The health status of young people, including Aboriginal and Torres Strait Islander young people

Start with the fact that surprises people. On the measures from Lesson 3, young people are the healthiest age group in Australia: mortality is low, and chronic disease of the kind that dominates older age groups is rare. If you judged adolescent health by death rates alone you would conclude there is very little to do.

That conclusion would be wrong, for three reasons, and holding all three together is what the dot point is asking for.

• The burden is non-fatal. Mental health conditions and injury dominate the burden of disease for this age group. Neither shows up in mortality data at anything like its real weight, which is exactly the morbidity-versus-mortality point from Lesson 3, met in a population where it matters most.
• The causes are overwhelmingly preventable. The leading causes of death and serious harm among young people — injury, including road trauma and self-harm — are not degenerative processes. They are events, with social and environmental causes that can be changed.
• This is where the next sixty years are set. Patterns of activity, diet, alcohol, smoking, sleep and help-seeking established in adolescence persist, and the chronic disease that dominates Australian mortality later is largely built here. Adolescence is low-burden and high-leverage at the same time.

So the honest one-sentence summary is: young people are physically healthy, carry most of their burden in mental health and injury, and are at the life stage where intervention pays off most. Any answer that says only “young people are healthy” or only “young people are in crisis” has taken half the picture.

The sub-point asks what are the trends, not what are the levels. A level is one number; a trend is a direction over time, and only a trend tells you whether something is being solved.

Across recent decades the Australian picture for young people has moved in both directions at once, which is why a single verdict is always wrong:

• Substantially improved: smoking, which is far less normalised among young Australians than a generation ago and is one of the clearest public health successes in the country's history. Road deaths among young drivers have also fallen substantially over comparable periods, alongside licensing, vehicle and enforcement changes.
• Worsened or newly prominent: reported mental health conditions, particularly anxiety and psychological distress, have risen in Australian surveys of young people.
• Contested in interpretation: that same mental health rise is genuinely hard to read, because improved recognition and greater willingness to seek help both increase reported rates without the underlying condition necessarily rising by the same amount. Lesson 6 met this problem; saying so is a strength in an answer, not a hedge.

A risk factor raises the likelihood of a health problem. A protective factor lowers it, or reduces the harm when the problem happens anyway. They are not mirror images: removing a risk is often impossible, while adding a protection is often achievable, which is why health promotion works mostly on the second list.

Look down the protective column and notice what most of the entries have in common: they are conditions and relationships, not decisions. “One trusted adult” is the most consistently protective factor in adolescent health, and it is not something a young person can choose to have. That is the point at which this dot point hands over to the determinants.

The third sub-point asks how the determinants of health affect health-related behaviours. Lesson 5 built the machinery; this card points it at young people specifically.

Take physical activity, which reads as the purest personal choice there is. For a young person, whether it happens depends on: whether organised sport is affordable, whether there is somewhere safe and lit to be active, whether the trip there is possible without a car, whether paid work occupies the after-school hours, and whether their family and friends already do it. Five conditions and one decision — and the decision is the last link in the chain, not the first.

The same analysis applies to every behaviour in Card 06. Help-seeking depends on whether a service exists, whether it is confidential, whether it is reachable after school, and whether a young person expects to be taken seriously rather than judged. Diet depends on what is sold within walking distance and at what price.

Two consequences follow, and both are examinable.

• Behaviour is where determinants become visible, which is why it is so easily mistaken for the cause. A behaviour is the point in the chain a person can be blamed for.
• Interventions aimed only at persuading young people to choose differently will improve the health of the already advantaged first and can widen the gap — the conclusion Lesson 5 reached, arriving here with a specific population attached.

The dot point names this group explicitly, and it requires precision rather than sympathy. Three things have to be got right.

First, the causes are historical and structural. The health inequities experienced by Aboriginal and Torres Strait Islander young people are the product of colonisation, dispossession, the forced removal of children, and the continuing social and economic disadvantage that followed — compounded by racism and by services that have not been culturally safe. They are not explained by culture, by attitudes to health, or by choices. An answer that reaches for those explanations has misunderstood the content and will be marked accordingly.

Second, the effects run through the determinants you already know. Lower average income, less secure housing, greater distance from services, interrupted schooling and experience of discrimination each act on health exactly as Lesson 5 described, and they cluster, so their effects multiply. Distance and remoteness matter, but note that most Aboriginal and Torres Strait Islander people live in urban and regional areas, so remoteness is one factor among several rather than the explanation.

Third, name strengths, not only deficits. This is the part most commonly omitted and it is genuinely part of the content. Connection to culture, community and Country is a documented protective factor for social and emotional wellbeing. Aboriginal Community Controlled Health Organisations, which are governed by the communities they serve, are an effective service model precisely because they build in the participation principle from Lesson 4. And the concept of social and emotional wellbeing — met in Lesson 1 — is a broader and in some respects more useful model of health than the individual-centred ones beside it.

A report that describes only gaps produces what is often called a deficit narrative: accurate in each figure and misleading overall, because it presents a population as a problem rather than as people with assets working against structural disadvantage. Writing about this group well means holding the inequity and the strength in the same answer.

Each statement below is written as though it describes a choice. Rewrite it as a chain of at least four links running from a determinant to the behaviour, naming the determinant group at each step. Then name one protective factor that would interrupt the chain, and say who would have to provide it.

Go to the Australian Institute of Health and Welfare's Australia's Health and find its material on young people, or the ABS National Health Survey. Choose one key health issue and answer the following, with the source and year recorded for every figure you quote.

• What is the current level, and what is the trend across the years reported?
• Which measure is it — mortality, morbidity, prevalence, burden of disease? What does that measure leave out?
• Is the data disaggregated by group? If it is, what does the gap look like; if it is not, what could that be concealing?
• Name two risk factors and two protective factors the report identifies.
• Write two sentences on how the determinants of health would shape the behaviour involved.

Then compare what you found with your card 01 answers. Note specifically anything you listed as a top-three threat that the data does not support, and anything the data shows that you had not thought of. That gap between impression and evidence is the thing this activity exists to make visible.