HEALTH

Australia 21 on the health and wellbeing of young Australians: 2020 Summit submission

The text below is from the Australia 21 Submission to the 2020 Summit, and is an extract from that submission (section 7). It is reproduced here with permission from its author, Richard Eckersley, and contains his minor corrections to the orginal submission made to the 2020 Summit:

Introduction:
The health and wellbeing of young Australians, an important indicator of Australia's future population health, is declining. This development is of immense social significance, with implications for national priorities and every aspect of public policy.

The orthodox view of young people's health and wellbeing is of a continuing improvement, in line with historic trends. It rests on two lines of evidence: declining death rates and high levels of self-reported health, happiness and life satisfaction. Both measures are flawed. Mortality might once have been a good summary measure of overall health, but this is no longer true. In Australia, death now strikes only about 40 in every 100,000 (0.04%) young people each year. The major cause of death is road accidents, which says little about health and wellbeing in general. Self-reported health and happiness represent a biased view because people use a range of cognitive tricks in reporting high levels. Many people with serious health problems will still say their health is excellent or very good.

The orthodox view underestimates the growing importance to overall health and wellbeing of non-fatal, chronic illness, especially, in the case of young people, mental illness. Research suggests 20-30% of young people are suffering significant psychological distress at any one time, with less severe stress-related symptoms such as frequent headaches, stomach-aches and insomnia affecting as many as 50%. Mental disorders account for almost half the burden of disease in young Australians, measured as both death and disability -- far more than the second biggest contributor, injuries. There is a growing body of evidence that mental disorders have increased over successive generations of youth (as have some physical illnesses, notably diabetes, linked to rising levels of obesity.)

The more tangible factors contributing to the decline in mental health include family breakdown, education and work pressures, media and technological impacts, dietary changes and chemical pollution. However, the causes also include cultural intangibles, such as excessive materialism and individualism. While young people are materially better off, and have more opportunities for education, leisure and travel than ever before, social and cultural changes have made it harder for them to develop a strong sense of identity, purpose, belonging and security: in short, to feel their lives have meaning.

At its most fundamental, the task of optimizing population health involves changing the stories or narratives by which Australians define themselves, their lives and their goals.

Recommendations

1. Better health (not greater wealth) should be the defining goal of government. This means seeing health as much more than a matter of healthcare services.

2. Emphasis should be shifted from the dominant, treatment-focused, biomedical model of health to a preventative, social model.

3. This should include specific goals such as increasing the proportion of the health budget allocated to prevention and public health to, say, 5% of the health budget by 2020.

This submission draws on the following publications:

Eckersley, R. 2007. The health and wellbeing of young Australians: present patterns and future challenges. International Journal of Adolescent Medicine and Health, vol. 19. no.3, pp 217-227.

Eckersley, R. (in press). The health and wellbeing of young Australians: Patterns, trends, explanations, responses. In DL Bennett, SJ Towns, Elliott, EL. Challenges in adolescent health: An Australian perspective (provisional). Freund Publishing, Tel Aviv.

Eckersley, R (in press). Progress, culture and young people's wellbeing. In A. Furlong (ed). International Handbook of Youth and Young Adulthood. Routledge, London.

2.

Young people's health: The Hobart declaration

The declaration below was composed by delegates to the June 2008 GP and Primary Health Care Research Conference, at the workshop on "Health for all young people: research, practice and policy implications". The declaration below is also available as a PDF from the conference website at:http://www.phcris.org.au/conference/2008/media/index.php

Declaration of Hobart:

The Youth Health Research Interest Group workshop of the Australian National GP and PHC Research Conference, meeting in Hobart this fourth day of June in the year two thousand and eight, expressing the need for urgent action by the Australian Federal Government and all State Governments, all health workers and the Australian community to protect and promote the health of all Australian young people, hereby makes the following declaration. In the declaration the term 'young people' refers to all groups of young people including young parents, migrants, refugees, high achievers, young people from both economically advantaged and disadvantaged backgrounds, intellectually and physically disabled young people, indigenous and homeless youth, same sex attracted and youth from culturally and linguistically diverse backgrounds. It is emphasised that any specific group are part of the whole community of young people.

The Declaration:

1. Young people have the right and duty to participate individually and collectively in the planning and implementation of their health care. To achieve this end, there needs to be a raising of awareness amongst young people of this right and duty and creation of opportunities to participate through the education system, youth health and welfare sector and also through providing education for parents and teachers.

2. The work shop strongly reaffirms that health, which is a state of complete physical, mental, social and spiritual wellbeing, and not merely the absence of disease or infirmity, is a fundamental human right and also, therefore, a young person's right.

3. The attainment of the highest possible level of health is a most important Australian social goal whose realization requires optimal communication and action and collaboration between the social, economic and health sectors.

4. Given Australia's prosperity, the existing gross inequalities in the health status of young people within rural and urban regions are politically, socially and economically unacceptable.

5. Economic and social development is of basic importance to the fullest attainment of health for all young people and to the reduction of the gap between the health status of different groups of young people. The promotion and protection of the health of young people maintains quality of life and is essential to sustained economic and social development and contributes to national peace. Governments need to support the economic and social development of young people to improve their capacity and chances for education, employment and other life opportunities (eg. by providing reasonable youth payments for welfare, housing and education).

6. Governments have a responsibility for the health of their young people, which can be fulfilled only by the provision of adequate health and social measures. A main social target of Australian governments and the Australian community in the coming decades, should be the attainment by all young people by the year 2020 of a level of health that will permit them to lead a socially and economically productive life and generate a greater sense of social inclusion and social cohesion. Indicators for young people's health need to be defined, with reference to ARACY and Foundation for Young Australians, and targets set for improvement of young people's health by 2020. Primary health care is one of the keys to attaining this target as part of development in the spirit of social justice.

7. Primary health care is essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to young people and their families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination. It forms an integral part both of the country's health system, of which it is the central function and main focus, and of the overall social and economic development of the community. It is the first level of contact of young people with the national health system bringing health care as close as possible to where young people live and work, and constitutes the first element of a continuing health care process. An important step in achieving adequate access to primary health care is the provision of Medicare cards to all young people, helping to remove at least one of the barriers of access to care. There needs to be appropriate continuing education and training for primary health care staff to work with young people. An additional step needs to see an increase in access to services, for example flexibility of opening hours.

8. Primary health care:

... reflects, and evolves from, the economic conditions and sociocultural and political characteristics of the country and its communities and is based on the application of the relevant results of social, biomedical and health services research and public health experience;

... addresses the main health problems in the community, providing promotive, preventive, curative and rehabilitative services accordingly;

... includes at least: education concerning prevailing health problems and the methods of preventing and controlling them; promotion of food supply and proper nutrition; an adequate supply of safe water and basic sanitation; maternal and child health care, including family planning; immunization against the major infectious diseases; prevention and control of locally endemic diseases; appropriate treatment of common diseases and injuries; and provision of essential drugs;

... involves, in addition to the health sector, all related sectors and aspects of national and community development, in particular agriculture, animal husbandry, food, industry, education, housing, public works, communications and other sectors; and demands the coordinated efforts of all those sectors;

... requires and promotes maximum community and individual self-reliance and participation in the planning, organization, operation and control of primary health care, making fullest use of local, national and other available resources; and to this end develops through appropriate education the ability of communities to participate;

... should be sustained by integrated, functional and mutually supportive referral systems, leading to the progressive improvement of comprehensive health care for all, and giving priority to those most in need;

... relies, at local and referral levels, on health workers, including physicians, nurses, midwives, auxiliaries and community workers as applicable, as well as traditional practitioners as needed, suitably trained socially and technically to work as a health team and to respond to the expressed health needs of the community.

... needs to support environmental health: advocating for clean energy, support for healthy life styles, encourage use of public transport and cycle ways and other ways to reduce greenhouse gas emissions for future health and wellbeing.

9. The Australian government should formulate national policies, strategies and plans of action to address known barriers young people have to accessing developmentally appropriate, affordable, acceptable and equitable primary health care. To this end, it will be necessary to exercise political will, to mobilize the country's resources and to use available external resources rationally.

10. All countries should cooperate in a spirit of partnership and service to ensure primary health care for all young people since the attainment of health by young people in any one country directly concerns and benefits every other country. In this context the joint WHO/UNICEF report on primary health care constitutes a solid basis for the further development and operation of primary health care throughout the world.

11. An acceptable level of health for all young people of Australia by the year 2020 can be attained through a fuller and better use of Australia's resources, a considerable part of which is now spent on armaments and military conflicts.

12. Media and technologies typically used by young people should be used to disseminate information about health issues and concerning decisions in which youth have a right to participate.

The Youth Health Research Interest Group (YHRIG) workshop of the GP and Primary Health Care Research Conference calls for urgent and effective national action to develop and implement primary health care for all young people throughout Australia. It urges governments, nongovernmental organisations, funding agencies, all health workers and the whole Australian community to support national commitment to primary health care for all young Australians and to channel increased technical and financial support to it, particularly in indigenous youth health.

The YHRIG workshop of the conference calls on all the aforementioned to collaborate in introducing, developing and maintaining primary health care for young Australians in accordance with the spirit and content of this Declaration. The authors of this declaration would like to establish a steering committee to move forward with action on some of the points here raised and to set a research agenda toward improving the primary health care delivery for young people.

For details, contact: Lena Sanci, email: l.sanci@unimelb.edu.au, Sam Stott, email: sam.stott[at]email.cs.nsw.gov.au or Carol Kefford, email: ckefford[at]med.usyd.edu.au

3.

'Australia's health 2008' is "THE essential reference for your bookshelf"

Australia's health 2008 is the 11th biennial health report of the Australian Institute of Health and Welfare. The 600 page publication provides a comprehensive and detailed statistical picture of what is happening in the Australian health care system. Chapter six, Health across the life stages, section 3, contains information relevant to children and young people. The AIHW media release, which contains selected highlights from the report, is at: http://www.aihw.gov.au/mediacentre/2008/mr20080624.cfm and see: http://www.aihw.gov.au/publications/index.cfm/title/10585 for the report itself. (Source: http://www.healthinsite.gov.au/news/Australia_s_Health_2008 , viewed 18 July 2008.)