Health disparities among teenagers

Introduction

Health disparities start at a young age and widen as children get older..The main ambition in the Health policy document Reducing health disparities together 2024-2027 is to reduce the health disparities between Utrecht's lowest and highest socioeconomic groups by 30% by 2040. The municipal council is also putting extra focus on equal opportunities with the coalition agreement Investing in Utrecht: Opting for equal opportunity, affordable housing and climate. Growing up with maximum opportunity is a key topic in both the Unequal investment for equal opportunities implementation program and in the Utrecht Social Vision, as this is where the greatest impact on equal opportunities can be achieved. Making unequal investment choices requires an understanding of which groups of teenagers are at the greatest disadvantage and insight into the development of disparities in health and determinants of health. This is outlined in this special issue on “Health disparities among Utrecht's teenagers”.

This issue of the Utrecht Public Health Monitor focuses on changes in disparities among adolescents aged 10 to 16 for the topics in the Utrecht health model:

Health: perceived health, mental health and physical health.
Determinants of health: lifestyle habits, social exclusion and problems in school functioning, physical environment and safety, vaccinations and family income.

We also describe which groups are at the greatest disadvantage in health and determinants of health in 2023.

We use the term ‘children’ for primary school students in groups 7 and 8 and the term ‘adolescents’ for students in years 2 and 4 of secondary school. When discussing both children and adolescents, we use the term ‘teenagers.

Changes in disparities in health and determinants of health were examined by gender, family composition, ethnic background, neighbourhood, family prosperity, year and school level. We described the groups in which changes have taken place and highlighted topics where favourable or unfavourable changes in disparities were noted for multiple indicators.

A favourable change in disparities is when disparities between groups narrow, as the group at a disadvantage shows a favourable development compared to the others.

An unfavourable change in disparities is when:

disparities widen

An example of widening disparities can be seen in the rates of a fear of failure between genders. In Utrecht, girls in groups 7 and 8 of primary school struggle with a fear of failure more than boys. Girls are at a disadvantage in this case. Because the percentage of children with a fear of failure increased among girls between 2017 and 2021 and remained constant among boys, the difference has widened over time.

disparities narrow unfavourably

In some cases, differences narrow unfavourably. An example of this can be seen in loneliness by year. In Utrecht, adolescents in year 2 of secondary school felt lonely less often in 2019 than adolescents in year 4. This rate increased among year 2 students between 2019 and 2021, but remained constant among year 4 students. This removed the disparities in loneliness by year. However, this is an unfavourable development because the most favourable group (in this case year 2) showed a more negative development compared to the other group.

For more information on health disparities among young children in Utrecht, please see the publication The First 1000 Days of Utrecht’s Children. For more information on health disparities among adults in Utrecht, please see the publication Health Disparities Among Adults.

Conclusions and recommendations

In this special issue, we describe the groups of teenagers (10 to 16-year-olds) and topics for which disparities in health and opportunities for health change over time. We also describe the groups that risk the greatest health disadvantage by 2023. Health disparities among adolescents have widened in four areas in the past five to ten years. These are vaccination rates, social exclusion, stress and a fear of failure, and perceived health. In contrast, disparities in poverty rates have narrowed. This study demonstrates the importance of continuing to invest unequally for equal opportunities for young people in Utrecht..

We use the term ‘children’ for primary school students in groups 7 and 8 and the term ‘adolescents for students in years 2 and 4 of secondary school. When discussing both children and adolescents, we use the term ‘teenagers’.

Which groups of teenagers develop less favourably over time?

Girls

Disparities between boys and girls have widened. Girls already struggled more with stress and a fear of failure than boys, and these disparities have widened.

Societal standards and expectations for young people are very high and, as a result, many teenagers experience great pressure to perform. These societal norms may have more impact on girls in the areas of stress and a fear of failure..Countering these high expectations is an important method to reduce stress in that group. Professionals (including teachers) and parents play an important role in reducing the negative impact of societal norms among girls. On the one hand, by focusing on strengthening individual factors (such as coping skills), and on the other, by strengthening girls' social environment to optimally support their socioemotional development...

Year 2

Disparities between adolescents in years 2 and 4 changed unfavourably. Adolescents in year 2 have more unfavourable developments in loneliness, online bullying and lack of control over social media use than adolescents in year 4.

As professionals and parents of adolescents in year 2, be attentive to loneliness, bullying and the lack of control teenagers have over their social media use. This can be done by identifying the issue, facilitating the conversation and providing support if necessary. Parents and schools play an important role here, as the online world is highly complex.i

Which topics show changes in disparities over time?

Disparities have changed unfavourably in four topics among multiple groups of teenagers in the past five to ten years. Disparities narrowed in one topic (poverty).

Vaccination rate

Disparities in vaccination rates between groups of teenagers have widened. This is due to a sharper-than-the-Utrecht-average decline for BMR (10-year-olds), DPT (10-year-olds) and MenACWY (15-year-olds) vaccination rates in the Noordwest, Overvecht and Zuidwest neighbourhoods. MenACWY vaccination rates also declined more sharply among adolescents of Moroccan or Turkish origin than among adolecents of Dutch origin.

Target the Noordwest, Overvecht and Zuidwest neighbourhoods and groups of teenagers of Moroccan or Turkish origin with the teenagers’ vaccination programme to reverse increasing disparities in vaccination rates.

In 2023 and 2024, we worked on a neighbourhood vaccination program in close cooperation with Stichting Sleutelpersonen Utrecht, through which key people and physicians engaged in discussions with the target group during meetings. The goal was both to share and gather knowledge from target groups with different cultural backgrounds about why parents choose not to have their child vaccinated.

We have also been actively lobbying for additional resources. We will use the additional state funding that the municipality of Utrecht will receive in 2025 to increase vaccination rates to broaden and strengthen the neighbourhood-oriented and target-group-oriented program.

Social exclusion and school functioning issues

The disparities in victimisation through bullying and discrimination have narrowed unfavourably between groups of children due to:

an increase in bullying and discrimination among children in families with a high level of prosperity and
an increase in discrimination among children of Dutch origin.

The disparities have widened due to:

an increase in discrimination among children in single-parent families
an increase in problems in single-parent families that may affect school functioning
- As bullying and discrimination are now also more common among groups where this was not the case in previous years, it is important to focus on this broader group. This can be done by identifying the issue, facilitating the conversation and providing support if necessary. It is also essential to maintain a dialogue with the children to understand their specific experiences and needs. This can lead to a more effective approach.
- The unfavourable narrowing of disparities in discrimination by origin may be due to the fact that third-generation immigrants are now seen as children of Dutch origin. Those who are most ‘rooted’ often experience discrimination the most..

Stress & a fear of failure

The disparities in stress and a fear of failure have changed unfavourably between groups of adolescents in Utrecht. This change has occurred by gender, year, school level and neighbourhood.

Professionals (including teachers) and parents play an important role in reducing the negative impact of social norms for girls, adolescents in the second year of secondary school, adolescents at VMBO, and children in Vleuten-de Meern. This involves focusing on strengthening individual factors (such as coping skills) and strengthening the social environment to optimally support their socioemotional
development...

Perceived health among adolescents

Disparities in perceived health among adolescents have widened by gender and origin. This is due to more unfavourable trends among girls and migrant adolescents.

Poverty

On the positive side, disparities in poverty have narrowed by family composition and neighbourhood. This increased health opportunities for single-parent families and children in Overvecht, Zuidwest and Noordwest.

The narrowing of disparities in poverty between single-parent families and other families may be related to the additional allowance in the child budget for single parents..Another possible explanation is that poverty schemes are broader than they used to be. Single-parent families may have used these more than other families.

No changes in disparities for most indicators

There were no changes in disparities for most of the examined indicators. This is especially true for the topics:

Perceived health of children
Smoking and alcohol among adolescents (except binge drinking)
Physical environment and safety (except Oost)

This is not necessarily good news. Existing disparities have not narrowed, and for topics such as smoking, the entire group of adolescents who smoke has grown.

Health disparities not narrowing on a national level

Although efforts have been made for years to resolve health disparities, they are still not yet narrowing on a national level. The Council for Public Health and Society, therefore, made several recommendations. Among other things, it is important to increase the focus on addressing societal causes of health disparities in policy while simultaneously focusing on lifestyle and behaviour. It is also important to focus on long-term policies. Health disparities have complex causes that do not appear overnight and, as such, cannot be resolved quickly.

Which groups have the greatest risk of health disparities?

The following groups had the greatest disparities in health and determinants of health in 2023:

Teenagers growing up in single-parent households
Teenagers with migrant backgrounds
Adolescents at VMBO and HAVO
Children growing up in families with a low level of prosperity
Children from Overvecht and Zuidwest

In general, the disparities have not increased for these teenagers in recent years.