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 (millions) Age-specific fertility rate (15-19 years) (Annual births per 1000 girls aged 15-19) Sub-Saharan Africa (Eastern/Southern Africa) (1.9)(111) (Western/Central Africa) (2.4)(143) Middle East/North Africa South Asia East Asia/Pacific Latin America/Caribbean CEE/CIS and Baltic States Developing countries 12.8xx Least developed countries Industrialized countries World 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

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

Source HBSC The global Obesity pandemic

Youth suicide in CEE/CIS rates per 100, year olds Male/female ratio = between 2 and 5

8 July 2002 – XIV3 Source: UNAIDS/UNICEF, % 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

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 ( 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