2.8 Social determinants of adolescent health: population displacement

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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

À partir de la leçon

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

In this lecture, we'll focus on the notion of population displacement,

as a key social determinant of health in adolescents.

Population displacement can occur as a result of natural disasters, such as

typhoons, earthquakes, and tsunamis, with very significant population movements.

It can occur from manmade disasters, such as war, and

from other forces, such as immigration, whether as refugees,

or as rural populations move to more urban regions,

either within the same countries or, indeed, to different countries.

Adolescents normally benefit from the influence of adult role models,

social norms, and structures, community groups,

the notion of social scaffolding in their lives.

But when people are displaced, family and social structures are disrupted.

Adolescents may be separated from their families or communities,

while formal and informal educational programs are discontinued,

and community and social networks break down.

Adolescents may be scared, stressed, bored or idle.

They may find themselves in risky situations that they are not prepared for

dealing with, and they may suddenly have to take on adult roles

without preparation, support, or positive adult role models.

Adolescents who live through crises may not be able to visualise a positive

outlook for themselves, and may develop fatalistic views about the future.

The loss of livelihood, security, and protection provided by the family and

community, places such adolescents at risk of poverty,

of violence, and sexual exploitation, and abuse.

While rural to urban migration is typically associated with

perceptions of greater opportunities for education and employment for

the young, there are also risks to health.

These risks can result from the break down of the capacity of families and

communities, to provide a safe and supportive environment for young people.

Or, due to greater risks that result from large numbers of people living at

close quarters, such as road traffic accidents, interpersonal violence,

social alienation, stress,

and the impact of thwarted expectations, especially around employment or

relationships, can contribute to increased mental health concerns,

sexual health risks, and substance use.

It's interesting to think about what proportion of the world's population

is living in large cities, including megacities,

cities that have a population of greater than ten million people.

Now, in about 1950,

it was thought that about 30% of the world's population lived in cities.

That increased to about 50% in the mid-2000s,

and it's estimated that by 2015,

about 60% of the world's population will be living in cities.

And similarly if we go back to the 1950s, where there was one mega city and

I'd ask you to think about which city you might think that might have been,

about 10 years ago it was thought that there were about 23 megacities,

populations greater than 10 million.

And in the next few years, it's estimated that there will be 36 megacities

in the world today, with over two-thirds of them in Asia.

Interestingly, in the next few years, it's also estimated that nearly 60% of

the population that lives in cities, is living in mega cities.

Given the proportion of the population, thought to be between about 30 to

50% of mega cities, who live in the equivalent of urban slums,

this is particularly concerning in terms of their health.

Whether that's in terms of lack of security of clean water,

of regular food, of safe housing, or indeed, greater exposure

to a range of physical, emotional and sexual and reproductive health risks.

In terms of population displacement, an important consideration is women's

physical safety, which is not only a basic human right, but

highly relevant to their sexual and reproductive health.

According to the UN global agency, UN AIDS, up to seven

in every ten women globally suffer violence from men in their lifetime.

It is much harder and often impossible for women to negotiate for safer sex, for

example, if they live in an environment of violence or fear of violence,

which is more common in the context of population displacement.

The executive director of another UN agency, UNFPA,

Babatunda Osotimehin said, we will not be able to stop HIV,

and improve women’s and girls’ health, until we empower women,

advance gender equality, and engage men and boys in this effort.

Intimate partner violence is associated with heterosexual transmission

of HIV to women.

For example, married Indian women, who are physically and

sexually abused by their husbands, have a four fold increased risk of HIV infection,

compared to women who are not abused by their husbands.

And in a number of parts of the world, including India, despite reductions

recently in the prevalence of HIV infection among the general population,

women account for a rising percentage of all HIV cases,

with husband's risk behaviour described as the major source of women's infection.

Displaced adolescents are at greater risk of sexual exploitation and abuse.

Because of their limited life experience, they may not recognise the sexual

nature of abusive or exploitative actions in strange settings.

Adolescents separated from their families, and adolescent heads of household, lack

the livelihood security and protection afforded by the family structure, and

are therefore more at risk from poverty,

as well as from sexual exploitation and abuse.

Separated adolescents, and adolescent heads of household,

may also be compelled to drop out of school, marry, or sell sex in order to

meet their basic needs for food, shelter, or, indeed, protection.

Adolescent girls selling sex are then at risk of unwanted pregnancy,

unsafe abortion, greater risk of STIs and HIV,

as well as sexual exploitation and abuse.

And survivors of sexual and gender based violence are similarly

at risk of unwanted pregnancy, unsafe abortion, STIs including HIV,

as well as mental health, psychosocial problems, and social stigmatisation.

An example in post-earthquake Haiti is that a significant proportion

of survivors of sexual violence treated by various non-government organisations,

such as Médecins du Monde, were adolescent and even pre-pubescent girls.

And we shouldn't forget that adolescents who are associated with

the armed forces or other armed militia groups

because in these environments, both boys and

girls are often sexually active at a much earlier age, and

sadly face increased risk of sexual violence and abuse,

mental health issues including post traumatic stress disorder, and

in the same range of sexual and reproductive health complications such as

unwanted pregnancy, unsafe abortion, STIs, and HIV infection.

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