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EACEA National Policies Platform: Youthwiki


7. Health and Well-Being

7.1 General context

Main trends in the health conditions of young people

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 proportion of 18 year olds who do not have breakfast is 19 per cent. Young people in vocational education have breakfast every day less frequently compared to young people in other types of education. In 2014, there were significant decreases in the percentage of young people in general education that have breakfast every day. The consumption of vegetables and fruit has stagnated compared to 2010. There is also a decrease in the daily use of soft drinks.

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 2016-2017 shows that 53.3% of pupils in secondary education drank alcohol the year before. One pupil out of eight drank alcohol weekly to daily (12.3%). Beer was drunk by the most students: 9% of all students drank beer at least once a week.

There are large differences in alcohol consumption depending on the age of the pupils. 59.4% of young people under the age of 16 have never drunk alcohol before. This is more than a few years ago and shows that the legislation prohibiting alcohol under the age of 16 is increasingly being complied with. From the age of 16 onwards, a large majority of young people do drink: 2 out of 3 pupils drank alcohol in the last month and a quarter drink regularly. Of all 17- and 18-year-olds, 57.0% were drunk last year.

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, 25.5% of young people in Flanders have ever smoked. Last year, 19.3% of the young people smoked. 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 (this year, too, there is a decrease of 3% compared to the previous school year), that final year use has barely decreased (this year's decrease compared to the previous school year is also minimal) and that regular use has also decreased strongly (this school year's figure remains stable compared to that of the previous school year).

The average age at which young people smoke a cigarette for the first time is 14.6 years. This is a small decrease compared to the previous measurement. But this starting age has been stable for 5 school years: the starting age continues to fluctuate between 14 and 15 years. 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. In the Pupils' survey, more than 4 out of 10 of the -16 year olds say they can easily get tobacco (for the +16 year olds, it is more than 8 out of 10).

Before 1 November 2019, it was possible to sell tobacco products to young people aged 16 In Belgium. 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 this downward trend, the differences according to education level still exist. According to the HBSC study, significant differences between education modes will remain in 2014: 24.2% of young people from the ASO have ever smoked a cigarette, compared to 41% from technical education and 46.1% from vocational education (there are significant decreases in each form of education compared to 2010).

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 2010 and 2014 will decrease significantly within the educational forms: in the ASO it will go from 4.2% to 3.6%, in the TSO from 15.7% to 12.6% and in the BSO from 29.2% to 24.2%. In BSO, therefore, 1 in 4 young people still smokes every day.

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 HBSC study 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 2015-2016 school year, 14.6% of young people aged between 12 and 18 said that they had ever used cannabis. This has remained stable compared to ten years ago. 11% of the students used cannabis in the year they were surveyed. 2.6% did so regularly (weekly to daily). From the age of 15-16 years, cannabis use increased significantly. More boys than girls used cannabis ever and for the last year. 3.5% of the students had once used illegal drugs other than cannabis. Among the oldest students (17 and 18), 2.4% used an illicit drug other than cannabis in the month before the survey. Xtc is the most common drug: 5.5% 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. The cannabis use of young people in vocational education is four times higher than the cannabis use in general secondary 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 field period for data collection of the Health survey 2018 runs from 8 January until 31 December 2018.

In 2014, a survey of the Department of Public Health of the University of Ghent (Factsheet Mentale Gezondheid) also mentions that 11,9 per cent of males and 20,4 per cent of females had considered ending their life by the time they were 17-18 years old. Young people following vocational education more commonly though about suicide compared to young people with other educational backgrounds. In total, more than 16 per cent of young people in higher secondary education hurt themselves intentionally, females more so than males.

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 2017 10.288 suicide attempts were undertaken in Flanders, which comes down to 28 suicide attempts a day. More women (62,4%) than men undertake a suicide attempt.

References: Suïcides in Vlaanderen

Main concepts

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.

  1. 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.

  1. 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.

  1. 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.