The first article in the four-part Lancet Series on adolescent health, © 2009 Sean Hawkey, Courtesy of Photoshare“Adolescence, a foundation for future health,” emphasizes the importance of health interventions during the adolescent years and argues for a “positive youth development approach” to improving adolescent health.   

The authors of this article maintain that there are many factors that affect the health outcomes of adolescents.  Biological changes during puberty affect health, behavior, and emotional well-being in complex ways. Social factors such as access to education, employment opportunities and family structures also affect adolescent health. 

Adolescence is a time when many adopt health behaviors that will not only affect their personal health but also the health of future generations. Yet, adolescents experience many negative health risks. Approximately 15% of the world’s disease burden is among 10-to 24-year-olds. Injuries,  accidents, maternal mortality, and disease are the leading causes of death among this population, challenging the widespread belief that adolescence is a healthy time of life. 

The authors of this article emphasize the need for a positive youth development approach that targets the health of adolescents as a whole rather than one that targets specific components of health.  In closing, the authors make these recommendations:

  1. Increase the focus on adolescent health within larger health agendas
  2. Adopt a cross-cutting approach to adolescent health addressing the health of adolescents as a whole rather than in terms of different diseases
  3. Increase attention to the health of adolescents
  4. Give adolescents a stronger voice by increasing youth engagement
  5. Increase the capacity of adolescent health providers

All of the health and development issues raised by the authors of this article are inextricably linked to young people’s sexual and reproductive health. In the same way that social factors influence other aspects of adolescent health, factors such as unemployment and education are also tied to the sexual and reproductive health of adolescents.

For example, the economic disparities that are often associated with unemployment and lack of education fuel the HIV epidemic and contribute to other negative health outcomes among young people, especially adolescent girls. Lower income levels can increase the risk of engagement in intergenerational relationships, early marriage, and sex work, all increasing the risk of HIV infection and early or unintended pregnancy.  The reverse is also true:  the economic strength of a country suffers when its young people’s sexual and reproductive health outcomes are poor.  If young people are sick, are burdened by early marriage, or experience unintended pregnancy, then they will be less able to fully contribute to society.

There is also strong relationship between education and young people’s sexual and reproductive health. Youth who do not attend school or who drop out prematurely miss many of the fundamentals of basic education. They also lose a valuable opportunity to learn about reproductive health and HIV in a stable classroom situation. Young women who become pregnant are more likely to leave school early, have a lower income, and have more children at shorter intervals throughout their lifetime. In contrast, young women who avoid unintended pregnancy are more likely to stay in school, participate in the work force, and have healthier, more educated children.

The authors’ argument for a positive youth development approach to adolescent health is well-founded.  Programs cannot effectively address any health or social outcome in isolation; however, in order for such an approach to be effective, young people’s sexual and reproductive health must be at the forefront.