53651 Adolescent Health at a glance Why address the health and · Reducing HIV infection in young people will reduce the devastating economic impact of development of young people? HIV/AIDS. More than a quarter of the world's population is · When young people postpone marriage and child- between the ages of 10 and 24. Most (86%) of the bearing, family size falls and population growth world's 1.7 billion young people live in developing slows. Combined with investments in health and countries, where they are often 30% or more of the education, these changes contribute to higher eco- population. nomic growth and incomes. · Investments to head off negative behaviors such as At first glance, youth appears to be a relatively tobacco use and drug abuse will pay off later for healthy -- although not hazard-free -- period of life. individuals and for society. Young people account for 15% of the disease and injury burden worldwide and over one million die Investments in the health and development of young each year, mainly from preventable causes. people build on and compound the benefits of past Nonetheless, roughly 70% of premature deaths government expenditures on child survival and educa- among adults can be linked to behavior initiated tion, and enhance future economic and social devel- during adolescence, such as tobacco use, poor opment. By contrast, risky or unwanted sex and other eating habits, and risky sex. unhealthy behaviors are tied to individual, family, and community factors that influence youth behavior, Young people face serious health challenges: and that are closely related to economic and educa- · About half of all HIV infections are in people tional prospects. Too many youth who lack opportuni- under 25, with girls disproportionately affected. ties to make a positive contribution to society turn to · On average, one-third of women in developing crime and violence and feed existing civil unrest. countries give birth before age 20; a large propor- tion of these pregnancies are unplanned. Investing in Youth Helps Break the Cycle of Poverty. · Each year, between 2 and 4 million adolescents Poverty and inadequate health systems compound undergo unsafe abortion. adolescent vulnerability to sickness and early death: · Teen mothers are twice as likely as older women to · When a young person becomes infected with HIV die of pregnancy-related causes, and their own or resorts to unsafe abortion to terminate an children are at higher risk of illness and death. unplanned pregnancy, poverty is often the root · Nutritional deficiencies such as anemia are wide- cause. spread in both young men and women. They · A poor teenager is more than three times as likely increase the risks that girls and young women face to give birth as a wealthy teen. during pregnancy and childbirth. · Millions of youth die tragically or suffer because of The Importance of Adolescent Health and other preventable health hazards such as road Development to Achieving the Millennium accidents, substance abuse, suicide, and infectious Development Goals. Most of the Millennium Development Goals are highly diseases such as malaria and tuberculosis. relevant to the health and welfare of youth. Better ado- lescent health will directly contribute to achieving five of Adolescent Health and Development affect Economic the eight internationally agreed-upon goals: reversing the Prosperity. Investing in health and development of spread of HIV/AIDS; reducing maternal deaths; reduc- young people is not only the right thing to do, it's the ing infant and child deaths; developing and implement- ing strategies for decent and productive work for youth; smart thing for countries that want their economies to and reducing poverty. grow faster: November 2002 Actions to Promote Adolescent Health and Development The key strategies to improve adolescent health and development typically have overlapping and synergistic goals. To emphasize the inter-relatedness of these strategies, the table combines intermediate and final outcome indicators for a range of desired adolescent health outcomes Objective: Improve Knowledge, Attitudes, and Behaviors of Young People Core Interventions Beneficiaries/Target Groups Indicators Provide information to young people to increase their knowledge and understanding of health issues and to motivate them to practice healthy behaviors through: Life skills and health and sexuality education in schools In-school youth, ideally starting before puberty and before Intermediate Outcome Indicators young people become sexually active % of sexually active youth using contraception, especially condoms for prevention of both preg- Peer educators deployed in a wide range of formal and informal settings such as Out-of-school youth; youth in hard-to-reach groups such as sex nancy and HIV/AIDS and other STIs schools and workplaces, to provide role models for other youth, to convey infor- workers, street kids % of young mothers with prenatal care and trained mation on health, and to refer peers to health services delivery assistance % of youth having high risk sex TV, radio, and other mass media campaigns, including popular theater and other All young people, especially those at highest risk of unhealthy % of youth with anemia culturally-appropriate means that appeal to youth behaviors % of youth who use tobacco products Age of marriage Provide health services to young people through: Age at sexual debut Subsidized social marketing of condoms and other reproductive health products Sexually active young people Final Outcome Indicators Rates of maternal death and disability for young Programs that reach young people at their places of work and through private Employed youth; youth who use private, for-profit health serv- mothers channels such as pharmacies and for-profit medical services, where many youth ices Rates of HIV and other STIs for youth prefer seeking care Rates of teen pregnancy (wanted and unwanted) Rates of unsafe abortion for youth Comprehensive adolescent health services through the public sector and NGOs All young people, but especially poor and rural youth % of youth who report being sexually abused or forced to have sex Community-based programs, for example those that distribute condoms and other All youth, but especially out-of-school youth; poor youth Rates of youth suicide and depression contraceptives Voluntary counseling and testing for HIV/AIDS Youth engaging in high-risk behaviors Expanding school and livelihoods opportunities for poor youth affected by AIDS, Poor youth living with HIV/AIDS or from AIDS-affected families; including AIDS orphans AIDS and other orphans Objective: Create a Positive Context for Adolescent Health Programs Policy Dialogue and Advocacy Develop national AH policies and service guidelines Decision-makers; legislators; community, religious and business Level of political support for AH leaders; civil society Existence of a national AH policy Create a supportive legal framework Adequate budget for AH Existence of program guidelines and regulations Promote anti-smoking policies such as taxes and advertising bans that support provision of AH care Existence and enforcement of positive legal frame- work (e.g. minimum age at marriage; legality of contraceptive sales to youth; ban on tobacco promotion) Change Social Norms Mass media and community mobilization efforts Parents; teachers; religious leaders; other influential adults Degree of family and community support for AH policies and programs Address Related Youth Needs through Multisectoral Interventions Primary and secondary school enrollment for girls Improve education opportunities, especially for girls and boys Youth unemployment rate Link AH with other youth activities, including education and youth development All youth, particularly those at risk programs that give young people broadly-applicable attitudes and skills Provide job training and other livelihoods programs 1 Indicators that correspond directly to Millennium Development Goals are in italics. · Poor health exacerbates poverty, by disrupting and Access to high-quality health services is as important cutting short school opportunities, by weakening or for youth as it is for older clients. Although some killing young people in the prime of their working young people seek care through the formal health lives, or by placing heavy financial and social bur- system, many others are deterred by the often judg- dens on families. mental attitudes of health care providers, particularly · Poor youth are particularly vulnerable to sexual when seeking care and advice on sexuality-related violence and exploitation. Girls in many countries matters. The most effective efforts to reach youth are report having sex in exchange for money or gifts. tailored to address their specific needs and reach · Youth from AIDS-affected homes, including 13 young people where they live, work, and play. million under age 15 orphaned by the disease, Subsidized sale of condoms and other health prod- often have to forgo schooling and other opportuni- ucts and services through social marketing programs ties, which diminishes their livelihood prospects, brings products and services to places in the commu- pushes them deeper into poverty, and increases nity that young people frequent, such as shops, their own chances of contracting HIV. kiosks, and pharmacies. Create a Positive Context for Improvements in How to Promote Adolescent Health Adolescent Health. Successful adolescent health and Development efforts also address the political and social context in which young people make decisions that affect their The range of adolescent health interventions is broad. health and development. All approaches are more effective when they provide youth with information and services, and create a Global commitment to meeting adolescent health positive context that allows young people to practice needs has never been higher. The 1994 International key health-promoting, inter-related behaviors. These Conference on Population and Development and the behaviors include: 2001 UN Special Session on AIDS affirmed the rights · delaying sexual debut and practicing abstinence, of young people to high-quality sexual and reproduc- and, for sexually active youth, safer sex and tive health information and services. Similarly, the increased contraceptive use Framework Convention on Tobacco Control recog- · postponing marriage and childbearing nizes the youth dimension of the smoking epidemic. · using safe delivery care Translating this international commitment into national · avoiding tobacco use and substance abuse policies, a supportive legal framework, and adequate · better nutrition. budgetary support is a priority. Provide Information and Services to Young People. A Improving adolescent health also requires changing number of approaches effectively give young people the social norms that promote negative health out- the information they need to make the right life comes, for example, gender discrimination, norms choices. Where school enrollment is high, it is cost- that promote early sexual activity or that stigmatize effective and important to reach students through using condoms, cultural expectations to marry and schools. For many young people, peers are a primary bear children early in adolescence, tolerance of sub- source of information on sexuality and health. Peer stance abuse, and poor eating habits. Mass media education programs are especially appropriate for and community mobilization efforts that engage influ- young people not in school and for hard-to-reach, at- ential adults such as parents, teachers, community risk subsets of the youth population, including sex and religious leaders, and pop and sports stars can workers and street children. The mass media have positively affect these norms. Multisectoral programs enormous influence on youth in most societies, and that meet the job and schooling needs of young can help to normalize positive adolescent behaviors people also can positively influence the factors that and gender roles, and to direct young people to put young people at risk. appropriate health services. Dos and Don'ts s With the exception of sub-Saharan Africa, school enrollments are increasing and the gender gap in DON'T underestimate the diversity of the youth age education is decreasing. group. A sexually inexperienced 11 year-old has s Cigarette smoking and injecting drug use among vastly different needs than a married 20 year-old. adolescents are decreasing in some industrialized Programs should apply different strategies to reach countries. youth who vary in age, sex, employment, schooling, and marital status. For more information DO involve young people. Policies and programs are more effective when young people are involved in all Elizabeth Lule, Population and Reproductive Health Advisor: aspects of design, implementation, and evaluation. elule@worldbank.org Involvement must go beyond tokenism and be real, Viviana Mangiaterra, Children and Youth Advisor: meaningful, and sustained. vmangiaterra@worldbank.org DO make health services appealing to youth. A key to rapidly expanding access for young people is to Useful websites make existing health services more "youth-friendly" by using specially-trained health workers and by bol- WHO Child and Adolescent Health: stering the privacy, confidentiality, and accessibility http://ww.who.int/child-adolescent-health/ of care. FRESH Initiative on School Health: DO address gender inequality. Gender inequalities http://www.schoolsandhealth.org expose young girls to coerced sex, HIV infection, Reproductive Health Outlook: unwanted pregnancy, and poor nutrition. Efforts http://www.rho.org/html/adolescent.htm should focus on changing the social norms that per- petuate gender inequalities. YouthNet: http://www.fhi.org/en/youth/youthnet/ ynetindex.html DON'T forget about boys. Adolescence presents a unique opportunity to help boys form positive notions UNFPA: http://www.unfpa.org/adolescents/index.htm of gender relations and to raise awareness of health issues. Program design should take into account the Documents and Data specific needs of boys and young men. Programming for Adolescent Health and Development: DO design comprehensive programs. Comprehensive Report of a WHO/UNFPA/UNICEF Study Group on programs that provide information and services while Programming for Adolescent Health, WHO Technical addressing the social and political context are more Report Series 886, World Health Organization, 1999, effective than narrowly-focused interventions. Geneva. http://www.who.int/child-adolescent-health/publi- cations/publist.htm Can we improve adolescent health and development? Advancing Young Adult Reproductive Health: Actions for Yes. Despite the challenges, when supported by their the Next Decade, Pathfinder International, FOCUS on families, schools and communities, young people can Young Adults, 2001, Washington DC. (and do) make the right life choices: http://www.pathfind.org/ s In Uganda, Tanzania, and Zambia, HIV preva- site/PageServer?pagename=Publications_ lence among young people has recently declined FOCUS_Publications by half or more, primarily because of changes in Monitoring and Evaluating Adolescent Reproductive Health behavior such as delayed first sexual experience Programs, Adamchak, Susan et al. 2000, Washington: and increased condom use. FOCUS on Young Adults. http://www.pathfind.org/ s Adolescent fertility rates have declined in many guides-tools.htm countries, with large increases in girls' education, Population Reference Bureau: The World's Youth 2000 rising age at marriage, and increased use of http://www.prb.org/Content/NavigationMenu/ effective contraception. Other_reports/2000-2002/ The_Worlds_Youth_2000_Data_Sheet.htm Expanded versions of the "at a glance" series, with e-linkages to resources and more information, are available on the World Bank Health-Nutrition-Population web site: www.worldbank.org/hnp