Inequalities in young people’s health across the UK

‘Getting it together for young people’s health’AYPH Conference

February 26th 2009

Professor Candace Currie

Child and Adolescent Health Research Unit (CAHRU)University of Edinburgh

Patterns of inequalities in young people’s health in UK

• Are there differences in health experience of young people in England, Scotland and Wales?

• What kind of health inequalities are observed within UK countries?

• Are these similar or different to inequalities observed in other countries in Europe and N America?

• What can we learn from this and what are implications for improving young people’s health experience in UK?

Drawing on evidence fromHealth Behaviour in School-Aged Children Study

• HBSC purpose to increase knowledge and understanding of adolescent health in social and developmental context

• HBSC surveys are conducted every four years in member countries

• common questionnaire and survey method • data collected on 11,13 and 15 year olds in each country

• sample size: 1,550 per age group in each country

Growth of HBSC study: countries by survey year

1983/1984 1985/1986 1989/1990 1993/1994 1997/1998 2001/2002 2005/6

1. England2. Finland3. Norway4. Austria5. Denmark

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

HBSC scope

• Includes measures on physical, emotional and social health and well-being

• Measures comprehensive range of behaviours that both risk and promote health

• Places health and behaviour of young people in social and developmental context

Health related behaviours measured in HBSC

• Tobacco, alcohol and cannabis• Physical activity• Consumption of food and drinks• Toothbrushing• Weight control behaviour • Fighting and bullying• Sexual behaviour• TV and computer use• Electronic communication

Health and well-being measures in HBSC

• self-rated health• life satisfaction• health complaints• body image • Body Mass Index (BMI)• injuries

Social context measures in HBSC

Family School environment

Peer relations

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

‘Inequalities in young people’s health’ report

• HBSC report presents evidence of widespread and diverse types of inequality in young people’s health experience

• why is this important?– indicates negative health experience and poor quality of

life for many young people in Europe and North America– this affects their education and social development– tracks through to adulthood affecting health, social and

economic outcomes

Defining health inequalities

‘measurable differences in health experience and health outcomes’ according to various characteristics such as:

• gender• age• geography• socioeconomic status

Gender

• United Nations has stated there is an international responsibility to achieve equality between the genders

• very little attention is given to gender differences in most youth health reports

• data are usually presented for both boys and girls together – e.g. recent UNICEF report - and so issue of gender inequality not addressed

Age

• as with gender, age differences are neglected in many studies

• adolescent age group often merged with younger children or with young adults in health statistics

• HBSC looks at ages 11, 13 and 15 separately

• different stages of puberty, physical and emotional development, growing independence and choice

• some health risks already established by age 11, others begin and increase during teenage years

Geography

• countries in HBSC span North America and Europe

• to manage country comparisons, UN country groupings (based on geographic and economic factors) were used:

North Europe and North AmericaWestern EuropeEastern EuropeSouth Europe and Western Asia

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)

Family affluence

low

mediumhigh

Iceland

Turkey

Chart showing country variation in levels of family affluence

Key questions

• How does health experience of young people in England, Scotland and Wales compare?

• What kind of health inequalities are observed within UK countries?

• Are these similar or different to inequalities observed in other countries in Europe and N America?

15 year olds who rate their health as fair or poor

• UK countries have similar ranks (E:8th, S:7th & W:6th)

• In UK and all other countries significant gender difference: girls poorer self rated health

• Among girls in most countries reporting of poorer health increases with age

family affluence fair/ poor health

Negative associationbetween family affluence and self–rated health

Self-rated health

• health experience of young people in England, Scotland and Wales is very similar

• find same gender, age and socioeconomic inequalities throughout UK

• similar to inequalities observed in other countries in Europe and N America

15 year olds who eat fruit daily

• Ranks are E: 3rd, W: 20th and Scotland: 21st

• In UK and all other countries girls > boys

• Fruit eating declines with age in almost all countries

family affluence daily fruit

Associations between family affluence and daily fruit consumption

Daily fruit consumption

• higher levels in England compared to Scotland and Wales

• same gender, age and socioeconomic inequalities throughout UK

• similar to inequalities observed in other countries in Europe and N America

15 year olds who smoke weekly

• England ranks low (29th) compared to Wales (19th) and Scotland (16th) but differences are due to girls

• In UK girls are more likely to smoke than boys and same is true in about half of countries; reverse is true in other countries (split is west/ east)

family affluence weekly smoking

Associations between family affluence and weekly smoking

• found in north (Europe and N America) and western Europe• found among girls more commonly than boys

Weekly smoking

• among girls weekly smoking levels lower in England compared to Scotland and Wales

• same gender, age and socioeconomic inequalities throughout UK

• gender and socioeconomic differences same as in other western/ northern countries

15 year olds who have been drunk at least twice

• All UK countries have high rates of drunkenness

• In UK girls are as or more likely to get drunk than boys unlike most other countries

Drunkenness

• Rates similar across UK countries

• same gender and age patterns throughout UK

• gender patterns different to most other countries

Overview of UK

Picture across UK is similar in terms of prevalence and gender patterns

• Self-reported health • Patterns of alcohol use

• Otherwise we find variation in patterns of health across the UK

Overview of UK inequalities

Eng relatively positive cf Scotland & Wales

– Food habits• Breakfast consumption• Fruit consumption• Soft drink consumption

– 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? Cultural similarities in health reporting?

• Difference 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

Social context of health

HBSC countries show quite marked differences in social contextual dimensions - some of these are now highlighted

15 year olds who find it easy to talk to their mother

• England ranks 26th (Wales is 23rd and Scotland 32nd )

• In most countries boys > girls

15 year olds who have three or more close friends

• England ranks 4th (Wales is 6th and Scotland 3rd)

• No gender difference in UK but in some countries boys > girls

15 year olds who like school a lot

• England ranks 13th (Wales 20th and Scotland 28th)

• No gender difference in England and Wales but in a girls> boys in around half of countries

Variation in supportive social contexts in UK

• England is doing well in terms of positive socioeconomic environment and in terms of liking school compared to other UK countries

• All UK countries score high on friendships with peers

• Family support appears weaker in UK than many other countries

15 year olds who feel pressured by schoolwork

• England ranks 3rd (Wales 2nd and Scotland 24th)

• Girls> boys in England and most other countries at age 15

15 year olds who spend four or more evenings out with friends

• England ranks 15th (Wales 12th and Scotland 7th)

• Boys > girls in most countries

Variation in ‘risky’ social contexts in UK

• Young people in England and Wales report a high level of pressure stemming from schoolwork – can impact on mental health

• Being out in evening with friends 4 or more 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

• there is variation in different dimensions of health experience across UK – we 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

• when developing policy and practice for health improvement existing inequalities (age, gender and socioeconomic) need to be taken into account

• important for priority setting as well for developing different strategies and approaches to prevention/ intervention

Influencing policy and sharing good practice at international and national levels

WHO/ HBSC Forum• Established in 2007 to address social and economic

determinants of young people’s health• Aim to raise awareness among policy makers of health

inequalities that young people experience• Showcasing of good practice at national level to reduce

inequalities and improve health• Demonstration of utility of HBSC to stimulate action and

monitor health improvement at national and international levels

WHO/ HBSC Forum themes

• 2006 healthy physical activity and nutrition • 2007 social cohesion for mental health• 2009 environment and health

• Reports including country case studies available from WHO or download via link from HBSC website www.hbsc.org

Forthcoming report:

• 2006 healthy physical activity and nutrition • 2007 social cohesion for mental health• 2009 environment and health

• Reports including country case studies available from WHO or download via link from HBSC website www.hbsc.org

HBSC contacts and information

HBSC International Coordinating Centre Child and Adolescent Health Research Unit,

University of EdinburghEmail: info@hbsc.org

HBSC web-site: www.hbsc.org

Acknowledgements

• The young people we study

• The HBSC Network

• The HBSC partner WHO

• Funding organisations

Further information on HBSC includingand its publications at www.hbsc.org