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Age group 12 to 17 years

Physical health

Physical health is a basic building block for young people’s current wellbeing and future life outcomes. Being physically healthy includes being physically active, having a good diet and being in the healthy weight range.

During adolescence, young people form health-related attitudes and behaviours that can stay with them for life, making it a critical time to support positive and deter negative health practices.1

Overview and areas of concern

This indicator considers some key measures of physical health for young people including physical activity, screen-time, diet, weight and long-term health issues.

Physical health is influenced by a range of factors including genetic, social and environmental influences. Research has found that Australian young people living in areas with a high risk of social exclusion1 have, on average, worse health outcomes than young people living in other areas.2 In particular, socio-economic indicators such as having higher income and education levels are linked to better health outcomes.3

Data overview

While research shows that the proportion of young people that are physically active is decreasing, almost three in every four (72.7%) WA young people aged 10 to 15 years were reported by parents/carers as being active or very active in 2017.

While in 2017 approximately 22.5 per cent of young people aged 10 to 17 years were overweight or obese (16.2 per cent overweight), there has been no significant increase in this proportion since 2012.

There is limited recent data, however the data that is available suggests that WA Aboriginal children and young people are more physically active than non-Aboriginal children and young people in WA.

Areas of concern

From 2012 to 2017, although some young people were increasing their physical activity, there was still a decline in the proportion of WA young people aged 10 to 15 years being assessed as meeting the recommended physical activity level (from 47.5% to 32.9%).

It is particularly concerning that only 32.5 per cent of WA female children and young people aged 5 to 15 years were reported as meeting the physical activity guidelines, compared to 46.2 per cent of male WA children and young people.

Consumption of the recommended daily serves of vegetables is very low. In the 2017-18 National Health Survey, only 6.1 per cent of WA young people aged 14 to 17 years were reported as meeting the recommended daily intake of vegetables.

In 2015, 53.1 per cent of children and young people entering out-of-home care had an initial medical examination, even though it is a departmental requirement. No more recent data has been reported on this indicator as at publication date.

Endnotes

  1. In this research social exclusion comprised five domains: socioeconomic circumstances, education, connectedness, housing and health service access.
  2. Australian Institute of Health and Welfare (AIHW) and National Centre for Social and Economic Modelling (NATSEM) 2014, Child social exclusion and health outcomes: A study of small areas across Australia, Bulletin 121.
  3. World Health Organisation (WHO) 2008, The determinants of health, WHO [website].
Measure: Adequate physical activity

Physical activity makes an important positive contribution to the health and wellbeing of children and young people. Doing regular moderate and/or vigorous physical activity supports the development of healthy bones, muscles, joints and a healthy cardiovascular system. It is also an important element to achieving and maintaining a healthy weight. Physical inactivity is strongly associated with obesity which is a major risk factor for chronic disease.1

Physical activity also enhances cognitive functioning including memory, concentration and the ability to learn.2 Furthermore, it is associated with social and emotional benefits including improved mental health and self-esteem.3

The current recommendation for physical activity is that young people aged five to 17 years should do at least 60 minutes of moderate to vigorous intensity physical activity every day.4

Data collected on the physical activity of children and young people is often survey-based information, either self-reported daily physical activity or parent-reported daily physical activity. Research shows that while parent-reported data on physical activity is valid, it has limitations depending on the questions asked (e.g. difficulty estimating unstructured activity).5 In recent years more researchers are using devices such as accelerometers and other technology to gather more ‘objective’ data.6

The majority of the data reported for this measure is using parent-reported survey data from either the WA Department of Health, Health and Wellbeing Surveillance System or the Australian Bureau of Statistics (ABS).

The WA Department of Health administers the Health and Wellbeing Surveillance System, which includes interviewing WA parents and carers with children aged 0 to 15 years.7 They ask parents and carers about their children’s activity levels and based on these responses determine the proportion of WA young people meeting the physical activity guidelines. Young people aged 16 years and over are included in the adult survey, with no disaggregation by age to report on young people separately.

Proportion of young people aged 10 to 15 years in categories of physical activity levels based on parent/carer ratings, in per cent, WA, 2012 to 2017

Not very active/
Not at all active

Moderately active

Active

Very active

2012

8.1

17.4

28.1

46.5

2013

5.7*

23.5

27.2

43.6

2014

7.9*

14.9

31.7

45.5

2015

7.2*

22.4

27.2

43.2

2016

7.0

16.8

22.5

53.8

2017

8.0

19.2

22.6

50.1

Source: Merema M and Radomiljac A 2018, Health and Wellbeing of Children in Western Australia in 2017, Overview and Trends, WA Department of Health (and previous years’ reports)

* Prevalence estimate has a relative standard error of 25 per cent to 50 per cent and should be used with caution.

Proportion of young people aged 10 to 15 years in categories of weekly physical activity based on parent/carer assessments, in per cent, WA, 2012 to 2017

No activity

1 to 6 sessions

7 or more sessions but less than 60 mins

7 or more sessions
and 60 mins or more
(meets the recommendation)

2012

6.2

35.9

10.4

47.5

2013

6.8*

39.4

14.3

39.5

2014

4.1*

42.5

13.2

40.3

2015

5.6*

38.9

16.4

39.2

2016

5.5*

40.2

17.8

36.5

2017

5.7*

50.1

11.3

32.9

Source: Merema M and Radomiljac A 2018, Health and Wellbeing of Children in Western Australia in 2017, Overview and Trends, WA Department of Health (and previous years’ reports)8

* Prevalence estimate has a relative standard error of 25 per cent to 50 per cent and should be used with caution.

From 2012 to 2017, there was a decline in young people aged 10 to 15 years being assessed as meeting the recommended activity level (from 47.5% to 32.9%). The proportion of young people that have been assessed by their parent/carer to be only completing between one and six sessions of activity a week has increased to just over 50.1 per cent.

In 2011-2012, the ABS conducted the National Nutrition and Physical Activity Survey (NNPAS) as part of the Australian Health Survey.9 In this survey parents were asked about their child’s previous week’s activity.

Proportion of children and young people aged 2 to 17 years - whether met physical activity recommendations in the past 7 days by jurisdiction, in per cent, Australia, 2011-12

Met recommendation

Did not meet recommendation

New South Wales

26.1

72.0

Victoria

26.1

72.9

Queensland

35.1

64.1

South Australia

35.4

63.8

Western Australia

32.5

66.9

Tasmania

33.5

64.7

Northern Territory

37.1

62.4

Australian Capital Territory

31.2

68.0

Total

29.7

69.1

Source: Australian Bureau of Statistics, 43640: Australian Health Survey: Physical Activity, 2011–12, Table 14.3 Whether met physical and screen-based activity recommendations by selected population characteristics, Proportion of children aged 2–17 years

Results show that the proportion of WA children and young people aged two to 17 years meeting the physical activity recommendations in 2011-12 was very low, although this was in line with other states and territories in Australia.

Research has consistently found that male children and young people are more likely to do more physical activity than female children and young people.10,11

In the WA Health and Wellbeing Surveillance System, the proportion of male and female children and young people completing sufficient amounts of exercise based on parent and carer reports has fluctuated considerably over the last six years,12 but with a higher proportion of male children generally meeting the recommended activity level.

Proportion of children and young people aged 5 to 15 years meeting the recommendation for 7 or more sessions at 60 mins or more by gender, in per cent, WA, 2012 to 2017

Male

Female

2012

55.0

42.7

2013

49.1

33.6

2014

39.8

40.3

2015

48.5

28.0

2016

39.9

39.5

2017

46.2

32.5

Source: Merema M and Radomiljac A 2018, Health and Wellbeing of Children in Western Australia in 2017, Overview and Trends, WA Department of Health (and previous years’ reports)13

In the Australian Bureau of Statistics 2011-12 Australian Health Survey,14 only 25.9 per cent of WA female children and young people aged two to 17 years met the physical activity guidelines compared to 38.6 per cent of WA male children. A greater proportion of WA male children and young people met the guidelines than male children and young people across Australia (38.6% compared to 31%). Conversely, a lower proportion of WA female children and young people aged two to 17 years met the recommendation than Australian female children and young people overall (25.9% compared to 28.3%).15

In 2008, researchers from Edith Cowan University and the University of Western Australia conducted the Child and Adolescent Physical Activity and Nutrition Survey (CAPANS) in WA. In this study participants wore pedometers and completed exercise diaries. The researchers also found significant differences between male and female respondents. While only 37.6 per cent of male secondary school students reported activity that met the recommended guidelines, even fewer female secondary school students (10.1%) reported activity that met the recommended guidelines.16 This survey has not been repeated.

The Australian Sports Commission AusPlay survey is a large scale national survey to track sporting behaviours and activities of the Australian population. For children and young people, the activity surveyed is restricted to organised sport or physical activity outside of school hours, such as swimming, football and gymnastics. For children and young people under 15 years of age it does not capture data on unstructured play or non-organised physical activity (such as walking, bike riding etc.). This survey also does not assess physical activity against the recommended guidelines. The survey uses parent/carer interviews for children and young people under the age of 15 years and young people aged 15 to 17 years self-report.

While the children’s survey provides data by jurisdiction, it is limited. The only data reporting an age breakdown was the proportion of WA children and young people who participated in ‘organised (physical) activity out of school hours’ at least once a year (83.0% of 12 to 14 year olds).17

More data was collected for young people aged 15 to 17 years. In 2018, 89.5 per cent of WA young people aged 15 to 17 years participated in physical activity once a year, 73.5 per cent once a week, reducing to 57.8 per cent three times a week.18

In the 15 to 17 year old age group 78.1 per cent of young male WA respondents participated at least once a week, while 68.5 per cent of young female WA respondents participated at least once a week. Young women are more likely than young men to take part in non-sport related activities such as gym and fitness or walking.19

The AusPlay survey found that Australian young people are less likely to participate in organised physical activity outside school hours if:

  • they come from a low-income family
  • they live in a remote or regional area
  • a parent speaks a Language Other Than English (LOTE) at home
  • they have three or more siblings.20

They report that only 58 per cent of children and young people from low income families participate in organised physical activity outside of school compared to 73 per cent of young people from middle income families and 84 per cent of young people from high income families.21

The WA Government provides financial assistance to encourage WA children and young people to engage in sporting activities through the Kidsport program. The program provides up to $150 per year towards fees for sporting clubs for children and young people aged five to 18 years from low income families.

The 2016-17 Annual Report of the Department of Sport and Recreation (now Department of Local Government, Sport and Cultural Industries) stated that since 2011, KidSport has provided 141,227 vouchers to 70,339 individual children. It also reported that 90 per cent of parents, clubs, local governments and schools felt the program was valuable to the children involved.22 No data has been publicly reported on whether eligible children and young people have increased their physical activity as a result of the program.

Aboriginal young people

There is limited regularly reported data on the physical activity of WA Aboriginal young people or young people in metropolitan, regional and remote locations. The WA Health and Wellbeing Surveillance System does not provide disaggregated information on physical activity for Aboriginal children or by geographic location.

The data that is available suggests that WA Aboriginal children and young people are more physically active than non-Aboriginal children and young people in WA. In 2012-13, the Australian Bureau of Statistics (ABS) conducted the Australian Aboriginal and Torres Strait Islander Health Survey: Physical activity. They reported that a higher proportion of WA Aboriginal children and young people (45.6%) aged five to 17 years in non-remote areas met the physical activity recommendation compared with non-Aboriginal children and young people (40.5%).23

In remote areas across Australia,24 just over four in five (83.8%) Aboriginal young people aged 12 to 14 years did more than 60 minutes of physical activity on the day prior to the interview.25 The survey also found that just over three in five (66%) Aboriginal young people aged 15 to 17 around Australia had completed more than 60 minutes of physical activity on the day prior to the interview.26

There is no information available on the physical activity of WA Aboriginal young people in remote areas.

Endnotes

  1. Australian Institute of Health and Welfare (AIHW) 2018, Physical activity across the life stages, Cat No PHE 225, AIHW.
  2. WA Department of Sport and Recreation 2015, Brain Boost: how sport and physical activity enhance children’s learning, Centre for Sport and Recreation Research, Curtin University.
  3. Australian Institute of Health and Welfare (AIHW) 2018, Physical activity across the life stages, Cat No PHE 225, AIHW.
  4. Department of Health, Australia's Physical Activity and Sedentary Behaviour Guidelines and the Australian 24-Hour Movement Guidelines, Australian Government [website].
  5. Bauman A et al 2019, Physical activity measures for children and adolescents - recommendations on population surveillance: an evidence check rapid review, Sax Institute, p. 14.
  6. Sylvia LG et a 2013, Practical guide to measuring physical activity, Journal of the Academy of Nutrition and Dietetics, Vol 114, No 2.
  7. The WA Department of Health’s, Health and Wellbeing Surveillance System is a continuous data collection which was initiated in 2002 to monitor the health status of the general population. In 2017, 780 parents/carers of children aged 0 to 15 years were randomly sampled and completed a computer assisted telephone interview between January and December, reflecting an average participation rate of just over 90 per cent. The sample was then weighted to reflect the WA child population.
  8. This data has been sourced from individual annual Health and Wellbeing Surveillance System reports and therefore has not been adjusted for changes in the age and sex structure of the population across these years nor any change in the way the question was asked. No modelling or analysis has been carried out to determine if there is a trend component to the data, therefore any observations made are only descriptive and are not statistical inferences.
  9. To assess against the physical guideline recommendations and relating factors, the survey considered: number of days the child did physical activity for at least 60 minutes in the week prior to interview; the type and duration of physical activity undertaken for transport to or from school/place of study and other places on each of the seven days prior to interview; the type and duration of organised and non-organised moderate to vigorous physical activities undertaken on each of the seven days prior to interview. This was determined through a discussion with a parent/carer with child involvement where possible. Source: Australian Bureau of Statistics, 4363.0.55.001 - Australian Health Survey: Users' Guide, 2011-13 - Child Physical Activity (5 to 17 years).
  10. Martin K et al 2008, Move and Munch Final Report: Trends in physical activity, nutrition and body size in Western Australian children and adolescents: the Child and Adolescent Physical Activity and Nutrition Survey (CAPANS), Department of Sports and Recreation, WA Government.
  11. Telford RM et al 2016, Why Are Girls Less Physically Active than Boys? Findings from the LOOK Longitudinal Study, PloS one, Vol 11 No 3.
  12. This data has been sourced from individual annual Health and Wellbeing Surveillance System reports and therefore has not been adjusted for changes in the age and sex structure of the population across these years nor any change in the way the question was asked. No modelling or analysis has been carried out to determine if there is a trend component to the data, therefore any observations made are only descriptive and are not statistical inferences. 
  13. This data has been sourced from individual annual Health and Wellbeing Surveillance System reports and therefore has not been adjusted for changes in the age and sex structure of the population across these years nor any change in the way the question was asked. No modelling or analysis has been carried out to determine if there is a trend component to the data, therefore any observations made are only descriptive and are not statistical inferences.
  14. This release of the Australian Health Survey incorporated the National Nutrition and Physical Activity Survey (NNPAS) This included detailed adult and child physical activity results derived from self-reported and pedometer collection methods. Source: Australian Bureau of Statistics, Australian Health Survey: Physical Activity, 2011-12 Explanatory Notes.
  15. Australian Bureau of Statistics, 43640: Australian Health Survey: Physical Activity, 2011–12, Table 14.3 Whether met physical and screen-based activity recommendations by selected population characteristics, proportion of children aged 2–17 years.
  16. Martin K et al 2008, Move and Munch Final Report: Trends in physical activity, nutrition and body size in Western Australian children and adolescents: the Child and Adolescent Physical Activity and Nutrition Survey (CAPANS), Department of Sports and Recreation, WA Government, p. vi.
  17. Australian Sports Commission 2018, AusPlay: WA Data Tables – Ausplay survey results January 2018 – December 2018, Table 2 Children’s participation outside of school hours, Australian Government.
  18. Australian Sports Commission 2018, AusPlay: WA Data Tables – Ausplay survey results January 2018 – December 2018, Table 1 Demographics of participants, Australian Government.
  19. Australian Sports Commission 2017, AusPlay Focus: Women and Girls Participation, Australian Government, p. 7.
  20. Australian Sports Commission 2018, AusPlay Focus: Children’s Participation in Organised Physical Activity Outside of School Hours, Australian Government, p. 12.
  21. Australian Sports Commission 2018, AusPlay Focus: Children’s Participation in Organised Physical Activity Outside of School Hours, Australian Government. In this report, low income families were defined as those with gross (before tax) household income of less than $55,000 per annum; middle income families were defined as those with gross (before tax) household income between $55,000 and $174,999 per annum; and high income families are those with gross (before tax) household income of $175,000 or more per annum.
  22. WA Department of Sport and Recreation 2018, Annual Report 2016/17, WA Government, p. 28.
  23. Australian Bureau of Statistics, 4727.0.55.004 - Australian Aboriginal and Torres Strait Islander Health Survey: Physical activity, 2012–13, Table 9.3 Whether met physical and screen-based activity recommendations by Indigenous status by selected characteristics, Children aged 5–17 years in non-remote areas (proportion).
  24. Australian Bureau of Statistics note that testing indicated that the way the guidelines had been developed into a survey instrument for use in non-remote areas did not work well in more remote areas of Australia. As a result, in remote areas, minimal data was collected only for the day prior to the interview for a range of physical activities, with no measurement of the intensity of these activities.
  25. Australian Bureau of Statistics, 4727.0.55.004 - Australian Aboriginal and Torres Strait Islander Health Survey: Physical activity, 2012–13, Remote areas (5 years and over), Table 18.3 Physical activity and sedentary behaviour by age then sex, Aboriginal and Torres Strait Islander children aged 5-17 years in remote areas (proportion).
  26. Australian Bureau of Statistics, 4727.0.55.004 - Australian Aboriginal and Torres Strait Islander Health Survey: Physical activity, 2012–13, Remote areas (5 years and over), Table 18.3 Physical activity and sedentary behaviour by age then sex, Aboriginal and Torres Strait Islander children aged 5-17 years in remote areas (proportion).
Measure: Screen time

Over the past decade, it has been increasingly recognised that while media devices provide significant opportunities for learning and development, high levels of screen-based activities can be detrimental to young people’s health and wellbeing.1 A high level of screen time is associated with sedentary behaviour, low quality sleep and obesity.2,3

The Australian Guidelines for Healthy Growth and Development for Children and Young People (5 to 17 years) recommend that the use of electronic media for entertainment should be limited to a maximum of two hours per day and long periods of sitting should be broken up as often as possible.

Screen time is often used as a proxy for sedentary behaviour, however it should be noted that screen time does not report on overall levels of sedentary behaviour, which can include other activities such as reading, sitting or lying down.4   

Children’s screen time can include a range of activities such as watching movies, television shows or YouTube videos, playing games, social networking and doing educational activities (such as research for homework). This may be via a television, computer, smart phone, tablet or gaming console.

While the screen time guidelines are specifically related to entertainment, estimates of young people’s screen time will often include other activities, such as homework.5 Therefore, the data may over-estimate the amount of non-educational screen time.

The WA Department of Health administers the WA Health and Wellbeing Surveillance System, which includes interviewing WA parents and carers of children aged 0 to 15 years.6 They ask parents and carers about their children’s screen-based activities and based on these responses determine the proportion of WA children and young people meeting the guidelines.

Proportion of 5 to 15 year olds meeting/not meeting the daily guidelines for electronic media use, in per cent, WA, 2012 to 2017

Does not meet guidelines

Meets guidelines

2012

21.1

78.9

2013

25.5

74.5

2014

22.6

77.4

2015

23.8

76.2

2016

23.3

76.7

2017

22.6

77.4

Source: Merema M and Radomiljac A 2018, Health and Wellbeing of Children in Western Australia in 2017, Overview and Trends, WA Department of Health (and previous years’ reports)7

Over three-quarters (77.4%) of children and young people aged five to 15 years were reported as meeting the guidelines for screen-based activities in 2017. There has been little change to this proportion over the last six years.

A further breakdown of ages within the five to 15 year‑old survey data is not publicly available. In addition, it does not include data for young people aged 16 to 17 years old.

The last Australian Bureau of Statistics survey with data on screen time was the Australian Health Survey: Physical Activity: 2011-2012. In this survey the average time an Australian 12 to 14 year-old young person spent on sedentary screen-based activities per day was 157 minutes, while 15 to 17 year-old Australian young people spent 181 minutes per day,8 which are well above the recommended maximum of two hours (120 minutes) per day. Furthermore, only 24 per cent of children and young people aged two to 17 years old in WA met the screen-based recommendations across all previous seven days.9 These results are much lower than the results from WA Health and Wellbeing Surveillance System.

There has not been a repeat of this data collection since that time.

Longitudinal research has similarly found that young people aged 12 to 13 years spend 196 minutes per day on screen-based activities on average. Television is the main medium for screen-based activities for all age groups, with young people aged 12 to 13 years watching an average of 116 minutes of television per weekday.10

There is no data available from this study that includes young people aged 14 to 17 years.

In this research, the proportion of young people who met the screen-based activity guidelines was similar among male and female young people. However, there were differences in the types of activities done by male and female young people. Male young people were more likely than female young people to have spent at least an hour per day on electronic games within each age category. On weekdays, female young people spent more time using the computer for homework compared to male young people, and more time using the computer for social networking and online communication.11

The 2017 WA Health and Wellbeing Surveillance System also found that the proportion of young people meeting the guidelines was similar for young people across different socio-economic categories. The highest proportion of young people meeting the electronic media use guidelines was in the most disadvantaged areas (Quintile 1 - 71.1%), the second highest in the least disadvantaged areas (Quintile 5 – 68.6%) and the lowest proportion of young people meeting the guidelines in Quintile three (57.2%).12

The ABS conducted the Australian Aboriginal and Torres Strait Islander Health Survey: Physical activity in 2012–13 and found that 46.5 per cent of WA Aboriginal children and young people aged five to 17 years in non-remote areas met the screen-based activity recommendation on all three days prior to the survey, compared with only 36.4 per cent of WA non-Aboriginal children and young people.13

There is no information available on the proportion of WA Aboriginal young people in remote areas meeting the screen-based activity (sedentary behaviour) recommendations.

In 2013, the Australian Communications and Media Authority conducted an online survey to explore children and young people’s use of social networking services.14 As the survey was conducted through an online process from a panel of research participants (non-random) the data is not necessarily representative of the broader population of children and young people, particularly those who have limited access to the internet. However it does provide valuable insight into the majority of young people’s online usage.

In this survey they found that close to 100 per cent of Australian young people aged 16 to 17 years used social networking services and 71 per cent of this age group used social networking services on a daily basis.15

Young people’s frequency of social networking services usage, per cent of young people, Australia, 2012

12 to 13 years

14 to 15 years

16 to 17 years

Used social networking services

88.0

97.0

99.0

Used social networking services daily

36.0

62.0

71.0

Source: Australian Communications and Media Authority, Like, post, share: Young Australians’ experience of social media, 4.2 Use of Social Networking Sites

This survey also found that in 2012, 67 per cent of 12 to 13 year olds had a mobile phone, 87 per cent of 14 to 15 year olds, and 94 per cent of 16 to 17 year olds had a mobile phone.16

Children and young people from metropolitan areas tended to be more likely to have engaged in online activities and have mobile phones than those in non-metropolitan areas.17

Due to the increasing popularity of social networking services, the impact of increased use on young people’s level of physical activity, sedentary behaviour and the potential for associated mental health issues will be critical to monitor in the future.18

Longitudinal research using data from the Longitudinal Study of Australian Children suggests that children and young people who enjoy doing physical activities will spend less time in front of screens.19 This highlights the importance of engaging children and young people in fun physical activities to provide the foundation for an active life.

Endnotes

  1. Yu M and Baxter J 2016, Australian children’s screen time and participation in extracurricular activities, in The Longitudinal Study of Australian Children Annual Statistical Report 2015, Australian Institute of Family Studies.
  2. Laurson KR et al 2014, Concurrent associations between physical activity, screen time, and sleep duration with childhood obesity, International Scholarly Research Notices: Obesity, March 2014.
  3. Fuller C et al 2017, Bedtime Use of Technology and Associated Sleep Problems in Children, Global Pediatric Health, Vol 4.
  4. WA Department of Health 2019, Sedentary behaviour, WA Government, [website].
  5. Yu M and Baxter J 2016, Australian children’s screen time and participation in extracurricular activities, in The Longitudinal Study of Australian Children Annual Statistical Report 2015, Australian Institute of Family Studies.
  6. The WA Department of Health’s, Health and Wellbeing Surveillance System is a continuous data collection which was initiated in 2002 to monitor the health status of the general population. In 2017, 780 parents/carers of children aged 0 to 15 years were randomly sampled and completed a computer assisted telephone interview between January and December, reflecting an average participation rate of just over 90 per cent. The sample was then weighted to reflect the WA child population.
  7. This data has been sourced from individual annual Health and Wellbeing Surveillance System reports and therefore has not been adjusted for changes in the age and sex structure of the population across these years nor any change in the way the question was asked. No modelling or analysis has been carried out to determine if there is a trend component to the data, therefore any observations made are only descriptive and are not statistical inferences.
  8. Australian Bureau of Statistics (ABS) 43640 Australian Health Survey - National Nutrition and Physical Activity Survey (NNPAS) 2011-12 – Table 20.1 Average time spent on sedentary screen-based activity, Children aged 5–17 years (minutes), ABS.
  9. Australian Bureau of Statistics 43640 Australian Health Survey - National Nutrition and Physical Activity Survey (NNPAS) 2011-12 – Table 14.3 Whether met physical and screen-based activity recommendations by selected population characteristics, proportion of children aged 2–17 years, ABS.
  10. Yu M and Baxter J 2016, Australian children’s screen time and participation in extracurricular activities, in The Longitudinal Study of Australian Children Annual Statistical Report 2015, Australian Institute of Family Studies, p. 102, 106.
  11. Ibid, p. 114.
  12. Merema M and Radomiljac A 2018, Health and Wellbeing of Children in Western Australia in 2017, Overview and Trends, WA Department of Health.
  13. Australian Bureau of Statistics (ABS), 4727.0.55.004 - Australian Aboriginal and Torres Strait Islander Health Survey: Physical activity, 2012–13, Table 9.3 Whether met physical and screen-based activity recommendations by Indigenous status by selected characteristics, children aged 5–17 years in non-remote areas (proportion), ABS.
  14. Australian Communications and Media Authority (ACMA) 2013, Like, post, share: Young Australians’ experience of social media, 4.2 Use of Social Networking Sites, Australian Government.
  15. Ibid, p. 37.
  16. Ibid, p. 31.
  17. Ibid, p. 28, 31.
  18. Tandoc E et al 2015, Facebook use, envy, and depression among college students: Is facebooking depressing? Science Direct, Vol 43 p 139-146.
  19. Yu M and Baxter J 2016, Australian children’s screen time and participation in extracurricular activities, in The Longitudinal Study of Australian Children Annual Statistical Report 2015, Australian Institute of Family Studies, p. 119-120.
Measure: Healthy diet

Children and young people need to have a nutritious and balanced diet to grow and develop in a healthy way, and to reduce the risk of developing chronic diseases later in life. Research has shown that eating a wide variety of nutritious foods and limiting consumption of fatty and sugary foods is critical to healthy development and growth.1 

The Australian government publishes the Australian Dietary Guidelines to provide guidance on foods, food groups and dietary patterns that protect against chronic disease and provide the nutrients required for optimal health and wellbeing. The guidelines are:

  1. To achieve and maintain a healthy weight, be physically active and choose amounts of nutritious food and drinks to meet your energy needs.
  2. Enjoy a wide variety of nutritious foods from the five food groups every day.
  3. Limit intake of foods containing saturated fat, added salt, added sugars and alcohol.
  4. Encourage, support and promote breastfeeding.
  5. Care for your food; prepare and store it safely.

A key component of the guidelines are the recommended daily serves of fruit and vegetables.

Australian dietary guidelines – Recommended serves of fruit and vegetables by age group

12 to 13 years

14 to 18 years

Minimum recommended number of serves of vegetables per day

Boys

5.5

5.5

Girls

5

5

Minimum recommended number of serves of fruit per day

Boys

2

2

Girls

2

2

Source: National Health and Medical Research Council 2013, Australian Dietary Guidelines

The guidelines for fruit and vegetable consumption were revised by the National Health and Medical Research Council (NHMRC) in 2013. This had the effect of increasing the recommended serves of vegetables and reducing the recommended amount of fruit for some age groups.2

The WA Department of Health administers the WA Health and Wellbeing Surveillance System, which includes interviewing WA parents and carers with children aged 0 to 15 years.3 In this survey they ask parents and carers about their children’s eating behaviours and based on these responses determine the proportion of WA children and young people meeting the guidelines.

The change in the guidelines significantly reduced the number of children and young people meeting the recommended levels of vegetable consumption as outlined in the table below.

Proportion of young people eating the recommended daily fruit and vegetable serves by age group, in per cent, WA, 2012 to 2017

Consuming
recommended serves of fruit

Consuming recommended
serves of vegetables

8 to 11 years

12 to 15 years

9 to 15 years*

8 to 11 years

12 to 15 years

9 to 15 years*

2012

97.6

15.4

-

46.0

19.7

-

2013

95.3

16.4

-

36.1

23.6

-

2014

-

-

64.0

-

-

8.8

2015

-

-

62.7

-

-

6.5

2016

-

-

59.6

-

-

8.3

2017

-

-

61.7

-

-

4.1

Source: Merema M and Radomiljac A 2018, Health and Wellbeing of Children in Western Australia in 2017, Overview and Trends, WA Department of Health (and previous years’ reports)4

* The reporting methodology changed in 2013 to align with the age groups and recommended serves of the 2013 recommended guidelines.

Notes:

1. Prior to 2012/2013, children aged eight to 11 years old were recommended to eat at least three serves a day and 12 to 15 year old young people were recommended to eat at least four serves a day (now five to five and one-half serves). NHMRC Australian dietary guidelines for children and adolescence 2003 (since rescinded).

2. As the consumption of half serves is not captured in the questions currently asked in the WA Health survey, for the purposes of reporting, the recommended number of serves is rounded down to the nearest whole number.

While almost two out of three (61.7%) young people aged nine to 15 years are consuming the daily recommended serves of fruit, the proportion of young people eating sufficient vegetables in the same age bracket has reduced to as low as 4.1 per cent in 2017.

This survey does not report results for young people aged 16 to 17 years.

The Australian Bureau of Statistics (ABS) conducted the National Health Survey in 2014-15 and 2017-18 which reported on daily intake of fruit and vegetables for young people. This data is relatively consistent with the results of the WA Health and Wellbeing Surveillance System.

Proportion of young people meeting the daily intake of fruit and vegetables, in per cent, WA and Australia, 2014–15 and 2017–18

12 to 13 years

14 to 18 years

14 to 17 years

2014-15

2017-18

2014-15

2017-18

Fruit

WA

72.9

67.0*

52.7

58.9*

Australia

68.0

62.2

50.7

58.3

Vegetables

WA

0.0**

0.0**

6.5

6.1

Australia

1.4

2.6

3.7

5.7

Source: 43640: National Health Survey: Updated Results, 2014–15 and National Health Survey: Updated Results, 2017-18, Table 17.3 Children's daily intake of fruit and vegetables and main type of milk consumed, Proportion of persons, WA and Australia

* Proportion has a high margin of error and should be used with caution.

** The zero result means there was no data collected for this category in the sample. It does not represent a population estimate.

Proportion of young people by number of daily serves of vegetables consumed by WA young people by age group, in per cent, WA, 2014–15 and 2017–18

12 to 13 years

14 to 18 years

2014-15

2017-18

2014-15

2017-18

Does not usually eat vegetables

15.6

7.4*

5.4

7.3

1 serve or less

22.1

24.0*

36.5

26.5

2 serves

31.9

38.1*

20.3

25.6

3 serves

13.7

11.1*

23.0

27.8*

4 serves

10.9

3.0*

11.4

3.6*

5 serves or more

2.7

0.0*

6.0

9.6

Total

100.0

100.0

100.0

100.0

Source: 43640: National Health Survey: Updated Results, 2014–15 and National Health Survey: Updated Results, 2017–18, Table 17.3 Children's daily intake of fruit and vegetables and main type of milk consumed, Proportion of persons, WA and Australia

* Proportion has a high margin of error and should be used with caution.

** The zero result means there was no data collected for this category in the sample. It does not represent a population estimate.

Some of the WA data for 2017–18 has a high margin of error and therefore should be considered with caution.

In 2014–15 a very high proportion (41.9%) of WA young people aged 14 to 18 years eat only one or no serves of vegetables on a daily basis. Similarly, 37.7 per cent of young people aged 12 to 13 years eat only one or no serves of vegetables on a daily basis. In 2017–18 these rates appear to have dropped.

The ABS also conducted the National Aboriginal and Torres Strait Islander Social Survey in 2014–15. The data for this survey is reported with different age groups.

Proportion of Aboriginal young people meeting the daily intake of fruit and vegetables, in per cent, Australia, 2014–15

10 to 14 years

15 to 17 years

Adequate daily fruit intake

62.2

56.0

Adequate daily vegetable intake

6.2

4.4*

Source: AIHW 2017, Aboriginal and Torres Strait Islander health performance framework 2017: supplementary online tables, Table 2.19.11: Daily intake of fruit and vegetables, by age and remoteness by sex, Aboriginal and Torres Strait Islander persons, 2014–15

* Number and percent have a relative standard error between 25 per cent and 50 per cent and should be used with caution.

This survey only reports on WA Aboriginal children and young people aged from two years to 14 years. There is no data on WA Aboriginal young people aged from 15 years and over.

Proportion of Aboriginal children and young people (aged 2 to 14 years) by number of serves of vegetables they consume daily, in per cent, WA and Australia, 2014–15

WA

Australia

1 serve or less

37.2

39.2

2 serves

24.3

29.6

3 serves

19.2

16.7

4 serves

9.3

6.3

5 serves or more

7.1*

5.2

Does not usually eat vegetables

3.5*

3.2

Total

100.0

100.0

Source: AIHW 2017, Aboriginal and Torres Strait Islander health performance framework 2017: supplementary online tables, Table 2.19.9: Number of serves of vegetables consumed daily, Indigenous children aged 2 to 14, by state/territory, 2014–15

* Number and percent have a relative standard error between 25 per cent and 50 per cent and should be used with caution.

Consistent with the results for all WA young people, the majority of Aboriginal young people aged 10 to 17 years in Australia were not consuming sufficient fresh vegetables in 2014–15.

Research suggests that people living in poverty or with low incomes are more likely to eat calorie rich (high fat, high sugar) foods. The poverty rate for Aboriginal Australians is significantly higher than for non-Aboriginal Australians.5

Furthermore, fresh fruit and vegetables have less availability and affordability in remote and regional locations, where a large proportion of Aboriginal children and young people live.6 The 2013 WA Food Access and Cost Survey found that food costs increased significantly with distance from Perth, and cost substantially more in very remote areas. At the same time, fruit and vegetable quality was generally lower in remote communities.7

Refer to the following resource for a more detailed discussion on nutrition among Aboriginal communities:

Lee A and Ride K 2018, Review of nutrition among Aboriginal and Torres Strait Islander people, Australian Indigenous HealthInfoNet.

The low level of vegetable consumption for all WA young people is of significant concern.

Guideline three of the Australian Dietary Guidelines also recommends that adults and children should limit intake of foods and drinks containing saturated fats and added sugars such as biscuits, cakes, confectionary, sugar-sweetened soft drinks and cordials, fruit drinks and sports drinks.8

Reducing young people’s sugar consumption has been highlighted as particularly critical. Sugar consumption in childhood and adolescence is directly linked to being overweight and obese, and having dental health conditions, both of which impact lifelong health.9 There is also strong evidence to suggest that foods and drinks consumed by children early in life establish their preferences for tastes (e.g. sweetness) later in life.10

Unlike serves of fruit and vegetables, the consumption of sugar is more complex to measure as sugar occurs naturally in many foods. The World Health Organisation recommends reducing the intake of free sugars to less than 10 per cent of total energy intake in both adults and children.11 Australian recommendations are focused on reducing consumption of foods with added sugar including biscuits, cakes, soft drinks, cordial, fruit juice etc.

There is limited data on WA young people’s consumption of sugar.

The ABS National Health Survey collects data on children and young people’s consumption of sugar-sweetened drinks based on parent reports.

Proportion of young people who did not consume any sugar-sweetened drinks on a daily basis by age group, in per cent, WA and Australia, 2017–18

12 to 13 years

14 to 17 years

WA

48.2*

48.8*

Australia

42.0

42.5

Source: Australian Bureau of Statistics, National Health Survey, First Results 2017–18 – Australia and Western Australia, Table 17.3 Children's consumption of fruit, vegetables, and selected sugar sweetened and diet drinks

* This proportion has a margin of error between 10 and 20 per cent and should be used with caution.

In the 2017–18 survey the WA data has a high margin of error however suggests that less than half of WA young people aged 12 to 13 years and 14 to 17 years are reported by their parents to not consume any sugar-sweetened drinks on a daily basis.12 The estimate for both age groups is slightly higher than the result for all Australian children in those age groups, subject to the margin of error.

Endnotes

  1. National Health and Medical Research Council 2013, Australian Dietary Guidelines: Providing the scientific evidence for healthier Australian diets, Canberra, National Health and Medical Research Council.
  2. Prior to 2013, children aged 4 to 11 years of age were recommended to eat at least one serve of fruit each day, while 12 to 18 year olds were recommended to eat three serves. While children aged 4 to 7 years of age were recommended to eat at least two serves of vegetables each day, 8 to 11 year olds eat at least three serves a day and 12 to 15 year olds eat at least four serves a day. NHMRC Australian dietary guidelines for children and adolescence 2003 (since rescinded).
  3. The WA Department of Health’s, Health and Wellbeing Surveillance System is a continuous data collection which was initiated in 2002 to monitor the health status of the general population. In 2017, 780 parents/carers of children aged 0 to 15 years were randomly sampled and completed a computer assisted telephone interview between January and December, reflecting an average participation rate of just over 90 per cent. The sample was then weighted to reflect the WA child population.
  4. This data has been sourced from individual annual Health and Wellbeing Surveillance System reports and therefore has not been adjusted for changes in the age and sex structure of the population across these years nor any change in the way the question was asked. No modelling or analysis has been carried out to determine if there is a trend component to the data, therefore any observations made are only descriptive and are not statistical inferences.
  5. Australian Council of Social Services (ACOSS) 2018, Poverty in Australia 2018, ACOSS and University of New South Wales, p. 65.
  6. Department of the Prime Minister and Cabinet, Aboriginal and Torres Strait Islander Health Performance Framework 2014 Report, 2.19 Dietary behaviours, Australian Government.
  7. Pollard CM et al 2015, Food Access and Cost Survey 2013 Report, WA Department of Health.
  8. National Health and Medical Research Council 2013, Australian Dietary Guidelines: Providing the scientific evidence for healthier Australian diets, National Health and Medical Research Council.
  9. Diep H et al 2017, Factors influencing early feeding of foods and drinks containing free sugars—a birth cohort study, International Journal of Environmental Research and Public Health, Vol 14, No 10.
  10. Ibid.
  11. World Health Organisation (WHO) 2015, Guideline: Sugars intake for adults and children, WHO.
  12. Australian Bureau of Statistics (ABS) 2019, National Health Survey, First Results 2017-18 – Western Australia, Table 17.3 Children's consumption of fruit, vegetables, and selected sugar sweetened and diet drinks, proportion of persons, ABS.
Measure: Healthy weight

Being overweight or obese increases a young person’s risk of poor physical health in both the short and long term. Being obese increases a young person’s risk of a range of conditions such as asthma, Type 2 diabetes1 and cardiovascular conditions.2 In particular, over recent years the age of diagnosis of Type 2 diabetes has been steadily decreasing.3

Young people who are overweight or obese are more likely to be overweight or obese in adulthood.4 Overweight or obese young people who continue to be overweight or obese in adulthood face a higher risk of developing coronary heart disease, diabetes, certain cancers, gall bladder disease, osteoarthritis and endocrine disorders.5

Obesity in young people is also associated with a number of psychosocial problems, including social isolation, discrimination and low self-esteem.6

While obesity is often the focus of research and data, some children and young people are underweight which can be related to body image issues and eating disorders.

The data item for this measure is the Body Mass Index (BMI), which is a common measure of defining whether a person is overweight or obese. The BMI is calculated by dividing weight in kilograms by the square of height in metres. BMI scores take into account the age and sex of the young person.7

The use of BMI to measure healthy weight is contested, particularly as it does not distinguish between fat and muscle or the location of the fat.8 BMI is not a diagnostic tool. If a child or young person has a high BMI for their age and sex they should be referred to a health professional for further assessment considering physical activity and diet, and using other measures such as skin fold thickness or dual energy X-ray absorptiometry (DEXA).9,10,11 BMI is however considered an appropriate tool for population level measurement and trend analysis.12

The WA Department of Health administers the WA Health and Wellbeing Surveillance System, which includes interviewing WA parents and carers of children aged 0 to 15 years.13 In this survey parents and carers of children aged five to 15 years were asked to provide their child’s height without shoes and weight without clothes or shoes. A Body Mass Index (BMI) was derived from these figures by dividing weight in kilograms by height in metres squared.

Proportion of children and young people aged 5 to 15 years by BMI categories, in per cent, WA, 2004 to 2017

Not overweight
or obese

Overweight
or obese

Overweight

Obese

2004

73.9

26.1

19.1

7.0*

2005

71.7

28.4

19.5

8.9

2006

79.0

20.9

15.1

5.8

2007

82.5

17.5

12.9

4.6*

2008

80.3

19.7

14.0

5.7

2009

77.3

22.7

16.9

5.8

2010

77.0

23.0

17.0

6.0

2011

81.2

18.7

14.5

4.2*

2012

77.9

22.1

14.7

7.4

2013

78.9

21.1

15.1

6.0

2014

77.4

22.6

13.9

8.7

2015

78.4

21.6

15.6

6.0

2016

76.3

23.6

18.2

5.4

2017

73.7

26.3

16.4

9.9

Source: Merema M and Radomiljac A 2018, Health and Wellbeing of Children in Western Australia in 2017, Overview and Trends, WA Department of Health

* Prevalence estimate has a relative standard error of 25 per cent to 50 per cent and should be used with caution.

Note: This is trend data presented by the Department of Health. Data in all years has been standardised by weighting them to the 2011 estimated resident population.

Proportion of children and young people aged 5 to 15 years by BMI categories, in per cent, WA, 2004 to 2017

Source: Merema M and Radomiljac A 2018, Health and Wellbeing of Children in Western Australia in 2017, Overview and Trends, WA Department of Health

Over one-quarter (26.3%) of WA children and young people aged five to 15 years were overweight or obese in 2017. This proportion had not increased significantly over the last 12 years. However in 2017, there was an apparent increase in obesity. This will continue to be monitored to determine if this is an ongoing trend.

Proportion of young people aged 10 to 15 years by BMI category, in per cent, WA, 2012 to 2017

Overweight

Obese

Total

2012

15.5

5.9

21.4

2013

14.4

4.1*

18.5

2014

12.6

3.7*

16.3

2015

16.2

4.6*

20.8

2016

19.1

4.0*

23.1

2017

16.2

6.3*

22.5

Source: Merema M and Radomiljac A 2018, Health and Wellbeing of Children in Western Australia in 2017, Overview and Trends, WA Department of Health (and previous years’ reports)14

* Prevalence estimate has a relative standard error of 25 per cent to 50 per cent and should be used with caution.

A slightly lower proportion (22.5%) of WA young people aged 10 to 15 years are overweight or obese than the broader age group of five to 15 years. There has been no substantive increase in the proportion of young people aged 10 to 15 years who are overweight or obese over the last six years.

In 2017, AIHW presented a birth cohort analysis of prevalence of overweight and obesity for a particular group of people born in the same year. They noted that over the last 20 years (1995 to 2015) there has been no significant increase in rates of obesity and overweight in young Australian children aged two to five years or six to nine years. Yet, they reported that at ages 10 to 13 and 14 to 17, children and adolescents born most recently were significantly more likely to be overweight or obese than those born 20 years earlier.15

The WA Health and Wellbeing Surveillance System does not report on the proportion of children who are determined to be underweight based on the BMI calculation.

The WA survey also asks parents and carers their perception of their child’s weight. For children aged five to 15 years with a BMI that classified them as overweight or obese, the majority (71.8%) had parents/carers who perceived their child’s weight to be normal.16 This highlights that some parents’ and carers’ perceptions of their children’s weight may be overly positive, although in some instances it may indicate how BMI can be an imperfect proxy for unhealthy weight as children age.

The Australian Bureau of Statistics National Health Survey collects data on BMI categories for young people across Australia. The 2017–18 survey provides data on young people across Australia and also some data for WA. The WA data unfortunately has a high margin of error for a number of the proportions.

Proportion of children by BMI category and age group, in per cent, WA and Australia, 2017–18

WA

Australia

8 to 11 years

12 to 15 years

16 to 17 years

8 to 11 years

12 to 15 years

16 to 17 years

Underweight

0.0**

7.2

10.7

9.5

7.4

7.3

Normal weight

68.2*

70.3*

62.0*

65.4

71.6

65.8

Overweight

25.4

15.9

20.2*

17.7

14.8

18.0

Obese

9.1

3.2

4.4*

6.9

6.7

10.3

Overweight / obese

30.8*

22.2

25.8*

25.2

20.8

28.1

Source: Australian Bureau of Statistics, National Health Survey 2017–18, Table 16.1 Children's Body Mass Index, waist circumference, height and weight, proportion of persons

* Proportion has a high margin of error and should be used with caution.

** The zero result means there was no data collected for this category in the sample. It does not represent a population estimate.

The WA data suggests that a similar proportion of WA children aged 12 to 17 years are overweight compared with Australian children.

The survey estimates that 4.4 per cent of WA young people aged 16 to 17 years are in the obese category, which represents a small increase in obesity from the 12 to 15 years age group (subject to the margin of error). This is a smaller proportion of young people in the obese category compared to the Australian population.

The data also suggests that a significant proportion (10.7%) of WA young people aged 16 to 17 years may be underweight. This is higher than the Australian estimate of 7.3 per cent of young people aged 16 to 17 years.

In 2008, researchers from Edith Cowan University and the University of WA conducted the Child and Adolescent Physical Activity and Nutrition Survey (CAPANS) in WA. While this study is not recent, the researchers specifically highlighted that the proportions of secondary school girls who were classified as being underweight had almost doubled from 2003 to 2008, 5.5 per cent to 9.4 per cent respectively.17 They also recognised that this was a voluntary self-selected sample and therefore the results may be biased.18 The study has not been repeated since 2008.

While data shows rates of being overweight and obese are increasing for some age groups, unhealthy thin and ‘ultra-thin’ bodies are being idealised. The pressure to strive for such unattainable and unrealistic body images encourage body dissatisfaction and unhealthy eating behaviours.19

Data from the Longitudinal Study of Australian Children found that only a small proportion of young people aged 14 to 15 years met the diagnostic criteria for eating disorders (3.4% for female young people and 1.4% for male young people).20 However, negative feelings and beliefs regarding gaining weight and loss of control of eating can be problematic. These negative attitudes were very common for Australian female young people aged 14 to 15 years, with 54 per cent scared of gaining weight and 43 per cent expressing their concern` that they had lost control of their eating or had eaten too much in the last four weeks.21

Critically, anorexia nervosa was the third most common principal diagnosis for young people aged 13 to 17 years discharged from a WA public hospital with a mental health diagnosis. For the small number of children from five to 12 years of age discharged from a WA public hospital with a mental health diagnosis, anorexia was the most common diagnosis (refer age group 12 to 17 Mental health Indicator  for more information).22 This may be in part because children with anorexia are more likely to present at hospital than children with other common conditions, such as autism.

It is important that policies and programs which aim to address rates of overweight and obese children are sensitive to these issues and consider the potentially harmful impacts of language that stigmatises children who are overweight on self-esteem, body image and mental health.23,24

Over the last six years, a higher proportion of female children than male children aged five to 15 years were reported as overweight or obese, however the differences are not statistically significant.25

Proportion of children and young people aged 5 to 15 years in BMI categories, by gender, in per cent, WA, 2017

Male

Female

Not overweight or obese

Overweight

Obese

Not overweight or obese

Overweight

Obese

2012

76.9

14.4

8.7

78.9

15.0

6.0

2013

74.8

16.6

8.7*

83.0

13.7

3.3*

2014

78.6

13.4

8.0*

75.6

14.5

10.0*

2015

78.9

14.9

6.2*

77.7

16.3

5.9*

2016

77.8

16.5

5.7*

74.9

19.8

5.3*

2017

77.0

13.2

9.8

69.9

19.5

10.6

Source: Merema M and Radomiljac A 2018, Health and Wellbeing of Children in Western Australia in 2017, Overview and Trends, WA Department of Health (and previous years’ reports)26

* Prevalence estimate has a relative standard error of 25 per cent to 50 per cent and should be used with caution.

When results are disaggregated further by age, it becomes evident that a higher proportion of female children aged six to 10 years are overweight or obese (32.0%) than female children aged 11 to 15 years (18.9%).

Proportion of children and young people who are overweight or obese by gender and age group, WA, 2009–2016 (combined calendar years)

Male

Female

6 to 10 years

11 to 15 years

6 to 10 years

11 to 15 years

2009-10

24.5

24.4

26.8

17.5

2011-12

23.6

19.9

20.9

21.1

2013-14

27.3

20.8

28.4

14.9

2015-16

23.5

21.0

32.0

18.9

Source: Custom report provided to the Commissioner for Children and Young People WA from the WA Department of Health Epidemiology Branch, Selected risk factor estimates for WA children using the WA Health and Wellbeing Surveillance System, 2009–2016

Proportion of young people who are overweight or obese by gender and age group, in per cent, WA, 2009–2016 (combined calendar years)

Source: Custom report provided to the Commissioner for Children and Young People WA from the WA Department of Health Epidemiology Branch, Selected risk factor estimates for WA children using the WA Health and Wellbeing Surveillance System, 2009–2016

There is a decrease in overweight or obesity for female young people as they move from childhood to adolescence. This reduction in the prevalence of overweight and obesity from childhood to adolescence is not as evident for male children and young people.

The ABS National Health Survey records data for young people aged 12 to 15 years and 16 to 17 years. When the Australian results are disaggregated by gender and age it is evident that male young people aged 16 to 17 years are more likely to be overweight and obese than female young people.

Proportion of young people in BMI categories by age group and gender, in per cent, Australia, 2017–18

Male

Female

12 to 15 years

16 to 17 years

12 to 15 years

16 to 17 years

Underweight

5.4

8.1

8.1

4.3

Normal weight

73.8

59.9

69.1

69.4

Overweight

14.0

20.2

15.2

16.9

Obese

7.2

10.7

5.7

8.7

Overweight / obese

20.4

32.3

21.4

24.7

Source: Australian Bureau of Statistics, National Health Survey 2017–18, Table 16.1 Children's Body Mass Index, waist circumference, height and weight, Proportion of persons

There is a substantial increase in the proportion of male Australian young people that are in the overweight and obese categories from ages 12 to 15 (20.4%) to ages 16 to 17 (32.3%). Contributing factors for this increase as young people age may be food choices including high consumption of sugary drinks for young men,27 a lack of physical activity, low quality sleep and a high level of sedentary behaviour.28 There is however also some evidence that BMI in male young people may not always reflect an increase in body fat, therefore this data should be considered with caution.29

The Australian Bureau of Statistics does release WA based data from this survey on the BMI of children and young people, however most of the data has a high margin of error and has not been reported here. To review this data refer to the National Health Survey – Table 24: Western Australia.

The Australian Bureau of Statistics reports BMI data disaggregated by various characteristics as part of the Children’s Headline Indicators. The most recent disaggregated data is for the year 2014–15.

Proportion of children and young people aged 5 to 14 years categorised as overweight or obese, by various characteristics, in per cent, WA and Australia, 2014–15

WA

Australia

CALD background

Born in Australia

21.7

25.8

Born overseas

18.0

30.5

Sex

Male

23.1

26.4

Female

18.8

25.6

Remoteness

Major cities

18.5

26.2

Regional and remote

27.3

25.9

Socioeconomic status

Lowest SES

27.3

33.9

Highest SES

15.3

22.0

Total

22.2

26.1

Source: AIHW, Children’s Headline Indicators

In 2014–15, a lower proportion (22.2%) of WA children and young people were overweight or obese than Australian children and young people (26.1%). Children and young people living in WA regional and remote locations and areas of greater socio-economic disadvantage are much more likely to be overweight and obese.

In 2017, the WA Health and Wellbeing Surveillance System reported that a much higher proportion of children and young people aged five to 15 years living in the most disadvantaged areas of WA were overweight or obese compared with children and young people living in the least disadvantaged areas of WA (44.9% compared with 19.3%).30

Socio-economic disadvantage influences children and young people’s weight for multiple intersecting reasons including limited access to affordable fresh fruit and vegetables and easy access to fast food, availability of primary health services and access to quality outdoor green spaces.31 Additionally, parents with a lower level of education often have less access to nutritional knowledge which can lead to less healthy dietary practices.32

For complex reasons related to colonisation and intergenerational trauma, Aboriginal children are more likely to have a history of poverty, social exclusion, family violence and families with drug and alcohol issues. These factors influence the rate of overweight and obesity for a number of reasons. For example, there is evidence that the quality and duration of sleep influences obesity. A recent study concluded that Aboriginal children have a higher BMI than non-Aboriginal children, at least in part, because some Aboriginal children sleep less than non-Aboriginal children.33

In 2012–13 the Australian Bureau of Statistics conducted the Australian Aboriginal and Torres Strait Islander Health Survey (AATSIHS). In this survey they measured the BMI of participating Aboriginal children and found that Aboriginal children aged 10 to 14 years old were more likely than non-Aboriginal children to be obese (11.8% of Aboriginal children compared to 6.3% of non-Aboriginal children) and less likely to be in the healthy weight range (54.2% compared to 67.3%). Aboriginal young people aged 15 to 17 were almost twice as likely to be obese than non-Aboriginal young people the same age (14.2% compared to 7.4%).34

A WA study also found that the rates of type 2 diabetes in WA children and young people increased significantly from 1990 to 2002 and that Aboriginal children and young people were six times more likely to have Type 2 diabetes than the non-Aboriginal population.35

There is no recent data on the BMI (or other measures of healthy weight) of WA Aboriginal children.

Aboriginal adults are 1.6 times more likely to be obese than non-Aboriginal adults indicating increased risk of developing chronic disease,36 it is therefore critical to address overweight and obesity for Aboriginal young people by addressing the possible foundational causes.

Endnotes

  1. Type 2 diabetes is a progressive condition of unknown cause which is associated with modifiable lifestyle risk factors such as obesity. Refer to Diabetes Australia for more information.
  2. Australian Institute of Health and Welfare (AIHW) 2012, A picture of Australia’s children 2012, Cat No PHE 167, AIHW.
  3. Davis E 2018, Submission 33 to the Education and Health Standing Committee of the WA Parliament Inquiry: The role of diet in type 2 diabetes prevention and management, Perth Children’s Hospital.
  4. Venn AJ et al 2007, Overweight and obesity from childhood to adulthood: a follow-up of participants in the 1985 Australian Schools Health and Fitness Survey, The Medical Journal of Australia, Vol 186, No 9.
  5. Australian Institute of Health and Welfare (AIHW) 2012, A picture of Australia’s children 2012, Cat No PHE 167, AIHW.
  6. Australian Research Alliance for Children and Youth (ARACY) 2008, ARACY Report Card, Technical Report: The Wellbeing of Young Australians, ARACY.
  7. National Health and Medical Research Council 2013, Clinical practice guidelines for the management of overweight and obesity in adults, adolescents and children in Australia, Australian Government, p. 84.
  8. There is also increasing evidence to suggest that the type of fat is more important than overall weight – for example fat around the stomach has been shown to be more harmful than fat in other locations. Therefore some research has shown that someone with a relatively high BMI can be healthier than someone with a BMI in the ‘healthy’ range. Refer to Tomiyama et al 2016, Misclassification of cardiometabolic health when using body mass index categories in NHANES 2005-2012, The International Journal of Obesity, Vol 40, No 5.
  9. Centers for Disease Control and Prevention 2018, About Child and Teen BMI, National Center for Chronic Disease Prevention and Health Promotion (website).
  10. Nooyens AC 2007, Adolescent skinfold thickness is a better predictor of high body fatness in adults than is body mass index: the Amsterdam Growth and Health Longitudinal Study, The American Journal of Clinical Nutrition, Vol 85, No 6.
  11. Jensen NSO et al 2016, Review Paper: Comparison of methods to measure body fat in 7-to-10-year-old children: a systematic review, Public Health, Vol 133.
  12. Centers for Disease Control and Prevention 2018, Body Mass Index: Considerations for practitioners, Department of Health and Human Services USA.
  13. The WA Department of Health’s, Health and Wellbeing Surveillance System is a continuous data collection which was initiated in 2002 to monitor the health status of the general population. In 2017, 780 parents/carers of children aged 0 to 15 years were randomly sampled and completed a computer assisted telephone interview between January and December, reflecting an average participation rate of just over 90 per cent. The sample was then weighted to reflect the WA child population.
  14. This data has been sourced from individual annual Health and Wellbeing Surveillance System reports and therefore has not been adjusted for changes in the age and sex structure of the population across these years nor any change in the way the question was asked. No modelling or analysis has been carried out to determine if there is a trend component to the data, therefore any observations made are only descriptive and are not statistical inferences.
  15. Australian Institute of Health and Welfare (AIHW) 2017, An interactive insight into overweight and obesity in Australia, AIHW.
  16. Merema M and Radomiljac A 2018, Health and Wellbeing of Children in Western Australia in 2017, Overview and Trends, WA Department of Health, p. 38.
  17. Martin K et al 2008, Move and Munch Final Report. Trends in physical activity, nutrition and body size in Western Australian children and adolescents: the Child and Adolescent Physical Activity and Nutrition Survey (CAPANS), Department of Sports and Recreation, WA Government, p.82-89
  18. Ibid, p. 89.
  19. O’Connor M et al 2017, Eating problems in mid-adolescence, in The Longitudinal Study of Australian Children Annual Statistical Report 2017, Australian Institute of Family Studies, p. 113.
  20. Ibid, p. 115.
  21. Ibid, p. 115.
  22. Custom report provided by the Department of Health to the Commissioner for Children and Young People WA on the top diagnoses of children and young people separating from a WA public or private hospital with a mental health diagnosis or discharged from a mental health inpatient unit.
  23. Russell-Mayhew S 2012, Mental Health, Wellness, and Childhood Overweight/Obesity, Journal of Obesity, Vol 2012.
  24. O’Dea JA 2012, Studies of obesity, body image and related health issues among Australian adolescents: how can programs in schools interact with and complement each other?, Journal of Student Wellbeing, Vol 4 No 2.
  25. Merema M and Radomiljac A 2018, Health and Wellbeing of Children in Western Australia in 2017, Overview and Trends, WA Department of Health, p. 35.
  26. This data has been sourced from individual annual Health and Wellbeing Surveillance System reports and therefore has not been adjusted for changes in the age and sex structure of the population across these years nor any change in the way the question was asked. No modelling or analysis has been carried out to determine if there is a trend component to the data, therefore any observations made are only descriptive and are not statistical inferences.
  27. Scully M et al, 2012, Factors associated with high consumption of soft drinks among Australian secondary-school students, Public Health Nutrition, Vol 20, No 13.
  28. Morley B et al 2012, What factors are associated with excess body weight in Australian secondary school students?, The Medical Journal of Australia, Vol 196, No 3.
  29. Telford RD et al 2019, BMI is a misleading proxy for adiposity in longitudinal studies with adolescent males: The Australian LOOK study, Journal of Science & Medicine in Sport, Vol 22, No 3.
  30. Merema M and Radomiljac A 2018, Health and Wellbeing of Children in Western Australia in 2017, Overview and Trends, WA Department of Health.
  31. NSW Council of Social Services (NCOSS) 2016, Overweight and Obesity: Balancing the scales for vulnerable children, NCOSS.
  32. Ibid.
  33. Deacon-Crouch M et al 2019, The mediating role of sleep in the relationship between Indigenous status and body mass index in Australian school-aged children, Journal of Paediatrics and Child Health, November 2018.
  34. Australian Bureau of Statistics 2014, Australian Aboriginal and Torres Strait Islander Health Survey: Updated Results, 2012–13 — Australia, Table 9.3 Body Mass Index of children(a), by age by Indigenous status by sex, Proportion of persons.
  35. McMahon SK et al 2004, Increase in type 2 diabetes in children and adolescents in Western Australia, Medical Journal of Australia, Vol 180, No 3.
  36. Department of Prime Minister and Cabinet, Aboriginal and Torres Strait Islander, Health Performance Framework 2014 Report [website].
Measure: Long term health issues or disabilities

Long-term health conditions and disability are often inter-related. Long-term health issues and disability can both result in a functional limitation which impacts everyday life for children and young people. People with disability are also more likely to develop long-term health conditions, and people with long-term health conditions are more likely to develop disability.1

The most common long-term health issues for children and young people are asthma, diabetes and cancer.2

The Australian Bureau of Statistics (ABS) Disability, Ageing and Carers, 2015 data collection reports that approximately 23,700 WA young people (7.5%) aged five to 14 years and 25,600 WA young people (7.9%) aged 15 to 24 years have a reported disability.3,4 In this survey, children and young people whose long-term health conditions limit their activities are identified as having disability.5

Proportion of children and young people aged 5 to 14 years by disability status and gender, in per cent, WA, 2015

Male

Female

Total

Profound or severe core activity limitation

5.3

2.9

4.1

Moderate or mild core activity limitation

3.1*

1.4*

2.3

Schooling or employment restriction

8.3

4.6

6.1

All with specific limitations or restrictions

9.4

5.0

7.3

All with reported disability**

10.5

5.0

7.5

Source: Australian Bureau of Statistics 2016, Disability, Ageing and Carers, Australia, 2015: Western Australia, Table 3.3 All persons, disability status, by age and sex–2015, proportion of persons

* estimate has a relative standard error of 25 per cent to 50 per cent and should be used with caution.

** Includes those who do not have a specific restriction or limitation.

Note: Totals may be less than the sum of the components as persons may have both a core activity limitation and a schooling or employment restriction.

WA male children and young people aged five to 14 years are twice as likely to have a disability as WA female children and young people (10.5% compared to 5.0%).

There is limited other data on WA young people with disability and there is no recent data on Australian children and young people with disability. The following information was sourced from the 2009 Survey of Disability, Ageing and Carers Survey with additional analysis for children and young people.

Children and young people with disability by disability group, in number and per cent, Australia, 2009

5 to 14 years

Total number of children with disability

241,000

Intellectual disability

61.0%

Sensory or speech disability

37.0%

Physical disability

27.0%

Source: Australian Bureau of Statistics 2013, Australian Social Trends: 2012, Children with a disability

Note: Children can have one or more types of disability.

In 2009, almost two thirds (61%) of Australian young people aged five to 14 years with a disability had an intellectual disability, more than twice the proportion of children aged 0 to four years with a disability with an intellectual disability (29%).6 This is in part because as children age, developmental difficulties in certain areas (such as intellectual capacity) become more apparent. Furthermore, there is a lack of formal intellectual testing in very young children.7

The most commonly reported long-term conditions for Australian children and young people with disability aged 0 to 14 years in 2009 were mental or behavioural disorders (increased from 53% of children with disability in 2003 to 63% in 2009), while asthma was also common (a reduction from 24% of children and young people with disability in 2003 to 18% in 2009).8

Almost three quarters (74%) of Australian male children and young people and over half (56%) of female children and young people aged five to 14 years with a disability reportedly had a mental or behavioural disorder.9

The most commonly reported mental or behavioural disorders were autism and related disorders (13.0% of Australian children and young people with a disability in 2009, increased from 6.2% in 2003).10

It should be noted that an increase in reported diagnoses over time, does not necessarily represent an increase in the proportion of children with a particular condition – the increase could be due to better diagnostic tools and/or greater community awareness leading to more assessments being carried out.

The WA Department of Health publishes the Burden of Disease in Western Australia, 2011 which reports on the leading causes of disease in WA children and young people.11 In this collection, infant/congenital conditions, asthma and anxiety disorders were in the top three causes of disease burden for both male and female children and young people aged 0 to 14 years.12

For 15 to 24 year-old young people the leading causes of burden of disease were mental disorders and injury conditions. With suicide and self-inflicted injuries the leading cause for male young people and anxiety disorders for female young people.13 There is no further breakdown by age group.

One preventable condition that impacts an unknown number of WA children is Fetal Alcohol Spectrum Disorders (FASD) which is a "hidden” disability, and easily confused with disobedience or other conditions such as Attention Deficit Hyperactivity Disorder (ADHD).14 FASD is an umbrella term which covers a range of possible birth defects and/or developmental disabilities that can be caused by exposure to alcohol prior to birth. It has a significant impact on mental health and increases the likelihood of social and emotional behavioural issues throughout life.15,16

The diagnosis of FASD is complex and until 2016 there was not an Australian diagnostic tool for practitioners.17 As such, FASD is a condition that is under-recognised in Australia and often goes undiagnosed.18 In 2016, The Australian Guide to the diagnosis of Fetal Alcohol Spectrum Disorder (FASD) was released which provides health professionals with the tools necessary to diagnose FASD.19 

It is generally recognised that many children and young people in out-of-home care and in contact with youth justice services are living with undetected FASD.20 In 2017, a Telethon Kids Institute research team found that 89 per cent of young people in WA’s Banksia Hill Detention Centre had at least one form of severe neurodevelopmental impairment, while 36 per cent (36 young people) were found to have FASD. It is of significant concern that only two of the young people with FASD had been diagnosed prior to participation in the study.21

In the 2019 report, Inquest into the deaths of: Thirteen children and young persons in the Kimberley region, the WA State Coroner noted that a number of the children and young people were likely to have been on the spectrum for FASD, but that none had been formally diagnosed.22

Screening and assessment for FASD should occur as part of the universal child health checks and at key points across a child's life (e.g. kindergarten, school entry), as well as when a child or young person enters the child protection or justice system. Any diagnosis needs to trigger appropriate referrals and be linked to clear supports and services, as without this, a diagnosis will have limited impact in terms of improving outcomes for children and young people.

Aboriginal young people

There is limited robust data on the prevalence of disability among WA Aboriginal children and young people. This is principally due to a lack of adequate sample size for Aboriginal populations in general surveys and surveys are often not tailored to incorporate Aboriginal cultures and perspectives on health and wellbeing.23

The Western Australian Aboriginal Child Health Survey (WAACHS) was a comprehensive cross-sectional study of the health and development of a representative random sample of 5,300 Aboriginal and Torres Strait Islander children and young people aged 0 to 17 years living in 2,000 families across WA, including remote areas.24 The study was conducted in 2000–2001 and has not been repeated.

The Western Australian Aboriginal Child Health Survey asked questions about restrictions to WA Aboriginal children and young people’s core activities that included self-care, mobility and communication.25 While the data is not recent and the authors recognised limitations, in general the findings suggested that rates of disability among Aboriginal children were similar to those reported in the non-Aboriginal population.26

However, more recent data from the ABS Survey of Disability, Ageing and Carers reports that Aboriginal children and young people across Australia are more likely to experience disability than non-Aboriginal children and young people.27

Children and young people aged 0 to 14 years living in households, by Aboriginal status and disability status, in per cent, Australia, 2015

Aboriginal

Non-Aboriginal

Profound/severe core activity limitation

5.9

3.9

Moderate/mild core activity limitation

4.1

1.5

Schooling or employment restriction only

2.1*

0.9

All with specific restrictions

11.0

6.3

Has disability but no specific restriction

2.6*

0.9

All with reported disability

13.8

7.2

No reported disability

86.8

92.9

Source: Australian Bureau of Statistics, 44300: Survey of Disability Ageing and Carers: Aboriginal and Torres Strait Islander People with Disability, 2015, Table 2.3 All persons living in households, Indigenous Status by Disability Status, Sex and Age – 2015, Proportions

* Estimate has a relative standard error of 25 per cent to 50 per cent and should be used with caution.

This data is not available for WA and there is no further breakdown by age group.

There are a range of intersecting social factors that contribute to the higher prevalence of disability in Aboriginal communities. These can include poverty, low birth weight, poor access to quality primary health care and high levels of alcohol consumption by some mothers during pregnancy.28

Furthermore, differences between Aboriginal and non-Aboriginal people’s conceptualisations of disability may impact identification, diagnosis and treatment. In addition, Aboriginal families are more likely to mistrust government organisations due to the legacy of the stolen generations, information may not be available in community languages, and culturally appropriate services may not be available.29

Endnotes

  1. Australian Institute of Health and Welfare (AIHW) 2015, Chronic conditions and disability, AIHW.
  2. Australian Institute of Health and Welfare (AIHW) 2005, Selected chronic diseases among Australia’s children, AIHW.
  3. ABS uses the following definition of disability: ‘In the context of health experience, the International Classification of Functioning, Disability and Health (ICFDH) defines disability as an umbrella term for impairments, activity limitations and participation restrictions… In this survey, a person has a disability if they report they have a limitation, restriction or impairment, which has lasted, or is likely to last, for at least six months and restricts everyday activities.’ Australian Bureau of Statistics 2016, Disability, Ageing and Carers, Australia, 2015, Glossary.
  4. Estimate is to be to be used with caution as it has a relative standard error of between 25 and 50 per cent. Australian Bureau of Statistics 2016, Disability, Ageing and Carers, Australia, 2015: Western Australia, Table 1.1 Persons with disability, by age and sex, 2012 and 2015 estimate, and Table 1.3 Persons with disability, by age and sex, 2012 and 2015, proportion of persons.
  5. Australian Bureau of Statistics 2016, Disability, Ageing and Carers, Australia: Summary of Findings 2015, ABS.
  6. Australian Bureau of Statistics (ABS) 2013, Australian Social Trends: 2012, Children with a disability, ABS catalogue no. 4102.0, ABS, p. 3.
  7. Ibid, p. 3.
  8. Ibid, p. 3.
  9. Ibid, p. 3.
  10. Ibid, p. 3-4.
  11. Burden of disease measures the gap between current health and ideal health situations in the population. While one disease may be responsible for considerable loss of life due to early death, another may cause significant loss from disability. The total burden, Disability Adjusted Life Years (DALY) combines both premature deaths (YLL) and disability (YLD) into a single measure. Source: WA Department of Health 2012, Overview of Burden of Disease in Western Australia, 2011, WA Government.
  12. WA Department of Health 2012, Burden of Disease by age group in Western Australia, 2011, WA Government.
  13. Ibid.
  14. McLean S and McDougall S 2014, Fetal alcohol spectrum disorders: Current issues in awareness, prevention and intervention, CFCA Paper No 20, Child Family Community Australia (CFCA).
  15. Brown J et al 2018, Fetal Alcohol spectrum disorder (FASD): A beginner’s guide for mental health professionals, Journal of Neurological Clinical Neuroscience, Vol 2, No 1.
  16. Pei J et al 2011, Mental health issues in fetal alcohol spectrum disorder, Journal Of Mental Health, Vol 20, No 5, pp. 438–448.
  17. Bower C and Elliott EJ on behalf of the Steering Group 2016, Australian Guide to the diagnosis of Fetal Alcohol Spectrum Disorder (FASD), Telethon Kids Institute and University of Sydney, p. 4.
  18. Bower C and Elliott EJ 2016, on behalf of the Steering Group, Australian Guide to the diagnosis of Fetal Alcohol Spectrum Disorder (FASD), Telethon Kids Institute and University of Sydney.
  19. Ibid.
  20. McLean S and McDougall S 2014, Fetal alcohol spectrum disorders: Current issues in awareness, prevention and intervention, CFCA Paper No 20, Child Family Community Australia (CFCA).
  21. Bower C et al 2018, Fetal alcohol spectrum disorder and youth justice: a prevalence study amount young people sentenced to detention in Western Australia, BMJ Open, Vol 8, No 2.
  22. WA State Coroner 2019, Inquest into the deaths of: Thirteen children and young persons in the Kimberley region, Western Australia, WA Government, p. 256.
  23. Zubrick SR et al 2004, The Western Australian Aboriginal Child Health Survey: The Health of Aboriginal Children and Young People, Telethon Institute for Child Health Research, p.157.
  24. Telethon uses the following definition of level of remote isolation (LORI) ‘LORI allows greater discrimination of the circumstances of survey respondents with respect to their isolation from population centres of various sizes and better differentiates between areas and communities that are extremely remote from major metropolitan centres’
    Zubrick SR et al 2004, The Western Australian Aboriginal Child Health Survey: The Health of Aboriginal Children and Young People, Telethon Institute for Child Health Research, p.3.
  25. Ibid, p.157.
  26. Ibid p.157.
  27. To identify whether a child or young person has a particular type of limitation or restriction, the survey collects information on need for assistance, difficulty experienced, and use of aids or equipment to perform selected tasks from the parent/carer (source: ABS - Explanatory Notes).
  28. Department of Prime Minister and Cabinet 2014, Aboriginal and Torres Strait Islander: Health Performance Framework Report 2014, 1.14 Disability, Australian Government.
  29. DiGiacomo M et al 2013, Childhood disability in Aboriginal and Torres Strait Islander peoples: a literature review, International Journal for Equity in Health, Vol 12, No 7.

 

Young people in care

At 30 June 2018 there were approximately 2,240 young people aged between ten and 17 years in out-of-home care in WA, more than half (51.9%) of whom were Aboriginal.1

Young people in care have a higher prevalence of chronic and complex physical, neurological and developmental conditions when compared to the average young person in Australia.2 It is therefore critical that young people under the care of the state are provided with timely and comprehensive assessments of any health issues and services to meet those issues.

It is a requirement of the WA Department of Communities that children in care receive an initial medical examination within 20 days of entering care and then annual health assessments.3

In 2016, the WA Department of Child Protection (now Department of Communities) published the Outcomes Framework for Children in Out-of-Home Care 2015–16 Baseline Indicator Report. The outcomes framework identified two indicators related to reviewing the physical health of children and young people in out-of-home care.

The first indicator was the ‘proportion of children who had an initial medical examination when entering out-of-home care’. In 2015, 53.1 per cent of children and young people entering out-of-home care had an initial medical examination.4

The second indicator was the ‘proportion of children who have had an annual health check of their physical development.’ In this report they noted that there were limitations in data accuracy which prevented reporting on this indicator in 2015–16, however, data would be reported in 2016–17.5 No data has been reported on this indicator as at publication date.

There is no data available on the physical activity levels, diet or weight of young people in out-of-home care in WA.

The lack of up to date data on the health of young people in care and the low proportion of children and young people provided with an initial medical examination in 2015–16 needs to be urgently addressed.

Endnotes

  1. Department of Communities 2019, 2017-18 Annual Report, Child Protection Activity Performance Report 2017-2018, WA Government.
  2. Nathanson D and Tzioumi D 2007, Health needs of Australian children living in out of home care, Journal of Paediatric Child Health, Vol 43.
  3. Department of Child Protection and Family Support (Communities), Casework Practice Manual: Healthcare Planning, WA Government.
  4. Department for Child Protection and Family Support 2016, Outcomes Framework for Children in Out-of-Home Care 2015-16 Baseline Indicator Report, p. 5.
  5. Ibid, p. 10.
Young people with disability

Physical health is critical for young people’s current wellbeing and also their future life outcomes. The physical health of young people with disability is often viewed through the lens of their disability and other aspects of health can be overlooked.

There is a complex relationship between physical health and disability, however adults with disability are more likely to have long term chronic health conditions including heart disease, stroke and diabetes.1

Young people with disability who are able to participate in physical activities of some kind and have healthy diets are more likely to have better health outcomes over the longer term.2,3

The Australian Bureau of Statistics Disability, Ageing and Carers, 2015 data collection reports that approximately 23,700 WA children and young people (7.5%) aged five to 14 years have a reported disability.4,5

In 2013, the Commissioner consulted with children and young people with disability about the issues that were important to them. In this consultation, the children and young people highlighted that there was a lack of access to activities including sports and other community activities outside of school.6

In 2006, the Physical Activity Study of Children and Adolescents with a Disability (PASCAD) was conducted to examine the physical activity of children/adolescents with a disability in metropolitan Perth. This study found that the majority of children and young people with a disability were not meeting the recommended physical activity guidelines. They also found that children and young people with disability participated in a narrower range of activities with very low participation rate in community-based team/group activities being the most noticeable difference.7

The children and young people in this study, identified social barriers as one of the main obstacles to their physical activity. They reported that non-disabled peers and organisations did not know how to include them in physical activities.8

This study has not been repeated.

No other data exists on the physical health of WA young people with disability.

Endnotes

  1. Australian Institute of Health and Welfare (AIHW) 2018, Chronic conditions and disability 2015, Cat no CDK 8, AIHW.
  2. Heller T et al 2011, Physical Activity and Nutrition Health Promotion Interventions: What is Working for People With Intellectual Disabilities?, Intellectual and Developmental Disabilities Vol 49, No 1.
  3. Australian Institute of Health and Welfare (AIHW) 2018, Chronic conditions and disability 2015, Cat no CDK 8, AIHW, p. 21.
  4. ABS uses the following definition of disability: ‘In the context of health experience, the International Classification of Functioning, Disability and Health (ICFDH) defines disability as an umbrella term for impairments, activity limitations and participation restrictions… In this survey, a person has a disability if they report they have a limitation, restriction or impairment, which has lasted, or is likely to last, for at least six months and restricts everyday activities.’ Australian Bureau of Statistics 2016, Disability, Ageing and Carers, Australia, 2015, Glossary.
  5. Estimate is to be used with caution as it has a relative standard error of between 25 and 50 per cent. Australian Bureau of Statistics 2016, Disability, Ageing and Carers, Australia, 2015: Western Australia, Table 1.1 Persons with disability, by age and sex, 2012 and 2015 estimate, and Table 1.3 Persons with disability, by age and sex, 2012 and 2015, proportion of persons.
  6. Commissioner for Children and Young People 2013, Speaking Out About Disability: The views of Western Australian children and young people with disability, Commissioner for Children and Young People WA.
  7. Packer TL et al 2006, The Physical Activity Study of Children and Adolescents with a Disability, Curtin University of Technology.
  8. Ibid.
Policy implications

Most young people in WA are healthy, however a significant proportion of young people are not consistently engaging in healthy activities such as doing regular physical exercise, eating a healthy diet and limiting their screen time. This increases their risk of health issues during adolescence and into adulthood.

Available data suggests that most WA young people aged 10 to 15 years are not meeting the recommended physical activity guidelines. Female young people are also less likely to be meeting the physical activity recommendations than male young people. Additionally, only a very small proportion (less than 10%) of WA children aged four to 15 years are meeting the recommended guidelines for vegetable consumption. At the same time, while there is limited data on sugar consumption in this age group, it is important to reduce the amount of sugar in all young people’s diets.

Many young people who have participated in the Commissioner’s various consultations have identified sport, exercise and fitness as among the things that mattered most to them. They also discussed some of the barriers to getting involved in sporting activities that happened outside of school, including transportation, financial costs, inadequate facilities and equipment, a lack of role models, geographic isolation, parental restrictions and study.1

Research also highlights that individual-level barriers have been found to significantly contribute to a decline in involvement in physical activity for adolescents. Such individual-level barriers include young people’s belief that they are not good at sport, they do not have enough time for physical activity and that they do not enjoy it.2

For a variety of reasons, including socio-economic disadvantage, Aboriginal young people are at greater risk of having physical health issues, including obesity, over their lifetime which contributes to a higher risk of chronic disease. Life expectancy is 13.4 years lower for WA Aboriginal men, and 12.0 years lower for WA Aboriginal women than other non-Aboriginal WA adults.3 The difference in life expectancy is largely due to a higher incidence of chronic diseases, including heart disease, diabetes and various cancers.4

Socio-economic disadvantage, including parental income levels, education and access to health services have a significant influence on young people’s health.5 The data supports this, as Aboriginal peoples living in the most disadvantaged areas - a higher proportion of whom were living in remote Australia - have the lowest life expectancy.6

WA Department of Health’s strategy to improve health outcomes for Aboriginal children and young people is encompassed in its WA Aboriginal Health and Wellbeing Framework 2015-2030

Improving the physical health of young people in WA will require multifaceted interventions where evidence-based community level programs are combined with population-level strategies. Some key policy strategies include:7

  • policies and programs which improve and promote access to recreational physical activity, including the creation of more community-based environments that provide space for accessible recreational activity and improved transport options, such as bike paths
  • supporting all young people, including those with disability and living in regional or remote areas, to participate in organised sport and other recreational activities
  • policies and programs to ensure all young people have access to adequate and sustainable supply of affordable, healthy, nutritious food
  • limiting the availability and appeal of unhealthy food and beverages through marketing regulations and taxation policies
  • programs and policies, including education and information campaigns, to inform and support parents and carers to maximise health, physical activity, good nutrition and limiting screen time for children and young people
  • programs, guidelines and infrastructure to enable schools to support regular physical activity and healthy eating
  • broad strategies that address the social determinants of health including poverty and disadvantage.

While data shows rates of being overweight and obese are increasing for some age groups, there is also considerable pressure to strive for unattainable and unrealistic body images which can encourage body dissatisfaction and unhealthy eating behaviours.8

Problematic eating behaviours such as restrictive dieting can increase risk of the development of an eating disorder. Eating disorders which develop in adolescence can become a chronic problem affecting health and quality of life across the life span. It is important to intervene early to promote healthy eating and nutrition in order to reduce the potential for these behaviours to occur.9

Policies which aim to address rates of overweight and obese children must be formulated in ways which are sensitive and safe and give serious consideration to potentially harmful impacts on future self-esteem and body image.10,11

Data gaps

The WA Department of Health, Health and Wellbeing of Children in Western Australia survey which collects data on physical activity, sedentary behaviour, diet and healthy weight for WA’s children and young people does not separately report on young people aged 16 to 17 years. As highlighted in the Healthy weight measure, some young people in this age group have a high likelihood of being obese and overweight and collecting and reporting data on their health behaviours is important.

More information is needed on the prevalence of Fetal Alcohol Spectrum Disorders (FASD) in Australia and greater awareness and knowledge of FASD in healthcare and family services is necessary to ensure young people are properly diagnosed and able to be treated as early as possible.

There is very limited data on WA Aboriginal children’s physical health. In 2001 and 2002 the Telethon Institute for Child Health Research (now Telethon Kids Institute) conducted the Western Australian Aboriginal Child Health Survey. However, this survey has not been repeated. The Australian Bureau of Statistics conducted the National Aboriginal and Torres Strait Islander nutrition and physical activity survey (NATSINPAS) in 2011-2013. This survey provided limited data broken down by Australian jurisdiction. This survey has also not been repeated since that time.

The lack of data on WA Aboriginal young people’s health is a significant gap considering the poorer health outcomes experienced by Aboriginal peoples compared to non-Aboriginal peoples.12

The limited data being collected and reported on the physical health of WA children in out-of-home care is of concern. That 53.1 per cent of young people entering out-of-home care had an initial medical examination in 2015 and the lack of publicly available data makes it difficult to assess whether this issue has been remediated.

There is very limited data available on the health of young people with disability. The Australian Bureau of Statistics Disability, Ageing and Carers survey is conducted every three years, however does not always provide detailed data on children and young people in WA.

Endnotes

  1. Commissioner for Children and Young People 2018, Policy Brief March 2018: Recreation, Commissioner for Children and Young People WA.
  2. Jongenelis M et al 2017, Physical activity and screen-based recreation: Prevalence’s and trends over time among adolescents and barriers to recommended engagement, Preventive Medicine, Vol 106, p. 70
  3. Australian Bureau of Statistics (ABS) 2018, 3302.0 Life Tables for Aboriginal and Torres Strait Islander Australians, 2015-2017, ABS.
  4. Australian Institute of Health and Welfare (AIHW) 2010, Contribution of chronic disease to the gap in adult mortality between Aboriginal and Torres Strait Islander and other Australians, Cat No IHW 48, AIHW.
  5. Australian Institute of Health and Welfare (AIHW) 2017, Australia’s Health 2016: 4.2 Social determinants of Indigenous health, AIHW.
  6. Australian Bureau of Statistics (ABS) 2018, 3302.0 Life Tables for Aboriginal and Torres Strait Islander Australians, 2015-2017, ABS.
  7. For more information refer: Preventative Health Taskforce 2008, Australia: The Healthiest Country by 2020: A discussion paper prepared by the National Preventative Health Taskforce and Public Health Advocacy Institute of WA, Obesity [website].
  8. O’Connor M et al 2017, Eating problems in mid-adolescence, in The Longitudinal Study of Australian Children Annual Statistical Report 2017, Australian Institute of Family Studies, p. 113.
  9. Ibid, p. 113.
  10. Russell-Mayhew S 2012, Mental Health, Wellness, and Childhood Overweight/Obesity, Journal of Obesity, Vol 2012.
  11. O’Dea JA 2012, Studies of obesity, body image and related health issues among Australian adolescents: how can programs in schools interact with and complement each other?, Journal of Student Wellbeing, Vol 4, No 2.
  12. Australian Institute of Health and Welfare (AIHW) 2015, The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples: 2015 – Health and disability key points [website].
Further resources

For further information on physical health for young people refer to the following resources:

Endnotes

  1. Australian Institute of Health and Welfare (AIHW) 2011, Young Australians: their health and wellbeing 2011, AIHW, p. 1.