A second chance in the second decade

What determines differences in health and disease?


Unpacking determinants

Determinants affecting the health of adolescents may be proximal or distal to the adolescent. That is, they may work at the level of the individual adolescent or in the adolescent’s environment—both the immediate environment of family and friends and the wider environment created by national and even global values and political choices.

The influence of different determinants on indigenous adolescents Determinants

Individual characteristics that act as proximal risk and protective factors include age, gender, knowledge, aspirations (for example, a strong belief in the importance of staying at school13) and self-efficacy (such as the ability to resist peer pressure14).

The immediate environment is the sources of many determinants, including families15 (for example, caring parental relationships and the positive mental health of care-givers, or exposure to violence and victimization16); peers (for example, the attitudes of peers towards condom use, one of the factors that determines whether an adolescent will use condoms); teachers and schools,17 service providers and other significant adults in the lives of adolescents.18

WHO recognizes

In the WHO global consultation with adolescents, nearly 40% said that love and support from familiar, trusted people was what made them feel most safe, emphasizing the protective role of these relationships. Conversely, they were clear that lack of such support has negative effects. In response to the question, “What makes you sad?”, the leading cause selected by respondents was family conflict and feeling a lack of social support.

Adolescents are aware of the importance of their immediate environment. Nearly 50% of the respondents to the WHO global consultation indicated that they received information about health from their family.

Social values and norms are important underlying determinants, affecting many aspects of an adolescent’s life. They are often particularly insidious, as their effects cascade onto all the other levels of the ecological model. For example, gender norms have impacts in many ways—at a structural level, reflected in inequalities and restrictions in jobs and education; at a more proximal level in terms of family decisions about allocation of resources and the relative importance of education for boys and girls; and at an individual level, influencing adolescents’ expectations, what they feel they should or should not do, what they judge to be “right” and “wrong”.

Gender norms Promundo publications

Policies and laws, which often reflect dominant political positions and social values, also have effects that permeate all aspects of young people’s lives. They can either diminish or perpetuate the social and economic disparities that undermine adolescents’ health; they can either inhibit or encourage stigma and discrimination.

Policies also affect adolescents’ exposure to marketing by the tobacco,19 alcohol,20 food and beverage21 and fashion22 industries, which encourage behaviours that may have both immediate and long-term adverse effects on their health and development. They can also influence adolescents’ use of such products through taxation, health warnings and restrictions on access. Even further away, global economic policies and trade agreements, which embody the dominant values of international relations and political influence, have impacts on adolescent health at local levels.

Video by American University

Social determinants, the conditions in which adolescents live, grow and develop, which are shaped by the distribution of money, power and resources23 affect adolescents’ health in complex and interrelated ways.

While social determinants affect health at all ages, for several reasons they may be particularly important during the adolescent years24:

Interview with Sir Michael Marmot who discusses the effects social and economic policy has on adolescent health. The Lancet TV, 2012
  • They have an impact on the rapid physical and neurological changes taking place that influence health now and in the future.
  • They affect the initiation of health-compromising behaviours with both immediate and long-term effects, including on transitions to adulthood.
  • Their impact during adolescence is likely to be cumulative, the continuation of harmful physical and emotional environments that started during the first decade of life.

The physical and biological environment. In addition to the social environment, the biological environment (e.g. prevalence of malaria, water-borne helminths or HIV) and the physical environment (e.g. housing and pollution) are also critical determinants of adolescent health.25 These may have differing effects on adolescent girls and boys. For example, if safe and separate private sanitation facilities are not available within school grounds for menstrual hygiene, girls may miss school during menstruation or drop out of school completely.26 The built environment, safe places to walk and cycle, safe reliable and affordable public transport all have many health benefits, from decreasing air pollution, and road injuries to reducing obesity.27 28

Just over 15% of the respondents to the WHO global consultation with adolescents cited a lack of physical security as the main cause of feeling sad—a statistic that highlights the correlation between the physical environment and mental health.

The physical environment A photomontag

Adolescents on what makes them sad: The situation in my country. To not have a way to get products that are very important like medicine, food and hygienic products. Injustices and unemployment.

female, 18-19, Venezuela

I have a group of very close friends who looked out for me when I needed them most. I then talked to my parents and then saw a doctor about my situation. Since then I have been much happier and more content.

male, 15-17, United Kingdom

My country is poor, especially in this post-conflict era, and there are many risks to my health. Daily life is costly, and health care is difficult to access

male, 18–19, Burundi

I often use websites that allow for anonymous communication.

male, 18–19, Canada

The conditions in my country are so unsafe that I couldn’t just take a leisurely walk or do any sort of exercise outside, like running.

female, 18–19, Venezuela

Adolescents on what makes them sad: To see the situation not only in my city but in my country. To know that in my city the government can’t finish a simple public transportation project. Not being able to walk the streets without being in fear.

female, 15–17, Mexico

I get sad when I see indigenous people begging on the street, sick with skin diseases like vitiligo, breathing the dirty, smoggy air that they’re exposed to all day under the hot sun, to see other people begging for food, seeing that they’re dirty and sometimes mentally ill, begging to no avail and being exposed to the difficult life on the streets.

female, 18-19, Mexico

Adolescents on what can be done to improve their health: To protect the development of my country.

male, 18–19, Democratic Republic of Congo

The support, presence, tenderness, trust and above all the love of those close to me make me feel safe.

female, 15-17, France

Adolescents on what makes them feel safe: To see that the results of my efforts are becoming reality for myself and for others.

female, 18-19, Peru

Adolescents on what can be done to improve their health: Intervene and inform us more, create a web site where we can talk online with a psychologist, nurse, doctor, etc. Especially on the Internet and Facebook, as we are young and we tend to use these technologies very often.

female, 15–17, country not specified

Adolescents on what makes them feel safe: Knowing that my family and friends are there supporting me and that their reasons for not letting me do something is because they care about me or feel like I can do better.

18-19, Female, Thailand

I feel like I am safe when I am at school.

12-14, female, Malawi

Adolescents on what makes them feel safe: Having confidence in myself and in my potential.

male, 15-17, Venezuela

I usually procrastinate homework, and I have gotten into an habit when I "need" to do something funny and relax on my iPhone 30 minutes before I sleep. This combined leads to a habit where I go to sleep late

female, 15–17, Norway

I am currently drinking water from the well and we share with animals, my mosquito net is torn and I do not have money to buy a new net and drought has hit our area and am not eating well balanced food.

male, 18–19, Uganda

My culture/environment does not encourage exercise. For instance, housing areas are not fit/safe/appropriate for a morning jog.

female, 18–19, United Arab Emirates