1 Course overview
The focus of this course is young people's health and wellbeing, a topic that has received much attention from commentators and policy makers in recent years.
Specifically, the course will set out to answer the following core questions:
How has young people's health been constructed in public and policy discourse in recent years, and what are the implications for young people and those who work with them?
What might an alternative, critical framework for understanding young people's wellbeing look like?
How is young people's wellbeing shaped by diversity and inequality?
What are the implications of a critical approach for promoting young people's wellbeing?
We begin with two newspaper stories that are fairly typical of recent media coverage.
Activity 1 Stories about young people's health
Below are two extracts from newspaper articles. Read through them and make notes about the kinds of issues they are concerned with and the general picture they present of the current state of young people's health.
Depression, eating disorders, addiction, self-harm and the experience of frightening street violence … these stories are all around me, as if they are now normal rites of passage for young adults. At times it seems there is hardly a single family unaffected. This child, so bright and optimistic so recently, is sunk in grey depression and won't go to school. That one, so athletic and cocky, has been violently mugged and now avoids walking anywhere, lurking inside his bedroom. Another cuts herself. Another suffers extreme bullying and has ballooned in size. Another was stabbed while walking the dog. The papers are full of stories of the extreme edges of teenage trauma – the 12-year-old fathers and the child mothers; the suicide pacts made on the internet; the very young binge drinking; those who walk out and never come back.
(Ashley, 2005, p. 24)
Recent studies have painted a somewhat unsettling picture of life at 15: of the 788,000 15-year-olds in Britain, one in three have had sex, one in five regularly smoke cannabis, and most drink alcohol every week. Nearly 37% of 15-year-old girls consume soft drinks every day, and almost 3% are clinically obese. Last year, Childline counselled more than 14,000 15-year-olds on a variety of issues, including family relationships (14%), sexual abuse (12%) and pregnancy (10%). Between 2% and 8% of adolescents suffer from major depression.
A 25-year study of adolescent mental health by the Institute of Psychiatry at King's College London and the University of Manchester, published last summer, found that, compared to 1974 figures, today's 15-year-olds are more than twice as likely to display behavioural problems such as lying, stealing and disobedience, and are 70% more likely to experience emotional problems such as anxiety and depression.
(Barton, 2005, p. 2)
These two stories are concerned with a wide range of health related issues, including mental health, behavioural problems, victimisation, addiction and sexual health. The general picture they present is one of a decline in young people's physical and mental wellbeing, and their mood is generally pessimistic.
These extracts are fairly typical of recent media discussion of young people's wellbeing. Recent years have seen a succession of minor moral panics about the health related behaviour of teenagers. As in these extracts, the concerns have been wide-ranging rather than confined to a particular issue, giving a sense of an accumulation of overlapping problems afflicting young people today. However, we can identify a number of key images that recur in recent media coverage and public discussion of young people's health.
One key set of concerns relates to young people's physical health and is encapsulated in the popular media image of the young person as ‘couch potato’, eating too much (and too much of the wrong things) and not getting enough exercise. Here is a fairly typical selection of recent headlines from one UK newspaper, reflecting some of the contrary views on the issue.
Obese teenagers heading for heart attacks
MP outlines bill to ban junk food in schools
Children misclassified as obese
Childhood obesity fears ‘exaggerated’
The image of the unfit and overweight teenager has become a staple of anxious media coverage and of popular cultural representation. The picture that comes to mind is of a young person slumped on the sofa in front of a TV screen or hunched over a PlayStation, snacking on unhealthy food, rarely going out into the fresh air or taking part in physical activity.
A second set of concerns focuses on the health implications of ‘risky’ behaviour by young people. As indicated in the two extracts above, attention has focused recently on activities as diverse as sex, drug taking and binge drinking.
A third and increasingly pervasive image is that of the anxious teenager. Concern about young people's emotional wellbeing has grown in recent years, with a number of research studies claiming that there has been an increase in mental health problems among young people. For example, one report claimed that the rate of emotional problems such as anxiety and depression among adolescents has increased by 70 per cent in the last 25 years (Collishaw et al., 2004), while the Mental Health Foundation's Bright Futures study in the late 1990s claimed that 20 per cent of young people are experiencing psychological problems at any one time (Mental Health Foundation, 1999).
There is also a growing realisation that services set up to meet young people's mental health needs are patchy and inadequate. According to the Bright Futures report: ‘There is huge variety in the quality and speed of mental health services, with some children having to wait a year to see a child psychiatrist’ (Mental Health Foundation, 1999).
Taken together, these images – of the young person as physically unfit, risk taking and anxious – tell a story of an alarming decline in the state of young people's wellbeing. But how does this ‘story’ – reproduced in the media and increasingly in policy discussions – account for this apparent decline?
One explanation sees young people as under growing pressure to perform at school and to get a good job in an increasingly competitive jobs market. Other accounts speculate about failures on the part of parents. In the newspaper article cited in Activity 1, journalist Jackie Ashley wonders: ‘Perhaps the move of more women into the labour market in recent decades, with fathers not compensating for the time lost with children, is … a factor’ (Ashley, 2005, p. 24). Another journalist, Madeleine Bunting, has suggested that ‘an increasing minority of parents are unable or unwilling to provide the emotional nurturing which will ensure a resilient child’. She quotes Dinah Morley of the charity YoungMinds as claiming that ‘there is a failure in attachment … A growing number of us simply aren't bonding sufficiently with our babies’ (Bunting, 2004, p. 17).
Thus concerns about the unhealthy young person have become a lightning rod for wider anxieties about key aspects of contemporary life, such as changes in parenting and family life, and an increasingly competitive and stressful society.
Activity 2 Researching media stories of young people's health
Over the next few weeks look out for media stories about young people's wellbeing. Do they reflect the kinds of concerns – about physical health, risk-taking behaviour and mental wellbeing – that we have noted here, or do they embody other anxieties? How do the stories account for changes in young people's experience?
Although you may identify some similarities to the articles quoted in Activity 1, it is likely that new concerns about young people's health will have emerged by the time you read this. Look out for similarities and differences in the responses of media commentators and in the explanations they offer.
Analysing popular images and stories about young people's health is important, not least because they can have an impact on young people's behaviour. For example, the intense public focus on obesity appears to be having an effect on young people's sense of the ‘ideal’ body weight. In March 2005 the Guardian newspaper reported research that suggested that girls as young as five were fretting (unnecessarily) about their weight.
Another reason why these public narratives are important is that they help to shape policy in relation to young people, leading for example to bans on ‘junk’ food in school or initiatives to reduce teenage alcohol consumption. The UK government's Green Paper of 2005 on youth reflected many of the concerns discussed above:
Young people today have more opportunities than previous generations. Most teenagers take advantage of this and make the transition to independent adulthood successfully …
Yet in other areas there is little improvement or even poorer outcomes. This is the case, for example, with some aspects of teenagers' health such as drinking, sexual health and obesity. A minority of teenagers face serious or multiple problems and some become involved in anti-social behaviour and youth crime.
Some teenagers have health problems, including chronic clinical conditions such as asthma or diabetes. In the key areas of sexual health, obesity, alcohol, volatile substance abuse and mental health, the health of adolescents is either worsening or static. This is in contrast to marked improvements in the health of younger children and older people over the last thirty years. Some young people get into bad habits such as binge-drinking or drugs. Young people are in fact the heaviest drinkers, and are more likely than all other age groups to binge-drink. As well as harming their physical health, this can lead to violence and accidents.
Evidence suggests that at least 10% of young people have a diagnosable mental disorder. Mental problems can interfere with young people's ability to learn, develop and maintain relationships and to deal with the difficulties they face.
(DfES, 2005, pp. 12–13)
As in the media stories cited earlier, this extract reflects overlapping concerns about different kinds of health problems: physical, mental and emotional. There is also a blurring of concern for young people's health and a concern about the impact of their health problems on society in general.
How should we respond to these stories about the state of young people's health? What models of health and wellbeing do they assume, and what are their implications for policy and practice? Is it possible to offer an alternative way of thinking about young people's wellbeing, and what might be the implications of that model for work with young people? These are some of the questions that will be addressed in this course. Rather than offer a descriptive survey of the state of young people's health, or a detailed account of a range of health ‘problems’, the course will continue the critical analysis of current ways of constructing young people's wellbeing begun in this overview, and attempt to provide a critical framework for understanding and responding to young people's health needs.
Recent media coverage has painted a picture of a decline in young people's wellbeing and of increasing concern about their physical and mental health.
These images and stories influence young people's own perceptions and behaviour, and at the same time help to shape policy and practice.