National improvement framework for Scottish education: evidence report 2017

Key Priority: Improvement in children and young people's health and wellbeing

One of the aims of the National Improvement Framework is to improve children's and young people's health and wellbeing. There are many aspects to children's health and wellbeing, which the Getting it Right for Every Child approach defines as the SHANARRI indicators: Safe, Healthy, Achieving, Nurtured, Active, Respected, Responsible, and Included.

Families, communities and schools all influence these aspects. This chapter shows some of the main findings from recent data on aspects of children and young people's wellbeing that closely relate to the school environment: physical health and health behaviours, life satisfaction and wellbeing, relationships with peers, parents and teachers, experience of the learning environment, and leisure time.

This data is drawn from a range of surveys. The Scottish Government is continuing its work to review the existing health and wellbeing data collections and investigate the possibility of a new Scottish children and young people's health and wellbeing survey. It is anticipated that in future years this survey will be used as a key source for evaluating progress in health and wellbeing and for monitoring differences between those from the most and least deprived areas.

General Health

Each year in the Scottish Health Survey, participants aged 13 and over are asked to rate their health in general with answer options ranging from 'very good' to 'very bad'. For children under the age of 13 the question is answered by the parent or guardian completing the interview on their behalf.

Results from combining data from the Scottish Health Surveys conducted in 2015 and 2016 show that:

• 95% of children aged 0-15 continued to report to be in 'very good' or 'good' health in 2015/16.
• Overall, girls were more likely than boys to report 'good' or 'very good' general health ( 97% of girls, compared with 94% of boys).

Self-assessed health varied significantly by age with reported levels of 'good' or 'very good' health being lower among older children aged 14-15 ( 91%), compared with children aged 0-13 ( 95-98%). This finding could in part be explained by the survey design which involved asking parents of children aged 0-11 about their child's health status, and asking children aged 12-15 directly.

The pattern by age was different for girls and boys, with more fluctuation in rates for boys than girls. Furthermore, parents of younger girls (0-7) were more likely to report they had 'good' or 'very good' health than parents of boys in the same age range ( 97-98% for girls compared with 91‑96% for boys).

Long-Term Conditions

16% of children (aged 0-15) in 2016 had at least one long-term health condition. This proportion was comprised of 8% of children that had non-limiting condition(s) and 7% that had at least one limiting long-term condition.

Boys were significantly more likely than girls to have any form of long-term condition ( 18% and 14% respectively) as well as at least one limiting long-term condition ( 9% and 6% respectively).

Unpaid Caring

3% of children aged 4-15 in 2016 were providing regular, unpaid care to a family member, friend or someone else. There was little difference by gender ( 3% of boys, compared with 2% of girls providing care overall).

However, older children were much more likely to provide unpaid care than their younger counterparts ( 5% of those aged 12-15 compared with 1% of those aged 4-11).

The proportion of boys caring varied significantly by age, with boys aged 12-15 being the mostly likely to provide care ( 7%).

The difference between caring prevalence and age for girls was not significant ( 2% among girls aged 4-11 and 3% among girls aged 12-15 providing care).

Respiratory Health

This section looks at the self-reported lifetime prevalence of doctor-diagnosed asthma, wheezing or whistling in the chest in the last 12 months (referred to in the text as wheezing in the last 12 months), and lifetime wheezing.

10% of children aged 0-15 in 2016 reported having doctor-diagnosed asthma, unchanged since 2015, confirming the pattern of reduced prevalence since the start of the time series in 2003 ( 16%)

In 2016, the prevalence of doctor-diagnosed asthma was similar for boys and girls ( 10% and 9% respectively).

Prevalence of doctor diagnosed asthma fell for boys between 2003 ( 20%) and 2016 ( 10%) to a similar level to that for girls. Prevalence for girls fluctuated between 9% and 12% over the same period; 9% in 2016.

The prevalence of wheezing in the last 12 months for children was 13% in 2016; this has remained relatively constant since 2003 ranging between 12-14%. Similarly, rates of having ever wheezed remained relatively steady at 23%, having fluctuated between 21% and 25% since 2003.

Prevalence of wheezing in the previous 12 months was similar for boys and girls ( 15% and 12% respectively), with little change among girls since 2003 ( 11-12%) and some fluctuation for boys since 2003 ( 13-17%).

Prevalence of ever having wheezed has shown little change over time with higher levels for boys ( 24-29%; 26% in 2016) than girls ( 19-22%; 19% in 2016).

Physical Health

98% of schools ( 99% of primary and 93% of secondary schools) were meeting the target level of PE provision, the same as in 2016. More information can be found in the Summary Statistics for Attainment, Leaver Destinations and Healthy Living publication.

The Scottish Health Survey provides information in relation to children's physical activity.

Just over three quarters ( 76%) of children aged 2-15 were active at the recommended level (including activity at school) in 2016, representing a statistically significant increase of five percentage points since 2008.

This general trend of increased physical activity levels (including activity at school) was apparent for girls where it increased from 64% in 2008 to 72% in 2016. For boys the trend pattern was less clear fluctuating between 73% and 79% during the time period.

68 % of children aged 2-15 had participated in sport in the week prior to interview, continuing the relatively stable trend since 2010 (ranging between 70% and 66%) following a drop from 73% in 2009.

Younger children were more likely than older children to meet the physical activity guidelines, ( 82% of 5-7 year olds doing so, compared with 61% of those aged 13-15, school-based activity included).

Proportion of children meeting physical activity guideline over an average week, (including activity at school), by age and gender, 2016

Children's physical activity levels varied by area deprivation, although there was no clear pattern of association.

Proportion of children meeting physical activity guideline over an average week, (including activity at school), by area of deprivation, 2016

Activities In and Out of School

In the 2016 Scottish Survey of Literacy and Numeracy (SSLN) pupil questionnaire ,

• 20% of P4, 15% of P7 and 10% of S2 pupils reported that they ' Go to a library or mobile library' 'very often' outside of school time.

• 33% of P4, 30% of P7 and 40% of S2 pupils reported that they ' Read using an electronic device ( e.g. Kindle, tablet, smartphone)' 'very often'.

• 21% of P4, 25% of P7 and 31% of S2 pupils reported that they ' Read online ( e.g. web pages, blogs)' 'very often'.

• 44% of P4, 33% of P7 and 22% of S2 pupils reported that they ' Read storybooks (novels) for enjoyment' 'very often'.

The most popular activities outside of school, as reported by primary pupils over five SSLN surveys, were ' I play or talk with friends' or ' I play sports'.

P4 pupils reported over 70% played and talked to friends 'very often' whereas for P7 pupils this was nearly 80%. Between 62% and 66% of primary pupils reported they played sports 'very often' over the five years.

For S2 pupils, these were also the most popular choices with over 70% of pupils reporting that played or talked with friends, though responses to playing sports was lower than primary pupils ranging from 51% to 53%.

The proportion of pupils who report watching television and DVDs has declined between 2011 and 2016 for all three stages to around a third of P4 and S2 pupils and to about a quarter of P7 pupils.

This may be due to the increase in television and film content being viewed or streamed online, following the growth of the availability of these services since the beginning of the decade.

P7 and S2 pupils were most likely to use computers, tablets, etc. to do topic or project work. 53% of P7 pupils and 45% of S2 pupils reported they did this 'very often'.

The highest reported use of ICT by P4 pupils was completing work on their own ( 50%).

S2 pupils reported that they were most confident using ICT to find out information/carry out research and for typing or editing work ( 95% and 93% respectively).

A lower proportion of pupils across all stages reported they were confident creating tables and charts: 72%, 75%, 78% (P4, P7 and S2 respectively).

Diet

The Scottish Health Survey provides information on fruit and vegetable consumption among adults and children.

In 2016, 13% of children aged 2-15 met the 5-a-day fruit and vegetables recommendations on the previous day, the proportion remaining relatively stable since 2008.

9% of those aged 2-15 ate no fruit or vegetables on the previous day.

In 2015/16, there were significant differences in the proportion of children meeting the 5-a-day guidelines on the previous day by gender, with 15% of girls and 11% of boys meeting the guideline. There was no clear pattern by age group (ranging between 11% and 15%).

However, there was a pattern by age group for the percentage of children eating no fruit or vegetables the previous day. Among children aged 2-4 a comparatively low 4% had eaten no fruit or vegetables the previous day. However, those aged 11-15 were most likely to have eaten no fruit or vegetables on the previous day (at 12%).

Percentage of children (2-15) eating 5+ portions of fruit and vegetables and no fruit or vegetables on previous day, by age, 2016

School Meals

The Healthy Living Survey conducted in 2017 showed that:

• 37.6% of pupils were registered for free school meals ( 37.8% in 2016).
• 81.0% of those registered for free school meals and present on the survey day took a free meal ( 81.5% in 2016)
• 56.9% of those pupils present on the survey day took a meal (free or paid for) supplied by the school ( 58.1% in 2016).

Obesity

The Scottish Health Survey provides information on obesity among children.

In 2016, the prevalence of children aged between 2 and 15 in the healthy weight range was 70%. Trends in children who are a healthy weight have remained fairly stable since 1998, with the lowest prevalence occurring in 2011 ( 65%) and the highest in 2015 ( 72%).

Following the trend for all children, healthy weight prevalence amongst both boys and girls has remained relatively steady since 1998. The prevalence of healthy weight in boys had been on the rise since 2011, falling only in 2016 to 70% (down from 73% in 2015).

29% of children were at risk of overweight, including obesity. This has remained relatively stable since 1998.

14% of children were at risk of obesity, the same as in 1998. However, prevalence has been steadily decreasing since 2014, (from 17% in 2014 to 14% in 2016).

In 2015/16, prevalence of children in the healthy weight range was significantly associated with area deprivation; however the pattern did not follow a clear gradient. However, the prevalence of children at risk of obesity was not significantly associated with area deprivation.

Proportion of children in the healthy weight range or who were at risk of obesity, by area of deprivation, 2015/16

Children's Exposure to Second-Hand Smoke

The Scottish Health Survey provides information about the prevalence of

children's exposure to second-hand smoke. In 2016,

• 11% of children lived in accommodation in which someone regularly smoked inside, compared to 19% in 2012. A higher percentage of boys were affected ( 12% of boys compared to 9% of girls).
• 7% of children were reported to have been exposed to second-hand smoke in their home, compared to 12% in 2012. This percentage was the same for boys and girls.

There was a marked gradient by area deprivation for children who lived in accommodation in which someone smoked inside (from 3% for those living in the least deprived areas to 23% for those living in the most deprived areas).

Similarly, the percentage of children reported to have been exposed to second-hand smoke at home varied across area deprivation quintiles. For those living in the least deprived quintile areas, 1% of children were reported to be exposed to second-hand smoke in their home whereas the figure was 15% for those living in the most deprived quintile areas.

Experience of the Learning Environment

Attitudes to Learning

In the 2016 Scottish Survey of Literacy and Numeracy (SSLN) pupil questionnaire ,

• 96% of pupils in P4 agreed a lot or a little with the statement ' I want to do well in my learning', 97% in P7 and 96% in S2.

• 94% of pupils in P4 agreed a lot or a little to the statement that ' I try to find out the answers on my own', 96% in P7 and 93% in S2.

• 15% of pupils in P4 agreed a lot or a little to the statement that ' I don't like learning', 16% in P7 and 21% in S2.

  There was no significant difference for P7 and S2 to 2011 reported results, whereas there was a small increase of four percentage points for P4.

• 40% of S2 pupils agreed with the statement that ' Learning is boring', compared to 25% at P7 and 16% at P4.

  The result for S2 pupils has always been at least double that of P4 pupils across all six SSLN surveys (2011 – 2016).

Overall Opportunities for Children to Play

Every two years, the Scottish Household Survey provides an overview of the types of play areas available for children to play in, followed by perceptions of adults on how safe it is for children to play there. Findings in 2016 are generally similar to those in 2014 when these questions were last included in the survey.

92% of households with children aged 6 to 12 years old have access to play areas within their neighbourhood. Around two thirds have access to a park ( 65%), whilst over half have access to either a playground ( 56%) or field or other open space ( 53%).

There are some differences based on the level of deprivation in urban areas. In particular, of those households within the 20% most deprived urban areas of Scotland, only a third ( 36%) say there is a natural environment or wooded area in their neighbourhood, compared to half of households ( 50%) in the rest of the urban areas of Scotland.

There is evidence of greater variation in access to play areas for children when comparing urban to rural areas. As expected, a higher proportion of households in rural areas have access to either fields or other open space ( 62%) or natural environment / wooded areas ( 72%) than urban areas ( 51% and 46% respectively). Conversely, a higher proportion of households in urban areas have access to a park ( 67%) in comparison to rural areas ( 55%).

Children's Safety

Generally, households within rural areas are more likely to say children would be very or fairly safe when walking or cycling to play areas on their own compared to urban areas.

Furthermore, those in rural areas are generally more likely to say they think it is very or fairly safe for children to go to play areas with two or three friends than those living in urban areas.

However, across all urban and rural areas, the overall feeling of safety for playgrounds, parks and football or other games pitches is higher when children are going with two or three friends than they are when travelling alone.

Those from rural areas are less concerned about bullying by other children compared to those from urban areas across all types of play areas,

Furthermore, households in the 20% most deprived urban areas of Scotland are generally more concerned about bullying by other children compared to other urban areas.

There is a similar level of concern amongst householders of children being harmed by adults whilst playing in play areas. Households in urban areas are much more likely to be concerned about the safety of children being harmed by adults across all play areas than households in rural areas.

The average youngest age that most households consider it safe for a child to play in each of the different play areas without supervision is around 9 or 10 years of age.