The last group of social determinants I want to review are those that relate from increasing advertising and marketing to young people, the rise of consumer culture and the contribution of social media to young people's health. And I've put together this collage here that I think George had also used last week to really highlight some of these influences that we'll now go through. The first I want to highlight is the notion of unhealthy products. I would have liked to have put up here a set of immediately recognisable global brands, relating to tobacco, alcohol, hamburgers, or sugar-rich drinks, such as McDonalds or Coca-Cola, as it's these brands that so well reflect the extent of globalisation of advertising and marketing across the world. However, for copyright purposes, we can't, so I want you to imagine the slide full of branded images. But let's start on the left by thinking about tobacco, because this is, I think, a really important example to consider. And we'll come back to tobacco later on in our course, as well, in terms of thinking about policy responses to the tobacco epidemic. Tobacco is a legal product that, despite very clearly defined health consequences, continues to be sold commercially due to the extent of advertising and marketing, and in the context of nicotine dependence. The tobacco industry disproportionately sets out to target and recruit young smokers, because once young smokers are dependent on nicotine, adults then typically have decades of smoking ahead of them. Interestingly, as ever tighter laws are brought into play that are successfully reducing the rate of smoking in high income countries, so the tobacco industry has increasingly moved to create new markets, firstly in middle income countries, and increasingly, as well, in low income countries, through advertising and marketing. And young people across the world are highly susceptible to such advertising with its allure of social success, as can be seen by the dramatic increase in the rates of smoking in young people, in countries that historically had very low smoking rates. For example, over the past few years, Indonesia is a country that has experienced some of the highest per capita increases in the repulsion of young people who now smoke, with previous gender norms that had functioned to protect women from smoking, also being increasingly broken down. Growing marketing of alcohol across the world is having similarly devastating effects on the health of populations, including adolescents. With alcohol being a significant contributor to interpersonal violence within families, and within individuals obviously, a contributor to road traffic accidents, and also to poorer sexual health outcomes. And one only has to be aware of the outcry from high energy food and beverage marketers that gives some indication of the extent of their concerns about how possible taxation of added fat or sugar to food and drinks, might significantly limit their income. Yet, clearly the extent of overweight in obesity in adolescents across the globe is extremely worrying in terms of young people's health currently, as well as their future health, in terms of the risk of non-communicable diseases. So, for example, Type II Diabetes was hardly ever seen in adolescents, even a few decades ago. But sadly, it's now just all too common place in very overweight adolescents, with a future health risks of adolescent obesity being really quite profound. But marketing and advertising is not just around unhealthy products, but is also around unhealthy attitudes, unhealthy gender norms. For example, unhealthy attitudes to the body can create quite unrealistic expectations about appearance and sexual attraction, not just for young women, as has historically long been the case in high-income countries, but increasingly for young men as well. And I draw your attention to the image in the middle here, the shadowed image, that you or I might guess is highly modified in terms of the waist shape of this woman that's air brushed away almost to nothing. But for adolescents who don't have the sophistication of interpreting such images, take at face value these types of images as role models, for which they would like their own bodies to replicate. Now, many of these attitudes have distinct consequences for health. Some relate to the use of specific products by adolescents, such as the application of skin whitening agents, or protein supplement drinks by young men, with an expectation of bulking up their musculature. Other attitudes can result in behaviours with more explicit health risks. For example, body image dissatisfaction leads to dieting behaviours with increasing risks for eating disorders, while the increasing demand for plastic surgery to, for example, reduce the sizes of women's noses in the Middle East, or to change the appearance of the eyes of Asian women, carry with them distinct surgical risks. Now we know that social media provides an important opportunity to connect young people to each other, an important opportunity to reach the young in terms of health promotion. But it also brings with it, risks to health. Due to the unprecedented reach, and in particular the speed with which new ideas can be promoted or promulgated within particular groups of young people. As a community, we are still clearly in our infancy when it comes to understanding both the opportunities provided by social media for health, let along the challenges to health that can also result. The notion of social contagion is an interesting one for us to think about. It's long been understood in relationship to the phenomena of what's now described as copycat suicide, a phenomena that was first described by Goethe in the 1700s. And this is where a highly publicised death of a celebrity is followed by an increased rate of suicide using the same means. And this phenomena, or copy cat phenomena social contagion, has been similarly invoked to explain the dramatic increases we've seen in young people with very diverse behaviours impacting upon health, ranging from bulimia nervosa, to self harm by cutting, the sewing of lips together by asylum seekers. And even school shootings, a phenomena that was previously only seen within the United States of America, but is now sadly seen much more widely. In all these cases, one can appreciate how social engagement, whether at a face-to-face level,fuelled but particularly fuelled by social media, can dramatically increase the uptake of certain ideas, which have unprecedented reach when compared to old forms of media and communication. I was in Istanbul in 2013 for the International Association of Adolescent Health Conference, which happened to coincide with the protests at Taksim square, where many young people were demanding their democratic rights in relationship to transparency of government. In that case, social media was being very overtly used to bring protesters together, so overtly used that in its anger, the government jammed the Twitter feed. And increasingly, the up cry from the young meant this stance was unable to be sustained by the Turkish government. However, the development of social media sites such as Grindr are interesting. Grindr uses GPS to connect strangers who wish to have sex, one with another in the same vicinity. And already, this would appear to be linked to increasing rates of sexually transmitted infections in those individuals who access such sites and services. Do you think such sites should be more strongly promoting safer sex messages as well? Something to perhaps think about.