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Alexandra Hervish is an international education specialist with nearly 10 years of experience in capacity building, training and youth development. She has adapted and delivered policy communications workshops for youth and adults in both international and domestic settings. In addition, Alex has developed multimedia presentations that use innovative technologies to educate global and country-level audiences about population, health, and environment issues.
In January, the InternationalCenter for Research on Women (ICRW) and the United Nations Foundation (UNF) hosted a discussion about milestones in adolescent and youth health and development. All of the presenters emphasized the need for a holistic approach to the health and development of young people—one that enables them to delay marriage and childbearing, access youth-friendly health services, prevent the onset of mental disorders and non-communicable diseases, and thrive in a supportive environment. Amanda Keifer of the Public Health Institute highlighted that with the creation of the Bali Global Youth Forum Declaration, the global community is moving in the right direction by putting young people’s rights at the heart of development.
However, a participant raised an interesting point during the event: if we have compelling arguments about the importance of investing in adolescents and youth, why can’t we translate this information into tangible financial and political commitments? In my opinion, there are two distinct, yet inter-related answers to this question:
- We just do not have enough data. Upon opening the 8-page “centerfold” from the Lancet series on adolescents, one would immediately notice the abundance of dashes in lieu of data points for many countries around the world (particularly low- and middle-income countries). In fact, we only just recently calculated how many adolescents die every year. Contrary to what many would assume (after all, adolescence is considered the healthiest time of a person’s life), the figure is rather high: in 2004, 2.6 million people ages 10-24 died, with deaths increasing from adolescence into young adulthood.
- Even when we have reliable data, we are not doing enough with it. Though far from a complete picture, we have quite a bit of data about the sexual and reproductive health status of young people thanks to several large-scale surveys. But certainly, we cannot expect to achieve the types of investments we need across all sectors—health, education, economic development, governance, and gender, among others—if these data remain on our bookshelves and do not get into the hands of decision makers who determine funding levels and government priorities.
And that’s where we come into the picture. At the Population Reference Bureau, we are in the business of communicating technical data and research to decision makers in compelling, clear formats. One of the ways we achieve this goal is through our ENGAGE presentations. Integrating Trendalyzer and multimedia software platforms, ENGAGE presentations explore associations among fertility, health, economic, and environment indicators in a visually stimulating way. They have been used to define agendas, focus discussions, and encourage dialogue about solutions to today’s development challenges.
And there is even a presentation about young people! The ENGAGE presentation The Time is Now: Invest in Sexual and Reproductive Health for Young People delivers evidence-based messages about how sexual and reproductive health investments protect the well-being of young people and advance social and economic development. Using data and graphics, the presentation seeks to prioritize sexual and reproductive health for young people on policy agendas in sub-Saharan Africa. The presentation is available online in narrated and un-narrated formats in French and English with supporting presenter materials. And there are other issue-focused presentations to explore about family planning and poverty reduction as well as country-specific presentations and mini presentations.
It will take time to populate all of the dashes from the Lancet series with data points. But in the meantime, using policy advocacy tools that are available to us (like ENGAGE presentations) we can educate leaders about the importance of investing in young people to maximize their potential for healthy, productive lives.
The recent Lancet series emphasizes the urgent need to increase attention to adolescent health, with a growing acceptance for a life-course framework. This more holistic approach is an important step in moving the health issues of young people from a marginalized minority into mainstream global health. Yet, as the fourth paper in the series demonstrates, there are not only major gaps in youth programs targeting these issues, but also insufficient data collected on both risk and protective factors in many countries. Without comprehensive data, it is extremely difficult for practitioners and policy-makers to take the necessary steps to improve health outcomes of young people worldwide.
The article “Health of the world’s adolescents: a synthesis of internationally comparable data” uses 25 core indicators to assess the available sources of health information for young people. Details about how the indicators were determined and the countries included in the review are outlined in the article.
The authors included 192 countries in this review, constituting 99.53% of the 1.79 billion young people (ages 10-24) living in UN member states. They describe the discrepancies in health outcomes between countries based on geography, income level, population size and other relevant demographics. However, the article quickly shifts focus from the differences in health outcomes to the lack of data available for many of the indicators around the world, particularly in low-income regions. Several key points were clear at the conclusion of the article: most glaring are the incomplete health information and inequities between country profiles for almost all aspects of adolescent health. These differences are apparent not only between, but also within geographical regions. Information on mental health and non-fatal disabilities in this age group is particularly lacking. Aside from a Millennium Development Goal focus on HIV, there are also major gaps on data about health service delivery in every region.
Young people’s sexual and reproductive health has had significant policy and programmatic attention in recent years, leading to more clearly defined indicators and better data collection than many other issues. However, the article highlights concerns about the strength of these current data collection methods, particularly as they relate to the exclusion of young people at highest risk– including those out-of-school, homeless, and in juvenile detention. As outlined in a previous blog post, for the proposed comprehensive approach to be effective, young people’s sexual and reproductive health must be at the forefront of the movement. Many of the health indicators raised by the authors of this series are closely linked to YSRH and should not be reviewed in isolation.
The authors provided three sets of recommendations for improving the gaps and obstacles in collecting data on the health of young people worldwide. They include:
- Improving development and measurement of indicators
- Stronger research and the development of indicators in neglected areas of adolescent heath
- Better coordination and integration of present data collection
- Define a core set of global indicators
- Synchronize measures across surveys, including school-based
- Extending data coverage
- Improvement of data coverage for major health problems affecting young people
- Development of strategies to collect data on most-at-risk young people
- Enhanced leadership and coordination
- Development of strategies to fill the present knowledge gaps and align current systems, drawing in expertise from UN and its agencies, academia and other global partners
- Countries should be encouraged to produce a report on the health of young people to allow for coordinated efforts (both governmental and NGO) of health initiatives
- There is a need for detailed data strategies to guide policies for young people within future global health initiatives, considering age and sex disaggregation, risk and protective factors that occur during adolescence
The attention given to young people’s health in this series is sure to provide momentum toward improved programs and policies around the world. However, without consistent monitoring and review of existing health indicators at the global level, young people’s health will continue to languish in many regions around the world. Simply put, it will be difficult for global health leaders to improve future outcomes for young people when the current health information systems are so incomplete. This article takes the important first steps of outlining not only the current gaps in adolescent health data, but also proposes guidance for improvement. The future of young people may depend on paying attention to it.
The third article in the Lancet series describes advances in prevention science that improve health outcomes among adolescents and offers suggestions on making the most of these advances through systematic efforts to adapt and scale up successful interventions. The authors explain the way in which problems associated with adolescence, such as teen pregnancy and depression, can be linked to (1) the accumulation of problems from early in life, (2) a lack of protective factors, and (3) the presence of negative influences that occur during adolescence.
A systematic review of randomized and quasi-experimental trials shows that programs that increase positive influences and decrease risk factors for young people, both in early childhood and during adolescence, have achieved increases in educational attainment and reductions in young people’s misuse of alcohol and drugs, risky sexual activity, depression, and delinquency and crime. The authors then advocate for the increased use of effective programs and discuss barriers to and strategies for doing so.
This article clearly explains the multitude of ways in which effective prevention programs for adolescents can be structured. It also provides an excellent call to action for dedicating more resources to the adaptation and use of proven approaches, as well as specific programs that have been shown to work through rigorous evaluations. Many of the programs profiled in the article focused on issues that are the explicit focus of the Interagency Youth Working Group (IYWG), such as teen pregnancy and STI infection, and the others addressed factors that affect youth sexual and reproductive health (SRH), such as young people’s alcohol use and educational attainment.
Importantly, the article goes beyond the discussion of what works to a discussion of how to make programs that work available where they’re needed. The authors discuss a range of ways to scale up successful programs, including making research findings more user-friendly, providing cost information to help potential users of a new prevention program make decisions, and building capacity to adapt programs for use in new contexts. They also advocate for communities to learn how to identify their most salient needs so that they can identify programs best-suited to the problems they face. Special attention is paid to adapting programs designed and evaluated in developed countries to developing settings. Sexuality education is given as an example of one area in which western-based behavior change theories have been effectively used to reduce adolescent sexual risk across cultures and countries.
This article reminds us of all that has already been shown to work to improve youth outcomes — from changing contraceptive policy to promoting healthy families — and all the work that remains to be done to spread and adapt these evidence-based practices more widely. The dedication, expertise, and local knowledge of adolescent reproductive health practitioners around the globe, and the network of these practitioners formed through organizations such as the IYWG, create the opportunity to take on the Lancet’s challenge and make sure that what works in one place has the opportunity to do so for more young people around the world.
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.
The first article in the four-part Lancet Series on adolescent health, “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:
- Increase the focus on adolescent health within larger health agendas
- Adopt a cross-cutting approach to adolescent health addressing the health of adolescents as a whole rather than in terms of different diseases
- Increase attention to the health of adolescents
- Give adolescents a stronger voice by increasing youth engagement
- 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.
Today the world is home to 1.8 billion young people between the ages of 10 and 24; this is the largest generation of young people in history. Gains in child health and survival, nutrition, and infectious disease have resulted in a burgeoning youth population; however, the health of adolescents has received little attention. In the past 50 years, the health of adolescents has seen far less improvement than that of younger children.
“Surely we do not want to save children in their first decade of life only to lose them in the second.” –Anthony Lake, Executive Director, UNICEF
A growing youth population means a growing work force, and higher rates of unemployment. Poverty, lack of education, migration, natural disasters and political unrest lead to social situations that can devastate the health of adolescents. Adolescents face increasing health disparities; childbirth-related complications are the number one cause of death among adolescent girls ages 15-19. Road traffic accidents, suicide, and infections such as HIV are the leading causes of death among this age group.
“Irrespective of region most adolescent deaths are preventable and thus strongly justify worldwide action to enhance adolescent health.”—Lancet
Now, more than ever, greater attention to the health needs of this growing and unique population is needed. In April, the Lancet released its second series on adolescent health. This series includes four papers, “Adolescence: a foundation for future health,” “Adolescence and the social determinants of health,” “Worldwide application of prevention science in adolescent health,” and “Health of the world’s adolescents: a synthesis of internationally comparable data.”
This landmark series emphasizes the urgent need to increase attention to adolescent health. Join us over the next few weeks as we share the key messages from these articles and discuss their implications for the sexual and reproductive health of young people.