Young people’s health and wellbeing: 20 years of policy failure?

In September 1988, the Australian Commission for the Future published my report, Casualties of change: The predicament of youth in Australia, a wide-ranging analysis of the social and psychological problems faced by young Australians, expressed most clearly in rising rates of suicide, drug abuse and crime. It was, so far as I know, the first time anyone had looked at broad, generational shifts in young people’s wellbeing, and the report attracted a great deal of professional, political and public attention.

I said that, as a society, we appeared not to recognise the seriousness of the problems being experienced by young people. “To the extent that we do recognise the problems, we are applying remedies that will not work because they do not address the cause of the problems, causes that are deeply rooted in the fundamental changes occurring in Australian society.”

Today, 20 years later, despite sustained economic growth, a range of policy interventions and substantially higher spending on health, I believe this is still true. To give one example: in 1988 I said research suggested young people were not only drinking at an earlier age than previously, but also that “binge drinking” - with the frequent aim being “to get drunk and get drunk quickly” was becoming more common. Today we are still grappling with the same problem.

There have been gains in wellbeing over the past two decades, notably the reversals in the trends in youth suicide and drug-related deaths, which, with road accidents, are the leading causes of deaths in young people. However, the overall picture, when we look at new data on the total “burden of disease”, is disappointing and disturbing.

Recent research evidence suggests the health and wellbeing of young people, an important indicator of Australia’s future population health, is declining. About a quarter of young people are suffering significant psychological distress at any one time, with less severe stress-related symptoms such as frequent headaches, stomach-aches and insomnia affecting as many as a half. The weight of evidence suggests that mental illness has increased over successive generations of youth, as have some physical illnesses; notably diabetes, linked to rising levels of obesity. Violent crime is also continuing to increase.

The picture poses a challenge to the conventional, or official, view that things are getting better, and so to the way in which we, as a society, are addressing social problems. With the possible exception of increasing wealth, improving health is the most widely used measure of human progress. Wealth has only ever been a means to the end of a better life; health is a core component of that end. If health is not improving, it is hard to sustain the belief that, as a society, we are making progress.

The more tangible factors contributing to the decline in mental health include family conflict and breakdown, education and work pressures, media and technological impacts, dietary changes, and environmental pollution. However, the causes also include cultural intangibles, such as excessive materialism and individualism.

Most of these causes are associated with a particular form or model of national development, material progress, which focuses on economic growth and material welfare, even at the expense of other aspects of life. The various lines of evidence represent an intricate and complex web of cause and effect. They show that material progress does not simply and straightforwardly make people richer, therefore giving them the freedom to live as they wish. Rather, it comes with an array of cultural and moral prerequisites and consequences that profoundly affects how people think of the world and themselves, and so the choices they make.

The costs to health and wellbeing can no longer be regarded as unfortunate side effects of a model of progress whose major effects remain largely beneficial; they are a direct and fundamental consequence of how Western societies and cultures have defined and pursued progress.

Consequently, material progress is coming under growing challenge from a new model: sustainable development, which does not accord economic growth overriding priority. Instead, it seeks a better balance and integration of social, environmental and economic goals and objectives to produce a high, equitable and enduring quality of life. It does not only affect policy options and decisions; there is growing evidence that a cultural transformation is taking place meaning a profound shift in values and attitudes.

Closing the gap between the scale of policy responses and the magnitude of the challenge to optimise young people’s wellbeing will require fundamental actions that go well beyond specific health interventions. Examples include:

• conceptualising health as more than a matter of healthcare services, including shifting emphasis from the dominant, disease-focused, biomedical model of health to a preventative, social model;
• reorienting education to give it a clearer focus on increasing young people’s understanding of themselves and the world to promote human growth, development and wellbeing in the broadest sense; and
• setting stricter standards for the corporate sector, especially the media and consumer industries, to uphold the UN Convention on the Rights of the Child, which include the right “to protection from harmful influences, abuse and exploitation”.

At the most fundamental, cultural level, improving young people’s wellbeing means changing the stories or narratives by which Australians define themselves, their lives and their goals. These changes should include making better health (in the broadest sense), not greater wealth, the nation’s defining goal.