Youth Health: A Guide to Action

(full text version)

Published in September 2002

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Contents

Foreword

Preface

Acknowledgements

The Action Plan in Summary

Summary of Actions by Setting

1. Why a health action plan for young people?

2. Who are ‘young people’?
Proportion of the total population
Health status of young people
Specific health risks for young people: key points

3. What is a ‘healthy young person’?

4. Young people’s views on health services
Young people’s preferred style of health care

5. What works for young people
What works for Māori
Public health programmes

6. The context for the action plan
Youth-focused developments
Youth Development Strategy Aotearoa
Links with health and disability strategies

7. How the action plan was developed
Guiding rather than directing
Sources of information, advice and feedback
The principles underpinning the plan
Treaty of Waitangi
Involving families, whānau and the wider community
How the goals, objectives and actions were arrived at

8. The action plan

9. Health issues for specific groups of young people
Rangatahi
Pacific young people
Young people from minority ethnic communities
Disabled young people
Chronically ill young people
Lesbian, gay, bisexual and transsexual young people
Young parents

Appendix 1: Ministry of Health and intersectoral health strategies

Appendix 2: Other relevant documents and strategies

Bibliography


Foreword
Improving the health and wellbeing of young New Zealanders is an investment in the future of our nation. Not only is this a goal worth pursuing in its own right, it also contributes to achieving Government objectives in the areas of education, economic development, justice and welfare for young New Zealanders.

Youth Health: A Guide to Action proposes a plan of action to improve the health of New Zealand’s 12 to 24 year olds. It sets out goals, objectives and specific actions aimed at doing this.It is primarily for the health sector – but we hope it will also inspire others whose policies and programmes impact on young people.

Special emphasis is placed on dealing with the challenges to health that face many young people who are already suffering from social and economic disadvantage. The fact that young Māori continue to suffer a greater degree of ill health than their non- Māori counterparts is a matter of deep concern to the Government.

This action plan proposes a shift in the way the health sector has traditionally seen young people: from being 'at risk' and as 'a problem to be solved' to being valued participants in the community’s efforts to create a healthier environment. The action plan takes its cue from the Government’s Youth Development Strategy Aotearoa in recognising that the wellbeing of young people is dependent on healthy connections with whānau, schools, peers, work and training, culture and environment. The broad definition of health explicit in the action plan is consistent with Māori and Pacific models of health.

Part of the action plan involves building up the skills of the workforce and the body of knowledge around youth health issues. This has been identified as a necessary adjunct to the extension of programmes and services for young people.

Most importantly, the action plan creates opportunities for young people to actively participate and engage in health policy and service development. Young people want to be involved in decisions that affect them – at the personal level and at the community level. They are clear about what they want from health services. Making this happen is up to all of us.

Annette King
Minister of Health

John Tamihere
Minister of Youth Affairs

Preface
While this document is intended as a guide primarily for the health sector, other sectors and the community at large have a significant role to play in ensuring the good health of young people.

That is why we hope that many of the actions recommended in here will be picked up and acted on by local councils, iwi development groups, schools, and other organisations whose work impacts on young people. Working together across sectors will be the most effective way of creating an environment in which all young people can grow and flourish. We know that there are already a number of innovative youth-focused projects happening at the policy level, in communities, marae and health centres around the country. We want to share the information on what works so that more young people can benefit.

It will be the Ministry of Health’s responsibility to take the lead in advancing the recommendations in this document. Over the next months we will be working together with our colleagues in the health sector and in other sectors to implement as many of the recommended actions as we can.

We will also be establishing some realistic indicators of progress, so that in three years time, we can see what impact this Guide to Action has had on youth health services and, consequentially, on youth health.Acknowledgements
This document contains the ideas of many people about what needs to happen to improve the health of young people in Aotearoa New Zealand.

We would like to acknowledge the contribution of everyone who reviewed the document and whose ideas, insights and wisdom have added value to its content.

This has been a joint project with the Ministry of Youth Affairs and we would like to thank Rebecca Thomson in particular for her constructive contribution and support.

We want to thank the members of the Ministry of Youth Affairs’ Youth Advisory Forum whose energy, optimism and commitment are reflected, we hope, in the document.

Our guides throughout the development of the plan have been the members of our Youth Health Sector Reference Group. Their commitment to youth health continues to be demonstrated through their involvement over many months in the creation of this plan. We thank each of them for their inspiration and their patience.

Members of the Youth Health Sector Group have been:

	Dr Sue Bagshaw	198 Youth Health Centre, Christchurch
	Donna Rose McKay	Manager, Disability Information and Support, University of Otago
	Iain Potter	Health Sponsorship Council, Wellington
	Roger Jolley	Director, Treaty Relations, Wellington City Council
	Louis Smith	Porirua Youth Network, Porirua Safer City Trust, Porirua
	Dr Harith Swadi	Clinical Head, Youth Inpatient Unit, Christchurch
	Jane Ewing	Youth Health Advocate, NZAAHD
	Dr Nick Baker	Chairperson, NZ Paediatric Society, Nelson
	Ana Apatu	Ora Toa Health Unit, Porirua
	Dr Helen Rodenburg	Royal NZ College of General Practitioners, Wellington
	Dr Peter Watson	Specialist Adolescent Physician, Auckland

The Action Plan in Summary

Youth Health: A Guide to Action proposes a shift in the way the health sector has traditionally seen young people: from being a problem to be solved to being active participants in creating a healthier world.

As well as identifying the risks to mental and physical health where young people’s lifestyles make them particularly vulnerable, the action plan proposes ways of making health services more youth-focused and youth-knowledgeable. It emphasises the need to gather better information about factors that affect young people’s health and about ‘what works’ for young people.

The action plan emphasises the need for the health sector to reach out more actively and be more responsive to young people – particularly rangatahi – who suffer poorer health than their peers.

The Goals 1 A safer, more supportive environment for New Zealand’s young people Young people’s health is affected by what is happening in their families and whānau, with friends and in school. Families, schools, communities, and local and central government agencies all have a role to play in improving young people’s health and keeping them well. 2 A measurable improvement in young people’s mental health New Zealand has high rates of youth suicide, particularly among rangatahi, and high rates of mental illness and drug and alcohol abuse. Devising effective ways of keeping young people mentally healthy is a priority. 3 A measurable improvement in young people’s physical health Taking risks and trying new things are integral to young people’s lifestyles. Finding ways of reducing the negative outcomes is part of the action plan. 4 Young people influencing health policy and programme development Young people want to be actively involved in decisions that affect them and in decisions about their own health care. Programmes and services work better when young people participate in their design and/or delivery. 5 A higher level of knowledge about youth health and youth health services Youth health has been relatively neglected as an area of focus for research and medical specialisation. The action plan encourages the systematic acquisition and sharing of knowledge about youth health and youth health services. 6 High-quality, youth-friendly, accessible health services Existing health services often present barriers to young people. Cost, confidentiality, and privacy are issues for young people. There are four population-specific goals: 7 A measurable improvement in the health of rangatahi 8 A measurable improvement in the health of Pacific young people 9 A measurable improvement in the health of disabled and chronically ill young people 10 Better health outcomes for young people with multiple disadvantages

Summary of Actions by Setting

In this summary, we have taken a selection of actions from each of the goals and have linked them
to the various environments in which young people live and interact.

	Setting	Recommended Actions
	Family whānau	Promote the extension of parent education programmes to provide knowledge and support for families and whānau in dealing with young people’s developmental needs, particularly in the areas of mental health, sexual and reproductive health, and alcohol and drug abuse. More effectively provide and co-ordinate support to whānau and families of young people with chronic illness and mental illness. Identify the initiatives that are most effective in decreasing family violence and promote the wider implementation of these. Ensure that young people who cannot live at home have access to financial and other support (including access to adequate housing).
	School Kura Tertiary Education Training	Promote ‘Safer Schools’ and the implementation of anti-bullying programmes in schools. Acknowledge and respond to the needs of young people who are perceived as different because of their sexual orientation or migrant status. Support young people with chronic illness and increase awareness among students and school personnel of the issues for this group. Support further implementation of ‘Health Promoting Schools’ (including the ‘Mentally Healthy Schools’ resource). Promote the extension of the range of Māori language resources to support the Health and Physical Education Curriculum. Look at the feasibility of establishing or extending school health clinics in collaboration with schools, GPs, public health services and DHBs. Ensure that students have ready access to counselling and advice, particularly in the areas of mental health and alcohol and drug abuse. Provide training to assist teachers and other school personnel in recognising early signs of mental illness and alcohol and drug abuse.
	Community Hapu and iwi	Promote the active participation of young people in community development initiatives. Promote programmes that provide opportunities for disadvantaged young people to extend their skills. Positively promote the contribution that young people of different cultures and ethnicities make to the life of the community. Support the development of community-based youth health centres. Strengthen working relationships across sectors on youth-specific projects.
	Primary health care (GPs, public health nurses, family planning, etc)	Actively involve young people in designing primary health care services for young people. Explore ways of reaching out to those young people who don’t use existing health services, through: youth-specific health services mobile clinics at sports events, marae, dance parties, central city and rural locations extending the role/reach of public health services and practice nurses supporting Māori and other communities to develop their own services. Ensure that health services meet the needs of refugees and migrant young people. Encourage family health clinics to look at how they could become more ‘youth focused’ – taking account of young people’s expressed desire for privacy and confidentiality. Look at how user friendly they are for Māori and Pacific young people, and from the perspective of disabled and deaf young people. Support the extension of school-based health clinics, particularly for schools in low-income communities. Compile a web-based directory of health services for young people. Review consistency of eligibility of young people to access to health and other social services. Develop youth-focused guidelines to assist health workers to recognise early signs of mental illness and alcohol and drug abuse. Ensure that admissions and transfers of young people in hospital are based on the best interests of the young person.
	Hospital and specialist health services	Look at how hospital-based and specialist health services could become more ‘youth focused’. Ensure that families of young people with chronic illness have access to respite care and support. Develop a continuity of care for young people with chronic illness and complex needs across hospital, hospice and community services.
	District Health Boards	Actively involve young people in developing policies and health services for young people. Ensure that youth health services in the region are reaching those most in need. Consider innovative approaches to taking health care services to young people who don’t use GPs. Explore, together with schools and GPs, the feasibility of extending schoolbased health centres, particularly in low-decile schools. Identify gaps in mental health services for rangatahi and Pacific youth. Purchase services and programmes in line with advice in the DHB Toolkits. Increase the range and number of respite and care packages for young people with chronic mental health problems. Promote cross-sectoral initiatives to reduce suicide. Collect data that accurately identifies age and ethnicity of young people using health services. Develop a profile of the disabled and chronically ill young people in regions.

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