The health of young Australians

COMMUNITY VIEWS ON YOUTH HEALTH tend to be polarised and contradictory. On the one hand, adolescents are seen as having few overt health needs: mortality is low by comparison to that in older groups, and most young people, and their parents, rate their health as good. On the other hand, the emergence in recent decades of youth suicide, drug abuse and new infectious diseases (eg, HIV) has elicited strong and sometimes conflicting opinions about moral and social threats to young people's health. Individualism, a growth in permissiveness, and a decline in religious affiliations have all attracted debate. The recent report Australia's young people: their health and well-being 1999,1 from the Australian Institute of Health and Welfare (AIHW), provides some clarity. It follows an earlier report on child health! and gives the first comprehensive national picture of the health of young Australians. In general, Australian youth remain healthy, and retain a positive view of their health. Some health trends are positive: overall mortality in young people in the 1990s was at historically low levels (mostly due to the substantial reductions in motor vehicle deaths in the previous two decades); and rates of teenage pregnancy were low compared with those of other First World countries. However, new threats to youth health have emerged: • Mental and behavioural disorders are increasingly recognised as affecting youth disproportionately and account for over half their disease burden. • With the changing profile of infectious disease, newer bloodborne and sexually transmitted diseases have become prominent, with threefold higher notifications of both chlamydia and hepatitis C. The prevalence of syphilis has declined further, but gonorrhoea notifications have doubled. • Shifts in young people's lifestyle carry implications for health later in life. Tobacco use remains obstinately high, with 40% of young adults continuing to smoke. Physical activity declines across the teens, so that fewer than a third of women aged 20-24 years take part in regular, moderate to vigorous physical exercise. Moreover, 22% of 15-24 year olds already have a body mass index in the overweight or obese range for adults. • Some groups have disproportionately high levels of health problems. Low socioeconomic status is linked to higher death and hospitalisation rates, as well as to lower self-rating of health. Recent death rates for young Aboriginal and Torres Strait Islanders are close to three times higher in males and twice as high in females compared with rates for non-Indigenous youth. High levels of mental disorders and substance abuse are major contributors at one level, but the fundamental causes are more likely to be found in social and economic conditions, the loss of cultural identity and the disaffection of youth in many of these communities. The report's findings will inevitably prompt questions about current health provision for young Australians. At present, young people's primary care attendances, for example, are mostly for relatively minor respiratory conditions, musculoskeletal problems or acne. The conditions contributing to the disease burden in young people are less common reasons for