The idea of risk and protective factors derives from the field of public health. We've understood from the times of ancient Greece that lifestyle is related to health and disease. We now know that tobacco increases risks for later life diseases, such as lung cancer, emphysema, heart attacks and stroke. We therefore, refer to it as a risk factor for these later health problems. So too heavy alcohol consumption is a risk factor for cirrhosis of the liver. Obesity for type two diabetes and low physical activity for cardiovascular disease. We also know that social circumstances are associated with particular patterns of disease. Low socioeconomic statuses, for example, associated with higher rates of cardiovascular disease. These ideas have been adapted to thinking about the scope for promoting healthy child and adolescent development. In this context, risk factors are a little different to those used in public health. Risk factors are more social influences, perhaps from the family or community context that predict greater health problems or perhaps social adversity during the adolescent years. Protective factors are by contrast, positive influences on development. These may be nurturing and supportive relationships. Connection with institutions that promote healthy development. All the acquisition of skills, values and emotional resources that promote positive development across all aspects of life. These ideas about the broader social context, as well as more specific risk and predictive factors have been included in the conceptual framework that Susan presented in an earlier lecture. There is first, the broader. Social, cultural and economic contexts in which adolescents grow up. These include the overall economic development of the country, but also where in their country a young person may be growing up. In many large, middle income countries, the influence on health and development of a young person in an urban setting are quite different from those of an adolescent growing up in a poorer rural setting. Cultural and religious values, similarly have a great influence on identity, on health and the values that underpin health. Secondly, there are risk and protective factors that more typically relate either to attributes of the individual or the social context. One example of an individual attribute would be sensation seeking. It's a personality characteristic that heightens the likelihood of experimentation with sex, tobacco use, illicit drug use. Conversely, intelligence is an individual factor that is protective. Positive relationships with others that are also very protective. Positive connection with family, a connection with school and education that we discussed in the previous lecture and a connection and engagement with local community and peers who have a positive set of values and outlook on life. These are all protective. One common way of looking at this is to adapt the model of Urie Bronfenbrenner, one of the most influential developmental psychologists of the post-war years. His ecological systems theory proposes various levels of influence on the development of the individual through childhood and adolescence. Macro factors relate to the cultural values and attitudes that tend to persist over time within countries. At the next level down, there is the political, economic and service system environment in which development occurs. These macro factors in turn influence what happens at the next levels down. The more immediate influences on the young person's health and development are what happens in the community in the school in the families in which a young person is growing up. And ultimately, it is those a young person comes into contact with on a daily basis in these settings that have the greatest influence on their health and development. So why does this matter so much in adolescence? Looking at this slide of brain development during the adolescent years, we are increasingly coming to a view that adolescence is a phase in which the balance between emotion and emotional controls differs from that in other life phases. Good evidence of when our vulnerability for health and social problems and it is the quality of the social scaffolding during this period between these yellow lines, that influences whether or not young people develop many of the major health problems that emerge during the adolescent years and whether young people are able to achieve their full potential as they approach adulthood. So what does this social scaffolding look like in adolescence and how does it work? One useful perspective is the social development model of David Hawkins and Richard Catalano. It integrates a number of understandings about how social contexts influence health and development across childhood and adolescents. Social and emotional connections lie at the centre of this model of development. It is these relationships that an adolescent has with his family, her peer group, the school and the local community that lie centrally. Those connections fasted by the creation of opportunities to engage in those contexts and having the interpersonal and emotional skills to be able to engage. In a school setting, it's not only the skills of the young person that matter, but also those of the teachers. In the family settings, that's equally true of the skills that parents need in addition to those that the young person has acquired. Lastly, young people need to have the respect and recognition in those settings for the contributions that they're making. This is true at home, it's true at school. It's also true in the local community. Promoting greater connection by creating opportunities for engagement by teaching young people and they carry the skills to engage and insuring that young people are recognised for the achievements they make and the contributions they make are essential elements of the social scaffold for the adolescent years. Clearly, young people didn't bring different assets social emotional physical to their adolescent years. But getting all this right will mean that young people have a much greater likelihood of growing up with health promoting values and attitudes, your health risks behaviours and fewer health problems. Lastly, I want to take a look at how the social scaffold for health and development changes across these developmental years. So in this slide, adapted from the work of Neal Halfon, a US-based community paediatrician, I've tried to illustrate how the social contexts that influences the individual changes across childhood and adolescents. In very early life, family influences dominate. Later with the entry into education, the preschool and school met much more for the individual. The individual here acquires a set of capabilities that bring increasing independence. Community influences grow through childhood and adolescence as this independence also increases. But this pattern of development is likely to be quite different in low income settings, particularly in rural settings. Here the influence of family is likely to be much greater at all points in the life course, including the adolescent years. The influence of education is likely to be briefer and less pervasive in settings where retention is not so high. And the local village community is likely to have much greater influences on all aspects of health and health risk during the adolescent years. So during this lecture, I've tried to introduce a number of ideas about how the social context influences health and development during childhood and adolescents and how this changes over time. In the next lecture, I'll about the strategies to health action and the process for incorporating and understanding of risk and protective factors into health programs at levels from the national to the state to the district and to the local neighbourhood or village.
