The morning after problem 

The first report of the government's social exclusion unit* paints a shocking picture of this country's contemporary ills. It makes plain the complicated relationship between poverty, low educational achievement, and health. One of the issues raised is teenage pregnancy and the growing concern over the general question of sexual health among young people.

Writing in the British Medical Journal, researchers from the Communicable Disease Surveillance Centre point out there "there is substantial sexual ill health among teenagers in England and Wales". Between 1995 and 1996 there was a 34 per cent rise in the number of cases of gonorrhoea in 16-19 year old males and a 30 per cent rise among females. At the same time there were similar increases in the incidence of other sexually transmitted diseases.

In 1996 86,174 young women under the age of twenty became pregnant. Over 30,000 of these had abortions. The bulk of the terminations were in urban areas. Despite these facts, the teenage birth rates in England and Wales were the highest in western Europe.

The new white paper, Saving Lives: Our Healthier Nation, refers to the action plan of the Social Exclusion Unit which includes "a national campaign to mobilise every section of the community to achieve its clear goal to cut the rate of teenage conceptions by half in under-18s by 2010". There should also be "better prevention by tackling the underlying causes of teenage pregnancy through better education about sex and relationships, clearer messages about contraception and special attention to high-risk groups including young men".

Martin McKee, Professor of European Public Health at the London School of Hygiene and Tropical Medicine, writing an editorial on the subject in the BMJ, looks further for the causes of the increase in teenage pregnancy and sexual ill health. He comments: "What is especially worrying is that it is not only in sexual health that British teenagers to do rather worse than their continental counterparts". Indeed, at the end of 1998 the European Drugs Monitoring Centre reported that British teenagers were more likely to have used illicit drugs than their contemporaries in any other European Union country. In addition, a number of surveys show that the 15 year olds most likely to drink alcohol at least weekly are those living in Wales and Northern Ireland.

Saving Lives: Our Healthier Nation says: "Drug misuse is associated with poor health both directly, for example through the effect of overdoses and the spread of infection (specifically HIV/AIDS and hepatitis B and C); and indirectly, because of the link with social exclusion through homelessness, poverty, unemployment and criminal behaviour. And the problem is frighteningly widespread".

In themselves, each of these problems - sex, alcohol, and drugs - is alarming enough but together, Professor McKee argues, they suggest some "more fundamental malaise." The weakening of the family unit is one possible answer. More families live in poverty in the United Kingdom than anywhere else in the European Union and there is a complex but proven link between poverty and risk taking behaviour. British mothers and fathers work the longest hours in Europe and consequently families spend less time together. Moral imperatives which formerly were delivered by the churches or in schools as well as in families are often absent.

Education is an element in the problem. It is the case that a humane education plays a rôle in delaying pregnancy and surveys indicate that level of education has an effect on smoking. One beneficial effect of pre-school education has been shown to be a long-term reduction in harmful behaviours on the part of teenagers. The United Kingdom, however, whilst being amongst the leaders when providing for those at the top of the educational scale, has a sorry record of underachievement among the less gifted and underprivileged. In basic literacy and numeracy skills this country disputes bottom place with the United States.

Clearly there is a considerable amount of work to do in unravelling the factors involved in teenage pregnancy and sexually transmitted disease. Alcohol and other drugs are a factor but poverty and poor education appear to lie at the root. Many people involved in dealing with these problems will be looking to the translation of the government's words into deeds.

*Social Exclusion Unit. Bringing Britain together: a national strategy for neighbourhood renewal. London: SEU , 1998.