HEALTH FOR THE WORLD'S ADOLESCENTS

Implications for policy and programmes

This overview of determinants suggests nine implications for policy-making and programme design:

1. Focus beyond the individual. Understanding how a range of determinants affects adolescent health makes clear the need to think beyond individual-level interventions. Strengthening individual capacities is important, of course. Strengthening young people’s knowledge and skills is a necessary first step to health-promoting behaviours.

   Still, many important causative factors lie beyond the individual level. Research on determinants emphasizes the need to also work “upstream” from the adolescents themselves. It shows the importance of a range of interventions, from actions focused on the immediate environment, for example, supporting peers and parents, to actions directed to the social and political environment that aim to change pervasive discriminatory attitudes and policies, harmful social values and economic disparities.

2. Focus on both adolescent girls and adolescent boys. Gender attitudes and values are important determinants of adolescent health and development, for example, attitudes and norms that allow or encourage coercive sex, early marriage and early childbearing.₄₂ Much attention has focused on the vulnerability of adolescent girls,_43-46 but gender norms also adversely affect boys.₄₇ For instance, social norms and attitudes about masculinity may increase risk-taking behaviours and negative health outcomes (e.g. problem alcohol and drug use, driving under the influence of psychoactive substances, unsafe sex, and interpersonal violence) and may discourage help-seeking.₄₈
3. Focus on protection as well as risks. Young people want to be seen in a positive light, as actors, not as problems._{49 50} Focusing on protective factors and resiliency creates an assets-driven approach to adolescent health. Many influences and opportunities in the lives of adolescents have potential for both protection and risk. Examples include interactive communications technologies,₅₁ social networking technologies,₅₂ rapid social change₅₃ and migration._{54 55} So, while cyber-bullying is a growing problem during adolescence, nearly 50% of the respondents to the WHO global consultation of adolescents indicated that the Internet was an important source of health information.
4. Better advocacy for adolescent health policies and programmes. Understanding determinants provides a basis for advocacy. It clarifies how social and economic disparities, discriminatory policies and negative social norms, stigma, marginalization, and the disruption of families and communities are not only violations of adolescents’ rights, but also undermine adolescent health and development, with important public health and economic implications for the present and the future. Similarly, understanding determinants makes clear the need for policies and legislation that protect adolescents from the promotion of products and life styles that undermine their health and development.
5. Target interventions more effectively. Some risk and protective factors are difficult or impossible to change—for example, an adolescent’s age or sex, or their family structure. Other risk and protective factors can be changed, such as attitudes and perceived barriers about using condoms and other contraceptives_{56 57} and economic determinants, for example, through cash transfer programmes.₅₈

   However, all determinants are important to understand, even those that cannot be changed. This is because they both help define priorities for action and also assist with targeting interventions more effectively, by identifying particularly vulnerable groups.

6. Programme more strategically. Different risk behaviours often have common determinants,₅₉ and risk behaviours cluster in specific individuals and groups of adolescents as a result of their exposure to the same determinants.₆₀ Thus, strategies and interventions should address what is common across adolescents and their health problems, not only what is different. For example, programmes that strengthen family and school connectedness can decrease a range of risk behaviours and also contribute positively to adolescent development, improve physical and mental health,₆₁ foster development of their assets₆₂ and promote resilience.
7. Support the replication of interventions. Much of the evaluation research on interventions during adolescence has taken place in high income countries, and there are frequently questions about the applicability of the findings to low and middle income countries₆₃. An understanding of the determinants underlying adolescent health problems and behaviours in other contexts, whether they are the same or different, can help to guide decisions about replicating interventions in new and different settings
8. Strengthen collaboration among sectors. Since the determinants of health and health-related behaviours are diverse, many actors and sectors must respond. It is important to foster and invest in collaboration between different sectors and partners._{64 65} Many sectors, such as education, employment and criminal justice, are implementing policies and interventions that are directed to determinants of poor health and health-compromising behaviours. The health sector needs both to recognize these contributions and to strengthen and expand them (see Section 9).
9. Combine short-term and long-term interventions and solutions. The range of determinants argues strongly for combining short-term and long-term interventions. It can take many years to decrease the impact of structural determinants—for example, social and economic disparities and discriminatory social values and norms. In contrast, some individual-level changes, such as increasing adolescents’ knowledge, skills and aspirations, can be achieved more rapidly. Relatively rapid and measurable results are needed to keep decision-makers mobilized and engaged while attending to the long-term underlying determinants.