Health and wellbeing in adolescence and early adulthood
posted by Research Admin 1 on 4 March 2019
Editorial, The Lancet, Vol 393, Issue 10174, Page 847, March 2, 2019
That young people are less healthy in the UK than in similar high-income countries is the headline finding of a major report published last week. International comparisons of health and wellbeing in adolescence and early adulthood, published by the Nuffield Trust and the Association for Young People's Health, examines 17 indicators of health and wellbeing in young people aged 10–24 years in 19 similar high-income countries within and outside Europe.
Young people in the UK are more likely to die from asthma, be obese or overweight, or have a poor quality of life from long-term conditions such as type 1 diabetes than are most young people in similar countries. The mortality data for asthma are particularly concerning, given that most asthma deaths are preventable. Global Burden of Disease 2016 data show that the UK has the highest asthma mortality rate among European countries included in the report, and only Australia, New Zealand, and the USA have higher rates in young people aged 10–24 years. Time trends from 1998 to 2016 show a decline in asthma mortality rates overall but a plateauing since 2011 in the UK. Data from Asthma UK suggest that two-thirds of young people are not getting the care they need to prevent asthma attacks, with poor access to general practitioner appointments and the stigma of using inhalers at school or in public being important barriers.
One in five children are obese in the UK by the time they leave primary school (age 10 or 11 years), and there has been an overall increase in obesity prevalence among adolescents aged 15–19 years from 5·6% in 1995 to 8·1% in 2015. For all years studied, the UK's obesity prevalence was closer to the worst performing country (the USA) than to the best performing country (Japan).
Data from the UK Office for National Statistics released on Feb 22, show that a third of deaths of children and young people aged 0–19 years were classed as avoidable in 2017, with no substantial improvement since 2014. The leading cause of avoidable mortality in children and young people was injuries (intentional and unintentional), with maternal and infant causes (deaths from complications of the perinatal period, congenital malformations of the circulatory system, and spina bifida) the next largest category.
The Nuffield Trust report follows on from research on health in young children that also reported poorer health outcomes in the UK than in similar countries, in addition to data showing rising or plateauing of infant mortality rates in various UK regions.
For most health indicators, disparities in outcomes are driven by social inequalities, with more deprived young people having worse health outcomes than their wealthier peers. With the proportion of children living in relative poverty predicted to be 37% by 2023–24 by the Resolution Foundation, the outlook is grim.
Young people aged 10–24 years make up about a fifth of the UK population and are usually thought of as relatively healthy and low users of health care compared with other age groups. Adolescence is a formative time, when huge biological, psychological, and social changes occur. It should be a time when the foundations for adult life are laid, including an appreciation of the importance of prevention of disease and the value of a healthy lifestyle. Although there is some good news in the Nuffield Trust report, with fewer young people smoking, drinking alcohol, or taking cannabis compared with the previous decade, the rise in obesity and the decline in regular physical exercise do not bode well for healthy adulthood.
The report's inclusive remit, looking at young people up to the age of 24 years is welcome, and encompasses the three key phases—early adolescence (10–14 years), late adolescence (15–19 years), and young adulthood (20–24 years), as defined in the Lancet Commission on adolescent health and wellbeing. With a focus on children and young people in the UK National Health Service Long Term Plan, implementation of the Nuffield Trust report's recommendations would go a long way to improving the health of young people. Integration of young people's health in all policies and research agendas is crucial, including in sectors outside health, such as education, employment, and housing. Management of long-term conditions such as asthma and diabetes must improve and be targeted at the needs of young people. Actions to reduce health inequalities and to ensure equitable access to health services must be an increasing priority in the UK. The future of this generation is at stake.