1. Programming for Adolescent Health and Development WHO's 4 S Framework World Health Organization Paul Bloem London 6 February 2008

2. 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

3. 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.

4. 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

5. 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

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

7. 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 4.3127 (Eastern/Southern Africa) (1.9)(111) (Western/Central Africa) (2.4)(143) Middle East/North Africa 0.739 South Asia 3.756 East Asia/Pacific 1.418 Latin America/Caribbean 1.871 CEE/CIS and Baltic States 0.735 Developing countries 12.8xx Least developed countries 4.4127 Industrialized countries 0.724 World13.450 Source: 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

8. Top ten causes of death in adolescents (10-19) World, 1999 1 2 3 4 5 6 7 8 9 10 Road traffic accidents Malaria Respiratory Tract Infections Other unintentional injury Drowning Homicide Suicide HIV Diarrhoea Tuberculosis Male HIV Maternal conditions Malaria Respiratory Tract Infections Tuberculosis Suicide Diarrhoea Road traffic accidents Fires Other unintentional injury Female  Accidents are leading cause of death among adolescents in European Region

9. Source HBSC The global Obesity pandemic

10. Youth suicide in CEE/CIS 1989-1998 rates per 100,000 15-24 year olds Male/female ratio = between 2 and 5

11. 8 July 2002 – XIV3 Source: UNAIDS/UNICEF, 2002 38% 62% South Asia 1.1 million Industrialized Countries 240,000 67% 33% Middle East & North Africa 160,000 31% 69% Central and Eastern Europe 430,000 35% 65% 49% 51% East Asia & Pacific 740,000 31% 69% Latin America & Caribbean 560,000 38% 62% Sub-Saharan Africa 8.6 million Why we are concerned about young people and HIV Over 10 million young people (15-24) living with HIV/AIDS

12. 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

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

14. 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

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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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 +++++

23. 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

24. The health sector contribution Strategic Information Services and commodities Supportive evidence-informed policies Strengthening other sectors

25. 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!

26. 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

27. 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

28. 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

29. 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

30. 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

31. The health of adolescents in the world. Think globally, act locally Act locally, think globally