2 The health needs of children and young people across Scotland
In Scotland, many children are born into families from lower socio-economic groups with characteristics that may impact adversely on their health. Many unhealthy lifestyles are more common in those who are economically deprived or socially excluded ( NHS Fact File 2003).
Health related behaviour and lifestyles
Recent Scottish Executive health promotion initiatives have tended to focus on health-related behaviour. These have included television campaigns on the risks of smoking and drug misuse and the importance of healthier lifestyles and of regular exercise. Also, free fresh fruit is now provided to children in primary schools.
Diet is one important lifestyle factor where inequalities relating to deprivation are particularly evident and, despite efforts by professionals and government, the average Scottish diet remains unhealthy, being high in fat, salt and sugar and low in fruit and vegetables. However, since 1990, there has been an increase in the consumption of fruit, raw vegetables and salads on a daily basis by all age groups ( NHS Fact File 2003). Even so, childhood obesity is on the increase; in 1998-99, the prevalence of obesity in Scottish children aged 3 to 4 years was almost nine per cent compared with the UK reference standard of five percent ( NHS Fact File 2003).
Furthermore, three in ten boys and four in ten girls fall short of the amount of physical activity required for good health; this applies particularly to school age children between primary three and seven ( NHS Fact File 2003). In the UK as a whole, accidents are the most common cause of hospital admissions for children, whereas the most frequent reason for visiting the GP, accounting for half the visits to GPs of children under five, are respiratory conditions, including asthma and bronchitis (Hill and Tisdall 1997).
Smoking is another significant component of inequalities, in the dual sense that smoking is related to deprivation and itself leads to poor health outcomes. Evidence from inside and outside Scotland has shown that rates of adolescent smoking were higher in households where the head of the house was unemployed. Associations have been found between adolescent smoking (boys and girls) and in both the number of smoking parents a young person has (Greishbach and Currie 2001; Charles, Cosgrove and Hill 2002) and the young peoples' perceptions of parental disapproval. Daily smoking by boys and girls was higher if both parents smoked (Royal College of Physicians cited in Charles, Cosgrove and Hill 2002). There is also a link between smoking and poorer diet and lack of physical exercise. Daily smokers are significantly less likely than non-smokers to eat a consistently healthy diet (Greishbach and Currie 2001).
The NHS Fact File (2003) reported that smoking rates in Scotland for boys aged 14 to 15 years have fallen from 11% to eight per cent, but the figure for girls (13%) remained unchanged. However, these figures have been challenged by other research studies which found increases during the past decade in daily smoking among boys (12.4% to 19.2%) and girls (12% to 24%) (Greishbach and Currie 2001). This is the highest rate in Europe for smoking among 15 year olds. Moreover, smoking daily is an indicator that future patterns of habitual smoking have begun to be established; smoking rates for women in Scotland are already amongst the worst in Europe, at 32% ( NHS Fact File 2003).
Of concern is the growing number of young people drinking alcohol and the link between smoking, drinking and drug use. In Scotland, there has been an increase in the number of children and young people under 16 using alcohol and an increase in the frequency of use. The number of pupils aged 12 to 15 who had consumed an alcoholic drink in the previous week rose from 14% in 1990 to 20% in 2000 ( NHS Fact File 2003). The likelihood of weekly drinking increases with age and more young girls are drinking at least once a week, although boys aged 12 to 15 are drinking more than girls (12.8 units compared with 9.6) ( NHS Fact File 2003). In 2000, there were 1,428 emergency admissions of young people aged 10 to 19 with a diagnosis of acute intoxication, the majority of which (1,036) were aged between 15 and 19 ( NHS fact file 2003).
Older young people aged between 16 to 24 years are also drinking more; the average weekly consumption has risen from 20.8 units (1995) to 23.4 (1998) for men and 8.4 to 10 units for women during the same period. Young people in this age group are the most likely to exceed weekly recommended limits
Recent surveys of Scotland's young population have showed that the awareness and use of legal and illegal drugs is prevalent across the country; by their mid-teens around 40% of 15 to 16 year olds will have tried at least one illegal drug (McKeganey and Beaton 2001). Children aged 12 to15, who drink frequently, are more likely to report drug use. Boys were more likely than girls to have used drugs during the previous month (11% compared with 8%) and were also more likely to have been offered drugs than girls (41% compared with 36%) ( NHS Fact File 2003).
Early pregnancy brings health risk for the mothers and, on average, poor outcomes for the resulting children. Some research has found that sexual intercourse before the age of 16 may be associated with factors such as deprivation and low educational levels, and is more common among young people who have poor relationships with their own parents or whose mothers also gave birth while in their teens (Corlyon and McGuire 1997; Henderson et al. 2002). Sweeting and West (cited in Ely et al. 2000) also found that less time spent at home at the age of 15 was associated with early pregnancy. However, it is important to stress that the focus of this report is not on early sexual activity per se, but sexual behaviour that poses a threat to the young person's health in terms of sexually transmitted diseases and unplanned pregnancies.
A study set up to examine heterosexual risk behaviour in teenagers in Scotland (Greishbach and Currie 2001) found that those most likely to use contraception were those where the sexual relationship had lasted longer than a month, and where the couple had planned to have sex and had discussed contraception prior to doing so. The lowest proportion of contraception or condom use was found in cases where intercourse was unexpected and/or was carried out for the first time with a partner of less than a month's duration. Such unprotected sex carries the greatest health risks (Hill and Tisdall 1997; Greishbach and Currie 2001).
Mental health and emotional wellbeing
In Scotland, about 125,000 young people experience mental health problems that interfere with their daily lives (Health in Scotland 2002).
In 2002, Meltzer and colleagues conducted a three-year follow up survey of the mental health of children and adolescents in Great Britain. Information was collected twice from 2,938 children and, from the first round of data collection, 573 children were identified as having a mental disorder. The researchers found that 43% of the children assessed in 1999 as having a conduct disorder were also rated as having a disorder three years later. For children assessed as having a clinically-rated emotional disorder in 1999, 25% were assessed as having an emotional disorder three years on.
The authors concluded that children were more vulnerable to the onset of a mental disorder if the mother's mental health had deteriorated; if family functioning and relationships had worsened; if the child had experienced a number of stressful events; if there were changes in the employment status of the main breadwinner; and if children lived in households with high discord (Meltzer et al. 2003). One key factor that emerged linked the presence of an emotional disorder in a child with the mother's poor mental health.
Meltzer and colleagues (2003) also found that 18% of those with a persistent mental disorder were permanently or temporarily excluded from school. Children with either emotional or conduct disorders had missed more days at school than their peers without a disorder. Young people aged 15 and over with a mental health problem were less likely to be in full time education (63%) compared to young people with no mental health difficulties (83%). Young people aged 16 and over with persistent mental health problems were twice as likely to have no qualification as those with no disorder. More positively, those who recovered tended to obtain higher levels of qualifications than those who did not.
According to the NHS Fact File 2003, mental health problems may also be on the increase within minority ethnic communities in Scotland. This could be due to increased tensions between values and ways of life for different cultures and different generations, conflicting perspectives on the role of women and arranged marriages, and experiences associated with being a refugee or asylum seeker. However, further research is needed on this.
Suicide and deliberate self-harm
There has been a steady rise in both the number and rate of suicide in Scotland during the last 16 years. Scotland's rate is much higher than for other areas in the UK and one of the highest in Europe ( NHS Fact File 2003).
In 2001, there were 887 suicides and indeterminate deaths - an increase of 22% since the 1980s, with boys and men aged 11 to 24 as the group at particular risk (Hill and Tisdall 1997; Choose Life 2002a). The Scottish Executive reported in Choose Life (2002a) that, for the general population, key factors, events or triggers for suicidal thoughts include sexual abuse, homelessness, running away from home, experiencing violence, expulsion from school, major financial crisis, court appearance and looking for work for over one month. Those who reported three or more of these events were over three times as likely to have suicidal thoughts, while those experiencing six were nine times as more likely.
Oral health
In Scotland, child oral health remains poor with only 45% of Scottish five year olds free from dental decay in 2000, 15% short of the national target of 60% by 2010 ( NHS Fact File 2003).
The 1993 national child dental survey found significant associations between dental decay and deprivation for 15-year-olds living in the UK (cited in Jones, Woods and Taylor 1997). This association is echoed in the findings from surveys of five-year-olds, 12-year-olds and 14-year olds in Scotland (Jones, Wood and Taylor 1997) and from a dental health project set up to promote dental health among under-threes in the Drumchapel area of Glasgow, a housing estate associated with poverty and deprivation (McFayden, Lamb and Harper 2000).