Young people's health: the need for action
BMJ 2005; 330 doi: https://doi.org/10.1136/bmj.330.7496.901 (Published 14 April 2005) Cite this as: BMJ 2005;330:901
All rapid responses
"Few youth specific services exist" say Viner and Barker in their excellent article on Young People's Health. They are right - but attempts are being made to address the risky health behaviours of 13-15 year olds through a Dept. of Health funded programme - the Young People's Development Programme - which puts targeted youth in touch with youth workers for an average of 6-10 hours per week for a full year.
Programmes are multi-component, mixing health education around drug misuse, sexual health and diet - with arts, sports, lifeskills and volunteering.
The 3 year pilot programme is being rigorously evaluated and the work - based on promising U.S.schemes - is taking place in a variety of locations (coastal, urban,rural) with a range of groups (school excludees, asylum seekers, offenders etc) and has just ended its first year. The National Youth Agency is also hoping that, with support from the DH through programmes like YPDP, a much bigger network of health promoting youth projects can be created to ensure that medical expertise can be added to from those professions with experience in working productively with groups that many services find hard to contact or make progress with.
For a more extensive overview, please go to the National Youth Agency website - www.nya.org.uk - and access the YPDP link, or e-mail myself on richardm@nya.org.uk. Alternatively, the key contacts at the Dept. of Health are Karen Turner (karen.turner@dh.gsi.gov.uk) or Catherine Dennison (catherine.dennison@dh.gsi.gov.uk.
Competing interests: I am employed by the National Youth Agency as a Project Coordinator for the Young People's Development Programme, the subject of my response
Competing interests: No competing interests
RAPID RESPONSE TO ARTICLE: 19 APRIL 2005
This article touches on an issue of major concern to public health policymakers. Young people are now increasingly exposed to the full advertising force of big powerful companies. They are the new consumers in a market that does not take account of the long term health needs of the public.
A number of factors determine an optimum lifestyle. These include personal choice of diet, tobacco use, physical activity and the environment. It is hardly surprising that with so many influences, impressionable teenagers need support and guidance to give them the best chance of achieving long-term health and well-being.
Young people are under peer pressure to conform to the latest fad or lifestyle, and so popular sport and media role models do have a responsibility to send the right messages. A recent example of a positive role model is Jamie Oliver and the publicity given to the importance of using quality ingredients in school meals.
The Wanless Report sees the public taking a far more active role in healthcare. Today’s challenge is for the primary care sector to work in partnership with schools, social services and other agencies to enable young people to have the confidence to take more control over their health and lifestyle decisions.
Use of smart cards and re-registration with their GP’s between the ages of 14 and 15 will over time lead young people to be more responsible and healthier citizens. This can be a success so long as a supportive partnership of healthcare and other professionals compliments the increased freedom given to teenagers to make decisions.
Competing interests: None declared
Competing interests: No competing interests
The basics of health are very simple - clean air, pure water and nutritious food.
Unfortunately, these necessities are becoming less (not more) available in many developed countries. Instead, market-driven economies promote junk food, tobacco and alcohol exposures. Hormone use is added to sexual promiscuity. Tests revealing mineral, vitamin and essential fatty acid deficiencies, and toxic metal accumulations, are not widely used. This deprives doctors, teachers and parents of useful ammunition for counteracting unhealthy money-spinning propaganda.
Competing interests: None declared
Competing interests: No competing interests
As the author states the government is calling for a shift to a service focusing on health and wellbeing. The author also highlights many problems issues such as obesity, smoking, teenage pregnancies, diabetes and asthma. She argues of ways to deal with the problem and this includes developing services that engage young people with their health.
I do agree with the author in that there is a significant problem with adolescent health as demonstrated by the figures, however one must try and understand the reasons for the problem emerging before dealing with it. I would argue that even if health services were tailored to the needs of adolescent population, it would only result in a very small improvement in their failing health.
I believe the reasons behind the deterioration in the health of our young people are multiple and preventable by the health profession. Obviously doctors in primary and secondary care are there to deal with health problems that present themselves; they are also obliged to give sound and professional advice. However health care professionals are fighting a futile battle as the problems are often the result of many years of poorly thought out government policy.
The failing education system, which includes both the mental and physical sides of education, must be one area that needs to be improved. Many studies have demonstrated that adolescents are physically less active than ever before and that their diets are worsening. Surely compulsory nutritional standards should be introduced in UK schools as in some other countries ( France are one example). Physical activity and sports need to be increased at schools. A general improvement in education standards would surely result in improving adolescents’ self care and health behaviours. The whole responsibility cannot lie with schools; however maybe the problem with education is so long standing that it spans generations, meaning that the children of today’s health problems are in part a result of the lack of knowledge of their parents. The government also needs to improve our sporting and recreational facilities so that we can become a more active nation, instead of building many new homes in isolation. Also environment factors can have a profound influence on health; air pollution and chemical waste for example.
Therefore in conclusion I feel the author is right that we have an adolescent health problem that needs to be dealt with. The way to deal with this is mainly in prevention and health professionals direct impact on this problem can only be limited. The path forwards must involve careful cooperation between doctors and politicians in order to put into place a range of effective strategies that enable people to help themselves stay healthy. The way forward may involve many areas of government from education through to sports medicine, but the key is prevention. After all, is they way to deal with crime really as simple as to increase police numbers as crime rates escalate?
Yours,
Dr Benjamin Dean
Competing interests: None declared
Competing interests: No competing interests
Dear Dr. Rusell,
Your paper sheds sufficient light on the blind eye that the NHS has towards adolescent health issues, but apart from strategies suggested by yourself, I feel that an introspective look at the role models that the adolescents today have in front of them is equally important. Coming from a developing country like India, I am appalled by the extent of prevalence of unhealthy lifestyle practices followed by a wide section of the population. It is commonplace to see a large section of women in the reproductive age group smoke regularly. Many of them are mothers who we would expect to counsel their children on the ill effects of the cigarette. So it would not be unusual for a growing adolescent to assume that smoking is a fine thing, when he/she sees dad or mom at home having a smoke everyday. Sadly the same is true for drinking or indulging in high risk behaviour. The single parent trap does nothing better than add to this already vicious circle.
Health behaviours laid down in adolescence and maintained into adulthood influencing lifelong health are to a great extent imbibed from role models at home and in the community. Hence no matter what amount of work is done to improve or augment the health initiatives at the primary or secondary care levels, it would still be fruitless if the primary influences are not tackled. This would mean an acknowledgement of the above factors among the parent population and a conscious drive to change the role models being presented to the youth. A strong family network which eschews unhealthy habits in itself is the only way that primary prevention will work. As everyone knows, prevention is always better than the cure!
Competing interests: None declared
Competing interests: No competing interests
In the beginning was the Deed...
Editor: If indeed the government truly calls for a shift to a service focusing on health and well-being of the adolescent population and we, professionals and parents alike care for our children, I propose the introduction of 6- monthly compulsory Gamma GT and MCV blood tests (perhaps it would not be a bad idea of extending the proposal to, say, the working population as well).
Apart from possible objections on human rights grounds and some costs involved, the most serious negative consequence would potentially be a big hole in the government coffers. But let us concentrate on the long term immeasurable benefits...
adrian32xj6@yahoo.com
Competing interests: None declared
Competing interests: No competing interests