Healthy kids and teens: making prospects more equal

The Federal Office of Public Health (FOPH) is currently working on various strategies, programmes and projects relating to child and adolescent health. The topics are very wide-ranging as this overview, which is not exhaustive, shows: from substance use (e.g. alcohol or cannabis), physical activity behaviours, chemicals (protection of children in the household) and vac­cination to mental health and young carers (children and adolescents who look after sick (addicted) parents). The subject of the new coronavirus (SARS-CoV-2) is of course also having an impact on the health of children and adolescents right now. This edition of spectra aims to show what the FOPH is doing to protect and promote the health of children and ado­lescents and to describe the challenges facing us now and our focus areas in the future.

In December 2019 the Federal Council approved the new overall public health strategy “Health 2030” that will help to determine the way the Swiss health system develops during the coming decade. One of the aims listed in the overall strategy – ageing healthily – also mentions the health of children and adolescents, because it’s best to start young if you want to stay healthy well into old age. Health in advanced years is often a reflection of habits, behaviours and mental burdens early in life. Ex­periences of this kind can have a life-long impact.

Against this background, the Federal Council has formulated the following objective in “Health 2030”: “A healthy start in life is a decisive component of health as an adult. The federal government, the cantons and all the institutions involved in the upbringing and education of children and adolescents should develop measures to exploit previously unused potential during pregnancy, early childhood, in kindergartens, at school and at the transition to working life.” Prevention is a second focus of the strategy: health promotion and prevention should preferably begin at a young age and be supplemented as an adult. Good health behaviours in younger years and corresponding activities as the body ages can prevent disease.

The FOPH sees potential in many areas, among them the challenges relating to the mental health of children and adolescents. Many psychological disorders emerge at a young age but are unfortunately often not diagnosed until much   later. One in five young people in the 8- to 18-year-old age bracket experiences mental issues at least once, suffering from conditions such as anxiety or attention deficit problems.

Suicide prevention among Swiss adolescents is another challenge, as suicide is the second most common cause of death after accidents in this age group. Around 30 adolescents between 15 and 18 years of age take their lives every year in Switzerland, and the figure is roughly twice as high in the 19 to 24 age bracket. The number of attempted suicides is around 10 to 20 times higher. In a study by the Swiss Health Observatory, Obsan, 10 per cent of adolescents and young adults (15 to 24 years of age) stated that they had had suicidal thoughts in the previous two weeks.

The situation is compounded by the inadequate level of psychi­atric care for children and adolescents in Switzerland as a result of a lack of corresponding therapy programmes and specialists, all of which leads to long waiting lists. The FOPH is in no doubt that improvements in mental health are needed for all children and adolescents, ranging from prevention and creation of an evidence base to the provision of psychiatric care. 

This brings us to a further challenge: the paucity of good data. This applies not only to mental health but also to the health of children and adolescents in general. Having good data is the only way to understand the complex mech­anisms underlying health and to define measures that are truly      effective. Currently, for example, not many data are available for certain age groups (0–10 years). And in some cases the data recor­ded is not available to the public (because of data protection requirements, for example).

Another problem is the unequal access that children and adolescents have to healthcare. This begins with an unequal start in life, perhaps because the parents’ health skills are lacking or their financial situation is too limited for their children to take part in sports (pay membership fees for sports clubs or camps, for example). Deficits of this kind can affect the children, accumulating as they go through school; they can lead to problems in finding a vocational training place or even to adolescents dropping out of school; and they cul­minate in long-term effects on the health of these individuals.

Ein weiteres Problem ist der ungleiche Zugang von Kindern und Jugendlichen zur Gesundheitsversorgung. Das beginnt bei ungleichen Startchancen der Kinder, zum Beispiel aufgrund ungenügender Gesundheitskompetenz der Eltern oder bei ungleichen finanziellen Möglichkeiten, die Kinder sportlich zu fördern (zum Beispiel Mitgliederbeiträge von Sportvereinen). Solche Defizite können sich auf die Kinder übertragen, sich über die Schulzeit hindurch fortbilden, können zu Schwierigkeiten bei der Lehrstellensuche oder gar zu Schulabbruch führen – und enden damit in langfristigen Auswirkungen auf die Gesundheit dieser Personen. Entsprechend wichtig ist die changengerechte Förderung von gesunden Kindern und Jugendlichen. Denn wie erwähnt: In keinem Lebensabschnitt sind Gesundheitsförderung und Präven­tion so wirksam, nachhaltig und wirtschaftlich ertragreich wie in dieser Lebensphase.

Das BAG stützt sich bei den Arbeiten auf verschiedene Grundlagen:

• NCD-Strategie (Strategie zur Prävention nicht übertragbarer Krankheiten)
• Strategie Sucht
• Dialogbericht zu den Massnahmen im Bereich der psychischen Gesundheit
• Motion Ingold (Suizid­prävention)
• Betäubungsmittelgesetz
• Strahlenschutzgesetz (Radon)
• Förderprogramm betreuende Angehörige (2017–2020)