Inequalities in young people’s health and wellbeing: UK and international perspectives

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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) - PowerPoint PPT Presentation

Transcript of Inequalities in young people’s health and wellbeing: UK and international perspectives

  • Inequalities in young peoples health and wellbeing: UK and international perspectives

    AYPH Conference, March 1st 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 peoples 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 healthSocial determinants of health production on inequalities

  • Health inequalities Measurable differences in health experience and health outcomes according to characteristics such as:genderagegeographysocioeconomic status

  • Report from the Health Behaviourin School-Aged Children (HBSC)2005/06 Survey in 41 countries

    Currie et al, 2008. WHO, CopenhagenHealth Policy for Children and Adolescents, No. 5Inequalities in Young Peoples 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 Worlds 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 statussocioeconomic 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

    lowmediumhighIcelandTurkeyChart showing country variation in levels of family affluence

  • Examining the evidence: for young peoples health improvementhow 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 girls6th7th8th

  • family affluence fair/ poor healthFamily affluence and selfrated health

  • Daily fruit (age 15)

    UK variation

    In UK and all other countries girls > boys

    Fruit eating declines with age in almost all countries3rd20th21st

  • family affluence daily fruitFamily 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 Europe29th19th16th

  • family affluence weekly smokingFamily 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

    3rd5th8th

  • 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 habitsHours spent TV watchingSmoking Cannabis useCondom use

    England relatively negative cf Scotland & Wales

    Medically attended injuryDaily 60 minutes of physical activityBullying

  • 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, healthAsks 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 complaintshealthy eatingand frequency of vigorous physical activity

    All three are well-established markers for childrens current and future health - data are derived from the 2005-2006 HBSC Survey

  • Chart2

    1.35063879381.68723012181.7516343058

    1.25056201610.5210175070.8277481194

    Portugal0.41856166291.2681228637

    1.1563277476-0.4427293051.2279967793

    1.31015249720.15296429710.2953112058

    -0.49607479651.67456745750.2106966245

    1.2090663056-0.97563370071.1131156713

    0.3957360815-0.44797068641.1628323353

    -0.14927857781.4027396381-0.2679197728

    -0.12098973540.6678883030.2097688285

    0.0292692120.18324249990.4910353075

    0.6437483733-0.20782448670.0082993906

    -0.3036491954-0.59162856471.280059615

    -0.52646317110.8310173544-0.7514740693

    -1.87150475431.11421870730.1437707579

    0.9145162154-1.5431481541-0.2747373842

    -1.43513203961.2807181869-0.8771480325

    0.8929854864-1.0645817696-0.8607114383

    0.1967980642-0.3701694601-1.3082471924

    -0.25571560420.0195176526-1.3254174854

    -1.5939065778-0.7537505177-0.2828771331

    -0.434200202-0.9239336963-1.7403350215

    -1.5834673445-0.7779910693-1.0625615082

    -0.5794187946-1.854321978-1.2389627668

    -3.67210443881.0431543366-1.6449179878

    0.02177345370.47248941220.307357429

    0.1647085641-1.23552944931.2654133897

    -0.061508851-0.1166634187-0.706642257

    Physical activity

    Fruit and Veg

    Health Complaints

    Health Inequalities: a breakdown

    data 1 Health complaints

    Health complaints

    MedianAverage below the medianAverage absolute gapGap between the average below the median and the median (as % of median)95% CI

    Netherlands25.020.24.819.21.74

    Austria25.019.95.120.42.01

    Portugal25.019.95.120.42.00

    Germany23.018.34.720.51.42

    Denmark24.019.05.020.71.87

    Ireland23.018.24.820.81.80

    Norway23.018.14.921.52.03

    United Kingdom22.017.14.922.41.60

    Switzerland22.017.05.022.91.96

    Belgium23.017.75.323.11.49

    Czech Republic21.016.24.823.11.78

    France21.016.14.923.31.46

    Slovakia20.015.34.723.62.22

    Canada22.016.75.324.31.73

    Finland22.016.75.324.31.57

    Spain23.017.45.624.31.99

    Sweden22.016.45.625.52.23

    Iceland21.015.65.425.81.56

    Poland22.016.35.725.81.74

    Italy19.014.05.026.32.22

    Hungary21.015.45.626.82.26

    Luxembourg22.016.15.926.92.00

    Greece22.016.15.927.02.06

    United States22.015.86.228.02.31

    OECD-2522.317.15.223.60.39

    Source: HBSC 2005/6

    Note: OECD average is unweighted

    Turkey18.013.05.027.81.88

    ENG22.017.05.022.81.69

    SCT23.018.34.720.41.58

    WLS23.017.25.825.41.90

    data 2 Fruit & Veg

    Fruit & Veg

    MedianAverage below the medianAverage absolute gapGap between the average below the median and the median (as % of median)95% CI

    Netherlands10.06.53.535.4(2.26)

    Belgium10.06.53.535.4(1.56)

    Canada10.06.33.736.6(2.02)

    Poland8.55.33.237.1(1.90)

    France8.55.33.237.8(1.68)

    Sweden8.55.23.339.0(2.56)

    Czech Republic8.55.13.439.7(2.14)

    Norway8.55.13.440.3(2.10)

    Portugal8.55.03.540.8(2.35)

    United Kingdom10.05.84.241.8(1.94)

    Switzerland10.05.84.241.9(2.28)

    Greece8.54.93.642.5(2.39)

    Slovakia8.54.83.743.5(2.54)

    Luxembourg8.54.73.844.2(2.24)

    Germany8.54.73.844.5(1.74)

    Denmark10.05.64.444.5(2.08)

    Austria7.34.03.345.1(2.10)

    Spain8.04.33.745.8(2.47)

    Italy8.54.63.945.9(2.42)

    United States8.54.54.046.5(2.33)

    Ireland10.05.34.746.7(2.30)

    Iceland8.54.54.047.1(1.88)

    Finland8.04.13.949.2(1.94)

    Hungary7.33.63.750.5(2.47)

    OECD8.842.6(0.44)

    Turkey8.553.238.1(1.91)

    ENG10.05.904.140.5(2.28)

    SCT10.05.204.847.9(2.02)

    WLS8.54.803.743.1(2.18)

    Source: HBSC 2005/6

    Note: OECD average is unweighted

    1.00

    data 3 PA

    Physical activity

    MedianAverage below the medianAverage absolute gapGap between the average below the median and the median (as % of median)95% CI

    Netherlands8.006.11.924.1(2.32)

    Switzerland7.005.31.724.4(1.79)

    Norway7.005.31.724.7(2.56)

    Ireland7.005.31.724.9(2.31)

    Germany7.005.21.825.2(1.78)

    Finland8.005.92.126.7(2.04)

    Iceland7.005.11.926.8(1.81)

    Slovakia8.005.72.328.4(2.57)

    Denmark8.005.62.429.9(1.80)

    Luxembourg7.004.82.231.1(2.22)

    United Kingdom7.004.82.232.1(2.34)

    Czech Republic6.004.02.033.0(2.21)

    Canada8.005.32.733.2(2.26)

    Greece7.004.62.433.8(3.00)

    Austria7.004.62.434.1(2.54)

    United States7.004.62.434.9(2.68)

    Belgium7.004.52.535.3(2.11)

    Sweden7.004.52.535.5(2.74)