2.7 Social determinants of adolescent health: human rights and gender

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Global Adolescent Health

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The University of Melbourne

Global Adolescent Health

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This course will explore the dynamic factors affecting the health and wellbeing of young people around the world, and how important it is for individuals, communities and nations that we improve the health and life chances of this important population group. With over 25% of the world’s population aged between 10 and 24 years, today’s generation of young people is the largest in human history. As the future leaders and drivers of growth, productivity and innovation, young people are our greatest assets, and investment in their health and wellbeing has social, economic and other benefits that continue across the lifespan and into the next generation. In this course we will adopt a life-course framework to take a holistic view of youth health and wellbeing. We will explore changing patterns of adolescent health and development, including why adolescence is starting earlier and ending later; how puberty and adolescent brain development may shape future health; and how what happens in adolescence can affect the start to life for the next generation. We’ll also look at the major health and social issues affecting young people and ways of addressing these through policy, practice and programming. COURSE FORMAT: This course comprises short video lectures and interviews, required and recommended readings, online discussion, quizzes and written assignments. There is no required text for this course and all readings are provided. DO I HAVE TO PAY FOR THIS COURSE? No- you may access 100% of material in this course for free. You are also welcome to do as much or as little of the course as you like, including all (or none!) of the assessment tasks- it all depends on your learning goals. The option to pay for this course is there for those who wish to receive a Course Certificate as evidence of completion (which does require you to attempt and successfully pass the assessment tasks). WHO IS THIS COURSE FOR? This course will be relevant for anyone with an interest in the health and wellbeing of young people. You do not need to be of any particular personal or professional background to benefit from this course, but having some basic undergraduate study experience will be helpful to your learning (particularly if in a health related field). WHAT IS THE MOST INTERESTING THING I'LL LEARN IF I TAKE THIS COURSE? You’ll learn how so much of what happens during adolescence can impact not only the future health of individuals, but the health of the next generation as well. You’ll develop a greater understanding of the key factors impacting upon youth health and learn how to be a better advocate for the health and wellbeing of young people. View the MOOC promotional video here: http://tinyurl.com/z5l4mod

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Week 2 - Introduction to adolescent health: developmental and ecological perspectives (Part II)

This week we return to our conceptual framework and unpack the key concepts of social determinants of health and risk and protective factors. We explore what these terms mean and how they influence and shape adolescent health and development. We also begin to apply this knowledge at a practical level in terms of the interventions and actions we can take to improve or maintain health and wellbeing during the adolescent and young adult years, or prevent problems from happening in the first place.

2.1 Revisiting the framework6:43

2.2 Risk and protective factors: concepts9:43

2.3 Risk and protective factors: implementation11:57

2.4 Risk and protective factors: peer relationships6:04

2.5 Risk and protective factors: families, education and communities8:10

2.6 Social determinants of adolescent health: economic factors8:16

2.7 Social determinants of adolescent health: human rights and gender13:58

2.8 Social determinants of adolescent health: population displacement8:42

2.9 Social determinants of adolescent health: advertising and marketing9:33

2.10 Socially disadvantaged adolescents5:27

Interview with Prof Craig Jeffrey (UK/Aus) 22:40

Interview with Prof Rima Afifi (Lebanon/USA) 22:47

Interview with Baroness Susan Greenfield (UK) 21:06

Rencontrer les enseignants

Professor Susan Sawyer
Chair of Adolescent Health
Department of Paediatrics
Professor George Patton
Professorial Fellow
Adolescent Health Research

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.

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