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In 2017, the Department of Health published its tobacco control plan, Towards a Smokefree Generation: a Tobacco Control Plan for England. This is an all-age strategy, but discouraging young people from smoking is one of its priorities.
The main targets of the overall strategy are to be achieved by 2022, but there is also a commitment to continue with efforts to reduce smoking prevalence beyond then. The vision of the strategy is to create a smokefree generation, which will be regarded as achieved once smoking prevalence is at 5 per cent or below, across all age groups.
The aims of the strategy include:
reducing the prevalence of 15-year-olds who regularly smoke to 3 per cent or less by the end of 2022
reviewing the data on 16- and 17-year-olds to help in understanding the trends in smoking amongst young people
reducing the prevalence of smoking among adults, from 15.5 per cent to 12 per cent or less as a way of reducing the number of young people who smoke through being influenced by adults’ behaviour
reviewing the type and level of sanctions for tobacco retailers who repeatedly break laws designed to protect young people.
At national level, implementation of the strategy is mainly the responsibility of the Department of Health, NHS England and Public Health England. Implementation at local level is the responsibility of local councils and Clinical Commissioning Groups.
In 2017, the Government published a new drug strategy, setting out its approach to curbing the demand for and supply of drugs. It is an all-age strategy, but it includes the objective (p.2) of ‘preventing people – particularly young people – from becoming drug users in the first place’. Young people not in education, employment or training, and looked after children (those in the care of a public authority) are identified as particularly at risk. Actions relating to young people, include:
investing in a range of evidence-based programmes, which have a positive impact on young people and adults, giving them confidence, resilience and risk management skills to resist risky behaviours and recover from set-backs
providing support to school nurses, teachers and wider community services, including youth workers, to work together to promote health and wellbeing
providing information and intelligence to improve decision-making, enabling high quality and cost effective services.
Specific services which the Government will support under the strategy include developing its ‘Talk to FRANK’ service, continuing to develop and promote the ‘Rise Above’ digital hub and expanding the Alcohol and Drugs Education and Prevention Information Service (ADEPIS) to reach wider prevention partners, such as youth offending teams.
The strategy also emphasises the importance of good quality Personal, Social, Health and Economic (PSHE) education (see ‘Health education and healthy lifestyles education in schools’).
Responsibility for implementation is cross-governmental, driven by a Drug Strategy Board, chaired by the Home Secretary and including representation from key government departments and wider partners, e.g. Public Health England and the National Policing Lead on Drugs.
In 2017, the Government published an evaluation of its previous (2010) drug strategy. Findings include the importance of early intervention (especially pre‑school and family‑based programmes, as well as school-based Personal, Social and Health Education) in reducing risk factors associated with drug use and in turn drug use itself.
Public Health England’s strategic action plan for 2016-2019, Health Promotion for Sexual and Reproductive Health and HIV is all-age, but young people are identified as one of the groups at risk. The plan is set in the strategic context of the Department of Health's 2013 A Framework for Sexual Health Improvement in England.
To reduce the rate of under 18 and under 16 conceptions as well as narrow the variation in rates across the country, the action plan commits Public Health England to:
provide improved data to local authorities
promote evidence and effective practice to reduce teenage pregnancy and improve the public health outcomes for the school age population
ensure that young people have access to accurate information on sexual and reproductive health
promote training and capacity building for the wider school workforce to increase and improve delivery of Sex and Relationships Education and Personal, Social, Health and Economic (PSHE) education (see ‘Health education and healthy lifestyles education in schools’).
Implementation is mainly the responsibility of Public Health England, with the NHS and local authorities.
There is also a 2016 cross-Government action plan, Childhood Obesity: a Plan for Action, which is targeted across a broad population, but with specific initiatives for children and young people. Key relevant strategic objectives include:
Introducing a soft drinks industry levy across the UK, designed to encourage producers to reduce the amount of sugar in their products and to move consumers towards healthier alternatives. Revenue from the levy to be invested in programmes to reduce obesity and encourage physical activity and balanced diets for school age children.
Taking out 20% of sugar in products. A broad, structured sugar reduction programme to remove sugar from the products children and young people eat most.
Supporting innovation to help businesses to make their products healthier
Developing a new framework by updating the nutrient profile model to help families to recognise healthier choices.
Note that, at local level, Health and Wellbeing Boards and local councils have their own health and wellbeing strategies, both general and targeted, e.g. teenage pregnancy strategies, to reflect the needs and characteristics of their particular populations.
The national Healthy Child Programme 0-19, includes the Healthy Child Programme: From 5-19 Years Old. The programme sets out the recommended framework of universal and progressive services for children and young people to promote optimal health and wellbeing.
The 5-19 element is led by school nursing services (see section 'Stakeholders' in the article 'Mechanisms of early detection and signposting of young people facing health risks').
One of the six themes covered by the Department for Digital, Culture, Media and Sport’s Life Chances Fund, launched in July 2016, is young people. The young people theme focuses on reducing the risk of negative, social, economic and health outcomes amongst disadvantaged young people aged 11-24. The programme operates through Social Impact Bonds and £48m was made available in 2018 to fund 22 new projects.
The Healthy Universities Network supports whole university approaches to health and wellbeing. This extends to staff and the wider community, as well to students.
The Department for Education has introduced a Healthy Pupils Capital Programme in 2018. Funding is available to primary and secondary schools and sixth-form colleges for improving access to facilities for physical activity, healthy eating, mental health and wellbeing and medical conditions (such as kitchens, dining facilities, changing rooms, playgrounds and sports facilities). £100m of revenue generated from the Soft Drinks Industry Levy will be provided in 2018/19 for this programme.
Public Health England published Government’s recommendations for energy and nutrients in 2016. The Eatwell Guide is a policy tool used to define government recommendations on eating healthily and achieving a balanced diet. For schools, the Department for Education developed a School Food Plan in 2013. Updated regulations on school food were issued in 2014 and new School Food Standards became mandatory in January 2015.
Personal, Social, Health and Economic (PSHE) education is currently a non-statutory subject; Government guidance states that it is ‘an important and necessary part of all pupils’ education. Currently, under the Education Act 2002, maintained secondary schools must teach sex education but this does not extend to schools which have academy status. It is usually taught as sex and relationship education (SRE), within the curriculum for Personal, Social, Health and Economic (PSHE) education. There is no statutory programme of study but schools must have regard to statutory guidance.
However, from 2020, under new proposals, all pupils will study compulsory health education as well as new reformed relationships education in primary school and relationships and sex education in secondary school.
The PSHE Association has developed a (non-statutory) programme of study to support schools. Within the programme of study (p.5), one of the overarching concepts developed through PSHE is ‘A healthy (including physically, emotionally and socially), balanced lifestyle (including within relationships, work-life, exercise and rest, spending and saving and lifestyle choices).’
At Key Stages 3 and 4 (pupils aged 11-16) the core theme of ‘health and wellbeing’ includes a focus on:
how to make informed choices about health and wellbeing matters including drugs, alcohol and tobacco; maintaining a balanced diet; physical activity; mental and emotional health and wellbeing; and sexual health
parenthood and the consequences of teenage pregnancy
how to assess and manage risks to health; and to keep themselves and others safe.
The Government has provided grant funding to the PSHE Association, a charity, and the national membership organisation for Personal, Social, Health and Economic (PSHE) education, to enable it to help schools in their PSHE provision through advice and teaching resources.
Within the programme of study, for Key Stages 3 and 4 (ages 11-16), the core theme of ‘relationships' includes a focus on:
how to develop and maintain a variety of healthy relationships within a range of social/cultural contexts and how to develop parenting skills
how to recognise and manage emotions within a range of relationships
how to deal with risky or negative relationships including all forms of bullying (including the distinct challenges posed by online bullying) and abuse, sexual and other violence and online encounters
the concept of consent in a variety of contexts (including in sexual relationships)
managing loss including bereavement, separation and divorce.
Making informed choices about sexual health and learning about parenthood and the consequences of teenage pregnancy fall under the ‘health and wellbeing’ core theme.
There is a wide range of peer-based approaches operated by charities operating in the youth sector. Examples of these include:
Straight Talking Peer Education, funded through the Big Lottery, employs teenage mothers and young fathers to run courses in secondary schools about the realities of early parenthood, healthy relationships, child sexual exploitation and sexting.
This work aims to:
reduce teenage parenthood and sexual exploitation by allowing young people the opportunity to make better-informed life choices
reduce barriers to employment for teenage parents, supporting the development of skills and providing pathways towards economic independence.
Girlguiding Peer Educators. Peer Educators are 14- to 25-year-olds who help young people in the Girlguiding movement to explore important topics including mental wellbeing; body confidence and self-esteem; healthy relationships and making own decisions about alcohol, smoking, sex and drugs.
Sexpression:UK is a student-led independent charity that empowers young people to make informed decisions about sex and relationships by running sex education workshops in schools and community settings.
Under s.10 of the Children Act 2004 (as amended by the Apprenticeships, Skills, Children and Learning Act 2009), local authorities have a duty to:
make arrangements to promote cooperation between the local authority and named local partners with a view to improving the wellbeing of children in the authority’s area....
This includes cooperation on matters relating to ‘physical and mental health and emotional well-being’.
Under the legislation, local authorities were required to establish Children’s Trust Boards to facilitate a multi-agency approach to children and young people’s wellbeing.
Section 194 of the Health and Social Care Act 2012 provided for the establishment of Health and Wellbeing Boards and GP-led Clinical Commissioning Groups. It made them and local authorities jointly responsible for the Joint Strategic Needs Assessment process and required them to develop a Joint Health and Wellbeing Strategy (JHWS) to oversee and inform commissioning decisions.
There is no longer a statutory duty for local authorities to establish Children’s Trust Boards, but many of the Children’s Trusts/Children’s Partnership Boards’ structures remain and cooperate with Health and Wellbeing Boards through their governance arrangements.
Raising awareness on healthy lifestyles and on factors affecting the health and well-being of young people
The Time to Change campaign to end the stigma attached to mental illness is led by the mental health charity Mind and Rethink Mental Illness. The campaign is all-age, but there is a children and young people's programme within it. It is funded by the Department of Health, Children in Need and the Big Lottery Fund.
The MindEd website, funded by the Department for Health and the Department for Education provides educational e-learning resources applicable across health, social care, education, criminal justice and community settings.
Get Set is the British Olympic Association and British Paralympic Association’s youth engagement programme. It provides resources to encourage young people to develop a core set of sporting values, enabling them to make the right decisions on and off the field of play. The programme aims to:
Inspire young people to fulfil their potential and maintain healthy, active lifestyles
Give all young people the chance to learn about and live the Olympic Values of friendship, excellence and respect and the Paralympic Values of inspiration, determination, courage and equality
Build excitement about Team GB and ParalympicsGB, using the Olympic and Paralympic Games as a hook for learning and participation.
Local authorities offer services and information in their own areas. There is also much provision through charities and other third sector organisations.