Scottish children among the highest rates of health and social inequality in Europe

Young people in Scotland have some of the highest rates of health and social inequality in Europe and North America, a major new international study has found.

The Health Behaviour in School-aged Children (HBSC) study, led by academics at the University of St Andrews, presents new data on adolescent health, health behaviours and social determinants from 42 countries.

Among the findings, Scottish boys showed the highest level of inequality for multiple health complaints, moderate physical activity, tobacco initiation and cannabis use while Scottish girls showed the highest levels of inequality for ease of communication with their fathers.

On a more positive note, the report found 11-year olds in Scotland do better on a number of health indicators compared with many of their European counterparts. For example, a greater proportion of 11-year olds in Scotland reported having high life satisfaction (92% of boys and 93% of girls) compared to the international HBSC average.

The report, published by the World Health Organisation Europe, is launched today (Tuesday 15 March 2016) at the International Press Centre in Brussels and presented by Dr Joanna Inchley, deputy director of the Child and Adolescent Health Research Unit (CAHRU) based at St Andrews.

Key Scottish findings in the report are:

• Young people in Scotland showed a higher impact of socioeconomic inequality upon health compared to most other countries in the HBSC study. This means that young people from the least affluent households (lowest 20%) report poorer results on a number of health indicators than those from the most affluent households (highest 20%). These measures include life satisfaction, self-reported health, multiple health complaints, ease of parental communication, dietary behaviours (soft drink consumption, fruit consumption, daily breakfast consumption, evening family meals), sedentary behaviours (e.g. watching television), physical activity and substance use (tobacco and cannabis).
• Scottish 11-year olds scored significantly higher than the HBSC average on a number of health indicators including daily breakfast consumption, twice daily tooth brushing and spending time with friends outside of school. They were also less likely to report weekly substance use (smoking and drinking), bullying others and weight reduction behaviour.
• Scotland has a significantly greater proportion of 15-year old girls who report weekly multiple health complaints compared to the HBSC average. The proportion of both girls and boys from the least affluent households (lowest 20%) were significantly more likely to report weekly multiple health complaints than young people from the most affluent households (highest 20%) and the difference in prevalence between these groups was one of the largest across all HBSC countries.
• The proportion of 15-year olds in Scotland who report feeling 'some' or 'a lot' of schoolwork pressure has been increasing since 2006. There has been a widening gender difference during this time, such that the proportion of boys has increased from 46% to 59%, and girls from 60% to 80%. In 2014, Scottish 15-year olds ranked 2nd out of 41 countries on this measure. In contrast, 11-year old girls showed a significantly lower prevalence of schoolwork pressure than the international HBSC average.
• Prevalence of drunkenness (2 or more times) among 15-year olds has been on a downward trajectory since 1998. However, Scotland remains one of the countries with the highest prevalence in this age group (approximately one third). Alcohol consumption is one of the few topics in the HBSC survey for which there are no socioeconomic differences in Scotland.

Commenting on the report and the Scottish findings Dr Inchley said:

"The findings provide a better understanding of some of the issues facing young people today. It is encouraging that 11 year olds in Scotland are doing well compared with many of their European counterparts, but we see a clear worsening of health and wellbeing during the adolescent years.

"Particularly concerning is the increase in school-related stress which may be contributing to poorer mental wellbeing especially among 15 year old girls. It is essential that we look at ways of providing support to young people to help them navigate the challenges they face during adolescence."

Jamie Hepburn, Minister for Sport, Health Improvement and Mental Health, said:

"There are some positive findings in this report, including Scottish 11-year-olds doing better than the international average for life satisfaction, tooth brushing and spending time with friends outside school.

"However, we recognise that there are deeply ingrained health inequalities in Scotland - something which has existed for generations and which will not be solved overnight.

"At its root this is an issue of income inequality - and we need a shift in emphasis from dealing with the consequences to tackling the underlying causes, such as ending poverty, fair wages, supporting families and improving our physical and social environments.

"The Scottish Government is already doing as much as we can with the powers we currently have to address inequality, through measures such as driving investment in affordable housing, free school meals and continuing the social wage commitments including free prescriptions, concessionary travel and free personal care, as well as taking decisive action to address alcohol consumption, reduce smoking rates, encourage active living, healthy eating, and promote positive mental health.

"However, we want to do more and will use the new powers coming to Scotland to help create a fairer and more equal society."

Gerry McCartney, Head of Public Health Observatory, NHS Health Scotland said:

"This study is the only way of comparing the health of school children in Scotland to other countries around Europe and North America. It also allows us to compare all the important factors that lead children and young people to be healthy or unhealthy, such as how rich or poor their family is, and the social support they have around them.

"The report highlights the progress we have made in many aspects of health amongst young people in Scotland over time, such as the decrease in consumption of high sugar drinks, but it also highlights the stark inequalities in how healthy children feel themselves to be. Amongst boys, these inequalities are wider than in any other country included in the survey."