2.6 Social determinants of adolescent health: economic factors

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来自 The University of Melbourne 的课程

Global Adolescent Health

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The University of Melbourne

Global Adolescent Health

41 个评分

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

从本节课中

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

与讲师见面

Professor Susan Sawyer
Chair of Adolescent Health
Department of Paediatrics
Professor George Patton
Professorial Fellow
Adolescent Health Research

Let's turn now to focus on the social determinants of health with a focus beyond

the immediacy of family and peers, to a set of more distal or

structural social determinants of health.

There are many of these that can be grouped in many different ways.

I've arbitrarily grouped them into four key themes,

with the next few lectures addressing each of these in turn.

And, we'll focus on economic factors, human rights and gender,

population displacement, and advertising and marketing.

But, let's start by focusing on economic factors.

We know that greater national wealth is strongly associated with better health

outcomes in both sexes, with the exception of self-reported injuries,

exposure to violence, and smoking.

But, countries with a very low income have up to a 5 fold variation in,

for example, male adolescent mortality, and a 10 fold variation

in teenage birth rate, despite similar national wealth.

And in the next few slides, I'll show these on a graph.

This fact that this extent of variation suggests that cultural, religious or

other social factors strongly moderate the effects

of structural determinants, such as wealth.

Let's look at this in more detail on this graph.

This graph is taken from the second paper of the recent Lancet series on adolescent

health led by Russell Viner and colleagues.

And you can see on the horizontal axis is gross domestic

product per person calibrated to a thousand US dollars.

On the vertical axis is deaths per 100,000 population of 15 to 19 year olds.

And as can be seen with this line that I've drawn here,

which groups countries with the same, in this case, low gross domestic product.

You can see there's more than a five fold difference in mortality, for

the same level of GDP.

Similarly, in the next graph, where again,

we've plotted gross domestic product on the horizontal axis, and this time,

births per 1,000 girls, ages 15 to 39 years on the vertical axis,

which is grouping countries with

the same level of GDP, we can see up to a tenfold difference,

a highly dramatic difference in birth rate.

What this means is that it's more than just the level of income that matters.

Countries have political, economic and

social systems that produce more or less income inequality.

Those countries with greater income inequality

have poorer health across all outcomes.

Again, with the exceptions of reported injuries, exposure to violence and

smoking rates.

And the associations we see between national wealth, inequality and

adolescent health probably relate both to cumulative effects

that persist from earlier childhood, together with contemporary or

pathway effects that take place during adolescence itself.

Now we know that wealth generated by

national economic development is highly beneficial for adolescents.

But their health is vulnerable to income inequalities generated by development

particularly where rapid urban development and urbanisation

create large populations of deprived, marginalised and displaced young people.

And particularly when unemployment is high.

Employment is a mechanism through which young people share in the wealth

of a society.

Long-term unemployment or underemployment among young people carries a heavy price.

Young people who struggle to find work often suffer permanent scarring of their

future earning power with a potential for profound impacts on their health,

especially on mental health, including suicide and violence related mortality.

The particular challenge is that the young

are especially hard hit when economic times are tough.

For example, 15 to 24 year olds are nearly 3 times as likely

to be unemployed than older adult workers.

And while 15 to 24 year olds comprise 17% of the population,

they constitute 40% of the unemployed.

Now, the International Labor Organisation estimated the global unemployment rate

among 15 to 24 year olds to be 12.6% in 2013,

equating to 73 million young people jobless worldwide.

This compares threefold higher

to an estimated global unemployment rate at that time of 4.5%.

However, interestingly, the World Economic Forum estimated much higher rates,

suggesting that about 30% of

the world's 15 to 24 year olds are not in school and not employed.

There is less debate about where the highest rates of unemployment are, and

this is namely in the Middle East, North Africa and

Europe where youth unemployment rates have skyrocketed since 2008.

For instance, in developed economies and the European Union,

joblessness among young people has ballooned by nearly 25%

in the past five years, reaching a devastating 18.1% overall.

In the meantime, Europe is seeing a greater proportion of its youth

being forced to take jobs they are overqualified for, or

to take part time or temporary work.

A phenomena that is seen the world over.

Levels of informal employment among young people are soaring, and

young people are finding it ever more difficult to find jobs

that match their skills and education.

Not only does this mean that society is missing out on new skills from highly

qualified young people, but it also means that the overeducated young are preventing

less qualified and less skilled young people from entering the workforce.

In this graph, here, you can see that percent change in youth unemployment

in European countries over really a very short period of time, 2008 to 2013.

And as you can see, those highest increases in the rate of unemployment

are in Greece, Spain and Portugal.

Professor Sir Michael Marmot, professor of epidemiology and

public health at University College London,

is a global expert in inequalities in health and their causes.

Most recently chairing a review on the social determinants of health in Europe,

that was commissioned by the World Health Organisation.

He used the most powerful of language by referring to the growing

rates of youth unemployment in Europe as a public health emergency.

But it is not just public health advocates who share this same view.

Dr. Ken Henry is an economist and

past Secretary of the Department of Treasury in Australia.

He suggested that, young people that are not in the education system and

who are denied work are deprived of the freedom to lead a life that

they would otherwise choose.

And he argued that this is a threat to their human rights.

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