Youth Health: A Guide to Action

(full text version)

Published in September 2002

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9. Health issues for specific groups of young people

In this section, we highlight some of the health issues confronting specific groups in the youth population. This provides a little more context for actions recommended in the action plan. It also draws attention to some concerns that may not yet have been recognised or responded to in current health service provision.

Rangatahi
Young Māori represent almost 20 percent of New Zealand’s total youth population (Statistics New Zealand NZ Census 2001). With young Māori continuing to suffer more ill health than their non-Māori counterparts, the health sector has a responsibility to work with whānau, hapu, iwi and Māori communities to find solutions. This means going beyond treating the symptoms of ill health.

For Māori , good health is increasingly associated with Māori development, with strengthened cultural identity, with self-determination, with hope for the future.

In practical terms, for the health sector this means involving rangatahi in policy and programme design, offering training opportunities in health, developing the capacity of Māori providers, and advocating with colleagues in other sectors for adequate housing and support for young people – as well as making sure that existing health
services are responsive and appropriate to the needs of young Māori.

Pacific young people
Most young Pacific people currently resident in New Zealand were born here. These young people face the challenge of developing their own identities out of two or more cultures and often, conflicting attitudes and values. Pacific culture, values and practices are very strong in New Zealand, and many young people’s social, spiritual, cultural and youth development activities centre around the church.

For the health sector, recognising young Pacific people in the context of their families is important, as is acknowledging the differences between Pacific communities.

Pacific health workers advocate working alongside and through the church and community networks as the most effective way of promoting the good health of Pacific young people.

Young people from minority ethnic communities
New Zealand has a diverse range of ethnic communities. According to the 2001 Census (Statistics New Zealand), nearly one in five New Zealand residents was born overseas. One in 15 is of Asian ethnicity. A high proportion of new migrants each year come from non-English speaking backgrounds.

The needs and views of young people from different ethnic backgrounds vary with their backgrounds and the time spent in New Zealand. For example, many young people come to New Zealand as students and then return on temporary visas, so are often not eligible for health benefits that come with full citizenship. They may not have money or insurance to cover the costs if they become unwell. Others may have entered New Zealand as refugees, and have health needs that relate to experiences prior to their arrival in this country.

Issues for these young people may include:

• language barriers
• difficulties associated with making the transition to adulthood in a new and sometimes alien culture
• lack of connections into the community and knowledge of how to access health services
• being caught between two cultures: their own and that of their new country
• bullying, and fear of racism.

The health sector and the education sector share a duty of care for these young people. Feedback from the youth health sector indicates that there is an urgent need for the Ministries of Education and Health, in consultation with ethnic communities, to find appropriate ways of meeting the health needs of new young migrants and their families.

Disabled young people
About 8 percent of young people have physical, sensory or other impairments that limit their daily activities in some way (Statistics New Zealand NZ Census 2001).
This group includes:

• physically disabled youth
• blind, visually impaired or deaf/blind youth
• Deaf youth
• intellectually impaired youth.

Often these young people face huge barriers to achieving the kind of life that their peers take for granted. Because they are perceived to be ‘different’, disabled young people are often bullied at school and many do not feel that they
are part of a supportive environment.

For this reason, families, whānau, schools and health workers need to be particularly alert to signs of emotional and mental ill health among disabled young people.

Communication and access to health services is a major issue for disabled youth.

• Health information needs to be in an accessible form (eg, in large print, in audio or electronic format wherever feasible) and free of charge.
• Premises need to be easy to locate.
• Health staff need to be aware of and sensitive to the particular issues that disabled youth face.

Chronically ill young people
Young people with chronic illnesses (including cancer, diabetes, asthma, cystic fibrosis and multiple sclerosis) face some special challenges – particularly in connecting and keeping up with their peers. For those at school, their illness can mean that they have days and sometimes weeks away from classes. This interrupts both their learning and their relationships with their classmates. The symptoms of their illness – sometimes physical, like coughing; sometimes practical, like having to take medication – can make them feel self-conscious, and the object of embarrassing attention.

For the older group, money worries can compound their illness. Finding a job that is flexible enough to allow for intermittent bouts of sickness is difficult. Many costs associated with their illness are not covered through the public health system.

Chronically ill young people say that if people were more aware of how they felt and the issues they faced, that would make a difference.


Lesbian, gay, bisexual and transsexual young people
Young people whose sexual identity sets them apart from their peers are often having to function in an environment that is less than supportive. Many lesbian and gay young people report having to deal with bullying and discrimination in schools and in their workplaces.

For some young people this sense of exclusion can be overwhelming and may result in depression and even self-harm.

The primary need of this group of young people is support. Teachers, school counsellors and school-based health professionals are likely to be the first to identify pressure points for these young people, but families and whānau and primary health care workers also need to be alert to the signs of bullying or discrimination and ensure that appropriate support and pastoral care is available.Young parents
Young parents, and particularly young mothers, are potentially under greater pressure (with less support) than previous generations. With many of their peers postponing childbearing until their late 20s, young parents’ network of mutual support has shrunk. Grandparents may be in the workforce, and family and whānau are often scattered.

Young parents may also be under financial stress.

Young parents, and in particular young mothers, need:

• supportive communities, families and whānau
• support groups and income support
• opportunities for continued education and personal development.

Appendix 1

Ministry of Health and intersectoral health strategies

• New Zealand Disability Strategy 2001

• New Zealand Health Strategy 2000

• He Korowai Oranga: Māori Health Strategy Discussion Document 2001

• New Zealand Strategic and Action Plan for Public Health (discussion document)

• Reducing Inequalities in Health (June 2002)

• New Zealand Youth Suicide Prevention Strategy (1998) (an intersectoral strategy)

• An Integrated Approach to Infectious Disease: Priorities for Action 2002–2006

• The National Drug Policy 1998–2003 (an intersectoral strategy)

• National Alcohol Strategy 2002–2003 (an intersectoral strategy)

• Building on Strengths: A Guide for Building on Strengths: A Mental Health Promotion Strategy 2002 (under development)

• Healthy Food – Healthy Action: An integrated approach to nutrition, physical activity and healthy weight for New Zealand (under development)

• New Zealand Cancer Control Strategy (in early scoping phase)

• Pacific Health Action Plan 2002

• Child Health Strategy 1998

• Sexual and Reproductive Health Strategy (2001) (being developed into action plans)

• The Primary Health Care Strategy (2001)

• Through the Eyes of a Child: A National Review of Paediatric Speciality Services

• The Palliative Care Strategy (2001)

• Child Health Information Strategy (2000)

• The Health Workforce – A Training Programme Analysis

Appendix 2

Other relevant documents and strategies

	United Nations Convention on the Rights of the Child Ministry of Youth Development, December 2000 ISBN 0-478-25000-2 Contact: Ministry of Youth Development PO Box 10 300 WELLINGTON www.myd.govt.nz	About Time Department of Corrections, May 2001 ISBN #0-478-11330-7 Contact: Department of Corrections Private Box 1206 WELLINGTON www.corrections.govt.nz
	Youth Development Strategy Aotearoa Ministry of Youth Developement, January 2002 ISBN# 0-478-25004-5 Contact: Ministry of Youth Affairs PO Box 10-300 WELLINGTON www.myd.govt.nz	A Quick Reference for Primary Care Providers – detection and management of young people at risk of suicide Royal New Zealand College of General Practitioners Ministry of Youth Affairs, September 2000 Contact: Royal New Zealand College of General Practitioners PO Box 10440 WELLINGTON www.rnzcgp.org.nz www.nzgg.org.nz – National Health Committee/Guidelines Group.
	New Zealand’s Agenda for Children: Making Life Better for Children Ministry of Social Development, June 2002 Contact: Ministry of Social Development Private Bag 39993 WELLINGTON www.msd.govt.nz	Health for Young People – Effective General Practice Care for Young People Royal New Zealand College of General Practitioners Reissued 2000 Contact: Royal New Zealand College of General Practitioners PO Box 10440 WELLINGTON www.rnzcgp.org.nz
	WELLCHILD – Coordinated child health Royal New Zealand College of General Practitioners and Ministry of Health Revised 4th edition, May 2000 ISBN # 0-9582176-6-1 (HP 3419) Contact: Ministry of Health C/o Wickliffe Ltd PO Box 132 Dunedin moh@wickliffe.org.nz	Suspected Child Abuse and Neglect Ministry of Health; Royal New Zealand College of General Practitioners New Zealand Medical Association; Child, Youth and Family, December 2000
	Youth Offending Strategy Ministry of Justice, April 2002 ISBN 0-478-20174-5 Contact: Ministry of Justice PO Box 180 WELLINGTON www.justice.govt.nz	Report on Progress 1998–2000 towards implementing the Blueprint for Mental Health Services in New Zealand Mental Health Commission, February 2001 ISBN# 0-478-11375-7 Contact: Mental Health Commission PO Box 12-479 Thorndon WELLINGTON www.mhc.govt.nz
	Health and Physical Education Curriculum Ministry of Education ISBN# 0-478-23008-7 Contact: Learning Media PO Box 3293 WELLINGTON www.learningmedia.co.nz	A Child’s Right to Medical Treatment: Reconciling the Perceived Conflict between Children’s Rights and Parents’ Rights – Discussion Paper Office of the Commissioner for Children Contact: Office of the Commissioner for Children PO Box 5610 WELLINGTON www.children@occ.org.nz
	New Zealand Injury Prevention Strategy (Currently Under Development) Accident Compensation Corporation (ACC) Contact: Accident Compensation Corporation PO Box 2521 WELLINGTON www.acc.co.nz	Final Report on the Investigation into the Death of James Whakaruru Office of the Commissioner for Children, June 2000 Contact: Office of the Commissioner for Children PO Box 5610 WELLINGTON www.children@occ.org.nz
	Road Safety Strategy 2010 – a consultation document Land Transport Safety Authority National Road Safety Committee, October 2000 ISBN# 0-478-20693-3 Contact: Land Transport Safety Authority PO Box 2840 Wellington www.ltsa.govt.nz	Building a shared vision for our community Ministry of Pacific Island Affairs Pacific Capacity Building Christchurch Programme of Action Contact: Ministry of Pacific Island Affairs PO Box 833 Wellington www.minpac.govt.nz
	Blueprint for Mental Health Services in New Zealand – How things need to be Mental Health Commission, November 1998 ISBN 0-478-11357-9 Contact: Mental Health Commission PO Box 12 479 WELLINGTON www.mhc.govt.nz	Growing Young –Towards a Comprehensive Child Health Strategy Community Paediatric Committee Paediatric Society of New Zealand Contact: Paediatric Society of New Zealand

Bibliography

Dickson N et al. 2002. Unwanted Pregnancies Involving Young Women and Men in a New Zealand Birth Cohort. Dunedin: University of Otago.

Gray A. 1994. From Counselling to Cough Mixture: Young people’s views on health and disability support services. Gray Matter Research Ltd for Ministry of Youth Affairs.

Le Lievre B. 1999. Global Voice Report. Christchurch: Christchurch City Council.

Lower Hutt Youth Project, 2002. Lower Hutt Youth Project Research Report. Wellington: Project Adventure New Zealand.

Mathias K. 2002. Youth Specific Primary Health Care: Access, Utilisation and Health Outcomes : A Critical Appraisal of the Literature. NZHTA Report 5(1).

Ministry of Health. 1995. Effective Health Services for Young People: Te Toiora o Toku Whanaketanga.

Ministry of Health. 2000. A National Work Plan for Child and Youth Mental Health Services. Wellington: Ministry of Health.

Ministry of Health. 2000. Social Inequalities in Health: New Zealand 1999. Wellington: Ministry of Health.

Ministry of Health. 2002. New Zealand Youth Health Status Report. Wellington: Ministry of Health.

Ministry of Health. 2001. He Korowai Oranga: Māori Health Strategy. Wellington: Ministry of Health.

Ministry of Youth Affairs. 1998. Under One Roof: A review of one stop shop health services in New Zealand. Wellington: Ministry of Health.

Ministry of Youth Affairs. 2002. Youth Development Strategy Aotearoa. Wellington: Ministry of Youth Affairs.

Raeburn J and Sidaway A. 1996. One Stop Shopping. A literature review. Commissioned by Child and Youth Health, North Health.

Silva PA, Stanton W (eds). 1996. From Child to Adult: The Dunedin Multidisciplinary Health and Development Study. Auckland: Oxford University Press.

Sporle A. 1993. A Pilot Survey of Auckland Adolescent’s Perceptions of their Health Needs. Commissioned by the Auckland group of the New Zealand Association for Adolescent Health and Development.

Statistics New Zealand and Ministry of Youth Affairs. 1998. New Zealand Now: Young New Zealanders. Wellington: Ministry of Health.

Stroul BA. 1996. Children’s Mental Health: Creating systems of care in a changing society. Baltimore: Paul H Brookes Publishing Co.

Wellington Medical School. 2001. How Healthy Is Our Future? A Public Health Report for the Wellington Youth Health Service Project.

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1 For disabled youth, the process of achieving their own sense of identity may be particularly complex.

2 ‘Accessible’ means removing not just the physical barriers but also other barriers that limit disabled people’s access. Often they need communication support and access to information in alternative formats.

3 An accessible service addresses the physical, information and communication needs of its consumers, through alternative methods of communication and the production of information in mediums other than print.

4 The use of a capital D for Deaf denotes a group of people who consider themselves a distinct cultural and linguistic minority.

5 Appropriateness is vital especially in the areas of mental and sexual and reproductive health.

No Number 6 within the document

7 Young people who suffer from the cumulative impact of low or no income, abusive or violent environments, substandard housing, inadequate schooling, mental illness, chronic illness and drug or alcohol abuse.

8 Learning disorders are a significant risk factor for mental health co-morbidity.

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