The second article in the Lancet series looks at how social determinants of health (SDH) affect the well-being of adolescents and have important lifelong implications for health. Social determinants of health range from societal factors to individual factors and can be anything from the economic state of the nation in which an adolescent lives to an adolescent’s family group.
The article makes a clear argument for considering how SDH influence the health outcomes of young people – from their peer group to the political context of their country, region, and the world. Figuring out what health outcomes are linked with these different determinants can help us design programs that target these factors, ultimately leading to gains in health for adolescents.
Many of the health outcomes that are affected by SDH are sexual and reproductive health (SRH) outcomes. For example, higher participation in education at a national level is associated with lower HIV prevalence among adolescents and fewer teenage births. Also, peer factors have been found to predict partner communication and negotiation as well as HIV risk.
So, teasing out the most important social determinants of SRH could be a next step in developing effective programs for improving adolescent SRH. An example of this relates to improving parent–child communication about sexual behavior. The article noted the important role that family connectedness plays in adolescent health outcomes, and family norms and attitudes were found to strongly affect a range of sexual behaviors. Interventions that improve communication between parents and adolescents can be used in areas where this type of communication is outside of the norm.
This article argues that we must consider adolescents in the context of their families, peer groups, and communities and understand the impact that national and international factors have on health. Interventions aimed at improving the lifelong health of adolescents should acknowledge both the impact that outside factors have on adolescents as well as the potential adolescents have to play a role in their own health and the health of their peers.