Global Accelerated Action for the Health of Adolescents (AA-HA!)

ADOLESCENT PERSPECTIVES, PRIORITIES AND INTERVENTIONS:

ACCELERATED ACTION FOR THE HEALTH OF ADOLESCENTS (AAHA!)

Sao Paolo, July 24 2018Sonja Caffe, Ph.D., MPH, M.Sc.

OVERVIEW

• THE REGIONAL ADOLESCENT HEALTH RESPONSE

• THE CURRENT STATUS OF ADOLESCENT HEALTH

• THE FUTURE RESPONSE: AAHA!

Regional AdolescentAnd Youth Health

Strategy And Plan Of Action

2010-2018Objectives

Reduce adolescent and youth mortality

Guarantee sexual and reproductive health

Reduce injuries Promote nutrition and physical activity

Reduce violence Prevent chronic disease

Reduce the use of psychoactive substances and improve mental health

Promote protective factors

THE REGIONAL COMMITMENT: RESOLUTION CD49.R14

• STRATEGIC LINES OF ACTION:

1. Strategic information and innovation2. Enabling environments for health and development using

evidence-based policies3. Integrated and comprehensive health systems and services4. Human resources capacity-building5. Family, community, and school-based interventions6. Strategic alliances and collaboration with other sectors7. Social communication and media involvement

• 90% of Member States developed AH policies, strategies, plans.

• Development and revision of national legislation • Capacity building of stakeholders, including youth• Comments & technical opinions & Publications • Increased availability of data

PROGRESS

• 18 countries reported having defined a package of health services for adolescents

• 19 countries reported having national standards for delivery of health services specifically for young people (10-24 yrs.)

• 10 countries have systems in place for regular adolescent-specific training for health providers in first-level facilities

PROGRESS

• National programs limited, with insufficient funding and staffing

• Interventions not evidence-based, not implemented at scale

• Limited youth involvement• Adolescents face major legal, policy and societal

challenges to access health services• Health systems not responsive to adolescent health

needs

CHALLENGES

AGE-ADJUSTED MORTALITY RATE (ALL CAUSES) FOR ADOLESCENTS AND YOUTH IN THE AMERICAS (2008-2015)

Source: PAHO Mortality database

0

20

40

60

80

100

120

140

160

180

2008 2009 2010 2011 2012 2013 2014 2015

Males 10-19 years Females 10-19 years Males 15-24 years Females 15-24 years

AGE-ADJUSTED HOMICIDE RATES FOR YOUNG PERSONS (10-24 YEARS) IN THE AMERICAS,2008-2015

Source: PAHO Mortality database

0

10

20

30

40

50

60

2008 2009 2010 2011 2012 2013 2014 2015

Males 10-19 years Females 10-19 years Males 15-24 years Females 15-24 years

AGE-ADJUSTED MORTALITY RATES FOR YOUNG PERSONS (10-24 YEARS) IN THE AMERICAS, FOR LAND TRAFFIC

INJURIES, 2008-2015

Source: PAHO Mortality database

0

5

10

15

20

25

30

35

2008 2009 2010 2011 2012 2013 2014 2015

Males 10-19 years Females 10-19 years Males 15-24 years Females 15-24 years

AGE-ADJUSTED SUICIDE RATES FOR YOUNG PERSONS (10-24 YEARS) IN THE AMERICAS, 2008-2015

Source: PAHO Mortality database

0

2

4

6

8

10

12

14

2008 2009 2010 2011 2012 2013 2014 2015

Chart Title

Males 10-19 years Females 10-19 years Males 15-24 years Females 15-24 years

SUICIDE RATES IN YOUNG PERSONS 15-24 YEARS OLD IN SELECTED CARIBBEAN COUNTRIES

(PER 100,000; LATEST YEAR REPORTED TO PAHO/WHO)

COUNTRY (YEAR) FEMALES MALES TOTAL(RANK)

Belize (2014) 5.5 5.5 5.5 (#6)Dominica (2014) 0 15.9 8.2 (#2)Dominican Republic (2012) 1.1 2.8 2.0 (# 5)Guyana (2012) 19.9 41.3 30.7 (#1)Jamaica (2011) 0.4 1.9 1.1 (#9)St. Lucia (2014) 7.5 7.3 7.4 (#3)SVG (2015) 0 11.7 5.9 (#9)Suriname (2014) 18.1 19.7 18.9 (#1)Trinidad & Tobago (2012) 8.3 15.3 11.8 (#3)

Source: PAHO Mortality database

19.4

24.5

10.2

16.9

13.8

16.4

16

23.2

13.9

15.5

18.1

17

11.7

16

6.4

11

9.9

11.5

13.9

16.8

11.4

10.5

14.3

14

27

32.6

13.6

22.3

17.9

21.4

17.9

29.1

15.7

19.5

21.8

19.7

0 5 10 15 20 25 30 35

Anguilla (2009)

Anguilla (2016)

Argentina (2007)

Argentina (2012)

Guatemala (2009)

Guatemala (2015)

Guyana (2004)

Guyana (2010)

Suriname (2009)

Suriname (2016)

Trinidad & Tobago (2007)

Trinidad & Tobago (2011)

Percentage

Female

Male

Total

PERCENTAGE OF STUDENTS AGED 13-15 YRS WHO SERIOUSLY CONSIDERED ATTEMPTING SUICIDE IN THE PAST 12 MONTHS

Adolescent and youth mortality and the social determinants (1)

0

5

10

15

20

25

30

Poorest districts Middle tercile Wealthiest districts

Rate

per

100

,000

2010

2015

Mortality rates in 2010 and 2015 in

Belize, among youth aged 15-24 years,

by wealth index

Adolescent and youth mortality and the social determinants (2)

8.1

5

7.1

7.6

5.8

3.7

0

1

2

3

4

5

6

7

8

9

2008 2014

Rate

per

100

,000

National Regions with lowest wealth quintile Regions with highest wealth quintile

Changes in suicide rates

among adolescents

aged 10-19 in Chile, 2008-

2014, on national level and wealth quintile of

their region of residence

Leading causes of DALYs lost for adolescents 10-19 years in LAC, 2015

Source: Institute for Health Metrics

Rank10-14 years 15-19 years

Male Female Both sexes Male Female Both sexes1 Iron

deficiency anemia

Iron deficiency anemia

Iron deficiency anemia

Interpersonal violence

Skin diseases Interpersonal violence

2 Skin diseases

Skin diseases Skin diseases

Road traffic injuries

Depressive disorders

Road traffic injuries

3 Asthma Asthma Asthma Skin diseases Anxiety disorders

Skin diseases

4 Road traffic injuries

Anxiety disorders

Conduct disorders

Depression Migraine Depressive disorders

5 Conduct disorders

Migraine Road traffic injuries

Self-harm Low back and neck pain

Anxiety disorders

Rank10–14 years 15-19 years

Male Female Male Female1 Malnutrition Malnutrition Alcohol and

drug useMalnutrition

2 Alcohol and drug use Low glomerular filtration

Occupational risk

Occupational risk

3 Unsafe water, sanitation and handwashing

Unsafe water, sanitation, and handwashing

Malnutrition Alcohol and drug use

4 Low glomerular filtration

Unsafe sex Low glomerular filtration

Sexual abuse and violence

5 Unsafe sex High fasting plasma glucose

High fasting plasma glucose

High fasting plasma glucose

LEADING RISK FACTORS FOR DALYs LOST IN LAC (10-19 YRS) BY SEX

Percentage of current alcohol users among students aged 13-15 years in selected LAC countries, by sex,

2007-2016

0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0

Bolivia (2012)Peru (2010)

Bahamas (2013)Anguilla (2016)Curacao (2015)

British Virgin Islands (2009)Montserrat (2008)

Suriname (2016)Trinidad and Tobago (2011)

Guyana (2010)Cayman Islands (2007)

Antigua and Barbuda (2009)Grenada (2008)

Barbados (2011)Jamaica (2010)

Saint Vincent and the Grenadines (2007)Dominica (2009)

Saint Lucia (2007)

Honduras (2012)Guatemala (2015)El Salvador (2013)Costa Rica (2009)

Belize (2011)

Chile (2013)Uruguay (2012)

Argentina (2012)

Ande

anSu

breg

ion

Carib

bean

Cent

ral A

mer

icaSo

uthe

rn

Cone

Percentage

Females Males Total

Source: Global School-based Health Survey (GSHS)

SEXUAL HEALTH OF ADOLESCENTS AND YOUTH

• Early sexual initiation

• Rapid increase between 15-18 years

• Multiple partners• Age-mixing• Force/coercion

PERCENTAGES OF FEMALES AGE 15-19 WHO REPORT THEY HAVE HAD SEX WITH A MAN AT

LEAST 10 YEARS OLDER IN THE PAST 12 MONTHS

0

5

10

15

20

25

30

35

Barbados2011

Jamaica2008

DominicanRepublic

2007

Haiti 2006 Antiguaand

Barbuda2011

Dominica2011

Grenada2011

St. Kittsand Nevis

Perc

enta

ge

Source: MICS studies

0

50.0

100.0

150.0

200.0

250.0

300.0

1950-1955 1955-1960 1960-1965 1965-1970 1970-1975 1975-1980 1980-1985 1985-1990 1990-1995 1995-2000 2000-2005 2005-2010 2010-2015

15-19 20-24 25-29 30-34 35-39 40-44 45-49

TRENDS IN AGE-SPECIFIC FERTILITY RATE (BIRTH PER 1,000 WOMEN) IN THE CARIBBEAN 1950 – 2015

Source: United Nations Population Division. World Population Prospects: The 2015 Revision. File FERT/7: Age-specific fertility rates by major area, region and country, 1950-2100, available at https://esa.un.org/unpd/wpp/Download/Standard/Fertility/

• Slow decline in pregnancies 15- 19 year olds

• Increasing trends in 10-14 year olds

• Concentrated in indigenous, Afro-descendants, poor, rural, less educated

• Countries with low fertility rates also present high ASFR

0

5

10

15

20

25

30

35

40

45

50

Perc

enta

ge

Percentage of adolescents aged 15-19 years who had begun childbearing, by education level, in

selected countries of Latin America and the Caribbean, 2008-2016

No education Primary Secondary Higher

0

5

10

15

20

25

30

35

40

45

Barbados(MICS 2012)

Belize (MICS2015-16)

Bolivia (DHS2008)

Colombia(DHS 2015)

Costa Rica(MICS 2011)

DominicanRep (DHS

2013)

El Salvador(MICS 2014)

Guyana (DHS2009)

Haiti (DHS2012)

Honduras(DHS 2011-

12)

Mexico (MICS2015)

Peru (DHS2012)

Percentage of adolescents aged 15-19 years who had begun childbearing, by wealth index quintile, in selected countries of Latin America and the Caribbean, 2008-2016

Lowest Second Middle Fourth Highest

PERCENTAGE OF OVERWEIGHT STUDENTS AGED 13-15 YEARS

0

5

10

15

20

25

30

35

40

45

50

Perc

enta

ge

Total Male Female

Source: Global School-based Health Survey (GSHS)

MOVING FORWARD WITH ADOLESCENT HEALTH IN THE SDG ERA

1. Reduce preventable adolescent and youth morbidity and mortality, their risk factors, and determinants, and the risk for premature adult mortality

• Violence• Alcohol and other substances• Mental health• Nutrition

2. Promote positive adolescent and youth health and development

• Health promotion• Sexual and reproductive health • Resilience• Agency• Empowerment

SURVIVE

THRIVE

TRANSFORM

INTEGRATED, MULTISECTOR ACTION

Universal health

coverage and access

Evidence-based interventions in families, schools

and communities

Empowerment and participation

Strategic information generation

and use

Equity and human rights

Social determinants of health

Life Course approach

Oh, I get it now!

AAHA!

Adolescents are central to everything we want to achieve, and to the overall success of the

2030 Agenda

UN Secretary General, and senior co-chair of the High-Level Steering Group for Every Woman Every Chid

At 68th World Health

Assembly (May 2015), Member

States requested WHO to develop

guidance on adolescent

health

WHY NOW?

AAHA! package:- Main document:

core & annexes- Summary document- Comic book - Infographics

http://www.who.int/maternal_child_adolescent/documents/en/

Intervention Package Cost per capita

Benefit-Cost Ratio

Physical, mental, sexual health $4.6 >10

Road traffic injury $0.6 5.9

Child marriage $3.8 5.7

Secondary education $22.6 12

Returns in LICs > Lower MICs > Upper MICsSource: Sheehan et al, The Lancet, April 2017

MAKES A CASE FOR INVESTMENT IN ADOLESCENTS

• Showcases evidence-based interventions• Provides technical guidance to prioritize national

adolescent health needs • Highlights effective approaches to adolescent health

programming, monitoring and evaluation• Reinforces the importance of adolescent

participation in all aspects of programming• Shows, through 76 case studies, that the suggestions

can be done and have been done – at least to some degree and at least in one place

AAHA!

Positive development Unintentional Injury Violence

Sexual and reproduction health, including HIV Communicable diseases

Non-communicable diseases, nutrition and

physical activity

Mental health, substance abuse and

self-harm

Conditions with particularly high priority

in humanitarian and fragile settings

AAHA! ROLL-OUT IN THE AMERICAS

• Translation Spanish and Portuguese• Two sub-regional workshops for training

of facilitators• Country workshops in Barbados, Guyana,

Haiti, Brazil, Suriname• Technical support for development of

adolescent health strategic plans

THANK YOU!Caffes@paho.org