• By Kevin Mount
  • Posted on Tuesday 30th October, 2007

Things can only get better? Not very likely!

The orthodox view of well-being is one of continuing improvement. As the Australian Institute of Health and Welfare put it in 2004, young people “generally enjoy a level of health that is good and has improved in recent times, as indicated by levels of mortality, morbidity and disability”.However, in its latest four-yearly report the Institute is more ambivalent, still implying continuing improvement, but drawing attention to certain disadvantaged groups who are lagging behind: “While most young people in Australia are doing well,” it says, “there are areas where further gains in health and well-being could be made, particularly among young indigenous Australians, young people in regional and remote areas and young people suffering socioeconomic disadvantage”. The report shows that mortality rates continue to decline and life expectancy to rise. But mental disorders now account for about half (49%) of the burden of disease measured as both death and disability, by far the biggest component (injuries are next, at 18%).A range of evidence suggests the prevalence of mental disorders among young people is also rising (as it is for some chronic physical disorders such as diabetes). For example, hospitalizations for emotional and behavioral problems and intentional self-harm have risen.So while mortality or life expectancy might once have been valid indicators of overall health, this is now questionable. There are "anomalies of scale" in generalizing about health trends: death may only strike a few tens per 100,000 young people a year, but non-fatal, chronic illness is beginning to affect tens in every 100. All in all, research in Australia and other Western nations suggests a fifth to a third of young people are experiencing significant psychological stress and distress at any one time, with some estimates of the prevalence of a more general malaise (eg. frequent headaches, indigestion and sleeplessness) reaching 50%. The young are experiencing mental health problems at higher rates than older age groups, and retaining their increased risk beyond youth into older age.Two recent surveys illustrate the wider picture:A US community survey found 46.5% of adolescents engaged in some form of non-suicidal self-injury within the past year, 28% at a moderate or severe level, averaging 13 incidents of self-harm (biting, cutting, burning or hitting themselves). The most common reasons included: to feel something, even if it was pain; to get a reaction from someone; to get control of a situation, or to stop bad feelings.An Australian study of more than 10,000 students from prep school to year 12 found that “approximately 40% of students could be described as displaying lower levels of social and emotional well-being,” according to the lead researcher. Proportions ranging from 20-40% worry too much, or are very nervous or stressed, or have felt hopeless and depressed for a week and have stopped regular activities, or lose their temper a lot and have difficulty calming down.A wide range of factors have been implicated in the patterns and trends. They include structural changes, such as increasing inequality, work-life strains, education pressures, family breakdown, and mobility; also cultural changes, for example, excessive materialism and individualism.Increasing media use and media content linked to violence, consumerism, and social fragmentation and isolation are also blamed, as are the decline of religion, changes in diet, co morbidity – especially between drug use and mental illness; and environmental changes, such as the effect of chemical pollution on endocrine function, disrupting disease resistance and reproduction.The last - environmental change - looms large as a future health risk, especially global warming and its consequences. A major 2005 report warns that the dual trends of the growing exploitation of ecosystems and their generally declining condition are unsustainable. There is an increasing risk of "non-linear changes" in ecosystems … which could have "a catastrophic effect on human health".Therefore most, if not all, of the explanatory factors are associated with a particular form of national development that focuses on economic growth and material welfare. Along with other lines of evidence, it suggests a state of ‘over-development’, where social changes that were once beneficial to health have become harmful. As a result, material progress is coming under growing challenge from a new model – that of sustainable development, which does not accord economic growth overriding priority, but, instead, seeks a better balance and integration of social, environmental and economic goals and objectives to produce a high, equitable and enduring quality of life.This shift in the “defining idea” of progress, of how we make life better, will make a huge difference to specific problems such as child abuse and neglect. It will make the political climate more conducive to better policies and programs to prevent abuse. By improving the health and wellbeing of families, of both children and parents, it will make conflict and abuse less likely.The politics of health and well-being are much more than the politics of health care and community services; they should be the politics of everything. In other words, the defining goal of government should be to create better health, not greater wealth. The two goals are not the same; in fact, in important respects they are increasingly at odds.Further reading:Eckersley, R. 2007. "The health and wellbeing of young Australians: present patterns and future challenges." International Journal of Adolescent Medicine and Health, vol. 19, no.3, pp 217-227.Eckersley, R. 2006. "Progress, sustainability and human well-being: Is a new worldview emerging?": International Journal of Innovation and Sustainable Development, vol. 1, no.4, pp 306-317.

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