State of child health: School age and adolescence indicators

Healthy weight at Year 6 (10 to 11 years) - Proportion of children at a healthy weight during their final year of primary school

Human Papilloma Virus (HPV) vaccination - Proportion of girls who have received the completed Human Papilloma Virus (HPV) course of immunisation

Smoking in young people - Proportion of regular smokers aged 15 years

Alcohol and drug use - Proportions of regular alcohol users and drug users aged 15 years

Wellbeing - Proportion of young people aged 15 years who report high life satisfaction, by gender

Suicide - Suicide rate amongst young people aged 15 to 19 years per million

Road traffic injuries - Number of car drivers or passengers aged 17 to 19 years reported killed or seriously injured

Sexual and reproductive health - Number of conceptions per 1,000 females under 18 years of age

Healthy weight at Year 6 (10 to 11 years)

Key messages

Weight status at the end of primary school, like earlier in childhood, is an important predictor of health outcomes later in life.

Monitoring of trends in weight status across childhood helps identify pivotal points during childhood to intervene and prevent children becoming overweight and obese.

In England, the proportion of children at healthy weight at Year 6 has stayed fairly constant since 2007, although there was an increase in the proportion of obese children in 2015/2016.

Children living in the most deprived areas are more likely to be overweight or obese compared with children in the least deprived areas. 

Key actions

Enact cross-government childhood obesity strategies across all countries, including rigorous evaluation of their impact.

Robust evaluation to monitor the effectiveness of the proposed sugar levy and other sugar-reduction initiatives on sugar-sweetened beverages in all countries.

Expand nutritional standards to all schools. Make school-based health education a statutory subject in all schools, fostering and focusing on the importance of both physical activity and nutrition. 

Introduce a ban across the UK on the advertising of foods high in saturated fats, sugar and salt before 9pm, and evaluate the impact of online food marketing on children. 

Extend the reach and effectiveness of universal measurement programmes in different countries to include an increase in the number of measurement points and longitudinal tracking of children, starting much earlier in childhood. There should be sharing of data with general practitioners, school nurses and parents. Introduce Year 6 and P6 cohorts in child measurement programmes in Scotland, Wales and Northern Ireland.

Support a research environment that enables sustained, long-term expansion of basic science and applied research to identify the causes of obesity and effective interventions to tackle it. 

Ensure that overweight and obese children have timely access and support to attend evidence-based healthy weight programmes, via prescriptions or referrals by their GP.

Ensure children with significant underweight have timely access to specialist child health services. 

Human Papilloma Virus (HPV) vaccination

Key messages

The Human Papilloma Virus (HPV) vaccination during adolescence is a highly effective public health measure to prevent cervical cancer and genital warts.

The UK has one of the highest coverage levels for HPV (over 80% of girls have completed their HPV course), probably due to the school-based delivery mechanism in the UK. 

HPV coverage provides data on the performance of school immunisation services for adolescents.

Girls of black and ethnic minority background, and girls not in mainstream education, are less likely to take up or complete the vaccination course.

Universal HPV vaccination for adolescent boys should be considered across the UK.

Key actions 

Increase knowledge and awareness amongst girls and their families of the importance of the HPV vaccine.

Further research is required into the long-term effectiveness of the vaccine, including continued assessment of the optimal number of vaccine doses.

Further research to identify population groups less likely to commence or complete the vaccination course, including an exploration of barriers to access.

Ensure data on HPV vaccination are linked to child health data systems and cervical screening systems.

Examine the cost effectiveness of extending HPV vaccine to adolescent boys in the UK.

Smoking in young people

Key messages

Smoking continues to be the greatest single cause of avoidable mortality in the UK. Starting to smoke during adolescence increases the likelihood of being a life-long smoker. 

Latest figures show that the percentage of 15-year-olds smoking regularly is 6% in England and 8% in both Wales and Scotland. Smoking is rarely initiated after adolescence.

Significant inequalities in adolescent smoking persist, with higher rates of smoking in young people from deprived populations. 

Tobacco control measures across the whole population are the most effective measures for reducing smoking and smoke exposure in children and young people.

Key actions

Increase knowledge and awareness of the harms of smoking amongst children and young people through statutory evidence-based, personal health education in schools.

Extend bans on smoking in public places and in vehicles, coupled with sustained public health campaigns about the dangers of second-hand smoke for children and young people. 

Protect and extend population level tobacco control measures and individual level stop-smoking services for children, young people, and their parents. 

Continue to monitor the impact of electronic cigarettes on smoking behaviour in children and young people.

Strengthen data capture across the UK so rates of smoking in young people can continue to be monitored and compared.

Alcohol and drug use

Key messages

Alcohol and cannabis use in young people has significantly declined over the past decade, but the UK still ranks poorly among other European countries. 

In 2013, 9% of pupils in England had drunk alcohol in the last week, compared to 25% in 2003.

Alcohol and drug use among school-aged children often predicts negative social and health outcomes into adulthood, making health promotion activities at school a vital opportunity for intervention.

Whilst the prevalence of drug use in young people has steadily fallen, this decline has slowed since 2013, with 15% of pupils reporting that they had ever taken cannabis. 

Key actions 

Ensure all schools adopt comprehensive, up-to-date, evidence-based approaches to drug and alcohol education, which incorporate peer-led learning and are in line with NICE guidance. This should be within statutory personal social health and economic education (PSHE).

Strengthen implementation of NICE guidance across the UK, in particular the provision of brief interventions in primary and secondary healthcare settings.

Prevent the uptake of young people drinking alcohol by prohibiting products that are targeted to a younger market.

Restrict availability of alcohol to young people by ensuring the purchasing of alcohol is made by individuals with valid forms of ID and for the alcohol industry to encourage Challenge 21 and 25 schemes.

Governments should introduce and implement minimum unit pricing policies for alcohol.

Wellbeing

Key messages

Wellbeing is a broad concept often understood to include aspects of satisfaction with life and positive mental health as well as other elements. It can be defined as ‘a dynamic state, in which individuals are able to develop their potential, work productively and creatively, build strong and positive relationships with others, and contribute to their community.

Lower levels of wellbeing amongst young people are linked with bullying and disruptive behaviours at school, whilst higher levels of life satisfaction have been linked to healthier levels of physical activity, screen time, nutrition, and mental health. 

UNICEF reported that young people in Britain had low wellbeing compared with other rich countries in the last decade. 

Key actions

Reduce inequalities in health across a range of health outcomes. 

Promote protective and resilience factors in young people's lives.

Ensure full compliance with the UN Convention on the Rights of the Child. 

Analyse the effects of decision-making on children at a central and local government level. 

Maintain the commitment to eradicate child poverty in the UK by 2020, with a political focus on the poorest children, particularly in times of exceptional financial pressure on families.

Suicide

Key messages

Suicide is the second most common cause of death in young people aged 15 to 19, and accounts for more than a quarter of all deaths among this age group.

Suicide rates in England, Wales and Scotland have declined since 2002.

Young men are more likely to take their own lives than young women. 

Suicide is strongly linked with mental health problems, substance misuse, abuse, academic worries and bullying.

Suicide is preventable: reduced access to means of suicide and improved mental health support for young people is essential to reduce suicide rates amongst youth.

Key actions

Develop cross-government mortality plans to significantly reduce the number of preventable child and adolescent deaths, including deaths through suicide.

Develop national youth suicide prevention strategies, with particular focus on young people in deprived communities

Ensure all health, social care, youth justice and education professionals who work with children and young people are equipped with the skills and knowledge to ensure children and young people with mental health needs get the support they need as early as possible.

Ensure service design recognises the role and importance of schools in relation to children and young people’s health.

Ensure that paediatric and specialist CAMHS services have sufficient capacity to meet the needs of children and young people.

Road traffic injuries

Key messages

Road traffic injuries are a leading cause of death in young people in the UK. 

Globally, young people are the most likely age-group to be involved in transport accidents. 

In 2015 there were 847 reported car driver or passenger deaths or serious injuries amongst 17- to 19-year-olds in England, Northern Ireland, Scotland and Wales. Boys were 1.6 times more likely to be injured or killed on the roads compared with girls.

There has been a decrease in the number of road traffic injuries per 100,000 population amongst young people in all four nations over the past decade.

Compared with other wealthy countries, the UK has an excellent record on reducing traffic injuries; nevertheless, these are preventable causes of death and there remains room for improvement.

Key actions

Introduce Graduated Licencing Schemes across the UK for novice drivers, particularly young people. 

Strengthen the evidence base underpinning young driver education programmes across the UK.

Sexual and reproductive health

Key messages

Young people are the parents of the next generation. The sexual and reproductive health of young people is an important indicator of population health.

There has been an overall decline in the conception rate of 15- to 17-year-old females since 2007 across England, Scotland and Wales. 

Teenage conception rates are highest amongst young women in the most deprived areas. 

Statutory sex and relationships education, coupled with access to youth-friendly sexual and reproductive health services, are vital for improving the health of young people.

Early and coordinated support is needed for young parents to improve outcomes for themselves and their children.

Key actions

Provide universal statutory, comprehensive, evidence-based sex and relationships education as part of a wider health education curriculum, embedded within a whole school approach and linked appropriately with local sexual health service provision.

Strengthen implementation of NICE guidance Contraceptive services for under 25s.

Strengthen targeted measures for young people at increased risk of poor sexual and reproductive health, including implementation and continued evaluation of condom distribution schemes in response to local need.

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