7.8 Current debates and reforms
In the Croatian health care system, young people have a significant position and their health is viewed as a value which must constantly be promoted, improved and protected, and in case it is endangered by some disease, treated by providing health care and social welfare in accordance with the needs of the individual. There are numerous strategic and legal frameworks prescribing and envisaging programmes of improving, preserving and increasing youth health, however, the youth remain unrecognised by the health care system as an integral group and are often divided into other age groups such as children and adults because the health care system was adapting over time to the perspective of other frameworks. Accordingly, Croatia still lacks a completely developed system of comprehensive monitoring of youth health which results in the need for a continuous effort on improving and creating targeted age-specific public health youth policies. In general, the health care system is still disconnected and largely fragmented so the psychiatric patient care, rehabilitation and counselling efforts are still quite fragmental, while the preventive and promotional activities on the national level are strategically well defined but the system of implementing and evaluating on a local level is not yet developed. It is often the case that there is no continuous cooperation or responsibility division between relevant professions, such as individual stakeholders. It relevant to point out that certain areas are still not covered by national policies or have not been fully implemented.
There is a need to go beyond the provision of services towards the creation of structural changes incorporated in health in all policies (HiAP) or as health impact assessment initiatives. Systematic social inequalities in adolescents (applicable to both genders and for all three subjective health outcomes) are found in eight countries and regions, and no social gradient in only one. Croatia should review local policies to determine to what extent they address social determinants and how they should be tackled. Gender differences are found in all measures, with girls reporting lower levels of perceived health and life satisfaction and more frequent health complaints. These increase with age. Efforts need to be made to address this clear gender-difference issue. Screening and counselling for more sensitive mental health issues should be provided as part of routine preventive care to ensure a balance between physical and mental health. In addition to family wealth, other well recognized and interrelated social determinants of health in adolescence (such as access to high-quality education, developing personal skills, social support and safe neighbourhoods) should be addressed to increase understandings of pathways and mechanisms of inequity.
While overweight and obesity remain stable during adolescence or show a slight decrease with age, perceptions of overweight and dieting behaviour increase markedly in girls during this time. Clear gender differences are apparent, with boys tending to be more overweight in most countries and regions. Higher overweight prevalence is associated with lower affluence in some, but findings must be interpreted with caution due to the self-report nature of height and weight data used to categorize BMI status. Gender and age patterns in relation to body image and weight-reduction behaviour seem consistent with previous findings: girls are more likely to be discontented with their body weight regardless of country or region. Being female is a stronger predictor for self-perceived fatness and weight-reduction behaviour than BMI or family affluence. The prevalence of overweight and obesity is not increasing but remains high in many countries and regions. WHO provides leadership, advocacy and evidence-based recommendations for international action to improve dietary practices and increase physical activity through its global strategy on diet, physical activity and health. It also promotes and supports research in priority areas to facilitate programme implementation and evaluation. A systemic approach is needed to address high overweight and obesity rates and enable young people to have positive thoughts and feelings about their body as a means of improving well-being. Communities, families and individuals need to work together to address this issue. International and national support is needed to protect children and promote health through the provision of healthy and nutritious food, safe neighbourhoods, safe activities and opportunities for physical activity and sports participation. Identification of shared risk and protective factors for overweight and body dissatisfaction can support the development of relevant interventions for a broad spectrum of weight-related problems.