Adolescent and School health: A Global Health MatterAccording to World Health Organization (WHO), adolescent health refers to the variety of strategies involved in preventing, identifying and treating teens and young people, as well as maintaining their health and well-being. Adolescent health and well-being encompasses the physical, emotional, social and metal health of adolescents that enable them participate fully in the family, school and community units. Adolescents consist of teenagers and young people, therefore, the term Adolescent Health is often used interchangeably with Youth Health.
WHO defines ‘Adolescents’ as individuals aged between 10-19 years, ‘Youth’ aged between 15-24 years and ‘Young People’ covers the age range of 10-24 years including all adolescents and youths. About 1.2 billion people, or 1 in 6 of the world’s population are adolescents, hence, it is important to understand that Adolescents are heterogeneous people who exist in various situations and possess different needs. The adolescent stage of human development is naturally accompanied with dramatic physical, sexual, psychological and social developmental changes, all occurring simultaneously. Consequently, this presents a critical period of information acquisition and decision making that ultimately increase risks to health and well-being. According to Centers for Disease Control and Prevention (CDC), it is easier and more effective to acquire healthy behaviors during adolescence than trying to change unhealthy behaviors in adulthood.
Generally, adolescents are considered a healthy group as a result of high immunity of young people and absence of chronic diseases due to old age. However, many adolescents have died prematurely from accidents, substance abuse, drunkenness, suicide, violence, pregnancy related complications and other illnesses that are either preventable or treatable. Others are victims of hereditary diseases, long-term debilitating ill-health and disability. In addition, many serious diseases, illness or premature death later in adulthood have their origin in adolescence; for example, tobacco use in adolescence may lead to lung cancer in adult life; risky sexual behaviors may result in incurable, immune-compromising sexually transmitted infections including HIV/AIDS; poor eating and exercise habits lead to obesity and other weight related illnesses; some mental health disorders (such as depression) in adulthood start by age 14, but most cases are undetected and untreated.
Adolescent health is important because illnesses can hinder their ability to grow, develop and reach their full potential in life. Adolescence is an exciting stage of life full of self-discoveries and youthful exuberance. Adolescent behaviors may be influenced at the individual, peer, family, school, community, and societal levels. At the start of this period, many adolescents begin to mature and develop physically. They also become adventurous, trying out many new things which may compromise their health. This is why most preventable health risk behaviors are often started during adolescence and continue into adulthood, contributing to the leading causes of death. Some of these risky behaviors include substance abuse, drunk driving, violence, unprotected sexual intercourse and other poor behaviors which are began within the adolescent age range. In 2015, an estimated 1.2 million adolescents died- over 3000 daily, mostly due to preventable or treatable causes. For this group, road traffic injuries, respiratory infections, suicide, complications from pregnancy and childbirth, diarrheal diseases, and drowning are the major causes of death. Among girls aged 15 to 19 years, there are 44 births per 1000 annually.
To improve the health of young people, many sectors of the society should contribute to adolescent health, safety, and well-being- a collaborative effort that engages multiple partners. Government agencies and International organizations such as WHO, CDC and United Nations initiate or participate in producing evidence-based guidelines to support health services and other sectors, making recommendations to governments on adolescent health, providing high quality, age-appropriate health services, documenting progress in adolescent health and development, designing adolescent focused interventions and raising awareness of health issues for young people among the general public and other interested stakeholders.
The school environment is considered the best place, to develop healthy behaviors since schools have direct contact with millions of students daily during the most critical years of their social, physical, and intellectual development- adolescence. Research has shown that school health programs reduce the prevalence of risky behaviors among young people as well as have a positive effect on academic performance. Consequently, schools play a major role in promoting the health and safety of young people as well as helping them establish lifelong healthy behaviors.
Adolescents are pre adults or teenagers who may no longer be considered to be children. This group consists of young people between the ages of 10 and 19 years, and are often thought of as a healthy group. Nevertheless, many adolescent deaths result from accidents, suicide, violence, pregnancy related complications and other illnesses that are either preventable or treatable.
Adolescenceis one of the most rapid phases of human development characterized by increased engagement of many young people in sexual risk behaviors that can result in unintended health outcomes. This increase in sexual risk behaviors is demonstrated by the following statistics from the United States Centre for Disease Control and prevention (CDC).
• 41% of adolescents have had sexual intercourse
• 30% had sexual intercourse during the previous 3 months, and, of these, 43% did not use a condom the last time they had sex and 14% did not use any method to prevent pregnancy
• 21% had drunk alcohol or used drugs before last sexual intercourse
• Only 10% of students surveyed in the US have been tested for human immunodeficiency virus (HIV)
• Mostly adolescents accounted for an estimated 22% of all new HIV diagnoses in the United States in 2015
• Half of the nearly 20 million new STDs reported each year were among adolescents and young people, between the ages of 15 to 24
• Nearly 230,000 babies were born to adolescent girls aged 15–19 years in 2015
Adolescent health is an important topic because sexual risk behaviors are major public health concerns. These behaviors are the most common public health problem associated with this group, placing these teenagers at a high risk for HIV infection and other sexually transmitted diseases (STDs) as well as unintended pregnancies.
To prevent or decrease sexual risk behaviors and related health problems among adolescents, schools and affiliated organizations should promote the adoption of lifelong attitudes and behaviors that support their health and safety. This includes health education, health promotion and appropriate reinforcement to adopt and sustain healthy choices and behaviour. CDC’srecommendation for routine medical care includes a HIV test, especially for sexually active adolescents and adults.
Abstinence from vaginal, anal, and oral intercourse remains the only 100% effective way to prevent HIV, other STDs, and pregnancy. Additionally, the accurate and consistent use of condoms can reduce the risk of STD transmission while birth control pills reduce the risk of unwanted pregnancies only. However, no protective or control method besides abstinence is 100% effective, and condom use cannot guarantee absolute protection against any STD or pregnancy.
Programs and initiatives targeted towards adolescent sexual awareness include data collection and analysis, science-based guidance, funding to state and local departments of education and national nongovernmental organizations, research, evaluation and partnerships.
Culture is broadly defined as people’s way of living. It reflects the method of thinking, customs and attitudes of a group of people, community or country. Culture is not constant- overtime, it evolves and changes in different ways. The speed at which culture evolves differs in different places with the odds of change increasing significantly as a result of migration.
The impact of culture on health is broad, especially for youth who may struggle with change in cultures when they migrate from one environment or location to another. Culture affects how health, illness, death, disease and approaches to health promotion, are perceived, experienced and expressed as well as where patients go to find help or the types of treatment they prefer. Everyone, including health professionals and patients, is influenced by their respective cultures while health systems in general are shaped by the mainstream beliefs of historically dominant cultures. In health systems, cultural bias may result due to differences in the perception and preferences in health-related services.
Cultural competence is a skill that creates and increases the awareness, existence and reality of the cultural differences in a group. It is practised when health professionals acknowledge and ask about various beliefs and to incorporate this awareness into patient diagnosis and treatment planning. The importance of cultural competence lies in the fact that demonstrating awareness of patients’ culture promotes trust, efficient health care, improves treatment adherence and leads to higher rates of acceptance of diagnoses.
Health is perceived through culture and all cultures have health belief systems that explain the cause and cure of illnesses. Youth health is particularly influenced, to a great extent, by how much they believe health education and promotion is relevant to their culture. This then translates to how they receive the information provided as well as how willing they are to adopt the available information. In industrialized countries such as the United States and Canada, disease is viewed as a result of natural scientific phenomena, consequently, they advocate medical treatments that combat microorganisms and use advanced and innovative technology to diagnose and treat diseases. On the other hand, some non-industrialized countries and societies such as Nigeria believe that some illnesses are a consequence of supernatural phenomena and as a result promote prayer and other spiritual interventions to combat the forces that are responsible for the diseases.
This basic difference and understanding on how culture differs between and within countries reflects culture influences youth health.
Globally, sports remain one of the most popular and widespread activities among youths and children. More so, Football and Swimming are two of the most engaging sports all over the world.
Participation in sports has important benefits for physical, psychological, and social health. Youth development programs based on sports promote a wide range of learning and life skill acquisition. Sport participation encourages a healthy and happy lifestyle and reduces common issues faced by many youths such as obesity and depression. It also fosters physical and emotional health as well as encourages valuable social connections among participants. Besides these health benefits, sport involvement teaches and allows youth to form and strengthen relationships, value self-improvement over winning, remain relevant in a competitive society and work culturally with each other and authorities. It provides opportunities for play, exercise or physical activity and self -expression, acting as a healthy alternative to negative activities such as drug abuse and crime involvement.
Research shows that high school student-athletes are less likely to drop out of school and more likely to go to college.
On an international level, sports act as a uniting force which breaks barriers of differences by creating competition and entertainment. Sport involvement reduces differences in societies and communities which makes it a powerful tool for support and conflict prevention or resolution. Furthermore, a 2008 report on Sport for Development and Peace documented that sports contribute significantly to international, national and local efforts to offer children a healthy start. Sport also equips youth with the information, skills and support needed to transit the key stages of life smoothly and successfully.
Like most good things in life, sports can have some demerits if abused. They become detrimental to health and create negative experiences if overly focused on competition and winning at all costs and disregards the healthy development of youth. These negative experiences may result in low self-esteem, lead to negative relationships, encourage poor sportsmanship, permit aggression and violence, allow discrimination or give room for psychological, sexual and commercial exploitation and abuse. In addition, youth are more susceptible to sports injury due to high degree of training and incomplete development of their musculoskeletal system. According to the U.S. Centers for Disease Control, about 30 million children and adolescents participate in sports just in the United States. Among these participants, approximately 2 million injuries, 500,000 doctor visits, and 30,000 hospitalizations are reported each year. Common types of sports-related injuries among youth include sprains, strains and repetitive motion injuries.
To ensure that youth development remains at the center of all sports activities, sports-based youth development (SBYD) theory and practice model is used in programs to place the mental and physical health of a youth over their athletic success. This model ensures free or subsidized programming to reduce the barriers low-income youth face in accessing sports. Additionally, sports coaches should be chosen carefully, ensuring that they emphasize a positive development experience for youth.
Some successful youth icons include:
1. Katie Ledecky, Swimmer
2. Simone Biles, Gymnast
3. Jordan Spieth, Golfer
4. Evgenia Medvedeva, Skater
5. Chloe Kin, Snowboarder
6. Auston Matthews, Hockey
7. Kilian Mbapper Soccer player
Empowerment means equipping and arming people with the knowledge , potential and requirements to become independent or self sufficient in order to achieve a goal. Youth empowerment is a process where young people are encouraged, supported and equipped to take charge of their lives. Empowerment requires addressing negative or limiting situations so as to take action in order to improve access to resources and consciously transform oneself through beliefs, values, and actions. The aim of youth empowerment is to improve the quality of life of young people and increase dependence on oneself. This is achieved by creating and encouraging participation in youth empowerment programs such as training, education and information sessions or workshops.
Around the world, several youth empowerment models and programs are used to help youth achieve empowerment. These programs are available through non-profit organizations, government organizations, schools or private organizations, individual foundations. Some youths often take the initiative to empower themselves by seeking and taking advantage of these programs. Over the years, various social action and empowerment movements, including youth empowerment, educate the girl child, poverty alleviation and women empowerment spring up, and become institutionalized. Youth empowerment is often described as a marker of development, as well as a roadmap to economic growth, intergenerational equity, civic engagement and democracy building. This is because many activities such as education, business, media, rights, leadership and activism focus on the youths due to increased youth involvement in community decision-making.
The importance and benefits of youth empowerment to individuals, families, communities and nations cannot be overstated. The rationale behind empowerment is to enable participation and enhance control through shared decision making by creating opportunities to learn, practice, and increase skills. Empowerment theory predicts that engaging young people in social, knowledge-acquiring and community-enhancing activities which they define and control, allows them to gain essential skills, responsibilities, and confidence necessary to become productive and healthy adults. Youth empowerment ensures the existence of the five competencies of a healthy youth: (1) positive sense of self, (2) self- control, (3) decision-making skills, (4) a moral system of belief, and (5) pro-social connectedness.
Empowerment takes various forms and considers six interdependent areas including individual, community, organizational, economic, social and cultural.
Individual empowerment enhances individual’s consciousness by increasing awareness and knowledge of problems and solutions. This creates self-confidence and sufficiency in decision making and problem solving thereby increasing the quality of life. Community empowerment focuses on community enhancement through leadership development, communication, and networking to address community issues. Organizational empowerment creates a resource base for the community, including organizations and associations that protect, promote and advocate for the less privileged. Economic empowerment provides training and entrepreneurial skills including how have income security. Social empowerment teaches youth about social inclusion and literacy as well as promotes proactivity. Cultural empowerment highlights and emphasizes cultural practices, rules and norms.
These different forms of empowerment help to develop the youth in one or more aspects of their lives. The overall aim of youth empowerment programs is to create healthier and higher qualities of life for underprivileged and at-risk youth.
Employment is the process of being hired as employee, for a wage, salary, fee or payment to perform or carry out a task, work or job for an employer. Employment is an important marker of development, and can be used to predict how well a country is doing economically. Countries where there is low youth employment usually have very high crime rates since people will often find other means- including illegal ways, to make money.
As determined by John Maynard, unemployment like inequality, is one of the major loopholes of capitalism. Clearly, the link between unemployment and inequality rests on the fact that the inability to obtain a job results in poverty which is the major determinant of inequality resulting from class and status. Youth employment reduces crime and poverty, increases productivity, generates revenue in forms of taxes and creates a sense of responsibility and fulfilment among the youths. Employment helps youth to provide and maintain support for government projects, producing useful outputs. It also generates respect for, and feelings of self-worth in, the workers employed in these projects.
Employment offers several benefits which are available to employees based on the type, length and agreement of the employment. Eligible employees include full and part-time staff hired into permanent, probationary, temporary, term or hourly position, scheduled to work at least 20 hours per week and whose length of employment is at least six months. Some common benefits of employment include:
• Health Insurance including Dental and Vision Insurance
• Basic and Department Life Insurance
• Supplemental Life Insurance
• Disability (Short Term/Long Term) Insurance
• Deferred Compensation
• Retirement Benefits
• Pension
According to a 2012 study on employment and health, employed people showed better self-reported health and longstanding wellness or wellbeing compared to the unemployed individuals. More so, the unemployed were more likely to smoke compared to the employed. Consequently, there is need for on-going job empowerment or health promotion and vocational rehabilitation efforts targeted towards unemployed youth in order to reduce the negative health, social and economic effects associated with unemployment.
Sport is a type of physical activity- defined as any bodily movement produced by skeletal muscles, requiring the expenditure of energy. Lack of physical activity has been identified as the fourth risk factor for worldwide mortality, causing approximately 3.2 million deaths. Being a type of physical activity, it is easy to see and understand the benefits of engaging in sports. Participation in sports is beneficial for all ages, gender and body types because it promotes physical, social and mental health through cardiovascular conditioning, team mindset and stress relief respectively. There are various kinds of sports and some remain more relevant or popular in some parts of the world, they include: Football, Basketball, Tennis, Badminton, Javelin, Shotput, Running, Jumping, skating, Handball, Soccer, Skiing, Bowling, Cycling, Swimming, Squash, Hockey, Volleyball, Boxing…. And much more!
Football and Swimming for example are very common in many parts of the world. These sports are also entertaining in nature and can serve many purposes in the form of recreation, leisure, revenue generation and entertainment. Typically, Football is a global sport played with a spherical ball between two opposing teams constituting of eleven players in each team. Football is played by over 250 million people in over 200 countries, making it the world’s most popular sport. The game is played on a rectangular field with a goal post at each end of the field. The aim of football is to score goals by getting the ball into the opposing goal post and the team with the highest number of goals wins. Swimming on the other hand is an individual or team sport which involves the use of arms and legs to move the body through water. The sport takes place in pools or open water bodies such as rivers, seas and lakes. Swimming is one of the most popular Olympic sports, having distance events in butterfly, backstroke, breaststroke, freestyle and individual medley. The aim of swimming as a sport event is to win competitors by being the fastest swimmer in any given event, as well as break personal or world records.
A good number of scientific evidence support the positive effects of engaging in sports and physical activities as part of a healthy lifestyle. These positive effects of regular physical activity are particularly obvious in the enhancement of the functional capacity of older people, as well as the improvement of quality of life and independence. Sports can also help in the prevention of chronic diseases, including: cardiovascular disease, diabetes, cancer, hypertension, obesity, depression and osteoporosis. A report by the United Nations Inter-Agency Task Force on Sport for Development and Peace states that young people can benefit from physical activity since it contributes to healthy bone development, efficient heart and lung function and improved motor skills or cognitive function. Physical activity can also help to prevent hip fractures among women and reduce the effects of osteoporosis.
Furthermore, studies have shown that sports have positive effects on depression and plays therapeutic roles in addressing a number of psychological disorders. Self-worth, including body image, has been linked to exercise and sports. Sport and physical activity can make substantial contributions to the well-being of people in developing countries as they are used in the treatment and rehabilitation of communicable and non-communicable diseases. Sports, from running track to playing football are exercises that act as stress reducers by causing the brain to release chemical neurotransmitters known as endorphins, which create euphoric feelings and reduce stress. Simply put, a mind focused on a game is not focused on worries.
Obesity is a worldwide health problem affecting all socio-economic groups, irrespective of age, sex or ethnicity. It is an established risk factor for cardiovascular disease, causing significant public health concerns in many countries. A World Health Organization study on nearly 130 million people, including 31.5 million children aged 5-19 years of age, found that the number of obese children and adolescents rose from 11 million in 1975 to 124 million in 2016. This showed that an additional 113 million children became obese within this period- a tenfold increase!
Obesityhas been shown to threaten the feasibility of basic health care delivery as it increases the risk of morbidity and mortality, especially in children and adolescents. The increased prevalence of childhood and adolescent obesity in addition to the potential health implications, have emphasized the need for obesity-related services including research and assessment, treatment and care, as well as prevention and policy making. In the United States, average weight in children has increased by greater than 5 kg when compared to the last three decades. Despite the persistence of economic hardship and poor nutrition, low and middle-income countries report similar or more rapid increase in child obesity just as the wealthy and high-income countries.
Childhoodand adolescent obesity is caused by a multitude of factors including genetic, physiological, endocrine, metabolic, psychological, environmental and socio-cultural. Other factors that promote obesity are children’s choices, diet and physical activity. Poor diet and physical inactivity have increased dramatically in the 21st century, emphasizing processed, unhealthy foods and drinks and sedentary lifestyles. In this advent of technology, children have also become particularly exposed and vulnerable to the marketing, low price and widespread availability of energy-dense and nutrient-poor unhealthy foods and drinks- there is evidence to support that marketing of unhealthy foods and drinks to children is related to childhood obesity.
Immediate and long-term impacts of child and adolescent obesity on physical, social, and emotional health include: increased risk of chronic health conditions and diseases such as asthma, sleep apnea, bone and joint problems, type 2 diabetes and heart disease; high tendency to be bullied and teased more often than their normal weight peers; increased likelihood of social isolation, depression, low self-esteem; and increased potential for adult obesity.
Co-morbid conditions associated with obesity include metabolic, cardiovascular, orthopedic, neurological, hepatic, pulmonary and renal disorders.
The treatment of overweight and obesity in children and adolescents requires a holistic, multidisciplinary, multi-phase approach which includes dietary management, physical activity enhancement, restriction and regulation of sedentary behavior, pharmacotherapy and bariatric surgery. Policies targeted towards nutrition and child obesity should promote healthy growth, secure household nutrition and provide children with incentive to be active and chose foods of good nutritional quality. To properly address the challenge of child and adolescent obesity, the governance of food supply and food markets as well as commercial activities must be improved, and primarily aimed to protect and promote children’s health.
Globally, over 100 million children work in hazardous environment in various sectors including agriculture, mining and domestic labor. On some farms, children work long hours under extreme weather conditions, exposed to nicotine and toxic pesticides that cause sicknesses. In Africa, Asia, and Latin America, child laborers work underground, using toxic mercury to process gold, increasing the risk of brain damage and other serious health conditions. In Nigeria more specifically, child labor remains a major source of concern despite many legislative means to end it. The number of children under the age of 14 who work in Nigeria is estimated at 15 million. Common examples of jobs Nigerian children are involved in include street vendors, beggars, car washers, bus conductors and shoe makers. Others leave their families at an early age to work as apprentices, mechanics, hairdressers, tailors, house maids, domestic servants and farm hands. The most common practice of child labor in Nigeria is the use of children as child domestics or domestic maids.
International Labor Organization (ILO) defines child labor as any work that deprives a child of his or her childhood including the potential for personal, social, emotional, physical and mental development. Most countries define children by age- In Nigeria for example, a child is defined as an individual who is below eighteen (18) years of age. There are various kinds of child labor with the most extreme case involving slavery. Factors that determine if some kinds of work can be termed child labor include: the age of the child, the type and number of hours worked, the conditions under which the work is performed and the objectives or purpose of the work in the individual countries. Work which constitutes child labor refers one to one or more of the following:
- Any work that is mentally, socially or morally dangerous
- Any work that interferes with schooling by taking away the opportunity to attend school or that requires combining school attendance with excessively long and heavy work
- Any work that is physically harmful to health or safety, by its nature or the circumstances in which it is carried out, and condones any form of abuse
- Any work that constitutes slavery such as the sale and trafficking, debt bondage and serfdom and forced or compulsory labor, including forced or compulsory recruitment of children for use in armed conflicts
- Hawking and unwilling separation from loved ones or abandonment at a very early age
- The use, acquisition or offering of a child for prostitution, pornography illicit activities and drug trafficking
Research shows that child workers exhibit poor educational achievements because they have insufficient time to study, rest and engage fully in school activities. Major causes of child labor include widespread poverty, rapid urbanization, breakdown in extended family connections, high school drop-out rates, and lack of implementation of laws designed to protect children. Sadly, children are made to work in order to contribute to family’s income and survival. Monies earned by children have become a significant part of income in poor families. These children often experience fatigue, irregular attendance at school, lack of comprehension and motivation, exposure to risk of sexual abuse and involvement in crime either as perpetuators or victims and drop out from school.
Thankfully, international organizations such as Human Rights Watch and ILO work to abolish child labor and to ensure that all children are protected from jobs that interfere with their health, safety, and education.
Tropical Climates are generally described as dry climates in which there are average temperatures of at least 18 °C (64 °F). The tropics are characterized by hot and humid weather as well as abundant rainfall due to the active vertical uplift or convection of air. In areas that have tropical climates, there are usually two seasons- the wet and the dry seasons only. Typically, these kinds of climates, located around the equator, feature no frost and have limited changes in the solar angle. Temperatures in tropical climates remain relatively constant- mostly hot, throughout the two seasons of the year. There are three variations of the tropical climates and they include:
- Tropical rain forest climate: In cities like Kismu, Kenya and Santos, Brazil
- Tropicalmonsoon climate: In cities like Kochi, India and Libreville, Gabon
- Tropical wet and dry climate: In cities like Lagos, Nigeria and Naples Florida in the United States
As stated earlier, the major characteristic of tropical regions is the persistence of high temperatures almost all year round. High temperatures have health impacts and consequences in countries and geographical locations with tropical climates. This is because temperature has an important influence on the presence and survival of insect vectors that cause vector-borne infectious disease. Specifically, warm temperatures are known to enhance vector breeding as well as facilitate the maturation period of pathogens within vector organisms. Of most significance are various species of mosquito vectors, which transmit diseases such as malaria, dengue fever and yellow fever. This perpetuates the death toll of malaria since adult mosquitoes thrive mostly in warm tropical temperatures because they need humid conditions to remain viable.
The sensitivity of diseases to climate is demonstrated by the fact that diseases such as malaria are mostly confined to tropical and subtropical regions. This climatic sensitivity is also illustrated by the increased transmission of malaria in deserts and highland fringe areas where there are high temperatures and rainfall. Additionally, diarrhoeal diseases vary seasonally in the tropics, suggesting sensitivity to climate. They typically peak during rainy seasons emphasizing that floods and droughts increase the risk of diarrhoeal diseases. Important etiologic agents of diarrhoea linked to heavy rainfall and contaminated water supplies are: Cryptosporidium, E. coli, Giardia lambia, Shigella dysentrae, and Hepatitis A virus.
Given their humidity, many tropical areas provide the desired environment required for the adaptation of their various domicile plants and animals. The tropics are homes for many small animals including monkeys, birds, snakes, rodents, frogs, and lizards. Many of these animals and a multitude of insects remain on trees, never setting foot on the ground- using the tall trees for shelter and hiding places from their predators.
