Child and adolescent health in Europe: Towards meeting the 2030 agenda

Abstract

Background: Childhood and adolescence are critical stages for a healthy life. To support countries in promoting health and development and improving health care for this age group, the WHO Regional Office for Europe developed the European strategy for child and adolescent health 2015-2020, which was adopted by all countries. This paper reports progress in the strategy's implementation until 2020.

Methods: A survey was sent to all ministries of health of the 53 Member States of the WHO European Region. Responses were received from 45 Member States. Results are presented in this paper.

Results: The European Region made overall progress in recent years, but increasing levels of overweight and obesity among children, adolescent mental health and low breastfeeding rates are recognized as key national challenges. Although forty-one countries adopted a national child and adolescent health strategy, only eight countries involve children in their review, development and implementation stages. Two-thirds of countries have a strategy for health-promoting schools and a school curriculum for health education. One-third of countries do not have legislation against marketing of unhealthy foods and beverages to children. Most countries reported routine assessment for developmental difficulties in children, but less than a quarter collected and reported data on children who are developmentally on track. There are major gaps in data collection for migrant children. Hospitalization rates for young children vary five-fold across the region, indicating over-hospitalization and access problems in some countries. Only ten countries allow minors access to health care without parental consent based on their maturity and only eleven countries allow school nurses to dispense contraceptives to adolescents without a doctor's prescription.

Conclusions: This paper shows the progress in child and adolescent health made by countries in Europe until 2020 and key areas where additional work is needed to move the 2030 agenda forward. The survey was undertaken before the COVID-19 pandemic and the war in Ukraine. Both will likely exacerbate many of the observed problems and potentially reverse some gains reported. A renewed commitment is needed.

Figure 1

Spider graph of responses from 45 countries in the World Health Organization (WHO) European Region on six selected problem statements.

Figure 2

Countries having or preparing a child and adolescent health strategy in 2017 vs. 2020.

Figure 3

Countries that involved young people in the review, development, and implementation stages of their child and adolescent health strategy, 2020, by individual countries.

Figure 4

Average monthly salary of paediatricians (adjusted for purchasing power parity (PPP)) and out-of-pocket expenditure as a percentage of current health expenditure, by country. Note: Bubble size refers to paediatricians’ monthly salaries in international dollars (PPP).

Figure 5

Hospitalization rates under 5 years, 2020 and 2017, by individual countries.

Figure 6

The prevalence of breastfeeding initiation within the first hour of birth.

Figure 7

Age at which adolescents can access health care without parental consent.

Figure 8

Countries having population-based surveys on child maltreatment completed also by children.

Figure 9

Countries able to provide estimates on the number of prescriptions issued for attention deficit hyperactivity disorder (ADHD), autism and depression.

Figure 10

School nurse dispensing contraceptives without a doctor’s prescription, by country.