who department of child and adolescent health and ......eylin 19, honduras january 2006. source:...
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Introduction to adolescence & to
adolescent health
WHO Department of Child and Adolescent Health
and Development
Training Course in Sexual and Reproductive Health Research
Geneva 2010
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Topics
1. The meaning of adolescence
2. The health problems that adolescents face
3. What adolescents need to grow & develop in good health
4. Who needs to meet the needs & fulfil the rights of adolescents
5. Why we should invest in the health & development of adolescents
6. Frameworks for addressing the health & development of
adolescents
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1. What do we mean by the term
'adolescents ' ?
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The second decade:
No longer children, not yet adults !
Adolescents 10 - 19 years
Youth 15-24 years
Young people 10-24 years
Source: A picture of health? A review and annotated bibliography of the
health of young people in developing countries (WHO, UNICEF, 1995).
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Adolescents are a diverse
population group
Different needs
Changing needs
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What is special about adolescence ?(What makes it different from childhood & adulthood ?)
• A time of rapid physical and psychological (cognitive and emotional) growth and development.
• A time in which new capacities are developed.
• A time of changing social relationships, expectations, roles and responsibilities.
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2. What do we mean by the term
'health' ?
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“Health is a state of complete
physical, mental and social well-being
and not merely the absence of disease
or infirmity."
Source: Constitution of the World Health Organization, 1948.
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3. What are the main health
problems of adolescents ?
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Many adolescents move from childhood through
adolescence into adulthood in good health.
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Key health problems in adolescence.
Sexual & reproductive
health
-Too early pregnancy
• risks to mother
• risks to baby
- Health problems during
pregnancy & child birth
(including unsafe abortion)
-Sexually Transmitted
Infections including HIV
-Harmful traditional
practices e.g. female genital
mutilation
-Sexual coercion
Source: United Nations. World Youth Report 2005. Young people today, and in 2015.
United Nations. 2005. ISBN 92-1-130244-7.
Other issues
- Injuries from
accidents &
intentional violence
- Mental health
problems
- Substance use
problems
- Endemic diseases:
malaria,
schistosomiasis,
tuberculosis
- Under/over-nutrition
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4. What do adolescents need to
grow & develop in good health ?
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What adolescents
need & why?
• Information & skills
(they are still developing)
• Safe & supportive environment
(they live in an adult world)
• Health & counselling services
(they need a safety net)
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5. Who needs to contribute to
meeting these needs & fulfilling
these rights ?
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Politicians
Journalists
Bureaucrats
Relatives
Friends
Family friends
Teachers
Sports coaches
Healthcare providers
Religious leaders
Traditional leaders
Parents
Brothers/Sisters
Adolescents
Musicians
Film stars
Sports figures
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6. Why should we invest in the
health and development of
adolescents ?
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• Demographic rationale
• Public health rationale
• Economic rationale
• Human rights rationale
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• 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.
Demographic rationale – 1/2
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Demographic rationale – 2/2
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• There are around
2.6 million deaths
among the 10-24
year age group
worldwide every
year.
• 97% occur in low
and middle income
countries.
Public health rationale: mortality – 1/5
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A Picture of Health, WHO/UNICEF (1995)
Death by condition by 5 year age group, 1999
100,000
200,000
300,000
400,000
500,000
600,000
700,000
MF5-9 MF10-14 MF15-19 MF20-24
Communicable,
maternal, perinatal
and nutritional
conditions Noncommunicable
diseases
Injuries
Public health rationale: mortality 2/5
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Source: UNAIDS/UNICEF, 2002
Public health rationale: morbidity – 3/5
38%
62%
South Asia1.1 million
IndustrializedCountries240,000
67%33%
Middle East & North Africa160,000
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
There are over 10 million young people (15-24) living with HIV/AIDS
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Public health rationale:
behaviours – 4/5
• Nearly two thirds of
premature deaths and
one third of the total
disease burden in
adults are associated
with conditions or
behaviours that
began in youth.
World Development
Report 2007
0
0.02
0.04
0.06
0.08
0.1
0.12
0 10 20 30 40 50 60 70
Age
female
male
Age of smoking initiation
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Health
problems /
health-related
behaviours
during
adolescence
Age when this has its major impact
Adolescence Adulthood Childhood
(next generation)
Injuries and
violence+++ +
Too-early
pregnancy ++ + ++
Human Papilloma
Virus infection+ +++
Tobacco use + +++ +
HIV infection + +++ ++
Public health rationale – 5/5
sound reasons for investment for this generation
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1. The benefits of
investing in
adolescents
2. The cost of not
investing in
adolescents
Economic rationale – 1/4
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Economic
rationale – 2/4
The need to make full use
of the demographic
dividend when one can.
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Economic rationale – 3/4
The need to act
before
the
demographic
transition
closes doors.
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Economic rationale - 4/4Socio-economic deprivation: a cause & consequence of
adolescent pregnancy
Too early
pregnancy
Loss of
educational
&
employment
opportunities
Poverty
" We young women are not prepared to become
mothers. I would like to continue my studies. But since
I have had my daughter, my options have changed
because I have many more obligations now."
Eylin 19, Honduras January 2006.
Source: World Development Report 2006 (World Bank, 2006.)
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Convention on the rights of the child
• Article 24: The right to the highest level of health possible & to access the required health services
• Article 17: The right to access appropriate information from the media & to be protected from harmful information
• Article 13: The right to seek, receive and impart information and ideas of all kinds
Choices: A guide for young people
Gill Gordon, 1999.
Human rights rationale -1/2
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Human rights rationale – 2/2
For many adolescents the world
is in fact 'flat':
• Greater access to education
• Greater access to information
about the world
• Greater ability to make personal
& professional choices
For many other adolescents, the
reality is very different
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6. Frameworks for addressing
the health and development of
adolescents
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First lens: Broadening opportunities
for young people to develop skills
and use them productively.
Second lens: Helping them acquire
the capabilities to make good
decisions in pursuing those
opportunities
Third lens: Offering them second
chances to recover from bad
decisions, either by them or by
others.
World Bank framework: Youth
transitions seen through three lenses
Source: World Bank. World Development Report 2007. Development and the next generation. World Bank. Washington,
USA. 2007.
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WHO: Delineating & strengthening
the contribution of the health sector
SStrengthening &
supporting
other sectors
SServices &
commodities
SStrategic
information
SSupportive
evidence-informed
policies
WHO. Strengthening the health sector response to adolescent health & development. WHO. Geneva. 2009.
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UNFPA framework for action
on adolescents & youth
1. Supportive policy making that applies the lens of population structure & poverty dynamics analyses
2. Gender & life-skills based sexual & reproductive health education
3. Sexual & reproductive health services
4. Young people's leadership and participation
Source: UNFPA framework for action on adolescents and youth. Opening doors with 4 keys. UNFPA. New York, USA. Undated.