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 [email protected]