The Danish HBSC team at the National Institute of Public Health, University of Southern Denmark, has published a comprehensive report examining trends in socioeconomic inequality in adolescent overweight and mental health and well-being. The report presents findings spanning three decades (1991-2022), providing crucial evidence for understanding how health inequalities among Danish adolescents have evolved and highlighting persistent disparities that demand urgent policy attention.
The publication reveals persistent socioeconomic inequalities across all health indicators examined, with some showing concerning patterns of widening gaps. Whilst inequalities in some indicators have remained stable or even declined, gaps in overweight/obesity, low self-esteem, and low mental well-being have increased substantially, driven primarily by rising prevalence among adolescents from the most disadvantaged families. The findings underscore that the benefits of overall improvements in adolescent health have not been shared equally across socioeconomic groups.
The Danish team analysed data from nine survey rounds conducted between 1991 and 2022, examining responses from 11-, 13-, and 15-year-olds. The 2022 survey achieved a sample of 5,823 students, with 4,749 included in inequality analyses. The analysis tracked multiple health indicators over time, with coverage periods varying by indicator based on when measures were introduced to the Danish HBSC questionnaire.
Widening gaps in overweight and key mental health indicators
Among the most concerning findings is the pattern of widening inequality in overweight and obesity. Whilst prevalence among adolescents from higher socioeconomic backgrounds has risen modestly from 5.5% in 1998 to 9.0% in 2022, rates among those from lower socioeconomic backgrounds have increased from 10.9% to 17.6%. This widening gap is particularly pronounced among girls and among 15-year-olds, where the 2022 data revealed markedly elevated prevalence in the most disadvantaged group.
Low self-esteem showed a similar pattern of widening inequality between 2014 and 2022. The prevalence among adolescents from more advantaged families increased from 20.9% to 30.8%, whilst among those from disadvantaged families it rose more dramatically from 23.7% to 40.9%. This increase was especially pronounced among girls from disadvantaged families, where prevalence reached 58.3% in 2022, up from 36.2% in 2014. The findings indicate that more than half of girls from the most disadvantaged families now report low self-esteem.
Low mental well-being demonstrated the starkest widening of inequality. Among 13-15 year olds, the gap between advantaged and disadvantaged groups more than doubled between 2014 and 2022, increasing from 6.0 to 13.7 percentage points. Whilst 19.7% of adolescents from more advantaged families reported low mental well-being in 2022, this figure reached 33.4% among those from disadvantaged families. Girls from disadvantaged families faced particularly elevated risks, with 46.1% reporting low mental well-being in 2022.
Contrasting patterns across health indicators
Whilst some indicators showed widening inequalities, the report documents more complex patterns across different health outcomes. Social inequality in frequent psychosomatic symptoms, measured consistently since 1991, actually declined over the 30-year period. This decline was primarily driven by increases in symptom reporting among adolescents from more advantaged families, suggesting a closing of the gap from above rather than improvements among disadvantaged groups.
Low life satisfaction showed relatively stable inequalities between 2002 and 2022, though with substantial fluctuation across survey waves. However, analyses by sex revealed increasing inequality among girls, where the gap between advantaged and disadvantaged groups widened from 5.5 percentage points in 2002 to 10.5 in 2022, driven primarily by rising prevalence of low life satisfaction among girls from disadvantaged families.
Loneliness demonstrated persistent socioeconomic inequalities throughout the study period, with adolescents from disadvantaged families consistently reporting higher rates. However, inequalities fluctuated considerably over time without clear systematic trends, reflecting the complex and variable nature of this health indicator.
Low self-efficacy, measured from 2010 to 2022, showed consistent socioeconomic inequalities but with substantial fluctuation across survey waves, indicating no clear trend towards either widening or narrowing gaps.
Disproportionate impacts on girls from disadvantaged families
A consistent finding across multiple indicators is the particularly disadvantaged position of girls from less well-off families. For low self-esteem, inequality among girls increased dramatically from 5.7 percentage points in 2014 to 15.2 in 2022, whilst boys showed smaller increases. The widening gap in low mental well-being was also more pronounced among girls, with inequality increasing from 7.7 to 18.5 percentage points compared to 4.4 to 8.9 among boys.
Analyses for overweight/obesity suggested larger increases in inequality among girls than boys, particularly in recent survey waves. These patterns suggest that girls from disadvantaged backgrounds may be experiencing compounding disadvantages across multiple dimensions of health and well-being.
Persistent inequalities across age groups
Socioeconomic inequalities are evident across all three age groups examined (11-, 13-, and 15-year-olds), though with varying patterns. For several indicators, inequalities were particularly pronounced among older adolescents. The 2022 data for overweight/obesity showed notably elevated inequality among 15-year-olds, driven by markedly higher prevalence among those from disadvantaged families compared to other survey years.
However, the report notes that age-specific patterns showed considerable fluctuation, highlighting that inequalities persist across the adolescent age range whilst precise trends within specific age groups remain difficult to establish with complete confidence.
Implications for policy and practice
The Danish team’s comprehensive analysis provides crucial evidence for understanding socioeconomic inequalities in adolescent health and developing targeted interventions. The widening gaps in overweight/obesity, low self-esteem, and low mental well-being, despite overall increases in prevalence across all groups, indicate that current universal health promotion approaches may not be adequately addressing the needs of adolescents from disadvantaged families.
The findings point to the importance of interventions that specifically target the social determinants of adolescent health. The particularly disadvantaged position of girls from less well-off families suggests the need for approaches that address both socioeconomic barriers and gender-specific risks and vulnerabilities.
The authors emphasise that continued monitoring of health inequalities over time remains essential for informing policies and interventions capable of improving health trajectories early in life. The persistence of inequalities across multiple indicators over three decades underscores that reducing socioeconomic disparities in adolescent health requires a sustained, coordinated public health effort.
About the study
Skolebørnsundersøgelsen is the Danish contribution to the international Health Behaviour in School-aged Children (HBSC) research project. Denmark has participated in HBSC since the early 1980s, conducting surveys every fourth year using an international uniform protocol for sampling, measurement procedures, and data collection.
The current report examines data from nine survey rounds (1991, 1994, 1998, 2002, 2006, 2010, 2014, 2018, and 2022) involving nationally representative samples of students in 5th, 7th, and 9th grade, corresponding to 11-, 13-, and 15-year-olds. Across all waves, 41,143 students participated, with time coverage varying by indicator based on when measures were introduced to the Danish questionnaire.
The 2022 data collection was funded by Sundhedsfremmepuljen, whilst this analysis was commissioned by the Centre for Childhood Health (Center for Sundt Liv og Trivsel). The full report, titled “Trends in social inequalities in adolescent overweight and low mental health and well-being: Results from Skolebørnsundersøgelsen, the Danish contribution to the international HBSC study”, is authored by Katrine Rich Madsen, Mogens Trab Damsgaard, and Mette Rasmussen.
Read the full HSBC Denmark report (English)