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Age group 6 to 11 years

Physical health

Physical health is a basic building block for children’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.

Children aged 6 to 11 years are in a critical phase for establishing positive health behaviours to support wellbeing outcomes over their lifetime.

Overview and areas of concern

This indicator considers key measures of physical health for children 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 children living in areas with a high risk of social exclusion1 have, on average, worse health outcomes than children living in other areas.2 In particular, socioeconomic indicators such as having higher income and education levels are linked to better health outcomes.3

Data overview

While less than half of WA children aged five to nine years were assessed by their parent/carer as meeting the recommended level of physical activity in 2017, the proportion of children that parents/carers reported as meeting the recommendation increased from 37.6 per cent in 2015 to 46.7 per cent in 2017.

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

Areas of concern

In 2017, the proportion of WA children aged nine to 15 years eating sufficient vegetables was very low (4.1%) and had reduced from previous years.

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.

Over one-quarter (26.3%) of WA children and young people aged 5 to 15 years were overweight or obese in 2017.

Proportion of children aged 5 to 15 years in 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

There is no data publicly available on the physical health of the 1,560 children aged five to nine years in care in WA. In 2015, 53.1 per cent of children entering out-of-home care had a medical assessment, as required by Departmental guidelines.

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, June 2014
  3. World Health Organisation (WHO) 2008, The determinants of health, WHO.
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 activity also enhances cognitive functioning including memory, concentration and the ability to learn.Furthermore, it is associated with social and emotional benefits in childhood, including self-regulation and improved self-esteem.2

The current recommendation for physical activity is that children aged five to 17 years should do at least 60 minutes of moderate to vigorous intensity physical activity every day.3

Data collected on the physical activity of children is often survey-based information, either self-reported daily physical activity or parent-reported daily physical activity. Measuring the physical activity of young children is difficult. It generally relies on parent-reported data collected from interviews or surveys.

Research shows that while parent-reported data on physical activity for children under 12 years of age is valid, it has limitations depending on the questions asked (e.g. difficulty estimating unstructured play).4 In recent years more researchers are using devices such as accelerometers and other technology to gather more ‘objective’ data.5

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.

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.6 In this survey they ask parents and carers about their children’s activity levels and based on these responses determine the proportion of WA children meeting the physical activity guidelines.

Proportion of children aged 5 to 9 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

2.8

27.0

19.6

50.6

2013

5.4*

28.9

21.8

43.9

2014

7.5*

27.6

25.1

39.8

2015

n/a

31.0

30.3

37.6

2016

n/a

30.4

24.7

43.2

2017

2.5*

31.4

19.3

46.7

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

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

n/a Prevalence estimate has a relative standard error greater than 50 per cent and is considered too unreliable for general use.

From 2013 to 2015, there was a decline in children aged five to nine years being assessed as meeting the recommended activity level, however in 2016 and 2017 the proportion of children meeting the recommendation has increased. Nevertheless, still less than half (46.7%) of WA children aged five to nine years were assessed by their parent/carer as meeting the recommended level of activity in 2017.

In 2011–2012, the Australian Bureau of Statistics (ABS) conducted the National Nutrition and Physical Activity Survey (NNPAS) as part of the Australian Health Survey.8 In this survey, parents were asked about their child’s previous week’s physical activity and data was collected by jurisdiction.9

Proportion of children 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

NSW

26.1

72.0

VIC

26.1

72.9

QLD

35.1

64.1

SA

35.4

63.8

WA

32.5

66.9

TAS

33.5

64.7

NT

37.1

62.4

ACT

31.2

68.0

Australia

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 are more likely to do more physical activity than female children.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 parents’ and carers’ 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

Males

Females

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 WA conducted the Child and Adolescent Physical Activity and Nutrition Survey (CAPANS) in WA.16 In this study participants wore pedometers and completed exercise diaries. The researchers also found significant differences between male and female respondents. While only 41.2 per cent of male primary school students reported activity that met the recommended guidelines, even fewer female primary school students (27.4%) reported activity that met the recommended guidelines.17 This study has not been repeated.

The Australian Sports Commission AusPlay survey18 is a large scale national survey to track sporting behaviours and organised activities of the Australian population. For children, the activity is restricted to organised sport or physical activity outside of school hours, such as swimming, football, gymnastics. It does not capture data on unstructured play or non-organised physical activity (such as walking, bike riding etc.). The survey uses parent/carer interviews for children under the age of 15 years.

While this survey provides data by jurisdiction, it is limited. The only data reporting an age breakdown was the proportion of WA children who participated in ‘organised (physical) activity out of school hours’ at least once a year (84.2% of five to eight year olds and 88.1% of nine to 11 year olds).19

This survey reported that Australian children 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

The survey found that only 58 per cent of Australian children and young people from low income families participate in organised physical activity outside of school compared to 73 per cent of children and young people from middle income families and 84 per cent of children and 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 children

There is limited regularly reported data on the physical activity of WA Aboriginal children or children 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 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 over four in five (86%) Aboriginal children aged five to eight years and an equivalent proportion of nine to 11 year olds (87%) did more than 60 minutes of physical activity on the day prior to the interview.25

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

Endnotes

  1. 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.
  2. Australian Institute of Health and Welfare (AIHW) 2018, Physical activity across the life stages, Cat No PHE 225, AIHW.
  3. Department of Health 2019, Guidelines for healthy growth and development for children and young people (5 to 17 years), Australian Government.
  4. 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.
  5. Sylvia LG et a 2013, Practical guide to measuring physical activity, Journal of the Academy of Nutrition and Dietetics, Vol 114, No 2.
  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. 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: 4363.0.55.001 - Australian Health Survey: Users' Guide, 2011-13 - Child Physical Activity (5 to 17 years).
  9. In subsequent Australian Health Surveys (and National Health Surveys) the physical activity data has not been collected by this age group and jurisdiction.
  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 Health and Wellbeing Surveillance System reports for each year and therefore has not been adjusted for changes in the age and sex structure of the population across these years. The Department of Health Epidemiology Branch have also not conducted any modelling or analysis 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. This study used a mixed methods approach of pedometers and questionnaires to collect data on physical activity.
  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. vi.
  18. This survey is conducted by computer assisted telephone interviewing (CATI). The children’s data (aged 0 to 14 years) is collected through a child interview. The annual target sample size for AusPlay is 20,000 adults aged 15 years and over, and approximately 3,600 children aged 0-14, spread evenly across the year. Australian Sports Commission 2018, Ausplay Method: Research and sample design.
  19. Australian Sports Commission 2018, AusPlay: WA Data Tables – Table 2 Children’s participation outside of school hours Australian Government.
  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.
  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).
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 children’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 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 children’s screen time will often include other activities, such as homework.5 Therefore, the data does not necessarily report the amount of non-educational screen time.

The WA Department of Health administers the WA Health and Wellbeing Surveillance System, interviewing WA parents and carers of children aged 0 to 15 years.6 In this survey they ask parents and carers about their children’s screen-based activities and based on these responses determine the proportion of WA children 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 data in this survey is not publicly available.

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 Australian five to eight year-old children spent on sedentary screen-based activities per day was 98 minutes, while nine to 11 year-old Australian children spent 119 minutes per day,8 which are below the recommended maximum of two hours per day. However, 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 and there is no further disaggregation by jurisdiction.

Longitudinal research has similarly found that children aged six to seven years spend 94 minutes per day on screen-based activities on average. Television is the main medium for screen-based activities for all age groups, with children aged six to seven years watching an average of 80 minutes of television per weekday.10

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

In 2013, the Australian Communications and Media Authority conducted an online survey to explore children and young people’s use of social networking services. 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 children and young people’s online usage.

In this survey they found that 78 per cent of children aged eight to nine years and 92 per cent of children aged 10 to 11 have used social networking services.12 These children were mainly playing games or watching YouTube.13

Due to the increasing popularity of social networking services, the impact of increased use on children’s level of physical activity, sedentary behaviour and the potential for associated mental health issues14 will be critical to monitor in the future.

The 2017 WA Health and Wellbeing Surveillance System survey also found that the proportion of children meeting the screen time guidelines was similar for children across different socio-economic categories. The highest proportion of children 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 children meeting the guidelines were in Quintile three (57.2%).15

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.16

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

Longitudinal research using data from the Longitudinal Study of Australian Children suggests that children who enjoy doing physical activities will spend less time in front of screens.17 This highlights the importance of engaging children in fun, physical activities to provide the foundation for a more active childhood.

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, Vol 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 (ABS), 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, pp. 102, 106.
  11. 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. 114.
  12. 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, p. 37
  13. Ibid, p. 37
  14. Pantic I 2014, Online Social Networking and Mental Health, Cyberpsychology, Behavior and Social Networking, Vol 17, No 10. 
  15. Merema M and Radomiljac A 2018, Health and Wellbeing of Children in Western Australia in 2017, Overview and Trends, WA Department of Health.
  16. 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.
  17. 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, pp. 119-120.
Measure: Healthy diet

Diet has a strong influence on wellbeing from birth. Children 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

2 to 3 years

4 to 8 years

9 to 11 years

12 to 13 years

14 to 18 years

Minimum recommended number of serves of vegetables per day

Boys

2.5

4.5

5

5.5

5.5

Girls

2.5

4.5

5

5

5

Minimum recommended number of serves of fruit per day

Boys

1

1.5

2

2

2

Girls

1

1.5

2

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  

This change in the guidelines has significantly reduced the number of children meeting the recommended levels of vegetable consumption as outlined in the table below.

Proportion of children 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

4 to 7 years

8 to 11 years

4 to 7 years

8 to 11 years

2012

95.5

97.6

64.0

46.0

2013

98.6

95.3

62.4

36.1

4 to 8 years*

9 to 15 years*

4 to 8 years*

9 to 15 years*

2014

97.3

64.0

11.7

8.8

2015

99.2

62.7

24.5

6.5

2016

97.8

59.6

12.4

8.3

2017

98.5

61.7

7.4**

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)3

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

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

Notes:

1. Prior to 2012/2013, children aged four to seven years of age were recommended to eat at least two serves of vegetables each day (now four and one-half), eight to 11 year olds to eat at least three serves a day and 12 to 15 year olds to eat at least four serves a day (now five to five and one-half serves). NHMRC Australian dietary guidelines for children and adolescents 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.

A very high proportion (98.5%) of young children (approximately aged four to eight years of age) are meeting the guidelines for fruit consumption. A smaller, but still substantial proportion (61.7%) of children in the older age groups are meeting the requirements for fruit consumption.

Since 2013, only a very small proportion of WA children are meeting the recommended guidelines for vegetable consumption. In the nine to 15 years age group the proportion of children eating sufficient vegetables is very low (4.1%) and has reduced from previous years.

The Australian Bureau of Statistics conducted the National Health Survey in 2014-15 which reported on daily intake of fruit and vegetables for children. This data is relatively consistent with the results of the WA Health and Wellbeing Survey, although the proportion of children meeting the recommended guidelines for fruit consumption are lower.

Proportion of children meeting the daily intake of fruit and vegetables, in per cent, WA and Australia, 2014-15 and 2017-18

2014-15

2017-18

4 to 8 years

9 to 11 years

4 to 8 years

9 to 11 years

Fruit

WA

71.9

61.1*

85.1

80.2*

Australia

73.1

69.9

77.8

74.2

Vegetables

WA

5.0

2.6

6.8

0.0**

Australia

3.3

3.8

3.8

5.9

Source: 43640: National Health Survey: Updated Results, 2014–15 — Australia, 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 margin of error >10 percentage points which should be considered when using this information.

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

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

Proportion of Aboriginal children meeting the daily intake of fruit and vegetables, in per cent, Australia, 2014-15

5 to 9 years

10 to 14 years

Adequate daily fruit intake

66.2

62.2

Adequate daily vegetable intake

4.8

6.2

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

Consistent with the results for all WA children, the majority of Aboriginal children in Australia were not consuming sufficient vegetables in 2014-15.

Proportion of children and young people by number of daily serves of vegetables consumed for Aboriginal children (aged 2 to 14 years) and all WA children by age group, in per cent, WA and Australia, 2014-15

Aboriginal children
2 to 14 years

All WA children

WA

Australia

4 to 8 years

9 to 11 years

Does not usually eat vegetables

3.5*

3.2

5.8

7.7

1 serve or less

37.2

39.2

32.7

29.7**

2 serves

24.3

29.6

26.4

37.2**

3 serves

19.2

16.7

16.9

19.0**

4 serves

9.3

6.3

9.2

5.3

5 serves or more

7.1*

5.2

5.0

2.6

Total

100.0

100.0

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 and ABS, National Health Survey: First Results, 2014–15 — Western Australia, Table 17.3 Children's daily intake of fruit and vegetables and main type of milk consumed, proportion of persons

* These NATSISS estimates have a relative standard error between 25 per cent and 50 per cent and should be used with caution.

** These National Health Survey proportions have a margin of error >10 percentage points which should be considered when using this information.

Proportion of WA Aboriginal children (aged 2 to 14 years) and all WA children by age group by number of serves of vegetables they consume daily, in per cent, WA, 2014-15

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 and ABS, National Health Survey: First Results, 2014–15 — Western Australia, Table 17.3 Children's daily intake of fruit and vegetables and main type of milk consumed, proportion of persons

While the proportion of Aboriginal children not eating the recommended amount of vegetables per day is similar to the proportion of all WA children, a much higher proportion of WA Aboriginal children eat only one serve of vegetables per day.

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.4

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.5 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.6

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 children 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.7

Reducing children’s sugar consumption has been highlighted as particularly critical. Sugar consumption in childhood is directly linked to being overweight or obese, and having dental health conditions, both of which impact lifelong health.8 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.9 

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.10 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 children’s consumption of sugar.

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

Proportion of children who did not consume any sugar-sweetened drinks on a daily basis, per cent, WA and Australia, 2017-18

4 to 8 years

9 to 11 years

WA

67.6

64.6*

Australia

69.4

56.3

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 of 13 per cent and should be used with caution.

In the 2017-18 survey they report that 67.6 per cent of WA children aged four to eight years and 64.6 per cent (with a 13.0% margin of error) of children aged nine to 11 years are reported by their parents to not consume any sugar-sweetened drinks on a daily basis.11 This was similar to the results for Australia overall, although WA looks to have a higher number of children aged 9 to 11 not consuming sugar-sweetened drinks, subject to the stated 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 four 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 four to seven years of age were recommended to eat at least two serves of vegetables each day, eight 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. 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. 
  4. Davidson P et al 2018, Poverty in Australia, 2018, Australian Council of Social Services (ACOSS) /UNSW Poverty and Inequality Partnership Report No 2, ACOSS, p. 65.
  5. Department of the Prime Minister and Cabinet, Aboriginal and Torres Strait Islander Health Performance Framework 2014 Report, 2.19 Dietary behaviours, Australian Government.
  6. Pollard CM et al 2015, Food Access and Cost Survey 2013 Report, WA Department of Health.
  7. National Health and Medical Research Council 2013, Australian Dietary Guidelines: Providing the scientific evidence for healthier Australian diets, National Health and Medical Research Council.
  8. 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.
  9. Ibid.
  10. World Health Organisation (WHO) 2015, Guideline: Sugars intake for adults and children, WHO.
  11. 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 child’s risk of poor physical health in both the short and long term. Being obese increases a child’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 with one out of 12 children diagnosed with diabetes now having Type 2 diabetes.3

Children who are overweight or obese are more likely to be overweight or obese in adulthood.4 Overweight or obese children 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 children 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 estimating 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 child, however, it is not recommended for children under two years of age.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, interviewing with 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 until an apparent increase in obesity in 2017. This will continue to be monitored to determine if this is an ongoing trend.

Proportion of children and young people by BMI category and age group, in per cent, WA, 2012 to 2017

Overweight

Obese

Total

5 to 9 years

10 to 15 years

5 to 9 years

10 to 15 years

5 to 9 years

10 to 15 years

2012

13.5

15.5

9.4

5.9

22.9

21.4

2013

16.1

14.4

8.6*

4.1*

24.7

18.5

2014

15.6

12.6

15.5

3.7*

31.1

16.3

2015

14.9

16.2

7.8*

4.6*

22.7

20.8

2016

17.0

19.1

7.3*

4.0*

24.3

23.1

2017

16.4

16.2

14.7

6.3*

31.1

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.

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 rates of obesity or overweight for young children across Australia. The 2017-18 survey provides data on children across Australia and also some data for WA. The WA data unfortunately has a high margin of error for a number of the statistics.

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

WA

Australia

5 to 7 years

8 to 11 years

12 to 15 years

5 to 7 years

8 to 11 years

12 to 15 years

Underweight

7.1*

0.0**

7.2

7.5

9.5

7.4

Normal weight

73.5*

68.2*

70.3*

65.1

65.4

71.6

Overweight

19.7*

25.4

15.9

17.4

17.7

14.8

Obese

4.2*

9.1

3.2

10.3

6.9

6.7

Overweight / Obese

28.4*

30.8*

22.2

27.5

25.2

20.8

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 higher proportion of WA children aged eight to 11 years are overweight than Australian children (25.4% compared to 17.7%). However, this gap reduces in the 12 to 15 years age group (15.9% of WA children are overweight compared to 14.8% of Australian children).

The data from the National Health Survey also suggests that a significant proportion (approximately 7%) of WA children and young people from five to 15 years of age may be underweight.

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 proportion of WA primary school girls who were underweight had significantly increased when compared with 2003 (9.9% in 2008 compared to 4.2% in 2003).17 They also noted 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 concern that they had lost control of their eating or had eaten too much in the last 4 weeks.21

Critically, 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 nervosa was the most common diagnosis (refer Mental health Indicator).22 Almost four times as many children in this age group were diagnosed with anorexia than autism, which was the next most common diagnosis. This may be in part because children with autism are less likely to present at hospital than children with anorexia, due to the nature of the conditions.

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

In the WA Health and Wellbeing survey, 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 by BMI category and 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 and obese by gender and age group, in per cent, WA, 2009-2016 (combined calendar years)

Male

Female

6 to 10 years

11 to 15 years

6 to 10 years

11 to 15 years

2009-2010

24.5

24.4

26.8

17.5

2011-2012

23.6

19.9

20.9

21.1

2013-2014

27.3

20.8

28.4

14.9

2015-2016

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 [unpublished]

Proportion of children and young people who are overweight and 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 [unpublished]

This represents a large decrease in the proportion of female children and young people being overweight or obese as they age. This reduction in the prevalence of overweight and obesity from childhood to adolescence is not as evident for male children and young people. For further information on the prevalence of overweight and obesity for young people aged 12 to 17 years refer to the Healthy weight measure.

The Australian Bureau of Statistics reports BMI data disaggregated by various characteristics as part of the Children’s Headline Indicators. The most recent disaggregated BMI 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

* Culturally and linguistically diverse

WA children living in areas of greater socio-economic disadvantage and regional and remote locations are more likely to be overweight and obese.

In 2017, 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%).27

Socioeconomic disadvantage influences children’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. Additionally, parents with a lower level of education often have less access to nutritional knowledge which can lead to less healthy dietary practices.28

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.29

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 five to 10 years were more likely than non-Aboriginal children to be obese (11.2% of Aboriginal children compared to 7.6% of non-Aboriginal children) and less likely to be in the healthy weight range (65.0% compared to 71.7%).30

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.31

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.32 It is therefore critical to reduce the prevalence of overweight and obesity for Aboriginal children 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, pp. 81-82.
  18. 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. 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. Ibid.
  28. NSW Council of Social Services (NCOSS) 2016, Overweight and Obesity: Balancing the scales for vulnerable children, NCOSS.
  29. 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.
  30. Australian Bureau of Statistics (ABS) 2014, Australian Aboriginal and Torres Strait Islander Health Survey: Updated Results, 2012–13 — Australia, Table 9.3 Body Mass Index of children, by age by Indigenous status by sex, proportion of persons, ABS.
  31. 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.
  32. Department of Prime Minister and Cabinet, Aboriginal and Torres Strait Islander, Health Performance Framework 2014 Report, Australian Government [website].
Measure: Long-term health issues and disability

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 are asthma, diabetes and cancer.2

The Australian Bureau of Statistics Disability, Ageing and Carers, 2015 data collection reports that approximately 23,700 WA children (7.5%) aged five to 14 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 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 1.3 Persons with disability, by age and sex, 2012 and 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%).

The rate of reported disability increases with age, from approximately three per cent of WA children aged 0 to four years to 7.5 per cent of those aged five to 14 years.6

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 types of disability (disability group) that are reported and diagnosed also vary with age. 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 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 and age group, in number and per cent, Australia, 2009

0 to 4 years

5 to 14 years

Total number of children with disability

47,300

241,000

Sensory or speech disability

63.0%

37.0%

Intellectual disability

29.0%

61.0%

Physical disability

35.0%

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, sensory or speech disabilities had the highest prevalence (63.0% of children with disability) in very young children (aged 0 to four years), however in children aged five to 14 years intellectual disability was the most prevalent (61.0% of children with disability).

The most commonly reported long-term conditions for Australian children 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 widespread (a reduction from 24% of children 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% 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 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 conditions such as Attention Deficit Hyperactivity Disorder (ADHD).13 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.14,15

The diagnosis of FASD is complex and until 2016 there was not an Australian diagnostic tool for practitioners.16 As such, FASD is a condition that is under-recognised in Australia and often goes undiagnosed.17 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.18 

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.19 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.20

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.21  

Aboriginal children

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 that surveys are often not tailored to incorporate Aboriginal cultures and perspectives on health and wellbeing.22

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.23 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.24 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.25

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.26

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

Total

100.0

100.0

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

* 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.27

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.28

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 (ABS) 2016, Disability, Ageing and Carers, Australia: Summary of Findings 2015, ABS.
  6. Australian Bureau of Statistics (ABS) 2016, Disability, Ageing and Carers, Australia, 2015: Western Australia, Table 1.3 Persons with disability, by age and sex, 2012 and 2015, proportion of persons, ABS.
  7. Australian Bureau of Statistics (ABS) 2013, Australian Social Trends: 2012, Children with a disability, ABS catalogue no. 4102.0, ABS, 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. 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. 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).
  14. 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.
  15. Pei J et al 2011, Mental health issues in fetal alcohol spectrum disorder, Journal Of Mental Health, Vol 20, No 5, pp. 438–448.
  16. 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, p. 4.
  17. 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.
  18. Ibid.
  19. 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).
  20. 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.
  21. WA State Coroner 2019, Inquest into the deaths of: Thirteen children and young persons in the Kimberley region, Western Australia, WA Government, p. 256.
  22. 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.
  23. 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.
  24. 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.
  25. Ibid, p.157.
  26. 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).
  27. Department of Prime Minister and Cabinet 2014, Aboriginal and Torres Strait Islander: Health Performance Framework Report 2014, 1.14 Disability, Australian Government.
  28. 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.
Children in care

At 30 June 2018 there were approximately 1,560 children aged five to nine years in out-of-home care in WA, more than half (56.7%) of whom were Aboriginal.1

Children in care have a higher prevalence of chronic and complex physical, neurological and developmental conditions when compared to the average child in Australia.2 It is therefore critical that children 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 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, only 53.1 per cent of children 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 health of WA children in care including their physical activity levels, diet or weight.

The lack of up to date data on the health of children in care and the low proportion of children and young people provided with an initial medical examination in 2015-16 is inadequate. 

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.
Children with disability

Physical health is critical for children’s current wellbeing and also their future life outcomes. The physical health of children 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

Children 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 (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 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 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 children 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 children in WA are healthy, however a significant proportion of children 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 their childhood and into adulthood.

Available data suggests that most WA children aged six to 11 years are not meeting the recommended physical activity guidelines. Female children are also less likely to be meeting the physical activity recommendations than male children. 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 children’s diets.

Many children and 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

For a variety of reasons, including socio-economic disadvantage, Aboriginal children 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.The difference in life expectancy is largely due to a higher incidence of chronic diseases, including heart disease, diabetes and various cancers.3

Socio-economic disadvantage, including parental income levels, education and access to health services have a significant influence on health in childhood.4 The data supports this, as Aboriginal peoples living in the most disadvantaged areas - a higher proportion of whom are living in remote Australia - have the lowest life expectancy.5  

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

Improving the physical health of children in WA will require multifaceted interventions where evidence-based community level programs are combined with population-level strategies. Some key policy strategies include:6

  • 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 safe unstructured outdoor play and improved transport options, such as bike paths
  • supporting all children and their parents, including those with disability and living in regional or remote areas, to participate in playgroups, organised sport and other recreational activities
  • policies and programs to ensure all children and young people have access to an 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
  • health advice and preventative services delivered to parents in primary healthcare settings
  • 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.

Where possible, it is also important for the home environment to be supportive of outdoor play. Recent research in WA has shown that the main factor associated with increased playtime for children was the number of fixed play structures (such as, sandpits, swings etc.) at home, with each additional piece of equipment adding an average of five minutes to a child’s daily playtime.7 When outdoor play at home is restricted, community parks with play equipment are essential.

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

More information is needed on the prevalence of FASD in Australia and greater awareness and knowledge of FASD in healthcare and family services is necessary to ensure children 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 children’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 children entering out-of-home care had an initial medical examination in 2015 is of significant concern. 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 children 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. Australian Bureau of Statistics (ABS) 2018, 3302.0 Life Tables for Aboriginal and Torres Strait Islander Australians, 2015-2017, ABS.
  3. 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.
  4. Australian Institute of Health and Welfare (AIHW) 2017, Australia’s Health 2016: 4.2 Social determinants of Indigenous health, AIHW.
  5. Australian Bureau of Statistics (ABS) 2018, 3302.0 Life Tables for Aboriginal and Torres Strait Islander Australians, 2015-2017, ABS.
  6. 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].
  7. Armstrong G 2019, Associations between the home yard and preschoolers’ outdoor play and physical activity, Public Health Research & Practice, Vol 29, No 1.
  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 children refer to the following resources: