7.1 General context
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The Department of Public Health of the University of Ghent assesses the state among of young people every four years. This survey is part of the international study Health Behaviour in School-Aged Children (HBSC) and carried out under the supervision of the World Health Organisation (WHO).
Health and psychosomatic complaints
Health is defined as a ‘resource for living a productive life’ in the WHO international study HBSC of WHO.
In 2014 in Flanders, the majority of young people believes that they have good health according to the survey of the Department of Public Health of the University of Ghent (Factsheet Subjectieve gezondheid). More males than females indicate that they have good health: respectively 83,2 per cent and 75,7 per cent. The survey also mentions that young people in vocational training and technical secondary education are less capable of estimating their health.
With regard to health problems, young people mention sufferring from sleeping problems. More females than males suffer from headaches, nervousness and backache. The survey revealed that the prevalence of health problems has increased compared to 2010. However, the prevalence of medication for this complaints has been decreased.
We see an evolution over the years. In the sixth national health survey in 2018, commissioned by all ministers with competence in public health, almost one in four (23%) in the population aged 15 and overrated their health as moderate to very poor. There is also an increase in conditions affecting young people: asthma, allergies, long-term fatigue and depression. In the population aged 15 years and over, 23.3% indicate that they suffer from a long-term disease. This percentage rises sharply with age and is higher among women, the low-skilled and in the Walloon Region.
According to official Eurostat statistics in 2018, which compare some thirty countries, Belgium is the second country after Iceland to have the highest number of young people (15 to 24 years) taking prescription drugs. The Belgian percentage is one and a half times higher than that of neighbouring countries such as Germany and the Netherlands. A new study by the Independent Health Insurance Funds confirms that: in 2016, 55% of the young people (12 to 18 year olds) in our country took at least one prescription drug.
Physical activity and nutrition
Less than 10 percent of the Flemish youth, aged 6 to 17, moves sufficiently every day. This is evident from the Flemish exercise report drawn up by researchers from KU Leuven and UGent within the framework of the international network Active Healthy Kids Global Alliance, that was taken in 2018. The international balance is also negative: a global report shows that in 75 percent of the countries children do not exercise enough.
The percentage of young people who will achieve the recommendation of at least 60 minutes of moderate to high intensity daily exercise by 2018 is 21.3% for boys and 13.7% for girls. These are significantly fewer girls than boys who comply with the recommendation. In comparison with the findings from 2014, a favourable evolution can be observed. After all, at that time the proportion of boys who met the recommendation was 17.4%, while the proportion of girls was 10%. Depending on age, significant differences can be observed in the proportion of young people who achieve the recommendation. The prevalence is highest for both boys and girls in the youngest age group (11 to 12 year olds) and is 24% and 19.0% respectively. From 13 to 14 years of age there is a clear tipping point and the prevalence decreases to 20.7% for boys and 12.2% for girls. This level is maintained in the older age groups.
Depending on the type of education, there is a difference in the percentage of girls who achieve the recommendation, but not in the case of boys. The number of girls who meet the recommendation is the most prevalent in technical secondary education (15.2%) and the least prevalent in vocational secondary education (9.4%). In comparison with 2014, the proportion of boys and girls in general and technical secondary education showing a favourable increase in the proportion of young people with sufficient physical activity at medium to high levels is positive. In vocational secondary education, there is also an increase in the prevalence of boys and girls who meet the recommendation, but this is not a significant difference.
The prevalence of obesity and percentage of overweight males and females is more or less equal (16,4 per cent and 16,1 per cent respectively), according to the factsheet on Nutrition of the Department of Public Health of the University of Ghent (Factsheet Voeding). This is an increase compared to 2010.
Almost 12% of young people are overweight. Of the children aged 4 to 17 years old, 11.7% were overweight in 2018, of which 9% were moderately overweight and 2.7% were severely overweight (obesity). Moderate overweight is more common in 12-17 year olds, while severe overweight is slightly more common in younger children aged 4-11. These figures are based on self-reporting of height and weight.
According to the HBSC study in 2014, Flemish youngsters aged 11 to 18 usually skip breakfast. However, this is one of the most important eating moments in a day. 71% of boys and 66% of girls have breakfast every weekday. Daily breakfast on weekdays decreases with age. Approximately 19% of 17- and 18-year-old youths never have breakfast on a weekday, for 11- and 12-year-olds this is 5% for boys and 7% for girls. Young people in general secondary education (ASO) eat breakfast most often on a daily basis, young people in vocational education (BSO) skip this meal most often. The consumption of vegetables and fruit has stagnated compared to 2010. There is also a decrease in the daily use of soft drinks.
According to the HSBC Factsheet Nutrition in 2018, 14% of boys and 13,5% of girls between 11 and 18 are overweight. This is a decrease from 15,9% and 15,8% respectively in 2014. There’s no significant difference between the distinct age groups of young people from 11 through 18. There are clear differences in prevalence of overweight and obesity among the different forms of education. In vocational secondary education (BSO), 24,6% of boys and 24,5% of girls are overweight or obese, whilst in general secondary education (ASO) it’s only 10,1% and 9,1% respectively.
In 2018, 68,8% of boys and 67,1% of girls aged 11 to 18 report having breakfast every day according to the HBSC study in 2018. For the boys, this is a significant decrease compared to 2014. Daily breakfast on weekdays decreases with age. Approximately 19% of 17- and 18-year-old girls and 21% of 17- and 18-year-old boys never have breakfast on a weekday. For 11- and 12-year-olds this is 4% of boys and 5% of girls. Young people in general secondary education (ASO) eat breakfast most often on a daily basis, young people in vocational education (BSO) skip this meal most often.
Boys aged 11-18 show a significantly less healthy eating pattern compared to girls of the same age, according to the HBSC study in 2018. 18,6% of boys and 24,8% of girls adhere to a healthy diet, which is an improvement compared to 2014 for both boys (11,9%) and girls (18,3%). There is a difference among the age groups of boys, with a distinct decreasing trend between 11-12-year-olds (26,1%) and 17-18-years-olds (12,3%). Girls show a similar decreasing trend between 11-12-year-olds (32,3%) and 15-16-year-olds (21,3%). There is a slight increase in 17- and 18-year-old girls (22,1%). Young people in general secondary education (ASO) show a more healthy diet (20,5% of boys and 25,4% of girls) compared to young people in vocational secondary education (BSO) (9,4% and 12% respectively). Young people in vocational secondary education also show no significant improvement compared to 2014, whilst young people in general and technical (TSO) secondary education do
Substance abuse (alcohol, tobacco and drugs)
Despite recent signs of a decline in the prevalence of legal and illegal drug usage, the use of alcohol and cannabis remains widespread among adolescents and young adults in contemporary European society. Many people initiate alcohol and drug use during their years as a teenager. Research from the most recent student survey of the Flemish Expertise Centre for Alcohol and Other Drugs (VAD) (2018-2019) shows that 56,7% of pupils in secondary education have drunk alcohol at least once before. 51,2% drank alcohol the year before. One pupil out of eight drank alcohol weekly to daily (12.2%). Although in general there’s a trend of decreasing alcohol use between 2009-2010 and 2018-2019, there is a slight increase compared to the 2017-2018 study in both for the use of alcohol ‘at least once before’ and ‘the year before’. Beer was the most popular alcoholic drink: 9,3% of all pupils drank beer at least once a week and 39,7% drank it at least once the year before.
There are large differences in alcohol consumption depending on the age of the pupils. 59.1% of young people under the age of 16 have never drunk alcohol before. This is more than a few years ago, although there’s a slight increase compared to the 2017-2018 study. The average age of onset is also continuously rising from 2010-2011 onwards. This shows that the legislation prohibiting alcohol under the age of 16 is increasingly being complied with. The fact that alcohol is prohibited for young people under 16, is also increasingly seen as motivation not to drink From the age of 16 onwards, a large majority of young people do drink: 65,5% of pupils drank alcohol in the last month and a quarter drink regularly. Of all 17- and 18-year-olds, 51,6.0% were drunk last year. The differences in prevalence of alcohol use between boys and girls were found to be minimal, although the age of onset is lower for boys compared to girls (14,5 years and 14,8 years respectively) and boys drink more frequent (14,6% of boys drink regularly compared to 9,7% of girls).
95% of the students in higher education in Flanders said in 2017 that they once drank alcohol. Almost all these students also drank alcohol last year (94%). During the teaching periods, the frequency of use of alcohol was higher than during the examination periods. Of the students who drank alcohol last year, 11% drank it weekly or more often (1), 15% drank it weekly or more often before going out, and 10% played drinking games weekly or more often. The survey of the Department of Public Health of the University of Ghent mentions that there are still significant differences between males and females (Factsheet Alcohol). Male students drink remarkably more. The results of the same survey reported that there are also differences regarding education level. Young people in technical education choose to drink beer every week, while young people in vocational education drink more often spirits and alcopops. Young people in general education are less likely than young people in other types of education to consume alcohol.
According to the most recent Student Survey in 2018-2019, 22.7% of young people between 12 and 18 years in Flanders have ever smoked. Last year, 18,8% of them smoked at least once the year before and 10,7% the month before. If we look at the evolution for the past 10 school years, it is noticeable that there has been a significant decrease in ever use, although there is a slight increase for 2018-2019 in both smoking once before, the year before and regular smoking. Smoking at least once before has decreased more than smoking the year before, which implies that less young people who smoked at least once before quit smoking. On the upside, regular smoking has the largest decrease relative to the 2009-2010 study.
The average age at which young people smoke a cigarette for the first time is 15,2 years. This is a small increase compared to the previous measurement (15,0 years). This means that the average age of onset has risen by more than one year since the first measurement in 2010-2011. Before 1 November 2019, the sale of tobacco products to young people under the age of 16 was prohibited in Belgium, even though 11,5% of young people under 16 stated to have smoked at least once and 8,8% stated to have smoked the year before. This is an increase relative to the 2017-2018 study (8,0%) and is not in line with the decreasing trend from 2013-2014 until 2017-2018. Four out of ten of the -16 year-olds say they can easily get tobacco (for the +16-year-olds, it is more than 8 out of 10). The age of 16 is also too young: tobacco should not be offered for sale to minors (who are particularly vulnerable to addiction). In almost all European countries, cigarettes may only be sold to adults. This age limit is now raised to 18 years, as it already applies in France, the Netherlands and Germany. The seller may therefore ask the young person to prove his or her age by presenting the identity card.
Despite the downward trend, the differences according to education level still exist. According to the HBSC study Factsheet Risk-taking Behaviors (2018), significant differences between education modes will remain in 2018: Both for boys and girls, the prevalence is highest in BSO (36,1% and 33,9% respectively) and lowest in ASO (24,9% and 18,8% respectively). Pupils in TSO are somewhere in between. There is however a stark and significant improvement in life time prevalence among boys and girls in TSO and BSO compared to the 2014 study.
There are also more daily smokers among young people from vocational education and training than among young people from technical and general secondary education. However, the percentage of young people who smoke daily between 2014 and 2018 will decrease significantly within the educational forms: in the ASO it will go from 4.7% of boys and 2,5% of girls to 2,2% and 0,9% respectively, in the TSO from 13,3% of boys and 11,7% of girls to 8,8% and 6,2% respectively. In BSO it goes from 25,2% of boys and 22,9% of girls to 15,2% and 10,5% respectively. The conclusion of the HBSC study is that the inequalities between forms of education persist. More young people from vocational education and training smoke and start smoking at a younger age, which increases the risk of addiction.
The 2014 HBSC study on smoking habits states that the immediate environment is an important predictor of young people's smoking behavior. Young people with both parents smoking have a higher chance of taking up smoking themselves than young people with no or only one parent smoking. If the father smokes, the young person is 2.15 times more likely to smoke himself. If both parents smoke, 25.1% of young people smoke at least once a week. If no parent smokes, only 5.8% of young people smoke.
Cannabis was the most widely used illegal substance among young people in secondary education. During the 2018-2019 school year, 13,8% of young people aged between 12 and 18 said that they had ever used cannabis. Relative to the 2009-2010 study, the lifetime prevalence of cannabis follows a downwards trend from 2013-2014 onwards, being 8% lower in 2018-2019 compared to 2009-2010. 11,5% of the students used cannabis in the year they were surveyed. This rate remains relatively stable. 2.3% used cannabis regularly (weekly to daily). This rate also remains relatively stable. From the age of 15-16 years, cannabis use increased significantly. The average age of onset is 15,7 years in 2018-2019. More boys than girls used cannabis ever before and the last year before. There are differences between the educational forms. The BSO has the highest rate of pupils that used cannabis at least once (24,6%), whilst the ASO has a rate of 16,3% and the TSO is somewhere in between with 22,2% of pupils reporting to have used cannabis at least once.
3.7% of the students had once used illegal drugs other than cannabis. Among the oldest students (17 and 18), 2.5% used an illicit drug other than cannabis in the month before the survey. Xtc is the most common illicit drug other than cannabis: 4,9% of all 17-18-year-olds have ever used xtc.
In a survey in 2013, 40% of students in higher education in Flanders indicated that they had ever used cannabis. 22% had used cannabis in the past year. 21% of final-year users used cannabis at least once a week, i.e. regularly during the academic year. 5% used cannabis daily. Among students in higher education in Flanders, the use of amphetamines, ecstasy and cocaine in 2013 is limited to a small part of the student population: 3% had used ecstasy in the past year, 2% amphetamines and 2% cocaine.
Furthermore, there are significant differences according to education and age: the use of cannabis increases as people grow older. In addition, more young people in vocational education use cannabis than young people in other types of education. In general, usage during the past year is at around 12 per cent. Young people using cannabis once a week is limited to 2 per cent and is lower than a few years ago.
Emotional and mental well-being
In 2013, there was a Health survey,
commissioned by the Flemish and Federal Government. The emotional problems assessed in this health survey were anxiety disorders, depressive feelings and sleeping problems. Young people suffer with emotional psychological problems more than in the past. The prevalence of emotional problems among young people between the ages of 15 and 24 increased in 2013. Young women more than young men suffer from emotional problems.
The 2018 Health Survey concluded that, compared to girls, boys are more likely to develop attention and hyperactivity disorders, behavioral disorders and relational struggles with peers. Until the age of 15, emotional problems are equally prevalent in boys and girls. Between 15 and 18 years, girls are more likely to develop emotional problems. The level of education and family composition are correlated to some disorders.
In 2018, a survey of the Department of Public Health of the University of Ghent (Factsheet Mentale Gezondheid) also mentions that 13% of boys between 13 and 18 and 22,1% of girls between 13 and 18 had considered ending their life. For boys, this is a significant increase relative to the previous study in 2014 (11,1%). For the various age-groups in the study, the rate is stable compared to the 2014 study, except for 17- and 18-year-old boys. There is a remarkable increase in that age-group from 11,9% to 17,8%. For boys, there are no significant differences between the different levels of education. There is also an increase in suicidal thoughts in the ASO and TSO compared to the 2014 study (9,7% to 13,7% and 12% to 15,4% respectively). For girls, there are no significant differences relative to 2014. However, girls following vocational education more commonly thought about suicide compared to girls with other educational backgrounds. In 2018, 8% of boys and 20,8% of girls in secondary education have hurt themselves intentionally. This is a decrease compared to 2014.
In 2016, the Agency for Care and Health found on the basis of mortality certificates that 1.057 persons in the Flemish region committed suicide. This comes down to almost 3 suicides a day. Almost three out of four (72 per cent) were men. The suicide rate reveals a slight non-significant increase among men compared to the previous year (from 23,9 suicides per 100 000 inhabitants to 24,1) and a slight non-significant increase among women (from 9,1 to 8,9). Suicide is one of the most common causes of death among young adults between the ages of 15 and 54.
The Unity for Suicide Research (Eenheid voor Zelfmoordonderzoek (EZO)) from Ghent University estimates that in 2019 9.745 suicide attempts were undertaken in Flanders, which comes down to 27 suicide attempts a day. More women (62,5 per cent) than men undertake a suicide attempt.
Studies confirm that young people and young adults, more than other age groups, experience mental health problems such as loneliness, gloominess and anxiety as a result of the corona measurements. Therefore, extra funds have been made available for municipalities to offer young people and young adults in corona times more perspective. Municipalities are now faced with the task, in the short term, to strengthen the accessible, preventive support for young people and young adults.
https://www.zelfmoord1813.be/feiten-en-cijfers/cijfers-over-su%C3%AFcide-en" https://www.zelfmoord1813.be/feiten-en-cijfers/cijfers-over-su%C3%AFcide-ensu%C3%AFcidepogingen#Cijfers Suïcides in Vlaanderen
Three elements constitute the basis of well-being, as referred to in the Flemish Youth and Children’s Rights Policy Plan (2014-2019). Children and young people should feel good about themselves, not be afraid to say otherwise and know who they can turn to when they have questions. These three elements are the basis of the operational objectives. The Flemish Government wants to take measures to increase the resilience of children and young people by focusing on preventive work and investing in accessible support.
- More than just a label
There is a growing tendency to apply labels to children and young people. As the number of labels grows, so does the use of medication by minors. The Government of Flanders is taking initiatives which will ensure a more conscious use of these labels. In sectors coming under integrated youth support the Diagnostics Quality Centre wants to develop instruments, conduct research and offer support in order to realise higher quality diagnostics. This should allow for the achievement of higher quality care. Efforts are also made towards developing a policy for pupils with special educational needs.
- Help break taboos
The mental well-being of children and young people is often surrounded by taboo. Several methodologies and tools are already in place to open up discussion about this topic. However, the process used for this is mostly too complex or cumbersome. The Government of Flanders wants to do a thorough job in making information accessible with broad access to youth support. The accessibility to services and support is improved by extending the ‘Children's Centres' (Huizen van het kind), organising parenting support for parents from disadvantaged groups and investing in extensive and easily accessible networks. In a 'Children's Centres' (Huizen van het kind), parents and children can enjoy everything about upbringing and growing up. It is a collaboration between organisations that help parents with childcare, health care, leisure activities, parenting support, workshops and much more.
- There is someone who can help young people with questions
Every child and young person should have someone they can rely on for support. Attempts are made to establish a unique communication platform for children and young people. We more widely publicise the helpline 1712 (violence, (child) abuse). Finally, we offer support to confidential advisers of minors in youth support.
According to the 2020-2024 Youth and Children’s Rights Policy Plan, a targeted integrity policy will be pursued, which actively works to tackle violence against children and young people. In addition, there’s stated that Flanders will stimulate initiatives both on a collective and an individual level that lead to encounters, enhance toughness and acknowledge the resilience of each child an young person. The voice, needs and competencies of the child and/or young person always takes centre stage. This is translated into two tactical objectives and several operational objectives.