Outcomes for youth wellbeing: health and wellness

Growing Up Healthy and Strong - Outcomes #1, #2, #3

In order for Ontario's young people to reach their potential, we need to engage and support them to be physically and mentally healthy, emotionally resilient and able to make positive lifestyle choices.

Health and wellness matters to young Ontarians:

A healthy lifestyle in adolescence enables cognitive, social and physical development and can lead to a healthier adult life. Youth who are emotionally resilient can build positive social skills and relationships. Healthy young people also tend to participate in a wide range of opportunities that support their development.

And it's important for Ontario:

Healthy physical, social, emotional and cognitive development allows young people to develop the skills they need to become positively engaged and contributing members of our communities. Having healthy young Ontarians will also help minimize demands on health care and canprovide long-term benefits for communities.

Snapshot of Youth Health and Wellness in Ontario.

Health care costs are rising: Ontario's health care system is facing unprecedented fiscal challenges. Economists have forecasted that without significant changes, our health care spending will consume 70% of the provincial budget within 12 years^{footnote 54[54]}.

Youth could be healthier: Research suggests that today's youth will not necessarily be healthier than their parents^{footnote 56[56]}. Studies show that just 7% of Canadian children between six and 19 years are getting a recommended hour of exercise per day^{footnote 57[57]}. Health challenges such as childhood obesity increase risks for chronic issues such as hypertension, diabetes, heart disease and kidney disease^{footnote 58[58]}.

Many young people face mental health challenges: Young people between 15 and 24 years are more likely to report experiencing mental illness and/or substance use than other age groups^{footnote 61[61]}. A recent study showed that the risk for mental health challenges increases between 16-17 years and 18-21 years, especially among femalesMinistry of Health and Long-Term Care. 2012. "Youth Foundation Research: A Comprehensive Study of the Health Attitudes and Behaviours of Ontario Youth 12-29 years old."^{footnote 62[62]}. It is estimated that 15 to 21% of Ontario's youth and children are affected by a significant mental health problem or mental disorder^{footnote 63[63]}.

Some youth face barriers to good health: Marginalized groups – such as newcomer youth, Aboriginal youth or young people living in poverty – tend to experience a higher number of barriers to good health. Some youth living in poverty may not have access to safe drinking water, nutritious food, primary medical care, opportunities to participate in sports and recreation, a safe place to live or the same enriching life experiences as their peers. Many youth with disabilities or special needs, including those with physical, developmental, communication, learning and neuro-developmental disabilities, regularly face additional and complex health challenges.

#1 Support youth to be physically healthy

Supporting young people to be physically healthy is one of the best ways to support positive development. Good nutrition and physical activity is vital to a young person's growth, development and wellbeing. Youth who eat well and participate in regular physical activity are more productive and focused at school, and tend to have improved academic achievement. As young people age, they take on more responsibility for their health including dental care, personal hygiene and diet choices.

Important aspects of promoting physical health for young people include:

Encouraging healthy habits: Healthy habits formed early in life are key protective factors against chronic disease and lay the foundation for a healthy adult lifestyle. Regular exercise helps fuel optimal growth and supports positive pro-social activities. Research shows young people involved in activities such as team sports are more likely to have higher grades in school and to graduate from postsecondary education^{footnote 66[66]}. Making healthy, nutritious food choices during adolescence is also important and supports brain development while decreasing the risk for heart disease, cancer, diabetes and obesity^{footnote 67[67]}. As young people become more independent in choosing what they eat, we know they benefit from a strong awareness about nutrition and access to healthy food. Lastly, ensuring youth get enough sleep is important for them to grow and perform in daily routines. Keeping healthy sleep patterns can be challenging for youth as the physical changes associated with adolescence can cause them to feel awake late at night and have difficulty waking up in the morning^{footnote 68[68]}.

Providing positive options: Enabling healthy choices in youth is best achieved when the healthy choice is the easy choice. Communities need to be empowered to support healthier choices where young people live, work and play^{footnote 70[70]} . Creating supportive environments in communities involves many partners, including government, local agencies and organizations, businesses, urban planners, educators and individuals.

Focusing on the social determinants of health: Social determinants of health refer to an individual's personal living conditions and experiences in society that impact their health and wellness. Taking social determinants into consideration can help in understanding why some young people are healthier than others^{footnote 72[72]}.

Improving access to health care: Having access to primary, preventive health care is an important component of physical health. Although many of Ontario's young people have access to a regular primary health care provider, youth in lower-income neighbourhoods are less likely to have a regular family physician^{footnote 73[73]} and often rely on Community Health Centres or walk-in clinics for their primary care. Additionally, youth in rural or remote communities may face barriers to accessing services including lack of transportation or availability of providers. Ensuring that youth regularly visit care providers, and have dental checkups, annual physicals and other paramedical services when needed, can mitigate long-term health challenges.

Outcome we want:

#1 Ontario youth are physically healthy.

How we can tell:

• ▲Proportion of youth who are a healthy weight
• ▲Proportion of youth who are physically active
• ▲Proportion of youth who consume at least five servings of fruits or vegetables daily
• ▼ Proportion of youth who did not visit a doctor in the past year

#2 Support youth to be mentally well

Adolescence is a time of increased vulnerability to mental health problems^{footnote 74[74]}, ^{footnote 75[75]}. Youth face a number of transitions in different areas of their lives that can be difficult and sometimes overwhelming. For youth who face bullying, have body image challenges, or who have disabilities or special needs, this period can be especially difficult. Supporting positive mental health in adolescence can lead to better long-term life outcomes.

Components of supporting mental health include:

Supporting youth to develop resilience: Families, friends and schools all play an important role in teaching youth to identify the factors that put them at risk - such as stress, peer pressure and challenges with self-regulation. Research shows that youth who learn adaptive emotional regulation strategies are able to maintain good relationships, grades and overall wellbeing^{footnote 76[76]}.

Intervening early: Addressing mental illness involves recognizing the signs of emotional problems, and intervening early to reduce further risks. Despite the fact that mental health problems affect one in five young people, data from 2002 indicates that fewer than 25% of children and youth with mental health problems receive specialized treatment^{footnote 82[82]}. Identifying mental health needs as early as possible is important to ensure youth receive high quality support^{footnote 83[83]}. This involves designing and delivering services in an inclusive and accessible way.

Reducing Stigma: Many factors can contribute to mental health problems, including genetic influences, brain trauma, severe life stress, substance use, or family history^{footnote 85[85]}. We know that some of Ontario's youth are more vulnerable to mental health challenges. Immigrant and refugee youth, for example, may have past experiences with trauma that requires specific intervention^{footnote 86[86]}. Youth from racialized and Aboriginal communities who live with mental illness may be more likely to access services that are youth-friendly and culturally sensitive or based. Promoting awareness, equity and diversity helps to reduce stigma around mental illness and ensures that young people are able to get the support when they need it^{footnote 87[87]}.

Outcome we want:

#2 Ontario youth feel mentally well.

How we can tell:

• ▼Proportion of youth who are experiencing symptoms of anxiety/depression
• ▼Proportion of youth who are experiencing elevated psychological distress
• ▼Proportion of youth who had serious thoughts about suicide in the past year

#3 Understand and address risk-taking

All teenagers take risks as a normal part of growing up. Curiosity and yearning for novel experiences present tremendous opportunities for positive development,^{footnote 90[90]} self-exploration and growth.

Supporting youth to take healthy risks includes:

Supporting growth and independence: Supporting young people to make positive choices means helping them build on their personal strengths and try new things in safe ways. Positive, pro-social and pro-developmental risks can take the form of sports, pursuing artistic abilities, volunteer activities, travel, making new friends or simply becoming more independent. Research shows that positive risk-taking, such as travelling or working abroad, can result in social, emotional, behavioural, intellectual, and moral development in youth^{footnote 91[91]}.

Helping youth to see the consequences of unhealthy risks: As young people seek out new experiences, they may be introduced to unhealthy activities and unsafe behaviours. Life stress, negative influences, a lack of information, and lack of positive alternatives can increase the likelihood of youth participating in unhealthy activities (things like tanning beds, smoking, unsafe sex, drug use and driving under the influence).

We know that for some youth, participating in unhealthy risk-taking behaviour can lead to challenges with addiction, illness or injury. We also know a young person's ability to anticipate the long-term consequences of their actions is still developing in adolescence^{footnote 94[94]}. This means that youth may need support from adults to discuss and understand the consequences of risks they take.

Outcome we want:

#3 Ontario youth make choices that support healthy and safe development.

How we can tell:

• ▼Proportion of youth who smoke cigarettes
• ▼Proportion of youth who have recently consumed excessive alcohol
• ▼Proportion of youth who have used any illicit drug
• ▼Proportion of youth who have had a sexually transmitted infection

What is Ontario doing to support these outcomes?

The Government of Ontario has a number of initiatives that support health and wellness for youth:

• Aboriginal Fetal Alcohol Spectrum Disorder and Child Nutrition Program
• Aboriginal Health Access Centres - Healthy Eating and Active Living (HEAL) Program, Smoke-Free Ontario (SFO) Program, Diabetes Prevention Program
• Aboriginal Mental Health and Addictions workers
• Aftercare Benefits Initiative
• Autism - Applied Behaviour Analysis (ABA) -based services and supports
• Autism - Connections for Students
• Autism - School Support Program
• Autism - ASD Respite Program
• Autism - Transition Supports
• Autism - Grant Assistance Program (GAP)
• Autism - Potential Programme
• Child and Youth Mental Health Services
• Children in Need of Treatment (CINOT)
• Children’s Treatment Centres
• Community Aboriginal Recreation Activator (CARA) program
• Concussion Policy
•  Community Capacity Building
• Daily Physical Activity in Elementary Schools
• Foundations of a Healthy School Framework
• Healthy Communities Fund, Program and Partnership streams
• Healthy Smiles Ontario
• Healthy Schools Initiatives
• Immunization - School Age Children and Youth
• Increased Mental Health Supports for Youth in Post-Secondary Education
• Integrated Transition Planning for Young People with Developmental Disabilities
• Leave the Pack Behind
• Mental Health and Addictions Nurses in District School Boards program
• Moving on Mental Health
• No Time to Wait: The Healthy Kids Strategy
• Northern School Fruit and Vegetable Program
• Ontario’s Action Plan for Health Care
• Ontario’s After School Program (ASP)
• Ontario Federation of Indian Friendship Centres - Urban Aboriginal Healthy Living Program
• Ontario’s Narcotics Strategy
• Ontario Sport and Recreation Communities Fund (OSRCF)
• PLAY (Promoting Life-skills for Aboriginal Youth)
• Pharmacy Smoking Cessation Program
• Public Residential Treatment Program for Eating Disorders
• Quit the Denial Campaign
• Responsible Gambling Council Ontario
• Sabrina’s Law (An Act to Protect Anaphylactic Pupils)
• School-Based Tobacco Use Prevention Pilot
• School Food and Beverage Policy
• Simplified Access to Respite
• Skin Cancer Prevention Act (Tanning Beds), 2013
• Smoke-Free Ontario Strategy
• Smoke-Free Ontario School-Based Tobacco Use Prevention Pilot
• Student Nutrition Program (expanded)
• Tele-Mental Health Services
• University of Toronto Problem Gambling Council
• Wasa-Nabin Urban Aboriginal Youth Program
• YMCA Youth Gambling Awareness Program
• Youth Suicide Prevention Plan

Stepping Up: Big Brothers and Big Sisters

Case study

Big Brothers Big Sisters is a not-for-profit organization that provides mentors to children and youth in need of additional positive adult support. Mentors serve as role models, teaching by example the importance of giving back, staying in school, and building positive relationships with family, friends and community. Each time a young person is paired with a mentor, they are supported to grow into a successful, thriving member of their community. It's something the staff, volunteers and donors of Big Brothers Big Sisters help bring about every day with pride.

In Grade 3, I had a wonderful teacher named Mrs. Halls. Not only was she a caring, wonderful and patient teacher, she taught me how to read and write despite my learning disability. When Mrs. Halls took a job at a different school, I was sad because I wasn't going to see her anymore. My sadness was replaced with utter joy when I received a call from Big Sisters - informing me that I had been matched with Mrs. Halls as a mentor. I will never forget that day. Someone chose me and advocated for me, and has continued to do so ever since.

I spent my summers picking strawberries, doing crafts, singing songs, going to Canada's Wonderland, and chatting about anything on my mind. I was even given the opportunity to go to camp through Big Sisters. I finished high school and soon after decided to attend college for Nursing. I was 18 years old, legally an adult, and Big Sisters kept me under their wing. They provided me with financial support on several occasions and moral support and always ensured that I was doing well.

Big Sisters is not just an organization, it was my family. A family that gave me more than my own family was capable of giving me. I know I am not just a Little Sister. I am strong. I am deserving of all things in life. I am unconditionally loved and supported. Big Sisters gave me more than a friend once a week for few hours; they gave me a life that I otherwise wouldn't have. It is easy to say that I would not be who I am today or where I am today without Big Sisters.

Ashley Boudreau