World Health Organization

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

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. • 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.

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 "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 Male Female 1 2 3 4 5 6 7 8 9 10 HIV Maternal conditions Malaria Respiratory Tract Infections Tuberculosis Suicide Diarrhoea Road traffic accidents Fires Other unintentional injury Road traffic accidents Malaria Respiratory Tract Infections Other unintentional injury Drowning Homicide Suicide HIV Diarrhoea Tuberculosis • Accidents are leading cause of death among adolescents in European Region

9. The global Obesity pandemic Source HBSC

10. Youth suicide in CEE/CIS1989-1998 Male/female ratio = between 2 and 5 rates per 100,000 15-24 year olds

11. Central and Eastern Europe 430,000 35% 65% 33% 67% East Asia & Pacific 740,000 Industrialized Countries 240,000 49% 51% Latin America & Caribbean 560,000 38% 31% 62% 69% South Asia 1.1 million 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 Middle East & North Africa 160,000 69% 31% Source: UNAIDS/UNICEF, 2002 8 July 2002 – XIV 3

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

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 locallyAct locally, think globally