London 6 February 2008
Programming for
Adolescent Health and Development
WHO's 4 S Framework
Paul Bloem
World Health Organization
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.


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.
Different needs.
Changing needs.
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
 Global
development
 Human
goals and targets
rights
UNICEF region
Adolescent sexuality
and fertility
"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
Sub-Saharan Africa
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
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
12.8
xx
Least developed
countries
4.4
127
Industrialized countries
0.7
24
13.4
50
Developing countries
World
Source: UN Population Division, Population Estimates and Projections, 2000 Revision.
Top ten causes of death in adolescents (10-19)
World, 1999
1
2
3
4
5
6
7
8
9
10
Male
Female
Road traffic accidents
Malaria
Respiratory Tract Infections
Other unintentional injury
Drowning
Homicide
Suicide
HIV
Diarrhoea
Tuberculosis
HIV
Maternal conditions
Malaria
Respiratory Tract Infections
Tuberculosis
Suicide
Diarrhoea
Road traffic accidents
Fires
Other unintentional injury
 Accidents are leading cause of death among
adolescents in European Region
The global Obesity pandemic
Overweight (%), 15 years olds
<= 25
<= 20
<= 15
<= 10
Last
Available
<= 5
EUROPE
No data
No data
Min = 0
Source HBSC
bai
ja
Arm n
eni
a
G
FY
eor
RM
gia
ace
do
nia
Ro
ma
n
Mo ia
l do
va
Slo
vak
ia
Uz
be
kis
tan
Hu
nga
ry
Az
er
Ta
ji ki
sta
Yu
n
gos
lav
ia
B
ulg
Cz
ari
ech
a
Re
pu
blic
Po
lan
Ky
d
r gy
zst
Tu
an
rkm
eni
sta
n
Uk
rai
ne
La
tvi a
Es
to n
ia
Be
lar
us
Slo
ven
ia
Lith
uan
Ka
zak ia
hst
an
Ru
ssi
a
FR
Youth suicide in CEE/CIS
1989-1998
Male/female ratio = between 2 and 5
50
1989
Rises
rates per 100,000 15-24 year olds
1998
40
Falls
30
20
10
0
Why we are concerned about young people and HIV
Over 10 million young people (15-24)
living with HIV/AIDS
Central and
Eastern Europe
35% 430,000
65%
33%
67%
Industrialized
Countries
240,000
31%
62%
38%
South Asia
1.1 million
62%
Sub-Saharan Africa
8.6 million
Source: UNAIDS/UNICEF, 2002
8 July 2002 – XIV
49%
38%
Latin America & Caribbean
560,000
69%
East Asia & Pacific
740,000
Middle East
69% & North
31%
Africa
160,000
3
51%
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
 Global
development
 Human
goals and targets
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
 Global
development
 Human
goals and targets
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 (1524 years) reduced prevalence by 25% globally
Why focus on young people?
 Public
health
 Economic
 Global
development
 Human
goals and targets
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 evidenceinformed 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




Evidence base: need for quality interventions research


Health Workers Orientation Modules – Commonwealth Medical
Association
EUTEACH – European collaboration
Liverpool School of Tropical Medicine - district managers
training
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