Macedonia 30. Netherlands 31. Italy 32. Croatia 33. Malta 34. Slovenia 35. Ukraine 36. Luxemburg 37. Turkey 38. Slovakia 39. Romania 40. Iceland 41. Bulgaria 1. Finland 2. Norway 3. Austria 4. Belgium (French) 5. Hungary 6. Israel 7. Scotland 8. Spain 9. Sweden 10. Switzerland 11. Wales 12. Denmark 13. Canada 14. Latvia 15. Poland 16. Belgium (Flemish) 17. Czech Republic 18. Estonia 19. France 20. Germany 21. Greenland 22. Lithuania 23. Russia 24. England 25. Greece 26. Portugal 27. Ireland 28. USA 29. tfyr Macedonia 30. Netherlands 31. Italy 32. Croatia 33. Malta 34. Slovenia 35. Ukraine 36. Luxemburg 37. Turkey 38. Slovakia 39. Romania 40. Iceland 41. Bulgaria 42.Albania 43.Armenia

37. 2009/2010

38. 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

39. 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

40. 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

41. 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