7.1 General context
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Children and young people represent the healthiest group of the population. Their health has continuously improved since the beginning of modern health care. The reduction of infant and child mortality as well as the containment and improved treatability of communicable diseases have had a major impact on this development. However, for some years the slowing of this trend and even a tendential trend inversion have been observed. Above all, chronic diseases (e.g., atopic diseases, cancer and diabetes), musculoskeletal disorders, psychological disorders (anxiety disorders, depressive disorders) as well as behavioural and developing disorders (ADHS, circumscribed developmental disorders) seem to have increased. They are discussed under the term 'modern morbidity' and represent a health-political as well as a macrosocial challenge.
The living conditions of children and young people are of particular importance. They influence their health behaviours, attitudes, convictions and values as well as their competence. According to Statistik Austria, in 2019 14.9% of children and youths under the age of 17 and 14.9% of young adults between the ages of 18 and 24 were considered at-risk-of poverty after inclusion of social transfer paxments (compared to 19.5% of people under the age of 17 before inclusion of social transfer payments). In the group of young adults, a significantly higher number of women was considered at risk of poverty, with 16.7% in comparison to 13.1% of their male contemporaries (see Chapter 4.1 for more details on social inclusion).
Both the development of individual health competence and the guaranteeing of a healthy environment are crucial to children's and youth's short and long term health. According to the Working Group on the Austrian Health Targets (Umwelt und Gesundheit - Eine kommt selten allein / Environment and health - one rarely comes alone), environmental pollution can be detrimental to health in various ways:
- Chemical pressures (e.g. the release and spread of pollutants in the air, water, soil, food chain, everyday products such as cosmetics, and the human body)
- Physical pollution (e.g. noise, particles or radiation)
- Biological pollution (e.g. moulds or blue-green algae)
Child and Youth Health Report
The Child and Youth Health Report (Österreichischer Kinder- und Jugendgesundheitsbericht) has been first published in January 2016 (reporting year 2015). It accompanies the Child and Youth Health Strategy and provides information on the health situation of children and adolescents based on available data. In doing so, it addresses individual and social health determinants, focuses on the topic of equal opportunities, and highlights challenges and problem areas by means of international comparisons, thus providing important points of reference for the development of counter-strategies and the setting of priorities in health policy. The report gives a detailed overview of the situation of young people’s health in Austria. It inter alia states:
- The self-estimated state of health and the general life satisfaction are problematic for 11 percent of male pupils and for 13 percent of female pupils.
- 22 percent report about two or more different symptoms which occur several times per week, most commonly problems falling asleep and irritability.
- Boys are treated more often in a hospital than girls. The most frequent causes for inpatient stays in hospital are injuries and illnesses of the respiratory organs. The hospital frequency is steady since the beginning of the 1990s.
- The number of people suffering from cancer is slightly rising (14 new cases per 100,000 in 2011), the relevant mortality, however, falling (2.8 per 100,000 in 2014). The most frequent tumor type among children and young people is leukaemia.
- Psychological diseases have become increasingly common among boys and girls.
- Eating disorders have remained steady.
- Suicide rates decreased. According to Laido, Z., Voracek, M., Till, B. et al., the total average suicide rate for Austrian minors (10-19 years) was 4.57 per 100,000. The male:female-ratio was 3.5:1. The total youth suicide rate significantly declined from 2001 to 2014.
- The incidence of diabetes increases. In 2007, 18.7 new cases per 100,000 were registered among 0 to 14-year-olds.
- According to literature, atopic diseases are increasing. About 5% of the 6 to 7-year-olds suffer from asthma and/or hay fever, twelve percent suffer from neurodermitis.
- Action is required in the field of dental health. Only 50% of 6-year-olds are 80%-caries-free.
- The prevalence of developmental delays can be estimated only roughly: 10% of the 4 to 7-year-olds have language problems, 6-15% of the 6 to 12-year-olds (depending on the severity) show problems with skills at school. About 25 percent of the 4 to 5-year olds show motoric anomalies.
- 4% of all family allowance receivers obtain raised family allowance due to severe disability, with a rising trend.
- About 17% of pupils suffered from more than one injury that needed medical care during the past 12 months prior to being surveyed. Each year about 50,000 injuries are treated by inpatient care; a steady trend for the last 20 years. Deadly injuries are clearly decreasing (about 120 in 2014).
- The total mortality is declining.
Austria has a health care system based on solidarity. It aims to ensure high-quality medical care for everyone, independent of their social status or income.
Austrian Health Targets
The 10 Austrian Health Targets have been developed with the aim to prolong the healthy life years of all people living in Austria, irrespective of their level of education, income or personal living condition. They were officially approved by the Federal Health Commission (Bundesgesundheitskommission) and the Council of Ministers in 2012. They are mentioned in the government program and are an important basis for the health reform process. The following are the objectives:
- To provide health-promoting living and working conditions for all population groups through the cooperation of all societal and political areas.
- To promote fair and equal opportunities in health, irrespective of gender, socio-economic group, ethnic origin and age.
- To enhance health literacy in the population.
- To secure sustainable natural resources such as air, water and soil and healthy environments for future generations.
- To strengthen social cohesion as a health enhancer.
- To ensure conditions under which children and young people can grow up as healthy as possible.
- To provide access to a healthy diet for all.
- To promote healthy, safe exercise and activity in everyday life through appropriate environments.
- To promote psychosocial health in all population groups.
- To secure sustainable and efficient health care services of high quality for all.
The main health strategies are
- the Health Reform Process,
- the Health Promotion Strategy and
- the Health Strategy for Children and Young People.
Health Strategy for Children and Young People (Kinder- und Jugendgesundheitsstrategie)
In 2010, the Children’s Health Dialogue was started by the then Federal Minister of Health. It led to the development of the Health Strategy for Children and Young People in 2011, which since then has been monitored and developed further. The current version of the strategy (last updated in May 2017) covers 5 topics and is subdivided into corresponding aims:
1. Societal framework
- Aim 1: Strengthen consciousness for special needs of children and young people
- Aim 2: Strengthen consciousness for the cross-cutting responsibility for health ('Health in all Policies')
2. Healthy Start to Life
- Aim 3: Provide the base for a good start at pregnancy and birth
- Aim 4: Build a solid foundation for long-term health in early childhood
3. Healthy development
- Aim 5: Strengthen life competence of children and young people
- Aim 6: Use education as the central influence factor on health
- Aim 7: Promote exercises for children and young people
- Aim 8: Promote a healthy diet of children and young people
4. Equality in health
- Aim 9: Promote equality in health of socially disadvantaged persons
- Aim 10: Promote equality children and young people with health disadvantages
- Aim 11: Improve early diagnosis and specific support for children and adolescent
5. Care of sick children and young people in specific areas
- Aim 12: Optimise outpatient initial treatment and improve edge times and weekends
- Aim 13: Strengthen paediatric competence in emergency care
- Aim 14: Make care in hospitals more child-friendly
- Aim 15: Improve care in selected fields (child and youth psychiatry, psychosomatics, neuro paediatrics and social paediatrics)
- Aim 16: Improve integrated care of 'modern morbidity'
- Aim 17: Adapt neonatal care to the changed demographic circumstances
- Aim 18: Improve rehabilitation programmes for children and young people
- Aim 19: Guarantee paediatric care and expand children's hospice care and palliative care
- Aim 20: Improve availability of pharmaceutical drugs appropriate for children
Several national and regional measures and their progress are combined in the strategy. The regular updates of the strategy are a quality assurance and monitoring tool.
Austrian Children's Environmental Health Action Plan
Protecting the environment and the population from burdens caused by biological, chemical, and physical pollutants is important for healthy development and health care. Thus, the Austrian Children's Environmental Health Action Plan (Kinder-Umwelt-Gesundheits-Aktionsplan für Österreich) has been developed. It is based upon four priorities:
- ensuring the supply of clean water and good sanitary conditions
- preventing accidents and ensuring that children have sufficient physical activity through child-friendly urban and transport planning
- ensuring clean outdoor and indoor air
- preventing exposure to hazardous agents
Around 99.9 per cent of the population are estimated to be compulsorily insured, self-insured or co-insured due to their status as dependents in the statutory health insurance system. They are entitled to benefits in kind and cash by law (Soziales: Hilfe für nicht krankenversicherte Personen). On the other hand, according to AmberMed’s annual report 2017, 0.5 % of the people living in Austria (or more than 100,000 people) may not have a valid health insurance. Charitable institutions offer unbureaucratic and free medical care for people who do not have health insurance (e.g. AmberMed, which is run as a cooperation between the Diakonie and the Austrian Red Cross and is partially financed by public funds from the Vienna Regional Health Insurance Fund, the Vienna Social Fund and the Federal Ministry of Health and partially relies on private donations).
Young people are usually co-insured with their parents for free until their 18th birthday. Up to their 18th birthday, young people count as dependants. After graduation from school, the co-insurance is not automatically extended and therefore a risk for young people. It is however extended in cases where the young adult is unable to work because of illness or infirmity or is unemployed, as well as alongside family allowance up to the age of 24 if the young adult seriously pursues further education (e.g. university). For all circumstances, documentation is required. More information about co-insurance is provided by the Austrian Health Insurance Fund.
Persons not covered by compulsory statutory health insurance and resident in Austria can insure themselves (self-insurance) at a cost of around € 450 / month.