Contributions from young people

Rose Lewis, Lisa Lewis

Climate change refers to the change of climate caused by human activity, as well as to the natural climate variability that alters the composition of the global atmosphere (UN General Assembly 1992). Young Australians consider it to be an important topic, with 30% listing ‘the environment’ as one of the top 3 most important issues (Tiller et al. 2020). Climate change was also one of the 2 most frequently raised youth priorities in the Commonwealth Youth Taskforce Interim Report consultations (DoH 2019:12).

Addressing climate change is integral to youth health now and in the future, yet more than 70% of young people believe their opinions on the topic are not being taken seriously (Chiw & Ling 2019).

The effects of climate change on wellbeing can be direct or indirect, immediate or delayed, and result in short- or long-term impacts on the individual (Sanson et al. 2019). To illustrate its impact on youth, some examples of the effects of extreme weather on health (direct impact) and the effects of changes to social determinants of health (indirect impact) are provided.

Direct impacts

There is a strong link between climate change and physical health. Climate change results in more extreme weather, such as intense rainfall, cyclones, droughts and bushfires (Steffen et al. 2019). These extreme weather events can cause physical health problems in youth. Bushfires, for example, result in increased asthma flare-ups, fever, gastroenteritis, and electrolyte imbalances, due to excessive heat (Forrest & Shearman 2015). Children and teenagers are at greater risk of heat stress than adults (Hughes et al. 2016).

Climate change also impacts mental health. To cope with the 2019–20 bushfires, 5,094 patients accessed 18,945 bushfire mental health services through the Medicare Benefits Schedule between 10 January 2020 and 11 October 2020 (AIHW 2020:18). This is because direct experience with climate-related events – such as bushfires, floods and drought – can result in traumatic stress and stress-related problems – such as post-traumatic stress disorder (PTSD), grief and anxiety disorders (Fritze et al. 2008). Children are affected not only by the event itself but also by the family stress, fractured social support networks and displacement that follow such extreme weather events (Burke et al. 2018). Bushfire recovery studies show evidence of delayed and prolonged effects on mental health, as many as 5 years after the event (Hayes et al. 2018).

Indirect impacts

Climate change can also impact wellbeing through changes to social determinants of health. Certain population groups, such as Aboriginal and Torres Strait Islanders and low‑income families, can be particularly affected.

For many Indigenous Australians, a connection with ‘country’ – defined as ‘a place of ancestry, identity, language, livelihood and community’ – is a key determinant of health (Green et al. 2009). Traditional owners of the land living in more remote areas are likely to face physiological, psychological, economic and spiritual stress as extreme weather makes it difficult for them to ‘look after their country’ (Green et al. 2009). Potential repercussions of climate change could include the loss of a cultural ‘point of reference’, or unliveable conditions that lead to the displacement of Indigenous Australians (Hunter 2009).

Climate change also undermines health through its impact on food supply: the observed and projected impacts include reduced food quality and nutrition, food price rises and spikes, increasing obesity and the instability of agricultural incomes (Mbow et al. 2019). Poorer families, in particular, struggle to cope with rising food, energy and water costs as resources become scarcer (Strazdins & Skeat 2011).

The development of indicators and further research are important, particularly to understand the indirect, delayed and long-term effects of climate change and to guide future decision making. Moving forward, greater consideration must be paid to youth and Indigenous Australian perspectives.

References

AIHW (Australian Institute of Health and Welfare 2020. Australian bushfires 2019–20: exploring the short-term health impacts. Viewed 19 February 2021.

Burke SEL, Sanson AV & Van Hoorn J 2018. The psychological effects of climate change on children. Current Psychiatry Reports 20.

Chiw A & Ling HS 2019. Young people of Australia and climate change: perceptions and concerns. Perth: Millennium Kids. Viewed 14 August 2020.

DoH (Department of Health) 2019. Youth Taskforce Interim Report. Viewed 19 February 2021.

Forrest D & Shearman D 2015. No time for games: children’s health and climate change. Adelaide: Doctors for the Environment Australia.

Fritze JG, Blashki GA, Burke S & Wiseman J 2008. Hope, despair and transformation: climate change and the promotion of mental health and wellbeing. International Journal of Mental Health Systems 2(13). Viewed 15 August 2020.

Green D, King U & Morrison J 2009. Disproportionate burdens: the multidimensional impacts of climate change on the health of Indigenous Australians. Medical Journal of Australia 190(1):4–5.

Hayes K, Blashki G, Wiseman J, Burke S & Reifels L 2018. Climate change and mental health: risks, impacts and priority actions. International Journal of Mental health Systems 12(28). Viewed 20 August 2020.

Hughes L, Hanna E & Fenwick J 2016. Climate change and health impacts of extreme heat. Australia: Climate Council. Viewed 15 August 2020.

Mbow C, Rosenzweig C, Barioni LG, Benton TG, Herrero M, Krishnapillai M et al. 2019. Food security. In: Shukla PR, Skea J, Calvo Buendia E, Masson-Delmotte V, Pörtner H-O, Roberts DC et al. (eds). Climate change and land: an IPCC special report on climate change, desertification, land degradation, sustainable land management, food security, and greenhouse gas fluxes in terrestrial ecosystems. 437–550. Viewed 19 February 2021.

Sanson AV, Van Hoorn J & Burke SEL 2019. Responding to the impacts of the climate crisis on children and youth. Child Development Perspectives 13(4):201–7.

Steffen W, Dean A & Rice M 2019. Weather gone wild: climate change-fuelled extreme weather in 2019. Australia: Climate Council. Viewed 15 August 2020.

Strazdins L & Skeat H 2011. Weathering the future: climate change, children and young people and decision making. Canberra: Australian Research Alliance for Children and Youth.

Tiller E, Fildes J, Hall S, Hicking V, Greenland N, Liyanarachchi D & Di Nicola K 2020. Youth Survey Report 2020, Sydney, NSW: Mission Australia.

UN (United Nations) General Assembly 1992. United Nations framework convention on climate change. Viewed 19 February 2021.

Harpreet Dhillon, Jahin Tanvir

Discrimination occurs when a person or group is treated less favourably than another person or group because of their background or certain personal characteristics (AHRC 2020). Young people can experience direct and indirect discrimination based on:

• age
• disability
• race
• ethnicity
• sexuality
• gender
• intersex status.

Discrimination associated with race or ethnicity is one determinant of health that can manifest in individual, interpersonal and/or structural forms of disadvantage, social exclusion and/or violence (AIHW 2016; Krieger 2000; Paradies et al. 2015). Further, some young people experience multiple and intersecting forms of discrimination, which can affect their health and wellbeing (Robards et al. 2019).

This section focuses on the experiences of discrimination among young Australians of migrant and refugee background. The Multicultural Youth Australia Census surveyed around 1,900 multicultural young people aged 15 to 24 in Australia in 2017–18 and found that almost half (49%) reported that they experienced discrimination in the last year (Wyn et al. 2018). Discrimination can affect the health and wellbeing of young Australians from migrant and refugee backgrounds, especially their sense of belonging (Mansouri et al. 2009).

Voices of young people in the Australian community convey some of the challenges of living in a country with a history of anti-immigration policies, which can make it harder to make friends, study and find employment (Box 1). In their family lives, some young people can feel excluded if they cannot speak their native tongue fluently or are unfamiliar with cultural practices, leaving them feeling ashamed or stigmatised.

Discrimination and health

Discrimination is associated with poorer physical and mental health (Black Dog Institute 2017; Ferdinand et al. 2013). Among youth specifically, discrimination is associated with higher rates of anxiety, depression and psychological distress (Priest et al. 2013) as well as with socio-emotional and sleep problems in adolescence (Priest et al. 2019). Emerging data also suggest that experiences of racial discrimination may be associated with increased biological risk factors for chronic disease later in life (Priest et al. 2020).

Educational institutions—a key setting

Findings from the Multicultural Youth Australia Census found educational institutions to be the most common place for acts of discrimination, followed by ‘on the street’; 18% of young people reported they had experienced discrimination in an educational setting and 22% had witnessed discrimination in these settings (Wyn et al. 2018).

In 2017, a survey of around 4,600 primary and secondary students from New South Wales and Victoria found that more than 40% of participants from each of the ethnic groups (Middle Eastern, African, South Asian, East Asian, South-East Asian) reported at least 1 experience of racial discrimination from peers (Priest et al. 2019).

During the COVID-19 pandemic, concerns of increasing racial discrimination were raised. A small survey of 16–25 year old Victorians found that 87% of respondents from a multicultural background reported concerns about returning to their post-lockdown life for fear of experiencing racial discrimination (Doery et al. 2020). The longer that multicultural youth live in Australia, the less optimistic and confident they become that they will achieve their study and work goals (Wyn et al. 2018).

Data on discrimination

While national population data on the experience of discrimination among young people overall are available, information about the experience of young Australians of a migrant and refugee background is limited. Improving the quality and availability of such data would assist understanding of:

• the experience of discrimination among this group, including how it compares with that of other young Australians
• the association between discrimination and health and welfare outcomes.

References

AHRC (Australian Human Rights Commission) 2020. Discrimination. Canberra: AHRC.

AIHW (Australian Institute of Health and Welfare) 2016. Australia’s health 2016. Australia’s health series no. 15. Cat. no. AUS 199. Canberra: AIHW.

Black Dog Institute 2017. Youth Mental Health Report 2012–2016.

Doery K, Guerra G, Kenny E, Harriott L & Priest N 2020. Hidden cost: young multicultural Victorians and COVID-19. Summary report. Melbourne: Centre for Multicultural Youth.

Ferdinand A, Kelaher M & Paradies Y 2013. Mental health impacts of racial discrimination in Victorian culturally and linguistically diverse communities: Full report. Melbourne: Victorian Health Promotion Foundation.

Krieger N 2000. Discrimination and health. In: LF Berkman LF & Kawachi I (eds). Social epidemiology. Oxford: Oxford University Press: 66–109.

Mansouri F, Jenkins L, Morgan L & Taouk M 2009. The impact of racism upon the health and wellbeing of young Australians. Melbourne: The Foundation for Young Australians. Viewed 22 February 2021.

Paradies Y, Ben J, Denson N, Elias A, Priest N, Pieterse A, Gupta A, Kelaher M & Gee G 2015. Racism as a determinant of health: a systematic review and meta-analysis. PloS one 10(9):e0138511.

Priest N, Paradies Y, Trenerry B, Truong M, Karlsen S & Kelly Y 2013. A systematic review of studies examining the relationship between reported racism and health and wellbeing for children and young people. Social Science & Medicine 95:115–27.

Priest N, Chong S, Truong M, Sharif M, Dunn K, Paradies Y, Nelson J, Alam O, Ward A & Kavanagh A 2019. Findings from the 2017 Speak Out Against Racism (SOAR) student and staff surveys. Canberra: Centre for Social Research & Methods, Australian National University. Viewed 22 February 2021.

Priest N, Truong M, Chong S, Paradies Y, King TL, Kavanagh A, Olds T, Craig JM, Burgner D 2020. Experiences of racial discrimination and cardiometabolic risk among Australian children. Brain, Behaviour and Immunity 87:660–665.

Robards F, Kang M, Steinbeck K, Hawke C, Jan S, Sanci L, Liew Y, Kong M & Usherwood T 2019. Health care equity and access for marginalised young people: a longitudinal qualitative study exploring health system navigation in Australia. International Journal for Equity in Health 18:41.

Wyn J, Kahn R & Dadvand B 2018. Multicultural Youth Australia: Census status report 2017/18. Melbourne: University of Melbourne.

Finn Stannard, Gale Marshall

The term LGBTIQ+, often used to refer to people of diverse sex, gender and/or sexual orientation, stands for lesbian, gay, bisexual, transgender, intersex, queer and/or otherwise diverse in gender, sex or sexuality. A range of factors including stigma, discrimination and lack of appropriate and/or adequate support services can contribute to poorer health and wellbeing for this diverse group (Sekoni et al. 2017).

An Australian Bureau of Statistics 2007 survey found that homosexual and bisexual people were a high-risk population group for HIV/AIDS (human immunodeficiency virus/acquired immune deficiency syndrome), syphilis, chlamydia and gonorrhoea, and were:

• 3 times as likely as the general population to experience depression and related disorders
• significantly more likely to experience verbal harassment than the general population – 56.2% of transgender and gender diverse young people (aged 14 to 21) reported experiencing verbal harassment in the past 12 months alone (LGBTIQ+ Health Australia 2021).

A 2016 online survey of almost 900 trans or gender diverse Australians aged 14–25 found that 75% of respondents reported being diagnosed with depression, and 72% with anxiety, at some time in their life (Strauss et al. 2017).

This section focuses specifically on the experience of stigma among young LGBTIQ+ people in school, and their experience with aspects of the health system. (The term LGBTIQ+ is used, except where information relates to a specific group included in the research.)

Stigma and schools

A 2013 survey of 704 Australian LGBTIQ+ secondary school students aged 14–18 found that 94% had heard negative terms to describe lesbians, gay or bisexual people, and 59% had heard negative terms to describe people who were transgender or genderqueer in school (Ullman 2015). Moreover, in circumstances where an adult was present:

• 35% of students reported that the adult never intervened when hearing transphobic language
• 22.9% of students reported that adults never intervened to stop harassment of LGBTIQ+ students (Ullman 2015:22, 27).

These results were broadly consistent with a 2016 study of trans or gender diverse Australians aged 14–25, which found that the majority experienced peer rejection (89%), and bullying (74%) (Strauss et al. 2017). In a 2012–13 study, some trans young people also reported experiencing bullying by teachers (Robinson et al. 2014).

Stigma can contribute to insufficient and unsupportive sexual health education, and affect sexual health literacy for LGBTIQ+ young people (Robinson et al. 2014).

Schools are an important setting for sexual health education and the majority of Australian teachers (94%) believe sexuality should be taught in school programs (AYAC 2012: 34).

Experience with the health system

LGBTIQ+ young people may not always view health services as culturally safe, relevant or accessible. Those looking for sexual health support may also face the difficulties that can arise from poor communication between health sectors (specifically mainstream health services and youth health services targeting marginalised young people, including LGBTIQ+ youth) (Kang et al. 2018). Some LGBTIQ+ young people (34%) often feel uncomfortable ‘coming out’ to doctors and other health-care professionals, who can be ill informed about queer young people’s sexual needs and sometimes be unsupportive, homophobic and transphobic (Robinson et al. 2014).

Findings from an Australian online survey that asked trans young people about their experiences with general practitioners found mixed results (Strauss et al. 2017): some said the experiences were positive; others, that improvements could be made with regard to medical professionals’ understanding and care of LGBTIQ+ individuals.

Box 1 includes some reflections from LGBTIQ+ young Australians on their experiences related to sexual health education or the health system.

Importance of data

Good-quality data are important to support decision making to improve the outcomes and experiences of LGBTIQ+ people. At a national level, there are limited quantitative data on LGBTIQ+ young people. Information identifying LGBTIQ+ people in national service-level data sets is also limited.

The development of a national standard for the collection of information on sex, gender, sexual characteristics and sexual orientation by the Australian Bureau of Statistics has the potential to improve and standardise the collection of relevant data (ABS 2020).

References

AYAC (Australian Youth Affairs Coalition) 2012. Let’s talk about sex: young people’s views on sex and sexual health information in Australia. Canberra: AYAC.

ABS (Australian Bureau of Statistics) 2020. Standard for Sex, Gender, Variations of Sex Characteristics and Sexual Orientation Variables, 2020. Canberra: ABS.

Kang M, Robards F, Sanci L, Steinbeck K, Jan S, Hawke C et al. 2018. Access 3: young people and the healthcare system in the digital age—final research report, 2018. Sydney: Department of General Practice Westmead, the University of Sydney and the Australian Centre for Public and Population Health Research, University of Technology.

LGBTIQ+ Health Australia 2021. The 2021 update. Sydney: LGBTIQ+ Health Australia.

Ullman J 2015. Free to be?: exploring the schooling experiences of Australia’s sexuality and gender diverse secondary school students. Penrith: Centre for Educational Research, School of Education, Western Sydney University.

Robinson K, Bansel P, Denson N, Ovenden G, Davies C 2014. Growing up queer: issues facing young Australians who are gender variant and sexuality diverse. Melbourne: Young and Well Co-operative Research Centre.

Sekoni AO, Gale NK, Manga-Atangana B, Bhadhuri A & Jolly K 2017. The effects of educational curricula and training on LGBT‐specific health issues for healthcare students and professionals: a mixed‐method systematic review. Journal of the International Aids Society 20(1).

Strauss P, Lin A, Winter S, Cook A, Watson V, Toussant D et al. 2017. Trans pathways: the mental health experiences and care pathways of trans young people. Perth: Telethon Kids Institute.