48. Young people in some parts of the world suffer from poor health as a result of societal conditions, including such factors as customary attitudes and harmful traditional practices and, in some cases, as a result of their own actions. Poor health is often caused by an unhealthy environment, by missing support systems in everyday life for health promoting patterns of behaviour, by lack of information and by inadequate or inappropriate health services. Problems include the lack of a safe and sanitary living environment, malnutrition, the risk of infectious, parasitic and water-borne diseases, the growing consumption of tobacco, alcohol and drugs, unwarranted risk-taking and destructive activity, resulting in unintentional injuries.
49. The reproductive health needs of adolescents have been largely ignored. In many countries, there is a lack of information and services available to adolescents to help them understand their sexuality, including sexual and reproductive health, and to protect them from unwanted pregnancies and sexually transmitted diseases, including HIV/AIDS.
Proposals for action
1. Provision of basic health services
50. All young people should have access to basic health services in the interest of all and of society as a whole. It is the indispensable responsibility of each Government to mobilize the necessary awareness, resources and channels. These measures should be supported by a favourable international economic environment and by cooperation.
51. Efforts should be expedited to achieve the goals of national health-for-all strategies, based on equality and social justice, in line with the Declaration of Alma Ata on primary health care 8/ adopted on 12 September 1978 by the International Conference on Primary Health Care, by developing or updating country action plans or programmes to ensure universal, non-discriminatory access to basic health services, including sanitation and drinking water, to protect health, and to promote nutrition education and preventive health programmes.
52. Support should be provided for stronger, better coordinated global actions against major diseases which take a heavy toll of human lives, such as malaria, tuberculosis, cholera, typhoid fever and HIV/AIDS; in this context, support should be continued for the Joint and Co-sponsored United Nations Programme on the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS).
53. Poor health is often caused by lack of information and lack of health services for youth, mostly in developing countries. The resulting problems are, among others, sexually transmitted diseases, including infection with HIV; early pregnancies; lack of hygiene and sanitation, leading to infection, infestation and diarrhoea; genetic and congenital diseases; psychological and mental diseases; narcotic and psychotropic drug abuse; misuse of alcohol and tobacco; unwarranted risk-taking and destructive activity, resulting in unintentional injuries; malnutrition; and poor spacing of births.
2. Development of health education
54. Governments should include, in the curricula of educational institutions at the primary and secondary levels, programmes focusing on primary health knowledge and practices. Particular emphasis should be placed on the understanding of basic hygiene requirements and the need to develop and sustain a healthy environment. These programmes need to be developed in full awareness of the needs and priorities of young people and with their involvement.
55. Cooperation among Governments and educational and health institutions should be encouraged in order to promote personal responsibility for a healthy lifestyle and provide the knowledge and skills necessary to adopt a healthy lifestyle, including teaching the legal, social and health consequences of behaviour that poses health risks.
3. Promotion of health services, including sexual and reproductive health and development of relevant education programmes in those fields
56. Governments, with the involvement of youth and other relevant organizations, should ensure the implementation of the commitments made in the Programme of Action of the International Conference on Population and Development, 3/ as established in the report of that Conference, in the Copenhagen Declaration on Social Development and the Programme of Action of the World Summit on Social Development, 4/ and in the Beijing Declaration and the Platform for Action for the Fourth World Conference on Women, 5/ as well as in the relevant human rights instruments, to meet the health needs of youth. The United Nations Population Fund and other interested United Nations organizations should continue to take effective steps on these issues. The reproductive health needs of adolescents as a group have been largely ignored to date by existing reproductive health services. The response of societies to the reproductive health needs of adolescents should be based on information that helps them attain a level of maturity required to make responsible decisions. In particular, information and services should be made available to adolescents to help them understand their sexuality and protect them from unwanted pregnancies, sexually transmitted diseases and the subsequent risk of infertility. This should be combined with the education of young men to respect women’s self-determination and to share responsibility with women in matters of sexuality and reproduction. This effort is uniquely important for the health of young women and their children, for women’s self-determination and, in many countries, for efforts to slow the momentum of population growth. Motherhood at a very young age entails a risk of maternal death that is much greater than average, and the children of young mothers have higher levels of morbidity and mortality. Early child-bearing continues to be an impediment to improvements in the educational, economic and social status of women in all parts of the world. Overall for young women, early marriage and early motherhood can severely curtail educational and employment opportunities and are likely to have a long-term adverse impact on the quality of life of young women and their children.
57. Governments should develop comprehensive sexual and reproductive healthcare services and provide young people with access to those services including, inter alia, education and services in family planning consistent with the results of the International Conference on Population and Development, the World Summit for Social Development and the Fourth World Conference on Women. The United Nations Population Fund and other interested United Nations organizations are to be encouraged to continue assigning high priority to promoting adolescent reproductive health.
4. HIV infection and AIDS among young people
58. Governments should develop accessible, available and affordable primary health care services of high quality, including sexual and reproductive health care, as well as education programmes, including those related to sexually transmitted disease, including HIV/AIDS, for youth. Continued international cooperation and collective global efforts are necessary for the containment of HIV/AIDS.
5. Promotion of good sanitation and hygiene practices
59. Governments, in cooperation with youth and volunteer organizations, should promote the establishment of youth health associations to promote good sanitation and hygiene programmes.
6. Prevention of disease and illness among youth resulting from poor health practices
60. Governments, in cooperation with youth organizations, should promote healthier lifestyles and, in this context, should investigate the possibility of adopting policies for discouraging drug, tobacco and alcohol abuse, including possibly banning the advertisement of tobacco and alcohol. They should also undertake programmes to inform young people about the adverse effects of drug and alcohol abuse and tobacco addiction.
61. Programmes should be instituted, with the appropriate assistance of the United Nations bodies and organizations concerned, to train medical, paramedical, educational and youth work personnel in health issues of particular concern to young people, including healthy lifestyles. Research into such issues should be promoted, particularly research into the effects and treatment of drug abuse and addiction. Youth organizations should be enlisted in these efforts.
7. Elimination of sexual abuse of young people
62. As recommended by the Vienna Declaration and Programme of Action, 7/ the International Conference on Population and Development, 3/ the World Summit for Social Development 4/ and the Fourth World Conference on Women, 5/ and bearing in mind that young women are specially vulnerable, Governments should cooperate at the international level and take effective steps, including specific preventive measures to protect children, adolescents and youth from neglect, abandonment and all types of exploitation and abuse, such as abduction, rape and incest, pornography, trafficking and acts of paedophilia, as well as from commercial sexual exploitation resulting from pornography and prostitution. 9/ Governments should enact and enforce legislation prohibiting female genital mutilation wherever it exists and give vigorous support to efforts among non-governmental and community organizations and religious institutions to eliminate such practices. 10/
8. Combating malnutrition among young people
63. Governments should promote post-primary-school and out-of-school health projects by individuals and youth organizations, emphasizing information on healthy eating practices. School lunch programmes, provision of food supplements and similar services should be available whenever possible to help ensure a proper diet for young people.
World Youth Report 2005
1. Health
58. Health may be defined as a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity. Because youth are a relatively healthy segment of the population, their health needs have generally been overlooked, except for their reproductive health. When they do suffer poor health, it is often a result of the effects of accidents, injuries caused by armed conflict, violence, substance abuse, HIV/AIDS and tuberculosis. Extreme poverty and malnutrition make some youth vulnerable to disease. Accidents and injuries are major causes of youth morbidity, mortality and disability.
59. Although early pregnancy has declined in many countries, it is still a major concern, especially because of the health risks for both mother and child and the impact on girls education and life prospects. Births to females below age 20 account for 17 per cent of all births in the least-developed countries, which equals 14 million births worldwide each year.23 One female in three in developing countries gives birth before age 20, and 55 per cent of all females in West Africa give birth before age 20. Pregnancy is a leading cause of death for females aged 15 to 19, with complications of childbirth and unsafe abortion being the major factors.
60. Young people worldwide are reaching puberty at earlier ages and marrying later. Premarital sex is becoming more widespread. Despite a trend towards later marriage in much of the world, millions of girls are still expected to marry and begin childbearing in their teens, often before they are ready to do so. Data for the late 1990s show that among young women who were sexually active by age 20, only 51 per cent in Africa and 45 per cent in Latin America and the Caribbean initiated sexual activity prior to marriage. By contrast, the corresponding proportion for males was 90 per cent in Africa and 95 per cent in Latin America and the Caribbean, and in many developed countries, most men and women initiate sexual activity prior to marriage.
61. In both developed and developing countries, many who become sexually active at a young age do not know how to protect themselves during sexual activity. Young women are often unable to negotiate condom use with male partners and may fear violence if they try to do so. One third of new cases of curable sexually transmitted diseases (STDs) each year – more than 100 million – are among women and men below age 25. Having an untreated STD significantly increases the risk of HIV infection.
62. Youth is a challenging time of life. However, when conflict erupts, risks associated with this period increase, especially for young women. Anxiety, depression, stress and suicide present disturbing aspects of youth health, especially prevalent in countries ravaged by war, occupation or sanctions. Trauma and lack of social support and services may seriously affect young people and cause lasting harm to their physical and mental health. When social structures break down in the face of war and instability, young adults frequently engage in high-risk drug use or high-risk sexual behaviour.
63. During the past 10 years, countries have made significant progress in addressing the issues of adolescent reproductive health, including the need for information, education and services that will enable young people to prevent unwanted pregnancy and infection. These efforts are increasingly being undertaken as part of a wider, holistic approach that aims to reach young people in diverse situations and equip them with skills to shape their own future.
64. Drawing on the experience of the past 10 years, a comprehensive approach to youth health programming has emerged as a global consensus that links reproductive health interventions to efforts to provide adolescents with choices and options through investment in education, job training and citizenship development. Health education, including life skills, should be introduced into school curricula and programmes designed for out-of-school youth. Investing in young people’s health, education and skills development, and empowering girls to stay in school, delay pregnancy and marry later, are essential interventions that can substantially improve their chances of becoming well informed, productive citizens. Youth health programmes and policies should be interdisciplinary and reach beyond the health sector. Efforts need to be scaled up to adequately confront the enormous health challenges facing the world’s youth.
65. Encouraging the full participation of youth in the development and promotion of health-related programmes and policies would enable them to become agents of change in their communities and positively affect their lives and those of their peers. Youth who do not have a nurturing family environment or for whom the family is the setting for abuse or neglect should be especially targeted.
66. Health workers should be provided with specific training to be better able to communicate with young people to provide youth-friendly services and to build competence in handling the health concerns of young people. They should learn how to deal with substance abuse among young people, vaccination and nutrition, chronic conditions, trauma and other health problems that may begin in youth and affect their well-being during adulthood.
67. Young people have called for increased access to national and international resources in order to establish formal and informal educational programmes on HIV/AIDS, substance abuse and sexual, reproductive and mental health. There is a need for Governments to facilitate improved access for youth to health information and services, including sexual and reproductive health services.
Footnotes:
23. See UNFPA, State of the World’s Population (New York, 2004).