9.2. Children and adolescents (age 1-18)

9.2.1. Introduction

Children are citizens in their own right, and at the same time they constitute a major part of the section of the community for which society as a whole carries a responsibility of duty of care, in that in their early years children are totally dependant upon adults for their health and well being. Even as they grow and become increasingly autonomous (not least in making health-related behavioural decisions), they nevertheless remain dependant upon society for provision of services including education and health services and wider facilities such as recreation.

Children are also a particularly vulnerable group in that whilst society may express little understanding of the pressures and challenges faced at this stage, but rather blame them for making wrong decisions, many commercial interests are very well aware of the importance of this life stage of childhood. Thus, there is considerable targeting of children directly or subliminally to encourage them to purchase products or adopt lifestyles which are far from healthy, not least with regard to eating and drinking patterns.

Child health covers maintaining the health, and supporting optimal wellbeing and development, from birth to young adulthood. It spans the complete care of children’s and adolescents’ physical, mental, and social health. Areas of development include physical growth, cognitive transitions, pubertal maturation, and psychosocial and social maturation. Physical development is most rapid in the first five years of life, while social and behavioural patterns are significant in the later years.

A healthy childhood is a critical determinant for health and development in adolescence and beyond, in the same was as a sound and supportive familial and social context. Good physical and mental health, as well as the knowledge and means to sustain good habits, are key factors for healthy development as many of the health-compromising behaviours emerge during childhood.

It is known that the major causes of mortality and morbidity in later childhood and adolescence are behaviour related, and therefore preventable. Such health related problems include unintentional injuries (such as motor vehicle accidents, drowning and sports/recreational related injury, most of which affect boys more often than girls), alcohol consumption, tobacco use, illegal drug use, obesity/overweight, eating disorders, teenage pregnancy and childbearing and sexually transmitted infections, including HIV. Major initiatives to address child safety issues in Europe are being taken by the European Child Safety Alliance (www.childsafetyeurope.org), and in particular through the EU-funded Child Safety Action Plans project (ECSA, 2008).

A balanced diet is essential for child health as it influences both physical growth and cognitive development. Similarly, adequate physical activity is essential for health and development, as well as setting an important lifestyle pattern for adulthood. Children who do not follow a balanced diet and adequate physical activity are at a greatly enhanced risk for lifetime healthcare problems such as obesity, diabetes, high blood pressure and cardiovascular diseases.

The consequences of the new morbidity such as overweight, diabetes and asthma in children play out over the lifespan, as unhealthy children typically grow up to be unhealthy adults. This unfortunately offsets the advances which have been made in the reduction of childhood infectious diseases through measures such as vaccination and modern sanitation and, especially in Western and Central Europe, in the virtual elimination of nutritional deficiencies. The way young people rate their health across Europe varies. Girls are more likely than boys to report poorer health in all countries and regions. Reported levels of poorer health among 15-year-old girls are higher in Latvia (over 42%) and Lithuania (WHO/HSBC, 2004).

The World Health Organization (WHO) Regional Office for Europe is currently promoting the European Strategy for Child and Adolescent Health and Development, which all EU Member States committed to address between 2005 and 2008. (WHO, 2005a). This gives an important context within which the European Commission can promote its own declared priority in child health. An earlier and still ongoing initiative is that of the Children’s Environment and Health Action Plan for Europe (CEHAPE), led by the WHO and widely supported. (WHO, 2008). This addresses both environmental and physical safety, and is endorsed by all European Health Ministers.

Both Child and Adolescent Health and Development Strategy and CEHAPE processes were due for report by each Member State to the WHO Regional Committee (the annual high-level national representative meeting) in September 2008.