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1、2021/4/251A Generation at Risk: Prioritizing Child and Youth HealthAlex EzehAfrican Population and Health Research CenterPrepared for Presentation at the Sub-Saharan Africa Showcase EventJan 15-16, 2010University of Warwick星战风暴 http:/2021/4/252Why focus on children and youth? (1) Young people under

2、the age of 25 represent close to half of the worlds population 90% live in the developing world Primary causes of poor health and social outcomes in this group are largely preventable“The successful achievement by 2015 or beyond of many of these UN Millennium Development Goals will require that poli

3、cy makers center their attention on young people” (Panel on Transitions to Adulthood in Developing Countries 2005) 2021/4/253Why focus on children and youth? (2)Population of Young People by Region (in millions)REGION Year 2006 Year 2025THE WORLD 1,773 1,845 Africa 305 424 Asia 1,087 1,063 N. Americ

4、a 71 74 S. America 161 165 Europe 140 111 Oceania 8 8Source: Blum 2009, presentation made at APHRC, Oct 15, 20092021/4/254The health profile of children and youth2.6 million deaths annually among children and youth aged 10-24 yearsFemales death rates lower than males, except in SSA and SE AsiaHighes

5、t mortality in least developed countriesRelative risk of death highest in SSAMaternal, communicable, peri-natal, and nutritional causes of death account for 48% of all female deathsRoad traffic crashes, violence, and self-inflicted injuries are the leading causes of death among malesHIV/AIDS and TB

6、drive the mortality burden among 20-24 year olds“The health and social needs of vulnerable and disenfranchised young people serve as an early warning system of threats that will ultimately engulf larger populations” Micheal Resnick and Glenn Bowes (2007) drawing from the words of Marian Wright Edelm

7、an2021/4/255Emerging trends impacting on child and youth health Globalization Urbanization The HIV/AIDS pandemic Education Marriage The labor market2021/4/256Globalization Children and youth growing up in a context characterized by rapid changes in Technological advances Transportation Global market

8、s Positive impacts Increased access to information Widening access to job and educational opportunities Improved health due to advances in health Negative impacts Social disruptions (e.g. increased access to illicit drugs) Breakdown of social structures and community cohesion Widespread inequalities

9、 2021/4/257Urbanization Populations are increasingly becoming urban 50% of the worlds population lives in urban areas 75% in Europe, North America and Latin America Africa and Asia primarily rural Bulk of urban growth will occur in these regions2021/4/258Trends in urbanization by regionSource: Popul

10、ation Division of the Department of Economic and Social Affairs of the United Nations Secretariat, World Population Prospects: The 2006 Revision and World Urbanization Prospects: The 2007 Revision, /unup, Thursday, December 31, 20092021/4/259The majority of urban residents in sub-Sah

11、aran Africa live in slums, with poor social services and livelihood opportunitiesUNHABITAT, 20032021/4/2510Impacts of urbanization Rapid urbanization coupled with poor economies and governance has resulted in the growth of large urban informal settlements (slums) in the developing world Nairobi: Slu

12、ms house over 2 million people about 50% aged 25 years Slums characterized by Poor housing, sanitation, and infrastructure High unemployment rates Violence Limited opportunities for formal education High levels of sexual risk behavior Higher HIV/AIDS prevalence than non-slum urban areas2021/4/2511 s

13、lum dwellers start sexual activity at an earlier ageKDHS, Nairobi City 2003 and NCSS 20002021/4/2512Diarrhea Incidence by Wealth Quintiles & ResidenceNCSS, 2000 & KDHS 19982021/4/2513Under-5 and Infant Mortality Rates by ResidenceSource: KDHS 2003, NCSS 20002021/4/2514The HIV/AIDS pandemic (

14、1)Young peoples sexual behaviors and their socio-economic and cultural contexts place them at high risk of acquiring HIV and other sexually transmitted infections. In 2007, more than 90% of new HIV infections were in low and middle income countries and about 45% of infections were among young people

15、 (15-24 years)Females are at higher riskThe HIV/AIDS pandemic has heightened the need to understand the drivers of HIV infections among young people. What studies show Knowledge gaps remain: identifying asymptomatic carriers, mother-to-child transmission and injecting drug use Young people are unabl

16、e to assess their risk of infection based on behavior HIV testing higher among ever pregnant females Low compliance with government guidelines on HIV testing in some settings2021/4/2515The HIV/AIDS pandemic (2)HIV prevalence (%) among 1524 years old, by sex, select countries, 200520070510152025% HIV

17、 prevalenceSwazilandSouth AfricaZimbabweCentral African RepublicCte dIvoireSierra LeoneRwandaHaitiGuineaEthiopiaBeninDR CongoNigerSenegalCambodiaIndiaUgandaChadDominican RepublicMaliFemaleMaleSource: UNAIDS, /en/KnowledgeCentre/HIVData/Epidemiology/epidemiologySlidesAuto.asp2021/

18、4/2516The HIV/AIDS pandemic (3)*Males are more likely to request an HIV test*About half of those who are sexually experienced and have not been tested say that they have not been tested because they do not think they are at risk2021/4/2517Education Changes in the global economy have increased the de

19、mand for formal education Schools are an important context for shaping youth socialization and development. Young people in the wealthiest social class are more likely to be enrolled in school School attendance is higher among urban dwellers The changing family, social, and economic context have con

20、tributed to shifts in educational participation. Decreasing family size linked to greater enrollment and lower gender disparities in enrollment rates Greater parental schooling translates to greater child enrolment Wider Benefits of Education Better health outcomes Lower rates of sexually transmitte

21、d infections, including HIV Lower substance use Better livelihoods2021/4/2518EducationSource: UNICEF, 2009 Statistics and monitoring, (15-24)2021/4/2519Impacts of EducationSource: Transitions to Adulthood project - APHRC2021/4/2520The poor access poor-quality non-formal schools2021/4/

22、2521Marriage (1) Young people are marrying later in life. Although there is an increase in age at first marriage in SSA, many young women still get married in their teens. About 40% of women in SSA married by age 20 compared to about 25-30% among women in Latin America and the Caribbean (Clark et al

23、. 2006). in counties such as Chad and Niger, more than 70% of 20-24 years olds reported being married before age 18 (Mensch et al. 2006). Reasons for the decline in female teen marriages: Increased mobility of young men Changing dynamics of the marriage process, including cash-based dowry payment an

24、d individual spouse selection Increased opportunities for employment Changes in the legal age at marriage Increased access to formal education Increased womens labor force participation 2021/4/2522Marriage (2)Increase in age at first marriage has risen more rapidly that age at first sex; thus, while

25、 marriage may have been a more common context for sexual initiation, pre-marital sexual initiation is increasingly common. Although pre-marital sex is often cited as problem behavior, recent evidence suggests that married young women are often at higher risk of pregnancy and STIs including HIV/AIDS

26、(Glynn et al., 2001, Clark et al 2006). Reasons Limited condom use within marriage Large age differences between spousesFurther research is needed to fully clarify the pathways through which marriage increases the vulnerability of young women to poor sexual and reproductive health outcomes. Some que

27、stions worth further investigation include: To what extent are these due to gender power relations between these adolescent girls and their often much older husbands? Or their limited access to information and SRH services? Given the fact that a considerable proportion of sexually active young peopl

28、e in SSA are married, it is important to clarify the extent to which marriage is a protective or risk factor in ASRH 2021/4/2523Labor participation (1)“The energy, skills and aspirations of young people are invaluable assets that no country can afford to squander, and helping them to realize their f

29、ull potential by gaining access to employment is a precondition for poverty eradication, sustainable development, and lasting peace.” (The World Bank, 2009)2021/4/2524Labor participation (2)The large number of young people, coupled with relatively high fertility rates in many parts of the developing

30、 world means that most countries have to grapple with the provision of job opportunities to meet the growing demands.Limited economic growth shuts out many young people from the labor market. Youth comprise a significant proportion of the unemployed: 43.7% globally & 60% in sub-Saharan Africa (T

31、he World Bank, 2009). Limited employment opportunities trigger widespread migration among the youth young people aged 15-30 years are the most mobile segment of the populationFor some young people entry into the labor market comes too early in life which may bring short term benefits of increased family earnings but comes at high long-terms costs in terms of lost educational opportunities Studies are needed to fully clarify the short- and long-term implications of early entry into the labor force. 2021/4/2525