Global Practices in Adolescent Health

By Rudrani Ghosh

About 1.2 billion people, or one-sixth of the world’s population, are adolescents (10-19 years). Almost nine out of ten people live in low and middle-income countries with limited access to health and social services, jobs, and livelihoods. Given that the number of adolescents is expected to rise through 2050, achieving the Sustainable Development Goals (SDGs), including universal health coverage (UHC) requires addressing the needs of this age group.

Young people are our future assets. They bring to us energy, productivity, innovation and progress and hence it is feasible to invest in the healthy development of our young people and to implement preventive interventions. In a study published by Lancet on Adolescent Health and Development, it was highlighted that attention to young people’s health is the next logical step to the foundation for a healthy adult life, which in turn will impact the future generation’s health.

Adolescent: Disease Burden and Health Needs

There is a general assumption that ‘adolescents are a healthy group of people'. However, many adolescents do die prematurely. According to the WHO, it is estimated that 1.7 million young men and women within the age group of 10–19 years lose their lives, mostly through accidents, suicide, violence, pregnancy and other diseases that are preventable or treatable. It is also found out that about 70% of the deaths induced by these young adults are mostly by their own behaviour-initiated patterns—for instance, tobacco use usually starts at the age of 19-20, which eventually leads to premature death in adolescence.

According to Dr. Mauricio A. Scarpello, Vice President of the International Association for Adolescent Health (IAAH), "The demands of adolescent health are usually related to mental health. The most typical manifestations are related to depression and suicide attempts, anguish, panic attacks, and difficulties with the family bond, among others. The epidemiological trend shows greater physical isolation and promotion of virtual links, which make differences in adolescent communication." There are various factors and influences within the wider environment that play a huge role in determining the choices and behavioural patterns of young people. For instance, the mass media, the entertainment, the parental bond, access to health services, economic opportunities, among others determine the ‘life chances’ open to young adults and influence the decisions they make about their lives.

Figure 1: Estimated top 5 causes of adolescent, WHO

Dr. Scarpello says that "it is during the regular health check-up consultations with the young people that we realise many of the difficulties they face which remain hidden otherwise." About 50% of the mental health conditions are usually noticed during the adolescent period (by the age of 14). Often overlooked by parents, health providers, or the young adults themselves, these issues go undetected due to a lack of knowledge and stigma.

"In order to address adolescent needs, a joint approach is required from the health system, education, family, and the community as a whole. These are shared responsibilities upon which everyone must act in order to promote adolescent health. The community works must have clear coordination, goals, and objectives, based on the local epidemiology or the situations that need to be resolved under the supervision of the state or government that facilitates the actions," opines Dr. Mauricio. 

Adolescent healthcare as near as a click away: Myth or Reality?

Around the world, health services and policies have typically ignored adolescence. This age group has failed to experience the improvements that the other segments of the population have seen. For example: the young girls who are usually vulnerable to unsafe abortion are less covered by services than older women. Most countries do not know the magnitude of the disease burden, health needs and barriers to services in this segment of the population. As a result, in many cases the need for adolescent-responsive health services is overlooked by UHC efforts; health care financing arrangements have not been evaluated with respect to adolescents.

Dr. Mauricio believes that "a crucial aspect that countries should know is the importance of investing in health for adolescent care." He further states that "adolescence is seen by most people as a "healthy" time period. We frequently hear parents say that their children's last check-up was when they were kids, and because they haven't been sick since, they haven't had a medical check-up after that. For this reason, it is crucial for the government to reach the population and highlight the importance of health screening in adolescence, which in turn will influence the future generation."

However, it is imperative to keep in mind that digital health and telemedicine have great promises to allow adolescent healthcare to expand by providing effective tools to greater access to consultations. Increasing school based telemedicine services, partnering with communities to reach out to youths who are involved in juvenile justice system, expanding access to confidential services like addiction; mental health; pregnancy and abortion are some of the ideas for future telemedicine uses.

Adolescent Medicine

Adolescent medicine is a young speciality. It was only in 1994 that the first examination in the subspecialisation of adolescent medicine was held by the American Boards of Paediatrics. In 1968, the US-based Society for Adolescent Medicine was formed, which became the most prominent society at an international level. In 2010, it changed its name to the Society for Adolescent Health and Medicine to reflect the importance of health and well-being for adolescents. Adolescent health specialists have to fight for their niche between the paediatric and adult medicine worlds.

According to Dr. Scrapello, "More and more professionals are dedicating themselves to Hebiatrics (specialty that corresponds to adolescence) and we are trying to promote training by promoting participation in courses, conferences, or other events to raise awareness and facilitate the development of human potential in this arena. Promoting adolescent health should be a health policy promoted by all states." He further states that the best in-facility adolescent practice is provided through "care practice, which must be interdisciplinary in its approach. It can be started with at least one who has such an approach and can understand the needs of the age, how to initiate care, together with the ability to carry out collaborative work with others. If we think in an ideal way, an interdisciplinary care team that has professionals trained in the area willing to work together and with an inter-institutional network in a friendly and accessible space would be an ideal for which to work."

On a community level, he continues, "a joint approach is required from the health system, education, family, and the community as a whole to facilitate adolescent healthcare. These are shared responsibilities upon which everyone must act in order to promote adolescent health. These community works must have clear coordination, goals, and objectives based on the local epidemiology or the situations that need to be resolved under the supervision of the state or government that facilitates the actions" 

The Indian Context

In the Indian context, there are 253 million adolescents in the age group of 10–19 years in India who are susceptible to several preventable health problems. Considering India has the largest population in this age group, the country needs to address their health issues as it will determine the country’s overall health, mortality, morbidity, and population growth scenario.

According to Dr. Sivakami Muthusamy, Professor, School of Health Systems Studies, Tata Institute of Social Sciences, "We cannot solve a problem that we do not measure. Indicators and systematic data measurement on all aspects of adolescents' health and developmental issues are limited in India, which poses a significant challenge in monitoring and communicating adolescents' health status at the national level. A robust mechanism is needed to collect routine data from adolescents, which would be monitored regularly to bring changes in the programme based on the demand and utilisation. Lack of intersectoral coordination across different health and developmental programs for adolescents significantly hinders timely clinical services, provision of information, advice and counselling."

Thus, investing in adolescent healthcare will help India to understand its demographic dividends. According to Professor Sivakami, "at the policy level, we must bring the voices of adolescents to understand their needs. Policies on adolescent health and development must also focus on the gatekeepers of the adolescents, such as parents, guardians, teachers, and religious and community leaders, and prepare them to support adolescents' needs. Implementing and enforcing various existing laws would go a long way toward providing adolescents with safety and preventing them from engaging in certain risky health behaviors. For example, to ensure better implementation of laws prohibiting the sale of tobacco products to minors near schools. Similarly, better implementation of the Prohibition of Child Marriage Act would save many young girls from adolescent pregnancy and other sexual and reproductive health complications."

Thus, to provide every adolescent– the right to health it is imperative to strengthen the service delivery, to prioritize and invest adolescent healthcare and develop and implement national quality standards for adolescent responsive health care services that are both technically sound and attractive to adolescents themselves.