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Community views on youth health tend to be polarised and
contradictory. On the one hand, adolescents are seen as having few
overt health needs: mortality is low by comparison to that in older
groups, and most young people, and their parents, rate their health as
good. On the other hand, the emergence in recent decades of youth
suicide, drug abuse and new infectious diseases (eg, HIV) has
elicited strong and sometimes conflicting opinions about moral and
social threats to young people's health. Individualism, a growth in
permissiveness, and a decline in religious affiliations have all
attracted debate.
The recent report Australia's young people: their health and
well-being 1999,1 from the Australian
Institute of Health and Welfare (AIHW), provides some clarity. It
follows an earlier report on child health2 and gives the first
comprehensive national picture of the health of young Australians
(see Box for key points).
In general, Australian youth remain healthy, and retain a positive
view of their health. Some health trends are positive: overall
mortality in young people in the 1990s was at historically low levels
(mostly due to the substantial reductions in motor vehicle deaths in
the previous two decades); and rates of teenage pregnancy were low
compared with those of other First World countries.
However, new threats to youth health have emerged:
-
Mental and behavioural disorders are increasingly recognised as
affecting youth disproportionately and account for over half their
disease burden.
- With the changing profile of infectious disease, newer bloodborne
and sexually transmitted diseases have become prominent, with
threefold higher notifications of both chlamydia and hepatitis C.
The prevalence of syphilis has declined further, but gonorrhoea
notifications have doubled.
- Shifts in young people's lifestyle carry implications for health
later in life. Tobacco use remains obstinately high, with 40% of young
adults continuing to smoke. Physical activity declines across the
teens, so that fewer than a third of women aged 20-24 years take part in
regular, moderate to vigorous physical exercise. Moreover, 22% of
15-24 year olds already have a body mass index in the overweight or
obese range for adults.
- Some groups have disproportionately high levels of health
problems. Low socioeconomic status is linked to higher death and
hospitalisation rates, as well as to lower self-rating of health.
Recent death rates for young Aboriginal and Torres Strait Islanders
are close to three times higher in males and twice as high in females
compared with rates for non-Indigenous youth. High levels of mental
disorders and substance abuse are major contributors at one level,
but the fundamental causes are more likely to be found in social and economic conditions, the loss of cultural identity and the disaffection of youth in
many of these communities.
The report's findings will inevitably prompt questions about
current health provision for young Australians. At present, young
people's primary care attendances, for example, are mostly for
relatively minor respiratory conditions, musculoskeletal
problems or acne. The conditions contributing to the disease burden
in young people are less common reasons for general practice
presentations, suggesting scope for the development of
"youth-friendly" primary-care services capable of responding to
youth health problems. With training in adolescent health care,
general practitioners can both learn and retain the skills for
responding to youth health needs,3 and such training could be
linked to health education for young people about access,
availability and use of health services.
Health promotion has an even greater role. Health problems cluster
not only in particular groups but also in individuals. For example,
the young regular tobacco user is more likely to engage in heavy
alcohol consumption and illicit drug use, have poorer mental health
and an overall less healthy lifestyle.4 The clustering can mostly be
traced back to common determinants of health in family, community,
school and developmental backgrounds. Recent North American
research has emphasised the protective influence of family and
school attachment on problems ranging from deliberate self-harm and
emotional distress to tobacco and illicit substance use, violence
and early sexual activity.5 Such findings have been
mirrored in recent Australian research.6,7 More importantly,
preventive intervention targeting these social risk and protective
factors is feasible and can be effective.8,9 Family and school-based
interventions, both in adolescence and during childhood, have been
shown to reduce adolescent problems as diverse as antisocial
behaviour, substance abuse and sexually risky
behaviour.9 Similarly, strategies
based on community mobilisation, peer support, mentoring and
legislative enforcement show promise in specific areas.
Many gaps in our knowledge remain. Mental health problems loom large,
but available data provide an incomplete picture of current need,
changes over time and effectiveness of current health provision.
Health profiles of groups with the greatest needs -- the young, the
homeless and the disabled -- are incomplete, as are those of
Aboriginal and Torres Strait Islanders. Much remains to be learned
about health interventions and their effectiveness. Most
importantly, data on the psychosocial processes that underpin youth
health are not available. Health promotion should be guided not only
by knowledge of the health problems of young people, but also by an
understanding of relevant risk and protective factors. For mental
health problems, these are likely to include parental care, the
experience of psychosocial adversity, trauma and violence,
victimisation, school failure and underemployment. This
understanding is of value, not only in selecting the focus of health
promotion, but in helping to ensure its continued relevance and
sustainability.
A recent report from the World Health Organization noted that most
investment has gone into innovation rather than continuing
programs, with only one in five youth health programs extending
beyond five years.10 Sustainable preventive
health programs for youth necessarily depend on effective
cooperation with government sectors such as education, justice and
employment, as well as non-governmental organisations involved
with youth, younger children and their families.
As the most comprehensive available account of the health of young
Australians, the AIHW report will do much to inform the intersectoral
dialogue that must underpin the setting of priorities and, in turn,
the development of a rational advocacy. However, implementing
effective responses to these priorities will require further work to
build a more complete picture of the psychosocial determinants of the
major health problems of young people.
George C Patton
Professor of Adolescent Health, Department of Paediatrics
University of Melbourne Centre for Adolescent Health, Melbourne,
VIC
pattonATcryptic.rch.unimelb.edu.au
Lynelle J Moon
Senior Analyst, Population Health Unit
Australian Institute of
Health and Welfare, Canberra, ACT
Reprints: Professor G C Patton, Department of Paediatrics,
University of Melbourne, Centre for Adolescent Health, 2 Gatehouse
Street, Parkville, VIC 3052.
-
Moon L, Meyer P, Grau J. Australia's young people: their health and
well-being. PHE19. Canberra: Australian Institute of Health and
Welfare, 1999.
-
Moon L, Rahman N, Bhatia K. Australia's children: their health and
well-being. PHE7. Canberra: Australian Institute of Health and
Welfare, 1998.
-
Sanci LA, Coffey C, Veit FCM, et al. Evaluation of an educational
intervention for general practitioners in adolescent health care:
randomised controlled study. BMJ 2000; 320: 224-230.
-
Hibbert M, Caust J, Patton G, et al. The health of young people in
Victoria. Melbourne: Centre for Adolescent Health, 1996.
-
Resnick MD, Bearman PS, Blum RW, et al. Protecting adolescents from
harm: findings from the National Longitudinal Study on Adolescent
Health. JAMA 1997; 278: 823-832.
-
Glover S, Burns JBH, Patton GC. The Gatehouse Project: the scope of
school based intervention for the prevention of adolescent
depression. Family Matters 1998; 49: 11-16.
-
Silburn SR, Zubrick SR, Garton AF, et al. Western Australian Child
Health Survey: Family and Community Health. Perth: Australian
Bureau of Statistics, 1996. (Catalogue No. 4304.5)
-
National Crime Strategy (Homel R, editor). Pathways to
prevention. Canberra: Attorney General's Department, 1999.
-
Toumbourou JW, Patton GC, Sawyer S, et al. Guidelines to inform
planning and purchasing of evidence-based practice: interventions
for promoting health in the adolescent population. Melbourne:
Department of Human Services, 1999.
-
WHO/UNFPA/UNICEF Study Group. Programming for adolescent
health and development. Geneva: World Health Organization, 1999.
©MJA 2000
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 Carolyn H Kefford, Lyndal J Trevena and Simon M Willcock. Breaking away from the medical model: perceptions of health and health care in suburban Sydney youth Med J Aust 2005; 183 (8): 418-421. [In Consultation - Research] <http://www.mja.com.au/public/issues/183_08_171005/kef10178_fm.html>
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