Most of the studies reported so far have looked at perceptions of health among children without significant health problems or special needs. Others, however, have examined the reality of health for young people with more specific concerns. Rushforth (1999), reviewed the evidence to address the issue of hospitalised childrens’ understanding of health and illness. They also examined what they thought about death. She argued that it is important to know what children think and understand when deciding whether or not they are competent to make decisions about their own treatment.
A variety of experiences have been recorded from young people’s perspectives in relation to conditions ranging from acquired brain injury (Heary et al, 2003), epilepsy (Ronen et al, 1999), blindness and partial sight (Cole-Hamilton and Vale, 2000), cancer (Bearison, 1991), chronic disease (Schmidt et al, 2003), diabetes (Datta, 2003), cerebral palsy (Waters et al, 2005), broader groups of disabled children (Connors and Stalker, 2003), and young people using assisted ventilation (Noyes, 1999).
The impact of the illness or condition on the child’s life, and its implications for quality of life, are among the issues that have been investigated. A few studies of non-disabled children’s views on disability have also been reported, either from the perspectives of siblings (Stalker & Connors, 2004) or among more representative groups of young people (Smith & Williams, 2001/2005). The purpose of some such studies has been to explore, developmentally, the understanding of causation and control in disability. The literature on children’s and young people’s views about their own health and healthy living presents a complicated picture.
While most children and young people appear ready to say they are in good health, a number of qualitative studies suggest that many may nonetheless have significant concerns about their health and their ability to live healthily. Stress, in particular, appears to be a major factor in the lives of many young people. More than 8,000 children aged 0 to 15 were interviewed (for children under 13, a parent or guardian answered questions on the child’s behalf with the child present) for the 2002 National Health Survey, in addition to more than 3,500 young adults aged 16 to 24.
The overwhelming majority of children and young people said their health was good – even though a significant minority identified a longstanding health problem of some sort. Children aged 15 or under were more likely than the young adults to report their general health as either good or very good (93% of boys and girls vs 87% of young men and 84% of young women). Boys (24%) were more likely to report a longstanding illness than girls (20%), but this difference was not found for the young adults (25% of males and 26% of females). Consistent with other findings, there was a link between better reported health and higher household income.
A survey of almost 3,000 children across six secondary schools in two areas of England produced broadly similar findings (Madge & Franklin, 2003). When asked to describe their health, 16% said it was excellent, 41% very good, and 40% good. Only 3% described their health as poor. Just over a quarter (27%) reported a medical problem or disability: asthma was by far the most common condition mentioned (411 pupils), followed by dyslexia (91), eczema (48), hay fever (42), migraine (16), diabetes (13), ADHD and epilepsy (11 each), and visual impairment (10).
Lower rates of health were reported by 2,800 11 to 14 year-old young people from 30 schools in East London (Stansfeld et al, 2003). Among this sample, most of whom were from black and minority ethnic backgrounds, 75% of boys and 72% of girls said their health was either very good or good. Furthermore, most of the adolescents expressed concerns about their health: for boys this was most likely to be about fitness, and for girls about weight.
In a survey of 2,000 young people in public care, one in eight reported a disability or long-term health problem that affected their daily life (Shaw, 1998). It is evident that, even if they say their health is good, many young people are experiencing significant problems. Many put a great emphasis on relationships, feelings and emotions. A number of qualitative studies suggest that stress in particular is a problem for many young people in their teens (Chapman et al, 2000; Kings Fund, 2000; Healey, 2002; Percy-Smith et al, 2003), with bullying playing a major role (Healey, 2002).
It appears that stress among young people is caused by many, and often inter-connected, circumstances that can include bullying, exam pressure, pressure from families, concerns about body image, peer pressure, and a lack of emotional support. The top worries among over one thousand young people in Waltham Forest and Redbridge were stress, followed by eating badly and not exercising, depression, body size, alcohol and having a worrying lifestyle, and smoking (Stockdale and Katz, 2002).