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1. Main trends in the health conditions of young people

2. Main concepts

Main trends in the health conditions of young people

The health status of young people in Bulgaria has undergone gradual changes since the early 2000s. While some traditional risk behaviours such as cigarette smoking and alcohol misuse have shown signs of decline over time, new health challenges have emerged, particularly in relation to mental health, sedentary lifestyles and social inequalities in well-being.

Risk behaviours continue to represent an important issue. Despite a long-term decrease in tobacco smoking among adolescents, the use of alternative products such as electronic cigarettes has increased. Alcohol consumption among young people remains relatively high compared to some other European countries, while early experimentation with psychoactive substances is still reported. (Health at a Glance 2025, OECD Indicators) (last visited on 24 March 2026)

Regular national surveys and data sources assessing the health status of young people include research conducted by the National Centre of Public Health and Analyses, the National Institute of Statistics and sectoral monitoring within the education system. These sources, together with international comparative studies, inform the development of national youth and health policies aimed at improving prevention, promoting healthy lifestyles and strengthening access to youth-friendly health services.

A national sociological survey on the situation of young people in Bulgaria (Установяване на ефекта от политиката за младежта върху младите хора) was conducted in November-December 2023 by an external research contractor commissioned by the Ministry of Youth and Sports. The study aimed to assess the impact of youth policies and to provide evidence for the implementation of the National Youth Strategy (2021-2030). 

The survey was carried out through structured face-to-face interviews with 672 young people aged 15-29, selected through a multi-stage nationally representative sample by gender, age and type of settlement. Participants represented all regions of the country and different settlement types, including the capital, regional centres, small towns and rural areas. 

The results indicate that young people generally perceive their health status positively, with 96% describing their health as good and 50% as very good, which corresponds to expectations for this age group. At the same time, financial barriers to healthcare remain relevant, as around one fifth of respondents report difficulties in purchasing prescribed medicines when needed. 

Preventive health behaviour appears relatively widespread. Regular medical check-ups are reported by 59% of respondents, while 53% attend dental examinations annually or almost annually. However, a significant share of young people still use healthcare services only when they experience illness. 

Physical activity levels show mixed patterns. Slightly more than half (56%) of young people report practising sport regularly, most often at home, in outdoor sports facilities or private fitness centres. Nevertheless, participation varies significantly depending on place of residence, with young people in rural areas reporting fewer opportunities for sport. 

Risk behaviours continue to affect youth well-being. The survey indicates that 10% of respondents have repeatedly used drugs, most commonly cannabis, while alcohol consumption is relatively widespread, with 24% reporting regular consumption of light alcoholic beverages and 14% of strong alcohol. Daily smoking remains common, with 28% smoking conventional cigarettes and 10% using electronic cigarettes daily. 

Mental health emerges as an important concern. Although 76% report overall life satisfaction, 45% describe their levels of stress and anxiety as high. A notable share of young people report serious psychological difficulties, including suicidal thoughts (11%), suicide attempts (2%), self-harm thoughts (8%) and self-harm attempts (6%). Limited awareness of available support services and unequal access to mental health assistance in some localities were also identified. 

The study also highlights challenges related to sexual and reproductive health awareness, as discussions on these topics are often perceived as taboo. Despite relatively high levels of general information, many young people underestimate their risk of sexually transmitted infections and a significant proportion report not using protective measures. 

Overall, the findings suggest that while young people in Bulgaria generally perceive themselves as healthy, important challenges remain in relation to mental well-being, substance use, preventive health behaviour and territorial inequalities in access to services. 

Main concepts

In Bulgarian political and strategic documents, health is understood as a multidimensional public value that goes beyond the mere absence of disease and this definition is generally aligned with the one used by the World Health Organization. According to the Health Act (Закон за здравето) (effective from 1 January 2025, last amendment and supplement, 10 February 2026) (article 2), the protection of citizens’ health, defined as “a state of complete physical, mental and social well-being” is declared a national priority. This legal formulation reflects the holistic approach adopted in national health policy and establishes health as a fundamental responsibility of the state.

The National Health Strategy 2030 (Национална здравна стратегия) frames health in terms of the “health potential” of citizens throughout their life course. The strategy sets out targeted measures to improve the health and well-being of children, adolescents and young people. Young people are identified as a priority group due to the long-term social and economic impact of their health status. The strategy adopts a preventive and life-course approach, focusing on reducing risk factors, improving access to health services and strengthening health literacy.

A key priority is the reduction of behavioural and environmental risk factors affecting young people. Measures include national programmes aimed at limiting tobacco use, alcohol consumption and drug use, as well as promoting physical activity and healthy nutrition. Particular attention is given to preventing overweight, obesity and non-communicable diseases from early age.

The strategy also emphasises the improvement of child and youth healthcare services. This includes expanding the coverage of preventive examinations and screening programmes, increasing immunisation uptake, and strengthening primary and school healthcare services. Ensuring timely and equitable access to outpatient care is considered essential for improving health outcomes among young people.

Mental health promotion and early intervention represent another central policy area. Planned measures focus on the early detection of mental health disorders and behavioural problems, the development of community-based support services, and the provision of psychological support within educational settings. Prevention of violence, substance dependence and suicidal behaviour is also highlighted.

In addition, the strategy addresses sexual and reproductive health through awareness-raising initiatives, prevention of sexually transmitted infections, and measures aimed at reducing early and unintended pregnancies. Improving access to counselling and health education services forms part of this policy approach.

Reducing health inequalities among young people is a cross-cutting objective. Targeted programmes are envisaged for vulnerable groups and for young people living in rural or underserved areas in order to ensure more equal access to healthcare services.

The strategy also promotes the development of health literacy and active youth participation in health-related initiatives. Educational campaigns, health promotion activities and the integration of health education into learning environments are intended to support healthier lifestyles and empower young people to take informed decisions regarding their health.

Another strategic document related to the health and well-being of young people is the National Strategy for Child and Adolescent Health and Paediatric Care 2030 (Национална стратегия за детско и юношеско здраве и педиатрична грижа 2030) defines the main policy framework for improving the physical, mental and social health of children and young people in Bulgaria. The strategy adopts a comprehensive, life-course and child-centred approach, focusing on prevention, early diagnosis, integrated care and equal access to quality paediatric services.

A central concept of the strategy is the strengthening of preventive healthcare. Planned measures include expanding neonatal and childhood screening programmes, improving immunisation coverage, and enhancing regular preventive examinations. Health promotion initiatives aim to support healthy nutrition, physical activity and the prevention of risk behaviours among children and adolescents.

Another key priority is the development and modernisation of paediatric healthcare services. The strategy envisages improving access to specialised paediatric care, strengthening primary healthcare and outpatient services, and ensuring better coordination between hospital, community and social services. Particular attention is given to the provision of child-friendly healthcare environments and the introduction of modern medical technologies and standards.

The strategy also highlights the importance of mental health support for children and adolescents. Measures focus on early identification of developmental and behavioural disorders, expanding community-based psychological and psychiatric services, and promoting cooperation between the health, education and social sectors. Preventive actions address bullying, violence, substance use and other risk factors affecting young people’s well-being.

Ensuring sexual and reproductive health education and counselling is another policy area, with the aim of increasing awareness, preventing sexually transmitted infections and reducing early pregnancies among adolescents.

Reducing regional and social inequalities in access to paediatric care is a cross-cutting objective. The strategy includes targeted interventions for vulnerable groups, children with chronic conditions or disabilities, and those living in remote or underserved areas.

Finally, the document promotes family involvement and health literacy as essential components of child and adolescent health policies. Supporting parents, strengthening community services and encouraging intersectoral cooperation are considered key mechanisms for improving long-term health outcomes for young people.