Promoting Health and Wellbeing through Schools


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It highlights successful approaches for promoting health and educational goals, and provides useful advice on planning and evaluation. Promoting Health and Wellbeing through Schools is invaluable reading for professionals working in and with schools to implement healthy schools programmes and to bring about improvement in health and wellbeing, including teachers, nurses, and health and education managers. It is also of interest to students, researchers and policy-makers. Search all titles. Search all titles Search all collections.

Your Account Logout. Promoting Health and Wellbeing through Schools. Consequently, this chapter will also show how important an understanding of the perspectives of young people is for interpreting their health behaviour and for responding to their health and well-being needs. The health of children and young people 9 Children and young people in the UK Children and young people constitute a major part of the population, both globally and closer to home.

In , there were 7. Life circumstances have a profound impact on how far children and young people are able to establish and sustain their health and well-being. It has been estimated that upwards of 3.

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Socio-economic disadvantage is also strongly associated with poorer emotional health and development Graham and Power, Family and household structures have also dramatically changed, with one-quarter living in a household headed by a lone parent Coleman and Brooks, Adult health status also affects the well-being of children and young people: poor adult health has long been associated with reductions in socioeconomic status for the whole family; moreover, over 50 per cent of children with an emotional disorder have been found to have a parent who also scored very low for psychological health Meltzer et al.

Significant numbers of children and young people take on long-term informal caring responsibilities for family members, often parents Dearden and Becker, The census identified that over , children aged between 5 and 15 act as carers for family members, with 27, providing twenty or more hours a week Doran et al. Children with ill or disabled parents do not inevitably provide informal care as, again, wider social determinants play a role in structuring the responsibilities of young people.

Young carers, for example, are more likely to be found in 10 F. Brooks single-parent families and those living in poverty Dearden and Becker, , Moreover, girls are more likely than boys to have considerable caring responsibilities, and around 15 per cent of all young carers come from BME communities Dearden and Becker, A worrying finding in relation to the lives of young carers is that many report their own health to be poor Doran et al. Outside of the home and family context, school is the environment where children and young people spend most of their time.

The school setting represents a significant potential resource for health among children; enjoying school is associated with positive self-esteem, lower levels of risk-taking behaviour and higher levels of self-rated health, while a dislike of school is associated with the reverse Nutbeam et al. From middle childhood onwards, young people may spend up to one-third of their waking time with peers and friends, with the school being an important arena for the development of peer relationships Brown and Klute, Peers and friendship groups can be a major determinant of risk-taking behaviour among young people.

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Pressure to conform can create norms that lead to an acceptability of risk-taking behaviour within a group, especially substance use Settertobulte and Gaspar de Matos, Moreover, persistent relational or physical bullying can isolate and marginalise children and young people, with detrimental effects on their health.

However, having a close circle of supportive friends can be a protective health asset and young people gain considerable support and pleasure from spending time with friends. Peers can enable young people to develop social competence and successfully manage stressful situations Settertobulte and Gaspar de Matos, Even some youth sub-cultures that may appear challenging to adult definitions of appropriate behaviour can provide a protective sense of community for otherwise marginalised young people Hodkinson, Physical health, mortality and morbidity The school years, especially in economically rich countries, are generally assumed to be a time of good health.

However, ill health and disability during childhood and adolescence can have a marked effect on the attainment of life and educational goals, as well as restricting social and emotional development Currie et al. Mortality in childhood in the UK is rare and fell continually during the latter half of the twentieth century. Apart from mortality in children under the age of 1, death rates among children and young people are highest between 15 and 19 years. For example, in the UK in there were deaths of young people aged 10—14, but 1, among those aged 15—19 ONS, This increase with age is due primarily to preventable deaths, caused by injury, self-poisoning and road traffic accidents.

In the UK, just The health of children and young people 11 over 1, young people aged 15—24 years die each year as a result of accidents, and the majority are road traffic related Donaldson, Media reports abound with concerns relating to young people as a risk to others. However, in reality young people are as likely to be victims of violence as the perpetrators of harm to others.

The —7 British Crime Survey identified that just over 20 per cent of all young people aged 16—24 years, and 14 per cent of young men, had been a victim of violent crime compared to around 4 per cent of those aged 45—64 Home Office, Recent data from London indicate that one-third of all victims of rape and sexual offences are children and young people, predominantly girls aged under 17 years Greater London Authority, While violence against young people is often perpetrated by peers, in many cases individuals they may know from their community are responsible for the crime Home Office Statistical Bulletin, In , nearly 28, UK children were identified as being at risk of serious abuse from their parents or other carers and placed on Children and Young People Child Protection Registers.

Overall, violence, abuse and injury either accidental or intentional represent a significant health risk for young people. In relation to morbidity, the vast majority of health issues among the pre-school and school-aged population are managed at home under the care of parents or guardians, with only 20 per cent of all disease and illness among young people resulting in a consultation with a general practitioner Bruijnzeels et al. Consultation rates with a general practitioner among the school-aged population have remained relatively stable over the last decade at about two consultations per young person a year.

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Among young men, the consultation rate remains constant through to early adulthood; however, for young women late adolescence 15—19 years marks a doubling of general practice consultations to four per year Hippisley-Cox et al. In terms of acute health service usage, and in contrast to the adult population, emergency hospital admissions are more common than planned admissions among children and young people under the age of Moreover, across the 5—19 age group in England, the number of emergency admissions to hospital has steadily increased over the last decade from , in —7 to , in —7, an increase that has been most dramatic among the 16—19 age group Cochrane, ; Coleman and Brooks, In the main, emergency admission rates reflect the higher rates of accidents and violent injury among young people; however, children and young people are also at risk from being admitted to hospital due to a long-term or chronic condition.

Brooks Over the last ten years, the prevalence of longstanding illnesses e. The most common longstanding illness or disability among the school-aged population 5—19 years is asthma, followed by autism and behavioural disorders Nessa, In terms of understanding the prevalence and character of severe disability among young people, there is a dearth of recent reliable data. Data from does, however, indicate that the prevalence of severe disability among BME young people is disproportionate to the general UK population Nessa, The overall trend appears to indicate a decrease in the prevalence rates of both longstanding and limiting conditions among children Health and Social Care Information Centre, In contrast, there has been a rise in hospital admission rates for the three key chronic and long-term conditions that affect young people the most Coleman and Brooks, The most dramatic increase has been for asthma admissions, which among 10—19 years increased by 19 per cent to 11, in the five years between —3 and —7 Donaldson, A number of sources indicate that policies relating to the management of long-term conditions within school settings may play an important role in the health of young people.

For example, a recent study of asthma in school-aged children in two UK cities found strong evidence that peaks in hospital admissions coincide with the end of the summer school holidays and the return to school Julious et al. However, the proportions of young people reporting to have good health declines with age, and significantly so for young women. The health of children and young people 13 Emotional well-being and mental health The absence of disease is an important aspect of health, but equally the absence of distress and the presence of a sense of well-being are also central components of the best possible health Seligman and Csikszentmihalyi, Self-reported life satisfaction among school-aged children has been associated with a range of health-related outcomes such as healthy weight, physical activity levels, substance use and attainment of goals Thome and Espelage, ; Zullig et al.

Findings suggest that the majority of young people in England, Scotland and Wales report that they are happy with their lives; for example, 85 per cent of all young people included in the study from England rated their life satisfaction to be 6 or above Brooks et al.


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Levels of life satisfaction found in Britain are also not too dissimilar to levels found in the rest of Europe; for example, in the Netherlands, the highest-scoring country, 94 per cent of year-old boys reported high life satisfaction compared to 89 per cent in England Currie et al. However, life satisfaction decreases from the age of 11 years and significantly more boys than girls are reporting higher life satisfaction by the mid to late teens Currie et al.

Although the majority of children and young people report being happy and satisfied with their lives, the prevalence of conduct disorders and poor mental health among some young people has been an issue of public and policy concern Coleman and Brooks, The prevalence of any emotional, conduct or hyperkinetic disorder among young people has remained relatively unchanged over the past five years at about 12—13 per cent for boys and 9—10 per cent for girls aged 11—15 Green et al. Among the 5—11 age group, the prevalence of any disorder is much higher for boys than for girls, especially in relation to conduct of hyperkinetic hyperactivity disorders; among girls emotional disorders are more common.

The disparity between boys and girls, in relation to emotional disorders increases with age Brooks et al. Girls also report being worried by schoolwork issues, including exams and friendship and family problems, more frequently than boys of the same age Balding, Although girls and young women are more likely to report feeling low and experience low self-esteem, it is young men who are at greatest risk from extreme feelings of hopelessness and suicide, with older young men being most at risk Bradford and Urquhart, Suicide among the younger school-aged population is rare, but among the 15—24 age group this figure for jumps to , the overwhelming majority of whom were male Samaritans, However, the suicide rates in the UK for young men do appear to be gradually reducing, so that in the rate for young men aged 15—24 was the lowest for a decade and 14 F.

Life circumstances and the experience of abuse and neglect play a role in the emotional well-being of children. In terms of the sources of support for emotional well-being, there is evidence that relatively fewer young people look to general practitioners as a means of support. Churchill et al. Instead, young people appear more likely to turn to family and friends as a means to address negative and distressing feelings Balding, The remainder of the chapter will therefore attempt to offer this more balanced perspective, looking at some of the health issues that are examined in more detail later in this book.

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Sexual health Sexual health is an essential component of well-being and encompasses the concept of a positive, pleasurable and safe sexual relationship World Health Organization, During the teenage years, sexual health is often seen as a cause for adult anxiety, due to the potential for a clash with dominant societal norms, as well as possible exposure to unplanned pregnancy and sexually transmitted infections STIs. The health of children and young people 15 Early sexual intercourse is one element of a set of health risk behaviours, each of which may reinforce other risk-taking behaviour and put the individual at increased risk of negative outcomes, including pregnancy, STIs and negative self-rated life satisfaction Godeau et al.

Sexual initiation during the early years of adolescence is associated with other risk behaviours such as substance use, most notably alcohol use Robertson and Plant, Moreover, sexual initiation earlier than age 14 is linked with lower self-rated quality of life in girls and higher levels of psychosomatic health complaints such as regular headaches, stomach aches and feeling low Currie et al. In terms of the prevalence of both early sexual initiation and sexual experience, young people in England, Scotland and Wales are comparable in their behaviours with those in other Northern European countries, with a number of studies concluding that around 20—30 per cent of year-olds report ever having had sex Brooks et al.

Experience of first sexual intercourse under 16 years has been found to be higher in some groups such as Black African Caribbean boys 43 per cent and lower among Asian boys 12 per cent and girls 4 per cent Testa and Coleman, Prevention of unintended pregnancy and STIs has been a central component of public health strategy within the UK. A recent study looking at sexual activity among young people in London found that the majority of sexually active young people do appear to use contraception, with non-use during first-ever sexual intercourse reported to be in the region of 17 per cent Testa and Coleman, However, there appear to be important variations by socio-economic status, with those from more affluent backgrounds being more likely to use contraception than other economic groups Brooks et al.

Variations have also been found between ethnic groups; non-use of contraception during first-ever sexual experience is more likely among Black African teenage men than White British young men. Although fewer Asian young people report ever having sex, among those who do use contraception much higher proportions of males and females reported not using any method of contraception than White British young people Testa and Coleman, The use of the contraceptive pill is highest in Western European countries, such as the Netherlands, where 61 per cent of sexually active year-old girls reported using the contraceptive pill the last time they had sexual intercourse compared to 23 per cent of sexually active girls in England Currie et al.

Condom use is more frequently reported by boys and is highest in Southern European countries such as Spain, Portugal and Greece, with between 85 and 95 per cent of young people reporting using a condom the last time they had sexual intercourse Currie et al. Condom use is also high among sexually active teenagers in England 82 per cent, both genders , Scotland 78 per cent and Wales 75 per cent Brooks et al. Brooks Over the last decade, there has been considerable policy attention given in England to a reduction in the teenage pregnancy rates.

In the UK, statistical data over the decade since suggests a general downward trend in the teenage conception rate and a respective rise in terminations TPU, However, among the most vulnerable teenagers conception rates remain high.


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  • For example, looked after young women are twice as likely to become pregnant under 18 as other teenagers, and it is estimated that one in four girls leaving care are already mothers or pregnant SCIE, New diagnoses of infectious syphilis are somewhat low in the UK, amounting to about cases a year in under 16s and 16—year-olds combined HPA, Gonorrhoea rates are higher, with over 30, new cases among young people each year, although recent data since —3 indicate a downward trend in new infection rates HPA, In terms of supporting the development of sexual health among young people, greater levels of understanding and knowledge need to be developed to fully understand how young people can develop positive value frameworks that lead to mature, pleasurable sexual relationships Ingham, Alcohol and substance use The UK has consistently been identified as having higher numbers of young people drinking alcohol regularly and to the point of drunkenness than many other countries in Europe and North America Currie et al.

    Although the proportion of young people who report having drunk alcohol in the previous seven days appears to have fallen slightly since Fuller et al.

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    Promoting Health and Wellbeing through Schools

    Children and adolescents are especially vulnerable to alcohol poisoning due to a lower body mass and metabolic processing of alcohol, and over the last decade excessive alcohol consumption has resulted in an increasing The health of children and young people 17 number of under year-olds being admitted to hospital for an alcoholrelated condition, and in particular alcohol poisoning Miller et al. Potentially, reflecting a shift in risk-taking behaviour among young women, girls in the UK, unlike in the majority of other European countries, have either achieved parity with boys in terms of frequency of drunkenness or are slightly more likely to report at age 15 having been drunk than boys of the same age Currie et al.

    Significantly, there were more female alcohol-related hospital admissions than male in —5 57 per cent of admissions were female , a pattern that occurred consistently across all regions of the UK NWPHO, Apart from alcohol consumption, levels of substance misuse and smoking among young people in the UK appear to be on a downward trend Hibell and Guttormsson, ; The Information Centre, a.

    Smoking in particular is less prevalent among children and young people in the UK than in other European countries, with 22 per cent reporting having smoked a cigarette in the previous 30 days compared to a 29 per cent European average Hibell and Guttormsson, In , 19 per cent of girls and 12 per cent of boys in England were regularly smoking at least once a week; however, this represents a significant reduction from the rates two years previously of 25 per cent for year-old girls and 16 per cent for boys Fuller, ; The Information Centre, a. Use of cannabis can also be seen to be relatively common among the UK school-aged population, with about one-third of young people reporting that they have tried the drug Currie et al.

    Aside from cannabis, the proportion of school-aged pupils who use any form of drug, including class A drugs and other drugs such as solvents, is relatively low in the UK, accounting for 6. Consequently, it is important that rates of smoking are reducing among young people in the UK, but also especially concerning to note is the high level of alcohol consumption, especially the increase among girls. Overall, levels of substance misuse among girls in the UK now mirror those of boys and we are seeing the serious consequences of this pattern, with high levels of alcohol hospital admissions among young women.

    Brooks Physical activity, healthy diet and healthy weight Active lifestyles have been demonstrated to have an array of positive impacts on the health and emotional well-being of children and young people Brooks and Magnusson, In the UK, identifying and promoting ways to sustain an active lifestyle among children has become a policy priority.

    Studies have found that around 15 per cent of year-old boys but 30 per cent of girls are undertaking significantly less than the recommended one hour of any moderate physical activity a day Craig and Mindell, Moreover, participation in any sport or exercise, while dropping by about 10 per cent for boys, declines for girls from 75 per cent participation at age 10 years to 45 per cent at age 15 Craig and Mindell, Although the causes of such gender differences are complex, findings suggest that the character of physical activity provision for girls warrants detailed consideration.

    Quality of nutrition is key to the health and development of young people. In , 11 per cent of children aged 2—15 in England were classified as clinically obese.

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    One decade later, in , this figure had risen to 16 per cent, with more boys 17 per cent than girls 15 per cent being likely to be obese.

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