Compared to some other high-income countries, the UK has a high level of income inequality. Recent research also indicates that child poverty rates are set to soar, with a predicted 35% of children living in relative poverty by 2023–2024, after housing costs have been taken into account. This would be the highest percentage since modern records began in 1961.
The strongest determinants of health and health inequalities are the wider determinants, including the political, social, economic, environmental and cultural factors that shape the conditions in which we are born, grow, live, work and age. These wider determinants impact on health and can compound health inequalities over a lifetime. However, there has been little specific attention paid to the impact of these wider determinants in adolescence and early adulthood, distinct from other age groups.
Adolescence and early adulthood is an important stage of life, marked by several transitions. These transitions include the move from education into employment, financial and housing transitions towards living independently, social transitions where peers and other people outside the family take on a greater influence, and transitions from carers/parents managing health to young people making health decisions for themselves. Without adequate support, any of these transitions may lead to increased vulnerability for a young person.
Social determinants of young people’s health
Key data on young people 2019 draws together health-specific data for young people aged 10–24 in the UK, published by the Association for Young People’s Health in October 2019 and funded by the Health Foundation. By presenting data from multiple diverse sources, the report gives a more holistic picture of young people’s health in the UK.
The report sheds light on some worrying trends in the wider determinants of young people’s health that can drive health inequalities for this age group. Young people today are increasingly living in the private rented sector, spending an average of a quarter of their income on rent. And further, young people are less likely to be able to afford good quality housing and are increasingly living with their parents as a result. The living conditions that drive health inequities extend to unsafe neighbourhoods. Recent data shows that a significant proportion of young people are concerned about their safety, with 21% of young people aged 8–15 reporting that they feel safety after dark is ‘poor’ or ‘very poor’.
Participating in education can provide an important source of social connections as well as support from peers and trusted adults, yet the percentage of secondary school exclusions increased by 64% between 2013/14 and 2016/17. Overall 10% of young people aged 10–24 report being ‘lonely often’ and other recent data has shown that young people aged 16–24 are more likely to feel lonely than any other age-group. Young people also face increasingly precarious labour markets with 9% of 16–24-year-olds on zero-hours contracts, compared to 3% of the rest of the population.
Health inequalities are already apparent in adolescence
One of the key messages from Key data on young people 2019 is that the gap in health between the rich and poor in our society is already apparent between the ages of 10–24 and for some key health indicators, that gap is widening over time. Key findings include the fact that severe obesity rates for 10/11-year-olds in the most deprived areas in England are four times those in the least deprived. The gap between obesity levels of 10/11-year-olds in the most and least deprived areas in England widened from 8.5% in 2006/2007 to 13.5% in 2017/18. Inequalities in obesity are thought to be largely influenced by the wider determinants of health, such as access to healthy food and green space for example. Data from Public Health England indicates that poorer areas have five times more fast food outlets than richer areas and we know that people living in the most deprived areas are 10 times less likely to live in areas with a lot of green space compared to people living in the least deprived areas.
Young people with long-term conditions also face significant inequalities: those who live in the most deprived areas are twice as likely to be admitted to hospital with asthma compared to young people living in the least deprived areas. Young people with diabetes living in the poorest areas are at greater risk of poor glycaemic control compared to their counterparts living in the least deprived areas. Health inequalities in adolescence and early adulthood also exist in smoking rates, under 18 conception rates, mental health prevalence and rates of road traffic injuries.
Young people in the UK face worrying trends in access to good-quality housing and stable good-quality jobs. They are experiencing increasing financial insecurity and have less access to support from their social connections, all of which have been shown to drive health inequalities. While describing health inequalities is invaluable to highlight where the problems lie, there is a need to move forward by assessing the impact of current and new policies in sectors outside health. This includes the effects that housing, education and employment policy have on the health inequalities faced by young people.
Commissioners of health services also have an important role to play. There is an urgent need for coordinated transition services for all young people, particularly those living in the most deprived areas. Integrated working between health, the voluntary sector and social care is required to design models of holistic care for young people, which also address the social determinants of health. Until there is this investment in today’s young people, we are unlikely to break the cycle of health inequality in the future.