Flavia Bustreo, Ex- Assistant Director-General, formerly Family, Women's and Children's Health cluster, WHO
Adolescents are not simply old children or young adults. This deceptively simple observation lies at the heart of Global Accelerated Action for the Health of Adolescents (AA-HA!): Guidance to support country implementation, which reflects the coming of age of adolescent health within global public health.
For years, the unique health issues associated with adolescence have been little understood or, in some cases, ignored. But that has now changed. Adolescent health and development was made an integral part of the Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030) (The Global Strategy) because, in the words of the United Nations Secretary-General, “[adolescents are] central to everything we want to achieve, and to the overall success of the 2030 Agenda”.
Why “central”? Because investments in adolescent health bring a triple dividend of benefits for adolescents now, for their future adult lives, and for the next generation. Their health and well-being are engines of change in the drive to create healthier, more sustainable societies.
In 2014, the WHO report Health for the World’s Adolescents showed that considerable gains from investments in maternal and child health programmes are at risk of being lost without corresponding investments in adolescent health. The latest data show that more than 3,000 adolescent die every day from largely preventable causes, and that many key risk factors for future adult disease start or are consolidated in adolescence. Adolescent mental health and well-being are often overlooked.
This Guidance is a milestone for translating the Global Strategy into action. It provides a wealth of information to policy-makers, practitioners, researchers, educators, donors, and civil society organizations – including the most upto- date data on the major disease and injury burdens that affect adolescents. It supports the implementation of the Global Strategy by providing the comprehensive information that countries need to decide what to do for adolescent health, and how to do it. It builds on on-going efforts to ensure that adolescents can Survive, Thrive and are in a position to Transform the societies in which they live.
But the guidance provides much more than facts and figures. It brings a paradigm shift about how we think about and plan for adolescent health.
First, the AA-HA! Guidance addresses adolescence not only through the conventional public health lenses of risk and protective factors, but also considers adolescents to be powerful societal assets whose contributions can be nurtured and augmented through meaningful engagement and participation. The level and quality of inputs to this document from adolescents and young people, including vulnerable groups, lend considerable weight to its recommendations.
Second, the guidance takes a radically different approach to traditional adolescent health programming. In the past, adolescent health advocates have had to look for “entry points” – such as HIV, or sexual and reproductive health – to access funding to address broader adolescent health issues. We argue that the triple dividend from investing in adolescent health is enough rationale for directing attention and resources to adolescent health in its own right, while making the case for “adolescent health in all policies”. In that respect, it recommends key actions that are needed in sectors as diverse as education, social protection, urban planning and the criminal justice system, in order to respect, protect and fulfil adolescents’ rights to health.
Third, there is a growing realization that adolescents often face disproportionate risks in humanitarian and fragile settings – including poor physical and mental health, harassment, assault and rape. Adolescent-specific considerations for programming in humanitarian and fragile settings have therefore been explicitly included.
Finally, this guidance not only provides information on what needs to be done – it demonstrates what is already being done. More than 50 case studies from across the globe provide concrete examples of how countries have done what is being promoted.
The partnership that was created while developing this interagency guidance sets the stage for a new era in global adolescent health. Coordinated by WHO, the guidance was developed with the active participation of UN agencies; civil society organizations; academics; governments; and most importantly, young people themselves. This model of engagement puts young people in the driver’s seat, consistent with the powerful motto “nothing about us, without us.”
At WHO, we believe that this is just the beginning. We look forward to this partnership developing and expanding to support the implementation of the AA-HA! guidance in countries, to ensure that adolescent health and development remains at the centre of national, regional and global health agendas.