Child and adolescent health and wellbeing: evidence review

10. Summary

This paper has reviewed the wide evidence base on health and wellbeing of children and young people in Scotland. This chapter highlights areas of success, where outcomes for young people are positive, or going in the right direction, and areas for improvement, which may usefully be picked up in policy development going forward.

This paper has reviewed each measure individually, but it is worth bearing in mind that many outcomes are interrelated and that many measures, as well as being outcomes in their own right, will also be risk factors or contributors to other outcomes. Additionally, young people who experience one negative outcome are more likely to experience others, and these often compound each other.

Areas of success

One area where significant progress has been made is smoking in the ante-natal period and early years. Both maternal smoking during pregnancy, and babies' exposure to second hand smoke have shown a substantial drop.

Substance use among young people has also reduced very substantially. Smoking has displayed the most substantial drop, but alcohol and drug use have also more than halved over the last decade.

Another area where outcomes are moving into the right direction is children's safety. Fewer young people are now involved in fights, and referrals for offending behaviours have also displayed a substantial reduction over the last decade. Hospital admissions for accidental injury have dropped substantially, and the number of child deaths has also fallen, particularly among children under the age of one and teenagers.

A final area of positive performance is in educational qualifications and positive destinations. A very large majority of young people in Scotland now leave school with at least one SCQF Level 4 qualification and are in education, training or employment 9 months after leaving school. Young people's views of support given by teachers also reflect positively on Scotland in international comparisons.

In all these areas there is room for further improvement, but the trends suggest that current policy activity and/or wider societal trends are developing in the right direction.

Possible areas for future action

There are a number of broad areas where outcomes for young people are less positive, or show substantial room for improvement. Many of these are interrelated.

In the early years, while breastfeeding rates have increased over time, they remain low in international comparison and also continue to display a substantial gap by area deprivation. Maternal obesity during pregnancy has also increased year on year since it was first recorded and again displays a strong deprivation gap.

Obesity is also increasing among children, which is likely to be partly because diet falls short of recommended good practice, with just over one in ten children eating the recommended five portions of fruit and vegetables and only two thirds eating breakfast every day. A substantial minority of children also do not meet the recommended guidelines of 60 minutes of physical activity per day.

The poor performance on diet and physical activity is also likely to contribute to falling levels of mental wellbeing, another source for concern. Many mental wellbeing measures - WEMWBS, SDQ and confidence - have shown a worsening position in recent years. This overall time trend is driven by change among girls, with little change among boys. Girls display lower levels of wellbeing than boys on all measures considered. This gender gap may be related to substantial gender gaps in measures that drive mental wellbeing, such as participation in sports and pressure of school work. Other factors such as social media use, on which there is currently no national cross-sectional data, may also be important. The gender gaps widen particularly among the older ages, and mental wellbeing also decreases with age, highlighting the importance of the teenage years.

Another driver of mental wellbeing is around relationships, and here Scotland also shows room for improvement. Looking at peer relationships, only around six in ten pupils report high levels of peer support, and that their classmates are kind and helpful. This is lower than the international average. Regular bullying is also experienced by 15 per cent of pupils, higher than the international average.

Regarding family relationships, a substantial proportion of between two and five in ten, depending on the measure, do not report good relationships with their parents. Scotland performed poorly in family relationships compared with the international average. Family relationships worsen with age throughout childhood on all measures. Public attitudes to young people also show that only a minority of people in Scotland hold positive attitudes to young people. For a significant number of young people, particularly young men, this means they have poor relationships with their peers their family and the wider society, suggesting their resilience and future wellbeing is severely compromised.

While progress in school qualifications and positive destinations measures are very positive for Scotland, the substantial area deprivation gap within this remains a concern. Teacher judgement data on attainment also shows that a notable percentage of between 15 and 30 per cent of pupils, depending on subject, do not achieve the given CfE level; and this data also shows that achievement drops off substantially throughout primary school, only picking up at secondary school.

A final area of concern to note is that child poverty has increased since 2011/12, with a quarter of children now living in relative poverty after housing costs. Poverty is a structural factor that is closely related to a wide range of negative health and wellbeing outcomes, and also has an independent long term effect on outcomes into adulthood. A large number of outcomes discussed in this review also vary substantially by area deprivation, highlighting the importance of understanding the interaction between place and different inequality gaps and of seeking to address them holistically.