To what extent do adolescent health conditions impact outcomes in later life? What are the new and emerging health challenges that adolescents and young adults may face within the European context? These were the driving questions that brought together an outstanding group of researchers and stakeholders at the Stakeholder Event Youth and Health in Advanced Societies. Risks, Consequences and Policies at Bocconi University on 6 September 2018. The event, chaired by Nicoletta Balbo (Assistant Professor in the Department of Social and Political Sciences and Research Fellow at the Dondena Centre for Research on Social Dynamics and Public Policies, Bocconi University, Italy) was devoted to exploring socio-economic, cultural and biological factors affecting young people’s health and health behaviours, as well as potential policy solutions.
The event started with an introductory overview on human development and health by Balbo. She stressed that during adolescence, young people begin to choose environments and form health behaviours, habits and lifestyles in a context of profound physical, biological and neurological changes linked to puberty. Those changes affect cognition, decision making and influence behavioural changes. This is a period in the life course where risks of bullying, depression, anxiety, eating disorders or substance abuse increase substantially, but it is also a critical time to intervene to improve health, particularly in terms of preventive measures. Unfortunately, this period of adolescence has not been sufficiently tackled yet, neither in research nor in public health or social policies. Balbo also insisted on the importance of investing in policies and scientific research to better uncover and meet specific needs of this life stage, address health-related challenges, and link the social and the biological research agendas.
Working to better bridge youth and health systems
Following Balbo’s presentation, Anna Ludwinek (Research Manager in the Social Policies unit at Eurofound, Ireland) shared the first results from a study she is currently conducting with colleagues at Eurofound on adolescent health. By exploring cross-national differences in Europe, she presented figures on risk of depression that are particularly high in Nordic countries and much more likely among girls than boys. In terms of bullying, Ludwinek pinpointed an important increase in figures for eastern European countries in the last years, particularly in Bulgaria, Czech Republic and Latvia. Regarding access to healthcare, the study identifies some main general trends: First, costs of access to healthcare have decreased for young people in the European Union (EU) during the last years, however problems with delay in making an appointment have increased by 8% since 2011, and with waiting time on the day of the appointment by 5%. Regarding the main barriers to access services for young people in Europe, she highlighted a series of personal (lack of information, reluctance to ask for help, parents intervention, unawareness of one’s rights), structural (administrative burden, legal restrictions, lack of funding), cultural and societal (geographical area, discrimination and prejudice, language problems) and operational (communication tools, design of services, competence of staff, facilities) aspects.
The event continued with three presentations from eminent scholars.
Bad habits in adolescence impacts adult health status
During the first presentation, Michael Shanahan (Director, Jacobs Center for Productive Youth Development, University of Zurich, Switzerland) presented results from a study conducted with Cecilia Potente, Justin Chumbley and Kathleen Mullan Harris on ‘Predisease Pathways: Integrating Life Course and Social Genomics’. The study was based on a life-course and multilevel modelling strategy focused on young people’s health before clinic manifestation of diseases. The authors looked specifically at the gene expression of individuals, as it is responsive to social, psychological and behavioural factors that, in turn, affect health. In other words, the authors focused on mechanisms that generate symptoms and disease before they can be observed. Conclusions from the study point towards an important role played by low educational levels, smoking and high body mass index (BMI) during adolescence on the chances of experiencing risk of myocardial infarction later in life. Overall, it shows the importance of the pre-disease state and the gene environment interactions with respect to the foundations of health performance later in life.
The far reaching impact of early life mental health
For his presentation, George B. Ploubidis (Professor of Population Health and Statistics, Director of Research & Chief Statistician at the UCL Centre for Longitudinal Studies, Department of Social Sciences, University College of London, United Kingdom) talked about later life impact of early mental health and its implications for population health and ageing. Ploubidis presented numerous studies with robust evidence on the effects of early life mental health on different outcomes in adulthood, ranging from socio-economic outcomes and health behaviours, to mortality, physical health and demographic transitions like the chances of entering a union, duration of relationships or having children. He stressed that mental health problems in childhood and adolescence are common and cast a long shadow over our lives. Only parental socio-economic status and childhood cognitive ability have been found to have similar long term impact so far. Consequently, he urged policy makers to develop population-based interventions in order to shift the distribution of risk and improve population health.
Adolescent health and well-being: What really matters?
The last presentation by Yvonne Kelly (Professor of Life Course Epidemiology, Director of the International Centre for Lifecourse Studies (ICLS) Faculty of Population Health, University College London, UK) was centred on adolescent health and well-being. She noted that in the last decades, while alcohol consumption, smoking and teenage pregnancy rates have declined among adolescents in the UK, screen based media use, being overweight, obesity and poor mental health have increased. Persistent and emerging challenges therefore include poor mental health, obesity, sedentary behaviours, poor sleep and widening inequalities. Kelly argued that social media use, particularly a ‘life of constant likes’ affects individuals’ self-esteem and stimulates comparisons among peers, bullying, and lower sleep and relaxation levels. It does have an influence on social standing of young people, yet the impact on mental health is yet not fully understood. Regarding policy interventions, she reminded the audience that multiple factors exert influences on young people, and that interventions are most effective when holistic approaches with multiple stakeholders are part of its design.
Panel Debate:
What are the urgent needs in research and in the policy agenda regarding adolescent health?
Frank Tillmann (German Youth Institute): Purely age-related definitions of adolescence (from age x to z) underestimate the role played by important processes during the transition to adulthood, e.g. entry into vocational or tertiary education and into the labour force, which go across and beyond pre-defined age periods.
Anna Ludwinek (Eurofound): Young adolescents need more direct access and specialised support by medical doctors without the participation of family members. In addition, our research showed that young people often mistrust public authorities and might not report drug consumption or depression to public authorities. There should be incentives for young people to meet the doctor and to share their concerns openly and in a safe space.
Gwyther Rees (UNICEF and University of York): Maltreatment during adolescence can create issues at any random point in the life course. Policy makers must be more aware of the long-term consequences of what happens during adolescence.
Aleksandra Torbica (Centre for Research in Health and Social Care Management, Bocconi University): Recent evidence highlights that approximately 99% of publications in Google Scholar and 95% in Pubmed on the first 20 years for life focus on children under the age of five. This bias in research is parallel (or caused by) similar bias in investment. The availability of adolescent specific publication reflects a lack of research funding and it results in a lack of data. Lack of data leads to lack of publications. It is all connected in a complex vicious cycle, and in order to encourage more research in this area, we need to break it.
Corrado Celata and Veronica Velasco (Milanese Agency for Health Protection): Health is created and lived by people within the settings of their everyday life; where they learn, work, play and love. In this respect, most young people are performing well and under good health parameters during adolescence. Health promotion policies should face specific vulnerabilities empowering adolescents and young people and recognise their independence. Still, social inequality issues, intercultural diversity and gender differences are key issues to be monitored.
To conclude, participants agreed that in terms of policy recommendations, there is a demand for more research, more evaluation of best practices and more policy intervention. Policy makers could be easily motivated to spend money on adolescent health, particularly on preventive actions and programmes, if they were more aware of the tremendous costs of not acting, i.e. in terms of health treatments, lower performance in the labour market, more vulnerability at older ages, or lower contributions to the social system.