SickKids contributes to framework to address global adolescent health and mortality

TORONTO - This week, as world leaders convene in New York City for the 71^st session of the United Nations General Assembly (UNGA), the momentum to bring adolescents and youth to the centre stage in global health and international development is palpable.

Adolescents are increasingly seen as a crucial group for the success of the newly adopted Sustainable Development Goals (SDGs). Embedded in the Agenda for Sustainable Development framework, the 2030 Global Strategy for Women’s, Children’s and Adolescents’ Health has extended the Every Woman, Every Child agenda to adolescence. Adolescence is a critical age group when major changes in health and health related behaviors occur, which may substantially dictate future health and prosperity.

Dr. Zulfiqar Bhutta, Robert Harding Chair in Global Child Health and Co-Director, Centre for Global Child Health at The Hospital for Sick Children (SickKids) is the senior author of an eight-paper supplement in the Journal of Adolescent Health: Interventions to Address Adolescent Health and Well-Being: Current State of the Evidence published on Wednesday, September 21, 2016. Dr. Miriam Kaufman, Head, Division of Adolescent Medicine, SickKids, is a co-author of one of the papers on sexual and reproductive health.

“The health of youth today is key to social and economic development of tomorrow,” says Bhutta who is also Founding Director of the Centre of Excellence in Women and Child Health at the Aga Khan University. “However, little information is available on evidence based actions to impact key health and nutrition outcomes in this age group, a focus of this collaborative effort between researchers at the SickKids Centre for Global Child Health and the Aga Khan University.”

Due to the success of child survival initiatives over the last few decades, there has been a dramatic rise in the population of adolescents especially in low- and middle-income countries (LMICs). A quarter of world’s population in 2012 (1.8 billion) comprised adolescents and young adults (10-24 years); of these, 90% lived in LMICs. Despite progress in child survival, there remains an unacceptable rate of mortality among adolescents, as an estimated 1.3 million adolescents died in 2012; 70% of these deaths occurred in Africa and Southeast Asia. The chances of dying during youth are almost two times higher in South Asia and four times higher in Sub-Saharan Africa than those in other regions.

“Until recently, global efforts to better the health status of adolescents focused on improving the outcome of pregnancies. Fortunately, we were able to find a number of interventions that address wider adolescent health issues. More work needs to be done, both in creating interventions and measuring their success,” says Kaufman.

The supplement identifies a set of interventions and delivery platforms to help prioritize areas of action for the global community and individual countries alike, where they can focus on improving adolescent health and reduce mortality in the adolescent period. It also identifies the gaps in literature and areas where more research is urgently needed. The papers cover interventions for the following areas:

• Sexual and reproductive health
• Nutrition
• Immunizations
• Substance abuse
• Mental health and violence
• Accidents and unintentional injuries

Unintentional injuries such as road traffic accidents and drowning are the leading causes of death in adolescents, while suicide, violence, infectious diseases, and teenage pregnancy are other important causes of mortality in this period. An estimated 330 adolescents die every day of road traffic accidents while 180 adolescents die every day from interpersonal violence. Among females aged 15-19 years, pregnancy-related deaths are the second leading cause of death after self-harm while road traffic accidents and interpersonal violence are the main causes of death among males in this age group.

Besides mortality, adolescents are also at risk of many nonfatal diseases and conditions that contribute to years lost to disability and disability-adjusted life years (DALYs) burden. Neuropsychiatric disorders, unintentional injuries, and infectious and parasitic diseases contribute to an estimated 70% of the years lost to disabilities for 10- to 24-year-olds.

Failure to invest in the health care of adolescents now will negatively influence the health of future generations. The Sustainable Development Goals provide an opportunity for renewed attention to meeting the health care needs of adolescents through the strengthening of health systems. To do this, the authors call for a specific focus on modes and channels of delivering targeted interventions via specialized health services, school-based delivery, youth organizations, community-based delivery, information communication technology, and mass media.

The preparation and publication of these papers was supported by the Bill & Melinda Gates Foundation (BMGF).