Let's now move to a discussion of human rights, legal frameworks, and gender inequality, as important social determinants of adolescent health. Children have two types of human rights, under international human rights law. Firstly, they have the same fundamental general human rights as adults. Although, some human rights, such as the right to marry, are dormant until they are of a particular age. Secondly, they have special human rights that are necessary to protect them during their minority. General rights that operate in childhood include the right to security of the person, to freedom from inhuman, cruel or degrading treatment, and the right to special protection during childhood. Particular human rights of children include, among other rights, the right to life. The right to a name. The right to express his or her views in matters concerning the child. The right to freedom of thought, conscience, and religion. The right to healthcare. The right to protection from economic and sexual exploitation. And the right to education. The primary instrument for protecting and fulfilling the rights of children is the United Nations convention on the rights of the child, which sets out the civil, political, economic, social, health, and cultural rights of children and young people. The United Nations Convention on the rights of the child, reflects the international consensus on standards for insuring the overall wellbeing of all children and adolescents up to the age of 18 years. In addition to presenting a channel for advocacy and practical support for child and adolescent health, The United Nation Convention on the Rights of the Child provides the normative and legal framework for protecting children's rights across a broad spectrum of child and adolescent health and development. Every member of the United Nations is party to the Convention, with the exceptions of Somalia, South Sudan, and interestingly, the United States. Human Rights frameworks for children can be thought of as aspects of rights relating to the provision of care for children and adolescents, the protection of children and adolescents, and their right to participation. In terms of provision of care, for example, children and adolescents have the right to an adequate standard of living, healthcare, education and services, and to play and recreation. While in terms of protection, the United Nations Convention on the Rights of the Child recognises that the child, by reason of his physical and mental immaturity, needs special safeguards and care, including appropriate legal protection, before as well as after birth. In this regard, children have the right to protection from abuse, neglect, exploitation, and discrimination. This includes the right to safe places, the right to constructive parenting, and acknowledgement of the evolving capacities of children and young people. These rights are fairly widely acknowledged, even though there is still a very large implementation gap of many of these rights, for both younger children as well as for older adolescents. However, I'd argue that it's rights to participation that are even more challenging. While we might state that children have the right to participate in communities, including involving them as decision makers, this is far less commonly applied in practice. And for adolescents, we also need to appreciate that some laws are much more about controlling young people's behaviours than necessarily about supporting their autonomy to make decisions for themselves, and to participate in their own communities, in ways that make sense to them. On this slide, I've outlined a list of some of the laws that explicitly relate to young people, with a focus on sexual and reproductive health laws. What is fascinating about this list is that there are many different ages that apply within even a single country about these laws that relate to different aspects of adolescent behaviours and rights, as well as very significant differences between countries for the same law. A number of laws try to balance that notion of participation and protection. So for example, a number of countries have introduced what's called graduated licenses for drivers. For example here in Australia, specific restrictions apply within the first few years of driving, such as the requirement for a zero blood alcohol level, rather than the level of .05% for those with full licenses, due to the greater experience of driving. And in addition, there are limits on graduated licenses and the number of other people that can be in a car at one time, which similarly don't apply to more experienced drivers with full licenses. But there are laws, and there are laws. The presence of a law in the statute books is important, but there is a wide range of customary laws that deal with standards that have been long established in a particular community. And how well a law is able to be implemented will depend on how well matched it is to community expectations. So in a given country, there may indeed be no laws preventing unmarried girls from obtaining contraception. But access to contraception for unmarried girls might be highly restricted in practice, because of the religious beliefs within a particular community, or because of particular community expectations in another community about what unmarried girls should or shouldn't do, in terms of sexual behaviours. So this is Clarisse, who's 17 and from Chad, who said when she was 14, her mom and her sisters began to prepare food and my dad asked my brother, sisters and me to wear our best clothes, because we were about to have a party. Because I didn't know what was going on, I celebrated like everyone else. It was that day that I learned it was my wedding and that I had to join my husband. I tried to escape, but was caught. So I found myself with a husband three times older than me. This marriage was supposed to save me from debauchery. But school was over, just like that. And ten months later, I found myself with a baby in my arms. One day I decided to run away, but I agreed to come back to my husband, if he would let me go back to school. I returned to school, have three children, and I'm in the seventh grade. Really brave young woman, in terms of her efforts to continue her participation in education, despite being married against her will. So much for child marriage laws. But gender or sex inequality remains a major barrier to human development. And during adolescence, it is the time that young women and young men begin to take on adult gender roles in all spheres of life, ranging from personal, to family life and to work. National, political, and economic opportunities for young women, together with cultural and religious gender norms, affect young people's exposure to risk and protective factors for health in a way that is highly gendered. Sex inequalities commence from early adolescence. For example, girls have poorer indicators of well being, such as self-rated health and life satisfaction in comparison to boys. Yet boys have higher levels of injury and overweight, in comparison to girls. Countries with greater sex inequality, have poorer heath outcomes for both sexes after adjustment for national wealth, which suggests that sex inequality is detrimental for both young men as well as young women, a fact that I think is perhaps, insufficiently appreciated. The Gender Inequality Index is one attempt at measuring gender disparity, which was introduced in 2010, in the Human Development Report by the United Nations Development Program. The Gender Inequality Index is a composite measure, which captures the loss of achievement within a country due to gender inequality. It has three dimensions for this particular index, namely reproductive health, empowerment, and labor market participation. The intent is that as none of the measures and the dimensions pertain to a country's level of development, a less-developed country could perform well if gender inequality were low. Within the Gender Inequality Index, the dimension of reproductive health has two indicators, the Maternal Mortality Rate and the Adolescent Fertility Rate. A low Maternal Mortality Rate implies that pregnant women have access to adequate health needs, therefore, the maternal mortality rate is a good measure of women's access to health care, with the understanding that women's health during pregnancy and child bearing, is a clear sign of women's status in society. A high Adolescent Fertility Rate, which measures early childbearing, results in health risks for mothers and infants, as well as a lack of higher education attainment. According to the UNDP data, reproductive health accounts for the largest loss, due to gender inequality among all regions, and I'll show this in a graph later on. If we turn to the empowerment dimension in the gender inequality index, it's measured by two indicators. The first is the share of parliamentary seats held by each sex, and this is measured in national parliament rather than local government or community involvement. And although women's representation in Parliament has been increasing, women have been disadvantaged in representation of Parliament with a global average of only 16%. Higher education attainment is the second indicator, as access to higher education expands women's freedom by increasing their ability to question, and increasing their access to information, which expands their public involvement. Women's access to education generally reduces the adolescent fertility rate, as well as child mortality rates within a country, which is why it's considered so important. Now, gender inequality plays out across virtually every sphere of life. And the example I've put up in this graph is education, where darker colours represent higher levels of gender discrepancy by education, including participation, and the presence of legal or cultural restrictions for girls. The third aspect of the gender inequality index is the notion of labor market participation. But sadly, in the absence of reliable earned income data across countries, labor market participation is a proxy measure for economic aspects of gender inequality. The world average gender inequality score in 2011 was .492, indicating a nearly 50% loss in potential human development due to gender inequality. And it's for this reason, that I've spent so much time in terms of thinking of gender inequality, as a key social determinant of health. For those who are interested, the highest ranked countries, in terms of gender equality are the Netherlands, Sweden, Denmark and Switzerland. Whilst the lowest ranked countries are the Central African Republic, Mali, Sierra Leone, and Mauritania.
