Adolescent health has been gaining attention in the past decade (Levine and others 2008; UNICEF 2011; WHO 2014; World Bank 2007). As described by the Lancet Commission on Adolescent Health and Wellbeing (Patton, Sawyer, and others 2016), the adolescent years are crucial for the development of human capital. During adolescence, neurocognitive and pubertal maturation interact with the social determinants of health, creating a highly dynamic profile of health as individuals pass from childhood through adolescence and into adulthood (Sawyer and others 2012).
During these years, the burden of disease rises, including the burden of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), mental disorders, and injuries. At the same time, new health risks emerge in response to biological maturation (sexual behaviors); marketing of unhealthy products (tobacco; alcohol; foods high in sugar, salt, and fats); and community attitudes, traditions, and values (female genital mutilation, lack of access to secondary education, support for too early marriage, unsafe work practices). Due to the extent of neurocognitive maturation, increasing participation in education and changing social contexts, adolescence is also a time when interventions to improve adolescent health outcomes can expand beyond families or health services to the wider settings in which adolescents learn, participate, and engage. Actions to improve adolescent health are most effective when embedded in contemporary understanding of adolescent development and prevention science (Catalano and others 2012), which underscores the importance of engaging with young people themselves as they become more active agents in their own lives (Patton, Sawyer, and others 2016).
Patterns of disease burden and health risk vary widely between countries as they progress through the epidemiological transition. As undernutrition, infectious and vaccine-preventable diseases, HIV/AIDS, and reproductive health needs are brought under control, the burden of road traffic injuries, violence, chronic physical disorders, mental disorders, and substance use becomes more prominent (Patton, Sawyer, and others 2016). Actions to improve health in adolescence need to include a wider range of health concerns in addition to sexual and reproductive health, and they also need to extend beyond treating disorders to addressing their root causes, including poverty and homelessness, lack of education, disability, minority sexual identity, indigenous status, and other causes of social marginalization in adolescents.
Following a brief review of the developmental context of adolescent health, this chapter categorizes countries according to their excess burden of disease and then describes six platforms that can be used to deliver health actions to adolescents (ages 10–19 years): health services, schools, media and social marketing, community, mobile health (m-health), and structural actions. The chapter discusses the rationale of these platforms for delivering health treatments for established health issues, for responding to emerging needs, and for preventing future health problems. It also emphasizes the importance of matching actions to health needs, responding to differences between and within countries, and aligning actions across platforms spanning different sectors, including health and education.
A key message relates to how knowledge of adolescent development promotes understanding of why different platforms are needed to deliver actions for adolescent health. While the term “action” is used interchangeably with the term “intervention,” action is preferred when describing the need for multicomponent interventions that require more than one platform and interventions that are more distal to the individual. The term “platform” is used to describe the mechanism or infrastructure that is required to deliver actions or interventions (health services, schools, laws). In reading the text, it is important to remember that nearly all of the data and evidence come from studies of programs in high-income countries (HICs). We cannot say with any certainty the extent to which the results presented here apply to low- and middle-income countries (LMICs). This limitation is a particular challenge in planning and selecting interventions for this age group and emphasizes the need for much more research into the health of adolescents in LMICs. Definitions of age groupings and age-specific terminology used in this volume can be found in chapter 1 (Bundy, de Silva, and others 2017).
© 2017 International Bank for Reconstruction and Development / The World Bank.