Programming for Adolescent Health and Development

WHO's 4 S Framework

World Health Organization

Paul Bloem

London 6 February 2008

Overview

Why focus on adolescents ? What contribution can different sectors - in

particular the health sector - make to improve adolescents' health?

Reflections on contribution a Professional Association can make to move the public health agenda - in the UK and abroad

Adolescents are a large and very diverse population group.

Different needs.

Changing needs.

One in five individuals in the world today is an adolescent (around 1.2 billion).

The largest number of adolescents in the history of mankind.

Defining the adolescent ….

"Child" according to CRC: < 18 years

According to the World Health Organization (WHO) “Adolescence” covers ages 10 to 19 years “Youth” covers ages 15 to 24 years “Young people” covers ages 10 to 24 years

What kind of world do today's adolescents live in ?

For some adolescents…

• Greater access to education• Greater access to information about the world• Greater ability to make personal & professional choices

While others…

• Limited or no parental support• Limited job opportunities• Social unrest and war

Why focus on young people?

Public health Economic development Global goals and targets Human rights

Adolescent sexuality and fertility

UNICEF region

Annual number of

births to girls aged 15-19(millions)2000-2005

Age-specific fertility rate

(15-19 years)(Annual births per

1000 girls aged 15-19)2000-2005

Sub-Saharan Africa 4.3 127

(Eastern/Southern Africa) (1.9) (111)

(Western/Central Africa) (2.4) (143)

Middle East/North Africa 0.7 39

South Asia 3.7 56

East Asia/Pacific 1.4 18

Latin America/Caribbean 1.8 71

CEE/CIS and Baltic States

0.7 35

Developing countries 12.8 xx

Least developed countries

4.4 127

Industrialized countries 0.7 24

World 13.4 50Source: UN Population Division, Population Estimates and Projections, 2000 Revision. 

"England and Wales now have the highest birth rates for under-16s in western Europe. In some areas, nearly one schoolgirl in every 50 is falling pregnant."

Telegraph , 7 January 2008

Top ten causes of death in adolescents (10-19) World, 1999

12345678910

Road traffic accidentsMalariaRespiratory Tract InfectionsOther unintentional injuryDrowningHomicideSuicideHIVDiarrhoea Tuberculosis

MaleHIVMaternal conditionsMalariaRespiratory Tract InfectionsTuberculosisSuicideDiarrhoeaRoad traffic accidentsFiresOther unintentional injury

Female

Accidents are leading cause of death among adolescents in European Region

<= 25<= 20<= 15<= 10<= 5No data

Min = 0

Overweight (%), 15 years olds

LastAvailable

EUROPENo data

Source HBSC

The global Obesity pandemic

Youth suicide in CEE/CIS1989-1998

0

10

20

30

40

50

Tajikistan

FR Yugoslavia

Bulgaria

Czech Republic

PolandKyrgyzstan

Turkmenistan

UkraineLatviaEstoniaBelarusSloveniaLithuaniaKazakhstan

RussiaAzerbaijan

ArmeniaGeorgia

FYR Macedonia

RomaniaMoldovaSlovakiaUzbekistan

Hungary

1989 1998

Rises Falls

rates per 100,000 15-24 year olds

Male/female ratio = between 2 and 5

8 July 2002 – XIV 3

Source: UNAIDS/UNICEF, 2002

38%

62%

South Asia1.1 million

IndustrializedCountries240,000

67%33%

Middle East & North Africa

160,000 31%

69%

Central and Eastern Europe

430,00035%65%

49%

51%

East Asia & Pacific740,000

31%

69%

Latin America & Caribbean560,000

38%

62%

Sub-Saharan Africa8.6 million

Why we are concerned about young people and HIV Over 10 million young people (15-24)

living with HIV/AIDS

Key adolescents health concerns Intentional and unintentional injuries Sexual and reproductive health (including HIV/AIDS) Substance use and abuse (tobacco, alcohol and

other substances) Mental health problems Nutritional problems Endemic and chronic diseases

Why focus on young people?

Public health Economic development Global goals and targets Human rights

Adolescent health figures on the global development public health agenda

Investing in young people makes economic sense Return on investments.. Using the "demographic bonus" Economic development requires a health educated

workforce

Why focus on young people?

Public health Economic development Global goals and targets Human rights

Global goals and targets

The UN General Assembly Special Session on Children provides the broader context

develop and implement national health policies and programmes for adolescents, including goals and indicators, to promote their physical and mental health

Global goals and targets

The MDGs of particular relevance to Adolescents

Have halted by 2015 and begun to reverse the spread of HIV/AIDS

Reduce by three quarters the maternal mortality ratio

Entry points: HIV & Maternal Mortality

Global goals and targets

The UN General Assembly Special Session on HIV/AIDS

provides focus to move from the aspirational to the operational

By 2010, ensure that at least 95% of young people have access to the information, skills and services they need…to reduce their vulnerability to HIV

By 2010 , HIV prevalence among young people (15-24 years) reduced prevalence by 25% globally

Why focus on young people? Public health Economic development Global goals and targets Human rights

Convention of the Rights of the Child - General Comment # 4 on Adolescent health and Development

Overview

Why focus on adolescents ? What contribution can different sectors - in

particular the health sector - make to improve adolescents' health?

Reflections on contribution a Professional Association can make to move the public health agenda - in the UK and abroad

What do young people need to improve their health and development?

Information and Life Skills Services and Counselling Safe and Supportive

environment Opportunities to

contribute and participate

A framework for programming for young people's health and development

Health Sector

Education Sector

Media And many others: labour, criminal-justice, social services, parents, peers, etc.)

Information and Life Skills + +++ ++ ++Services and Counselling +++ + + +Safe and Supportive Environment

+ ++ ++ +++Opportunities to participate + + + ++

What are the priorities for the health sector?

Collect, analyse and disseminate the data that are required for advocacy, policies and programmes

Provide services that include a focus on prevention, treatment and rehabilitation

Support the development of evidence-informed policies and strategies that provide vision and guidance

Mobilise, support and coordinate with other sectors

The health sector contribution

Strategic Information Services and commodities Supportive evidence-informed

policies Strengthening other sectors

Strategic Information

Collect, analyse and disseminate data needed for policies, programmes and advocacy

Monitor and evaluate the quality, coverage, (and cost) of interventions

At a minimum disaggregate existing data (epi and HMIS) by age and sex!

Services Increasing the coverage and utilization of services for

young people Delivering a package of evidence based interventions in effective and sustainable ways Standards of Care for adolescents to increase the

coverage of services for adolescents India Tanzania Moldova

Supportive evidence-base policies Support countries to develop policies

and strategies that are based on evidence

Strengthen Evidence-base: facts for policy makers HIV interventions for young people Prevention of Tobacco Use in YP Intervention for Mental health in resource poor settings

Overview

Why focus on adolescents ? What contribution can different sectors - in

particular the health sector - make to improve adolescents' health?

Reflections on contribution a Professional Association can make to move the public health agenda - in the UK and abroad

Contribution Professional Associations can make … in England and beyond

Build critical mass & capacity for adolescent health Health Workers Orientation Modules – Commonwealth Medical

Association EUTEACH – European collaboration Liverpool School of Tropical Medicine - district managers training

Evidence base: need for quality interventions research Mwanza trial – LSHTM

Advocate for effective Policies – eg. National youth health policy - Every Child Matters Sexuality education / substance education

Contribution Professional Associations can make … in England and beyond

Ensure access to services Ensure NHS provides quality services to adolescents

Your Welcome! GP standards QAF

Influencing the international youth health agenda DFID …ensuring the MDGs are reached IAAH

The health of adolescents in the world.

Think globally, act locally

Act locally, think globally