Thetripledividendofinvestinginadolescents

GlobalStrategyforWomen’sChildren’sandAdolescents’HealthTargets—alignedwiththeSDGs

SURVIVEEndpreventabledeaths

• Reduceglobalmaternalmortalitytolessthan70per100,000livebirths

• Reducenewbornmortalitytoatleastaslowas12per1000livebirthsineverycountry

• Reduceunder-5mortalitytoatleastaslowas25per1000livebirthsineverycountry

• EndepidemicsofHIV,tuberculosis,malaria,neglectedtropicaldiseasesandothercommunicablediseases

• Reduceby1/3 prematuremortalityfromNCDs andpromotementalhealthandwell-being

TRANSFORMExpandenablingenvironments

• Eradicateextremepoverty

• Ensurethatallgirlsandboyscompletefree,equitableandgoodqualitysecondaryeducation

• Eliminateallharmfulpracticesandalldiscriminationandviolenceagainstwomenandgirls

• Achieveuniversalandequitableaccesstosafeandaffordabledrinkingwaterandtoadequatesanitationandhygiene

• Enhancescientificresearch,upgradetechnologicalcapabilitiesandencourageinnovation

• Providelegalidentityforall,includingbirthregistration

• Enhancetheglobalpartnershipforsustainabledevelopment

THRIVEEnsurehealthandwell-being

• Endallformsofmalnutrition,andaddressthenutritionalneedsofadolescentgirls,pregnantandlactatingwomenandchildren

• Ensureuniversalaccesstosexualandreproductivehealth-careservices(includingforfamilyplanning)andrights

• Ensurethatallgirlsandboyshaveaccesstogoodqualityearlychildhooddevelopment

• Substantiallyreducepollution-relateddeathsandillnesses

• Achieveuniversalhealthcoverage,includingfinancialriskprotection,andaccesstoqualityessentialservices,medicinesandvaccines

Adolescents'HealthChallenges

Sources:HealthfortheWorld’sAdolescents.2014www.who.int/maternal_child_adolescent/topics/adolescence/second-decade &others

Sources:TrendsinMaternalMortality,1990-2013;LevelsandTrendsinChildMortality,Report2014.

Women'sHealthChallenges

Children'sHealthChallenges

Sources:TrendsinMaternalMortality,1990-2013;LevelsandTrendsinChildMortality,Report2014.

TheTripleDividend

RiskFactors• TobaccoUse• UnhealthyDiet• PhysicalInactivity• HarmfulUseofAlcohol

• HPVInfection• AirPollution• Genderbasedviolence/intimatepartnerviolence• EarlyMarriage

1.DuringAdolescence

Estimatedtopfivecausesofadolescentdisability-adjustedlifeyears(DALYs)lostbymodifiedWHOregion,2015.

2.Laterinlife

PrevalenceofCurrentCigaretteSmokingAmongYouth13-15yearsold,byWHORegion,2007- 2014

8 9 10 10 11 11 12

0

5

10

15

20

25

WesternPacific

EasternMediterranean

South-EastAsia

Global Europe Americas Africa

Percentageofyouth13-15yearsoldwhowereofferedfreecigarettesamples

Source:GlobalYouthTobaccoSurvey

Youthareprimarytargetsofsamplingandvalueincentivespromotedbythetobaccoindustry

Youtharemorelikelytosmokeifexposedtotobaccopromotion

Obesity• Adolescentobesitystronglypredictsadultobesityandassociated

morbidity,thecaseisevenstrongerwhenconsideringthematernalandintergenerationalhealthrisksofobesityinyoungwomen.

• Adolescentshavegreaterautonomyaroundfoodchoicesandaremorelikelytoeatoutofthehome,whichoftenleadstolesshealthyfoodchoices.Exposuretomediainfluencesandsusceptibilitytoprocessedfoodmarketingalsoincrease.

• Preventionofoverweightandobesitythroughtaxationofunhealthyfoods,restrictionoffastfoodadvertising,andpromotionofphysicalactivityinschoolandinthecommunity.

Cervicalcancer

• 270000deathseachyearworldwide.• About80%ofthecervicalcancersworldwideoccurinlow-income

countries• HPVvaccinationtobecost-effectiveandparticularlybeneficialinlow-

incomecountries,whichdonothaveaccesstogovernment-fundedcervicalscreeningprogrammes.Additionally,thebenefitofHPVvaccinationishighestamongwomenwithlowincomes.

IntimatePartnerViolence

• Thehealthconsequencesofintimatepartnerviolenceincludethoserelatedtophysical(eg,injuryordisability),sexualandreproductive(eg,HIV/AIDS),andmental(eg,anxietyordepression)health,aswellasdeath(eg,maternalmortalityorhomicide).

• 29%ofever-partneredgirlsaged15-19yearshavebeensubjectedtophysicaland/orsexualviolencebyacurrentorformerintimatepartner

Disease/injuryresultingfromviolence Effectsize(95%CI)

Unipolardepressivedisorders OR=1.97(1.56to2.48)

Alcoholusedisorders OR=1.82(1.04to3.18)

Suicide OR=4.54(1.78to11.61)

3.Intergenerational

Intergenerationallink- Earlylifeprogrammingisnowthoughttobeimportantintheaetiology of

obesity,type2diabetes,andcardiovasculardisease,openingupthepossibilitythatthesecommondiseasescouldbepreventedbyachievingoptimalfetalandinfantdevelopment.

- Mountingevidencelinkingmaternalobesityduringpregnancytoobesityinthechildren

- Maternalsmokinghasbeenlinkedtoanincreasedriskofobesityinthechildren

- Childmarriage

GestationalDiabetes• TheriskofdevelopingGDMincreasessignificantlywithincreasesinpre-

pregnancyBMI.RiskofGDMinoverweightwomen(BMI25.0–29.9)increasedmorethantwofoldandinobesewomen(BMI30.0–34.9)andseverelyobesewomen(BMI35.0–39.9),approximately3.5- and8.5-fold.

• ThepresenceofGDMincreasestheriskofeitherrestrictedorexcessfetalgrowth(macrosomia),fetaladiposity,predispositiontoobesitythroughoutlife,impairedglucosetolerance,T2DM,andmetabolicdisordersintheinfant.

Interventions

Life-yearsgainedfrominterventions

Life-yearsgainedfrominterventionstargetingNCDs

Lowincome

Lower-middleincome

Upper-middleincome

Total

Alladolescents 0.9m 3.6m 1.4m 5.9m

Maleadolescents

10–14years 0.1m 0.2m 0.1m 0.4m

15–19years 0.3m 1.3m 0.5m 2.1m

Femaleadolescents

10–14years 0.1m 0.2m 0.1m 0.4m

15–19years 0.5m 1.8m 0.7m 3.0m

HumanpapillomavirusvaccinationprogrammeDeathsduetocervicalcanceraverted(overlifetimeofadolescentstreated)

1.9m 2.5m 0.7m 5.1m

AccesstoServices• Adolescentsandyoungadultshavethepoorestlevelofuniversalhealth

coverageofanyagegroup• Barriers

– Externaltohealthservices• Legalframeworksgoverninghealthactions• FinancialbarriersandOut-of-pocketcosts• Culturalandcommunityattitudes,e.g.provider’sattitudesandbeliefs

– Developmentalcontextofadolescence• Increasingdesireforprivacyandconfidentiality,withembarrassment,shame,andfearofbeingjudgedrestrictingaccesstohealthcare.

• Concernisthattheirparentswillbeinformedaboutsensitiveissues,e.g.insuranceclaimsanditemised bills

AccesstoServices– cont.– Increaseswhen

• livingwithdisabilitiesorchronicillnesses• livinginremoteareasorcaughtupinsocialdisruptionfromnaturaldisastersorarmedconflicts

• stigmatizedandmarginalizedbecauseofsexualorientation,genderidentityorethnicity

• institutionalized,orexposedtodomesticviolenceorsubstanceabuseinthefamily

• exploitedandabused• married,orwhomigrateforworkoreducationwithoutfamilyorsocialsupport

• Multi-sectorapproach

Toolsetc.• AA-HA!

http://apps.who.int/iris/bitstream/10665/255415/1/9789241512343-eng.pdf?ua=1

• H6toolkithttp://www.everywomaneverychild.org/h6-toolkit/

• APracticalToolkitforYoungPeopletoAdvocateforImprovedAdolescentHealthandWell-beinghttp://www.who.int/pmnch/knowledge/publications/advocacy_toolkit.pdf?ua=1

• HPV,HIVandcervicalcancer,leveragingsynergiestosavewomen’sliveshttp://www.unaids.org/sites/default/files/media_asset/JC2851_HPV-HIV-cervicalcancer_en.pdf