SCENE: Three women in their early 20s meet at the food court of a shopping mall. The woman who organized the gathering clearly has something on her mind. It’s her boyfriend, Rob. He doesn’t want to use a condom. “But...he takes care of me,” the young woman says sheepishly in his defense. Her friends are clearly apoplectic at the notion. They pounce. “But nothing! Aren’t you still studying?” one friend asks. “Do you really want to have a child right now?” The other friend piles on, “You know this AIDS thing is spreading to women all over.” By the end of the 30-second television commercial, the young woman is convinced. If Rob wants to be a real man, he must wear a condom.
The ad, which ran in Trinidad and Tobago, was one of 30 television spots produced by PSI/Caribbean across 11 countries in the English-speaking Caribbean. The target audience for this ad was very specific: middle-class, “uptown” young women. The message was clear: insist your man wear a condom. Other ads produced by PSI/Caribbean as part of its Got It? Get it! campaign target the kind of young man who wears his machismo on his sleeve, poorer women, sex workers and other niche demographics. The goal of promoting condom use is the same across each group.
“The Caribbean is a very sexualized culture,” observes Kerry Singh, marketing and technical director for PSI/Caribbean. “Between reggae, dance hall and soca music, the average young person is put in a sexual light at a very young age.” The data bear out. According to a 2011 UNICEF report, Latin America and the Caribbean is the region with the highest proportion of adolescent females claiming to have had their sexual debut before age 15. There is no equivalent data for men, but, according to Singh, social pressures encourage young men to have children at a young age. “Among black Caribbean male youth, there is a tendency to think that once you are 17 and you don’t have a child on the way, there must be something wrong with you,” says Singh.
The challenges that these social pressures impose on public health are stark. The younger a girl is when she becomes pregnant, the greater the risks to her health. Complications related to pregnancy and childbirth are among the leading causes of death worldwide for adolescent girls between the ages of 15 and 19. And although AIDS is not a leading cause of death among young people worldwide, one-third of all new HIV infections involve young people aged 15-24.
Young people are a relatively healthy cohort compared with other age groups. The top killers are not disease but accidents – particularly motor vehicle accidents – and violence. Still, the World Health Organization (WHO) estimates that “two-thirds of premature deaths and one third of the total disease burden in adults are associated with patterns and behaviors developed in youth.” This includes tobacco use, unprotected sex and eating patterns that can lead to obesity.
Faced with this fact, there is a growing recognition that interventions targeted at promoting healthy behaviors of youth can have a long-lasting and positive effect on public health. “Even in places where risky behaviors are culturally ingrained, young people have shown that they can make big, substantial changes that have a public health impact,” says Paul Bloem, a technical officer for adolescent health at WHO.
This view is gaining wider acceptance in the global health community. In May 2011, the World Health Assembly approved a major WHO report on youth health issues. The accompanying resolution urges member states to “develop policies and plans to address the main determinants of health affecting young people, including health-related behaviors and their impact on health at later stages in life.”
“The international community needs to pay close attention to the specific needs of global youth,” says PSI CEO Karl Hofmann. “The behaviors that young people adopt today will have a major impact on the wealth, health and well-being of their communities over the next several decades.”
According to UN estimates, young people between the ages of 10 and 24 make up 27 percent of the world’s population. By 2032, the number of people in this cohort is expected to peak at 2 billion, with 90 percent living in low- and middle-income countries.
The global health community has traditionally not focused on this group, instead directing its efforts toward the health of children under 5 years old. The fact that a record number of young people are now coming into their adolescence speaks to the success of these interventions. It also presents a whole new set of health challenges that the world has not yet experienced.
Obesity is one such growing concern for developing countries. According to WHO, 65 percent of the world's population now lives in countries where more people die due to being overweight or obese than from being underweight. Close to 35 million overweight children are living in developing countries.
Almost no country suffers more from overweight and obesity than Mexico. About two-thirds of Mexican men and three-fourths of women are overweight or obese. “They talk about the three ‘Ts’ of the Mexican diet: tortillas, tacos and tostadas,” says Pamela Faura, country representative for PSI/ Mexico. In recent years, says Faura, substantial consumption of sugary juice drinks and American fast food has been added to the diets of young Mexicans.
To build momentum against this trend, PSI/Mexico conducted market research into a pilot campaign that would encourage young people to be more active and make healthier decisions. When launched, the campaign encouraged young people to engage in physical activities and shared information about nutrition and health. While limited in scale, the effort increased positive attitudes among youth toward water intake and physical activity and increased knowledge about the negative effects of drinking bottled juices and about what being physically active means.
If activities to promote diet, health and exercise are taken to scale, a Lancet study finds that up to 61,000 healthy life years could be gained in Mexico every year.
In 2009, the Nigerian government was debating an antidiscrimination law for people living with HIV. The law was a step forward, but one young woman living with HIV saw there was something missing in the proposed legislation. Like other young people living with HIV, Gloria had to lie about her status on her university application. At the time, being HIV-positive disqualified an applicant from accessing higher education.
With the support of the Washington, D.C.-based nonprofit organization Advocates for Youth, Gloria led a national campaign to reverse this law. She testified before the parliament and appeared in media in a successful bid to have the parliament include a provision on university admission in the non-discrimination law.
“Young people are leaders of today and absolutely the leaders of tomorrow,” says Advocates for Youth Executive Director Debra Hauser. “The more we work with them in partnership, the better off we are in helping them cultivate their own leadership skills as well as helping them become leaders in their communities.”
Gloria’s story underlines the extent to which empowered youth can be key agents of change. They are a critical demographic – a healthy adolescence and young adulthood not only leads to healthier aging populations, but healthier children. “Youth at this age will soon become parents and transmit their habits and environments to the next generation,” says WHO’s Paul Bloem. “People are realizing that this is the key period to intervene and to get behaviors right.”
– By Mark Goldberg, freelance writer, Washington, D.C.