Between 1998 and 2002, young people under 19 years took part in the Imagine London project which was designed to gather young Londoners’ views on how London could be made a healthier city (Kings Fund, 2000). These young people said that healthy living depended on the environment and their access to sports, social and leisure facilities. Many also identified pollution as a direct health concern, at least in urban environments. Morrow (2000/2001)) examined environmental issues and also explored the usefulness of Putnam’s (1993) concept of ‘social capital’ in relation to young people’s health and well-being.
It was warned that young people are not a homogeneous category, and that gender, ethnic background, socio-economic status and age all need to be taken into account. This was illustrated from the study by showing, how girls felt less safe in their neighbourhood than boys, that young people from minority ethnic backgrounds were alone in reporting experiences of racial harassment, and how younger children wanted more places to play safely while older teenagers wanted places where they could socialise.
It is perhaps worth noting that most of the qualitative studies that look at children and young people’s perceptions of health in detail appear to be based predominantly on the views of young people living in cities or other urban environments. It is possible that the views of children and young people living in other situations may be different in some respects. This was certainly suggested by a report from the Health Development Agency (2002) that pointed out how young people’s health needs can be marginalised within rural areas.
This conclusion was based on the views of 327 young people in Years 9 to 11 solicited in both school and non-school settings in an East Devon location. Young people’s main concerns seemed to relate to their mental well-being, and particularly around peer and family relationships, self-esteem, sexual health, and information and advice on drugs. Anecdotal evidence suggested these young people often did not use mainstream health provision as they were worried about confidentiality issues and as the services were often difficult to access.
This project led to the establishment of a multi-agency drop-in open during school lunchtimes and other convenient times, and there was some initial indication that this was well received. Knowledge of Health / Health Behaviour Even though most young people regard themselves as healthy, they do not necessarily say they lead healthy lifestyles or live in particularly healthy environments. Only 17 per cent of the young people who took part in a peer-led research project in Hounslow thought they lived in a ‘healthy society’.
Of the rest, 41% said they lived in an unhealthy society, and 42% were not sure (Percy-Smith et al, 2003). Shucksmith and Spratt (2002) reviewed qualitative research undertaken with young people between 11 and 25 years over the previous five years or so, and throw some light on the links between health and healthy living. They concluded that, even though young people tend to have good knowledge about how to maintain their health, they do not always act on this information. Importantly, it seems that the social context in which young people live is critical in determining their health behaviour in practice.
The researchers likewise deduced that young people’s health behaviour is often determined by a wish to act autonomously in reaction to the constraint and surveillance they often feel. Sometimes risky health behaviour can be a way of experimenting with a new ‘identity’ . Paradoxically, one health problem may lead to another. Thus Percy-Smith et al (2003) illustrated how young people may resort to smoking, drugs and alcohol to cope with stress. Their ability to cope with pressure from school can also affect their confidence and self-esteem.
There is considerable evidence to illustrate how young people’s knowledge about healthy living is, for a range of reasons, not necessarily reflected in their behaviour. This is examined in relation to: diet and nutrition; obesity and eating disorders; physical exercise; alcohol, drugs and volatile substances; smoking; and sexual health. Diet and nutrition The evidence on children’s diet and nutrition suggests that even if children and young people have a reasonably sophisticated knowledge of what constitutes healthy eating, they will not necessarily follow a healthy diet.
For many, this is not a priority in their day-to-day lives. Unsurprisingly, it has been suggested that children’s understanding about food and nutrition may be influenced by personal factors including age. Hart et al (2002) carried out a study with more than a hundred primary school children (ages 7 to 11) in which issues such as parental food rules, children’s perceptions of good and bad foods, links between diet and disease, and food groupings, were discussed.
First, gender and socio-economic status made a difference to parental control and children’s nutritional knowledge. Second, it seemed that cognitive development also played an important role in influencing children’s conceptualisations of food groupings and their understanding of the nutrients associated with different foods, and the health implications. It was suggested that primary school children may be most influenced by messages about healthy eating if these are appropriate to their cognitive level and, possibly, targeted separately at girls and boys.