Association for Public Policy Analysis & Management

A large body of literature establishes socio-economic gradients in average adolescent health indicators, but few studies investigate the determinants of relatively very poor outcomes. The current analysis examines the extent to which differences in the socio-economic backgrounds of adolescents are associated with reporting substantially worse health and well-being outcomes (the so called “bottom end”) relative to peers in the middle of the distribution. We use data from the last four cycles of the Health Behavior in School-Aged Children study (2001/2, 2005/6, 2009/10, and 2013/14) for 32 European and North American countries in the EU and/or OECD. We examined the following as indicators of adolescent health: psychosomatic health complaints; physical activity; healthy eating; “unhealthy” eating; and life satisfaction. Our measure of socio-economic background is the ridit transformed family affluence scale.

We find that in the vast majority of the countries studied at the four different points of time, adolescents from relatively low socio-economic status families had a greater likelihood of falling behind in health, controlling for age and gender. The largest, most persistent and widespread gradients are in life satisfaction, physical activity and healthy eating, while the findings are more mixed for unhealthy eating and psychosomatic health. In a sizeable minority of the countries, socio-economic inequalities in physical activity and healthy eating have widened significantly over time. Inequalities in unhealthy eating and life satisfaction have narrowed in several countries. Socio-economic inequalities in psychosomatic health are not as large, widespread or persistent as observed gender differences. Girls are significantly more likely to report poorer psychosomatic health than boys in any given year between 2001/02 and 2013/14 in every country studied, with the gender gap widening over time in 10 countries.

Thus, our findings indicate when studying socio-economic inequalities in adolescent health, very different conclusions may be drawn depending upon the indicator used. This analysis is unique to the adolescent health literature, as data were consistently collected via a common international protocol that has remained consistent across time, and the focus of the analysis remains of vital importance to populations of young people, providing foundational evidence to inform the creation of public health and social policies at international and national levels.