Widespread inequalities mean that many young people in the WHO European Region and North America are not as healthy as they could be, according to a new report on the Health Behaviour in School-aged Children (HBSC) study, published today (Wednesday, 2 May) by the WHO Regional Office for Europe.^* The HBSC Ireland study is based in the Health Promotion Research Centre at NUI Galway.

“Adolescence is a crucial life stage, when young people lay the foundation for adulthood, whether healthy or otherwise,” said Zsuzsanna Jakab, WHO Regional Director for Europe. “This report shows us that the situation across Europe is not fair: health depends on age, gender, geography and family affluence. But it doesn’t have to be that way. This report gives policy-makers an opportunity to act to secure the health of the next generation. Once again, young people have used the opportunity provided by HBSC to speak. It now falls to us – who cherish their aspirations, ambitions, health and well-being – to act.”

Dr Saoirse Nic Gabhainn, Principal Investigator for HBSC Ireland of the Health Promotion Research Centre, NUI Galway said: “This data are vital to support young people to be healthy and happy, policy makers and practitoners need to recognise that differences in the context of young people’s lives are important and we need to be sensitive to age, gender and socio-eoncomic differences.”

The report gives the results of the 2009/2010 HBSC survey, covering 39 countries and regions across the European Region and North America. The survey collected data from 11-, 13- and 15- year-olds on 60 topics related to their health and well-being, social environments and behaviour. HBSC reports have been issued every four years since 1996.

Cross-national differences

The latest report reveals important inequalities between countries. For example, rates of overweight and obesity for girls aged 11 range from 20% in Portugal and 30% in the United States of America, to only 5% in Switzerland (18% in Ireland, rank 3r^d).

Smoking rates, although fairly similar at age 11 (under 1%), differ dramatically across countries by age 15: over 25% in Austria and Lithuania, but 10% in Norway and Portugal (13% in Ireland, rank 30^th). This suggests that the socioenvironmental context can be changed to benefit young people’s health.

Young people’s experience of school also differs; 89% of 11-year-old girls in the former Yugoslav Republic of Macedonia like school, in contrast to 17% in Croatia (34% in Ireland, ranks 31^st).

Long term effects of adolesent health

Health inequalities emerge or worsen during adolescence, and may translate into lasting inequalities in adulthood if, for example, academic potential is not achieved. Adolescence is clearly a key stage for mental health, especially for girls. Girls’ satisfaction with their lives declines between ages 11 and 15. In Poland and Sweden, this decrease is around 15%, in contrast to 5% for boys (in Ireland the decrease is 12% for girls and 6% for boys, ranking 13^th at age 11 and 30^th at 15).

In addition, health-compromising behaviour increases during the adolescent years. Between ages 11 and 15, the average proportion of young people who report weekly smoking and drinking increases by 17%. Many of these young smokers will continue the habit throughout adulthood. Similarly, early sexual activity is an important marker for poor sexual health in adulthood, as well as other risk behaviour in adolescence. The report reveals that, on average, 26% of 15-year-olds are sexually active (in Ireland 22%, rank 28^th). In addition, healthy behaviour, such as eating breakfast and fruit, declines.

Gender differences

Boys and girls display different patterns of healthy and unhealthy behaviour, particularly at age 15. Although boys are more likely to be involved in fights and bullying at all ages, a 15-year-old boy in Latvia is more than 12 times more likely to be bullied by his peers than a girl in Italy (in Ireland bullying is reported by 4% of 15 year old girls and 10% of 15 year old boys, ranking 27^th) .

In Armenia, boys are almost five times more likely than girls to have been drunk by age 15. In some Scandinavian countries and the United Kingdom, however, 15-year-old girls are more likely than boys to have been drunk, and to have had sexual intercourse (among 15 year olds in Ireland 28% of girls and 30% of boys have been drunk, ranking 22^nd).

Further, girls are more concerned about being too fat and to be on a diet, but less likely than boys to be overweight. Overall, around 40% of girls aged 15 report being dissatisfied with their bodies (46% in Ireland, rank 13^th), and 22% are on a diet (21% in Ireland, rank 18^th), although just 10% are actually overweight or obese (12% in Ireland, rank 11^th).

Family affluence

Unsurprisingly, family affluence is associated with a healthier lifestyle: higher levels of fruit intake, breakfast consumption and physical activity. It is also associated with better communication with parents, greater support from classmates and numbers of close friends, and better mental health (in Ireland only fruit and breakfast consumption are higher among those with higher family affluence).

The picture for risk-taking behaviour is more complex. In many countries and regions, family affluence has less influence on patterns of smoking and drinking; other social factors – such as the influence of peers – may be more important. Further, injuries increase with higher family affluence (this holds for Ireland).

Protective factors

Support from family and classmates protects young people from negative influences; those who report easy communication with their parents are more likely to report positive health outcomes. Having close friends and peer support is also a strong predictor of positive health. The more sources of support, the more likely young people are to report good health.

The HBSC report shows that addressing the social determinants of health inequalities in childhood and adolescence can enable young people to maximise their health and well-being, ensuring that these inequalities do not extend into adulthood, with all the potential negative consequences for individuals and society.

ENDS