Estratégia integrada para a saúde de jovens e adolescentes 2008-2018

Publicado em:  16/09/2008

Regional Integrated Strategy for Adolescent and Youth Health 2008-2018  Projeto enviado por Sara Marques, da Unidade de Saúde da Criança e do Adolescente e Área de Saúde da Família e da Comunidade de Washington (EUA), com estratégia integrada para Saúde de Adolescentes e Jovens. As observações enviadas foram compiladas e a versão final do projecto consta a seguir. Esta versão foi aprovada pelo Diretor Adjunto da Organização Pan-Americana da Saúde (OPAS) para ser apresentado ao Comitê Executivo em junho. Para continuar a aperfeiçoar o documento, estão sendo realizadas consultas. Para enviar seus comentários, basta acessar o SharePoint: http://portal.paho.org/sites/fch/CA/WS/rahs/default.aspx I. Introduction/ Justification: 1.                  The Region currently has the largest cohort of young people[1]  in its history.   The changing context - demographic transition, globalization, environmental changes, and new communication technologies - calls for a new strategic approach to addressing their health needs of this cohort. Promoting and protecting adolescent and youth health is vital to ensure that Member States build social capital and have healthy populations in their most economically productive years and in older ages.   2.                  The commitment of the Pan American Health Organization (PAHO) Secretariat to improve the health and well-being of young people is long standing, having set priorities to reduce their most prevalent health problems.  In 1997, Member States formally recognized the distinct needs of young people by ratifying Resolution CD 40.R16.  The PAHO Strategic Plan (2008-2015) and the Agenda of the Americas[2] reaffirm the importance of addressing the adolescent and youth populations.  In line with these efforts and as a response to the changing context, this document proposes seven strategic lines of action to improve the effectiveness of actions promoting the health and wellbeing of young people in the Region.  It is grounded on the World Health Organization's constitution, which declares that "the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition."[3]  Furthermore, it is also consistent with global commitments such as the International Conference on Population and Development (ICPD), United Nations General Assembly Special Session (UNGASS), Millennium Development Goals (MDG), the UN Convention on the Rights of the Child[4], and other international/regional human rights instruments and standards[5]. II. Background: 3.                  This document has been guided by the results of an external evaluation of the implementation of Resolution CD 40.R16, conducted in 2007.  This evaluation revealed that 22 of 26 of responding countries are interested in addressing adolescent and youth health. It also showed that while the establishment of National Adolescent Health Programs represents clear progress, the response of the health systems and services to the needs of young people are often weak and limited. In addition, pertinent data and strategic information on the health of young people remains scarce and what is available is not used to inform policy decisions and program design. 4.                  This document presents a 10-year Strategy to strengthen the integration of the health sector's response and coordination with other sectors.  It intends to protect the achievements made in existing National Adolescent Health Programs, address the unfinished agenda in guaranteeing access to adolescent and youth health services with a focus on vulnerable groups[6], and face new challenges brought by the changing context. This Strategy is the product of a participatory process that included international experts, national stakeholders and strategic partners, including young people and PAHO/WHO country focal points. III. Analysis: 5.                  Young people represent 24.5% (232 million) of the total population in the Americas. They form a heterogeneous population, with considerable differences in age, education, marital status, culture, ethnicity, sexual orientation and identity, and economic circumstances. Living in the most socially unequal Region, young people are subject to the prevailing socio-economic, territorial, ethnic and gender-based inequalities, which shape their health and social opportunities. Poverty affects the Latin American and Caribbean (LAC) youth disproportionately, whereby an average of 39% of them live in poverty[7].  In all countries of the Region, indigenous, ethnic and racial minority young people, those living in female-headed households, and those living in rural communities are often the poorest and most excluded; they also tend to have access to the weakest educational and health services, and the least access to employment. In LAC, widely differential opportunities or lack thereof drives high levels of migration, both within countries to the urban areas and internationally, leading to the disintegration of families and communities, unsafe, illegal, and informal employment and numerous health risks. 6.                  Overall, young people suffer less mortality and morbidity in comparison to other age groups. National health policies, programs, and health services have traditionally neglected their distinct needs, in part because health continues to be conceptualized as the absence of disease. The main causes of mortality and morbidity among young people are injuries related to road traffic crashes (the leading cause of death among adolescents), interpersonal violence, suicide, complications of pregnancy and unsafe abortions. The consumption of alcohol and other substances is closely associated with the behaviors that often causes adolescent and youth morbidity and mortality.  Critical issues that must be addressed immediately include unwanted pregnancy, sexually transmitted infections, HIV/Aids, violence, mental disorders, substance abuse, obesity, and chronic illnesses.   Particular consideration must be paid to the disproportionate impact on low income, poorly educated, indigenous and ethnic minority young people and the role that traditional gender norms play in propagating associated behaviors.   7.                  Many countries in the Region are currently experiencing or about to enter a demographic "window of opportunity" in which there is a larger proportion of working-age persons relative to the dependent population. For these countries, the investing in young people is crucial, as it is a primary means to human, social and economic development for the future.  In particular, investing in their health contributes to the health of the future adult population as most habits detrimental to health acquired during adolescence and youth manifest themselves as health problems in adulthood.  Even in countries where this window has closed, the promotion of health and development of young people is essential to help increase their potential to support the growing dependent population. 8.                  Promoting health not only requires curtailing unhealthy behavior at an individual level, but also addressing the macro determinants of health. The health sector has a crucial role to play in health promotion, prevention and care, in addition to advocating and supporting coordinated actions with other sectors that are fundamental to influencing the proximal and distal determinants of health and the empowerment of young people.  9.                  Strategic information is critical for informed decision-making. Despite increasingly sophisticated information technology, social and health data on young people is still difficult to obtain, often incomplete, inaccurate or inconsistent in many countries. Moreover, stigma remains a barrier causing underreporting of some health issues (i.e. suicide and sexual abuse). Available data often does not enable the identification of groups at particular risk within and between countries or the risk and protective factors for health behaviors and outcomes.  Deficient monitoring and evaluation has resulted in continuing ineffective interventions.   10.              In general, policies, programs and services approach adolescent and youth health and development from a vertical and problem-oriented perspective, for example addressing HIV, pregnancy and alcohol consumption as distinct issues.  Sources of financing often reinforce this approach, resulting in expensive duplication of efforts and limited impact. 11.              Evidence suggests that programs should address interrelated health outcomes, associated behaviors and their common origins to improve impact and reduce expensive duplication of efforts.  Moreover, they must target the multilevel influences on young people, taking into consideration specific needs based on the stages of development, culture, age and gender so that they are appropriate to the distinct needs of the target population. Targeting early or during pre-adolescence can potentially influence behaviors before they become health-compromising habits. In addition, programs should recognize the pivotal role that supportive families, schools, and communities play as protective factors for health and the potential to facilitate access to health services and be critical spaces for health promotion. 12.              Adolescent and youth access to health services continues to be inadequate in most countries. Efforts to improve both supply of and demand for quality health services are needed to provide an important opportunity for promotional and preventive health messages along with screening, diagnosis, treatment and care for a range of health issues. In the context of the PAHO renewed primary health care model[8], health care providers are expected to respond to the needs of individuals throughout the life cycle and are therefore required to have knowledge of the specific needs of young people and the barriers they face. Many young people encounter legal barriers and unfriendly environments when they use health services, including breaches in confidentiality, judgmental and disapproving attitudes relating to sexual activity and substance use and discrimination. These barriers restrict access and utilization to health services. 14.              Innovative strategies to reach young people and train health providers can help keep abreast of demands for health promotion and prevention services and programs. Providers will have to be knowledgeable on new research and emerging technologies in adolescent and youth health, such as brain development research, new vaccine, and testing and screening methods. IV. Proposal: 15.              This Strategy outlines how PAHO can best support young people to develop the skills, abilities, and attitudes they need to take part positively in society now and in the future.  It is integrated with the 2008-2015 PAHO Strategic Plan of Action Strategic Objectives and rests on three pillars - primary health care, health promotion and social protection.  The Strategy calls for the integration of approaches and actions to tackle health issues of concern, is sustained by human rights[9], and assembled with information, evidence and knowledge. Gender, culture, and participation are crosscutting perspectives. 16.              Building on the WHO definition of health[10], this Strategy defines a healthy adolescent or youth as someone who fulfills the biological, psychological and social tasks of development with a sense of identity, self-worth and belonging, sees a positive path for the future, is tolerant of change and diversity, and has the competencies to engage as an active member of the community and labor force. 17.              Specifically, the Strategy aims to engage and respond to the needs of young people of both sexes living in the Americas, aged 10-24 focusing on the most vulnerable adolescent and youth populations, such as poor, rural, disabled, street youth, indigenous, afro-descendent, migrants, and sexually exploited young people. It seeks to address current and emerging needs in adolescent and youth health with specific consideration of prevailing disparities in the health status, both between and within the countries of the Region. The Strategy also calls for the coordination of actions in the health sector and with other sectors and key partners to effectively address the determinants of health and development of young people, to minimize duplication, and to maximize impact and investment. 18.              To achieve these goals, PAHO proposes seven lines of action and promotes their systematic and simultaneous integration to address health and development issues affecting young people: (1) strategic information and innovation; (2) enabling environments and evidence-informed policies; (3) integrated and comprehensive services; (4) human resource capacity building; (5) family, community, and school-based interventions; (6) strategic alliances and collaboration with other sectors; and (7) social communication and media involvement.  To support the implementation of these lines of action PAHO will use an inter-programmatic approach, prioritize countries and sub-regions by need, build networks, support an expert technical group, and mobilize resources.   19.              Strategic information and innovation – Promote the use of data on young peoples' health disaggregated by age, sex, and ethnicity, and the use of a gender-based analysis, new technologies (e.g. geographical information systems), and projection models to strengthen current and future planning, delivery, and monitoring of policies and interventions. Monitor and evaluate current health services, health promotion, and disease prevention programs to assess their quality, coverage, and cost. Research the impact of new and innovative approaches to improve the health and development of young people. 20.              Enabling environments and evidence -informed public policies - Promote and establish enabling environments that foster health and development for young people, by developing, implementing and enforcing policies and programs that are evidence-informed, consistent with the UN Convention of the Rights on the Child and other international/regional human rights conventions and standards, address determinants of health, and promote safe communities.  The importance of the environment in promoting behavioral change and health is well recognized in public health and PAHO will continue to promote evidence-based interventions in this area[11]. A balance should be achieved between the implementation of short-term programs targeting those young people already engaged in risky behavior and/or with health problems and health promotion and prevention programs. 21.              Integrated and comprehensive health services - Scale up the provision of quality health services - including promotion, prevention, treatment, and care - to increase the demand and utilization by young people. Based on the principles of primary health care[12], these services should be comprehensive, address young people from a holistic perspective and be developmentally appropriate. All young people should have access to affordable, non-judgmental and confidential care.  Alternative and innovative models of service delivery can be used to expand access, such as mobile clinics, school-linked health services, pharmacies, among others. 22.              Human resource capacity building - Support capacity building for policy makers, program managers, and health care providers to develop policies and programs that aim to promote youth and community development and quality health services that address the health needs of young people in an integrated manner.  Build capacity in the use of evidence-based interventions and in monitoring and evaluation, using new technologies, such as e-learning platforms to help meet the demand for professionals trained in the provision of adolescent and youth health services. 23.              Family, community, and schools interventions - Engage young people, their families, communities, and schools in the provision of culturally sensitive promotion and prevention programs as part of the comprehensive approach to improving the health and wellbeing of young people.  Establish opportunities for the meaningful participation and empowerment of young people, families and communities in the decision-making process, design and implementation of programs that affect them. 24.              Strategic alliances and collaboration with other sectors – Improve collaborative relationships within the health sector and with partners to ensure that actions and initiatives in adolescent and youth health and development are coordinated, minimizing duplication of efforts and maximizing the impact of limited resources.  Particular emphasis should be placed on strengthening collaboration between United Nations agencies, Organization of American States organs and agencies, government entities, private organizations, universities, media, civil society, youth organizations, and communities (including the religious community, teachers, parents, and young people). 25.              Social communication and media involvement - Capitalize on the reach and influence of media on young people, working with the media to create positive images of young people and promote positive behaviors, social norms and commitment to health issues. Use social communication techniques and new communication technologies to encourage adolescents' and youth's ability to adapt and maintain health-enhancing lifestyles and to access health-related services, and actively respond to promotion of negative behaviors where this influence could be detrimental to health. V. Action for governing bodies: 26.              The Executive Committee is requested to review the progress achieved by the Member States in developing public health programs for adolescents and youth, and provide feedback on the proposed 10-year Regional Integrated Strategy for Adolescent and Youth Health (2008-2018) that will be the basis for the plan of action (to be submitted at the 2009 Directing Council). 27.              In addition to laying out the areas in which PAHO will provide technical cooperation, the Strategy calls for Member States to commit themselves to a more sustained response following the seven lines of action to improve the health of their young people and to reduce inequalities, in order to contribute the achievement of their global health and development obligations.