At a time when the world is focused on addressing the core MDG targets for maternal and child mortality, why did the iERG raise the issue of adolescent health? The reasons are multiple.
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By Dr. Zulfiqar A. Bhutta and Dr. Stanley Zlotkin

With less than two years left to the 2015 Millennium Development Goal (MDG) targets for maternal and child health and survival, the UN Secretary-General's independent Expert Review Group (iERG) for monitoring progress did something remarkable last year. In their 2013 annual report, "Every Woman, Every Child: Strengthening Equity and Dignity Through Health," the iERG devoted an entire chapter to adolescent health, stating that "priorities for adolescents are invisible in both the Secretary-General's Global Strategy and the Commission on Information and Accountability for Women and Children's Health. Adolescents are marginalized, frequently living in poverty, and with fewer opportunities than many groups in society." The group recommended that adolescents must be taken more seriously in efforts to improve health worldwide.

At a time when the world is focused on addressing the core MDG targets for maternal and child mortality, why did the iERG raise the issue of adolescent health? The reasons are multiple. It is clear that this age group has been shockingly ignored in global health to date. There are almost 1.2 billion adolescents in the world, and almost 90 percent live in low and middle income countries.

In many countries, despite legislation, a large proportion of adolescents are married before they turn 18. According to recent figures from the United Nations Population Fund (UNFPA) in 2010, one in three young women aged 20-24 (34 percent, or 67 million) globally were married as girls; about 12 percent were married by 15 years of age. Of these, almost half were in Asia and one-fifth in Africa. UNFPA's report "State of World Population 2013" notes that pregnancy and childbirth are the leading cause of death among girls aged 15-19 in low- and middle-income countries. Twenty thousand girls below age 18 give birth in developing countries every day. Of the 7.3 million girls below age 18 who give birth each year in developing countries, 2 million are under age 15 and are five times more likely to die in childbirth than women over age 20.

The issues are not restricted to girls exclusively. Adolescent boys are also greatly neglected in terms of their health -- especially mental health and education needs -- and are disproportionately forced into child labour. The risks of drug use and violence are also considerably higher among boys, and young people account for almost 40 percent of all new HIV infections. Girls have much greater risks of coerced sex and are frequent victims of sexual violence. Worldwide, up to half of all sexual assaults are committed against girls under 16. Adolescent girls are more likely to be malnourished than adolescent boys with high rates of anemia and micronutrient deficiencies.

Why, despite the best efforts of some agencies, is adolescent health neglected? Firstly, some of the evidence linked to the importance of adolescent mental and physical health to human development is as yet not fully appreciated by policy makers. Secondly, the solutions to many of the issues affecting adolescents have not been systematically collated and are considered complex to implement. In the hands of practitioners and health care services, adolescent health remains void in much of the developing world, with few services able to provide comprehensive and user-friendly services to adolescents. Adolescent boys and girls currently fall between pediatricians and adult physicians, and even for those in schools, existing services do not provide comprehensive and confidential preventive and promotive care. Finally, notwithstanding the global statistics shared above, there are few indicators or measures by which to track adolescent health and wellbeing. Very few of the existing demographic and health surveys forming the basis for policy making globally have adolescent health and nutrition indicators -- and as a result there is an information gap at country level. There is some work underway in this regard, but it has not yet achieved much traction in low- and middle-income countries.

We, as long-standing proponents of global child health and nutrition, applaud recent efforts by the UN agencies, notably UNICEF, UNFPA and World Health Organization (WHO), to refocus attention on adolescents as a critical global gap and an "age of opportunity." However, we feel that much more needs to be done by health care professionals and practitioners globally to address the gap between broad policies and local action. This requires engagement with young people to assess their unmet needs, and in some patriarchal societies, this may prove challenging. But it needs to be done. Today, international experts convene at the Centre for Global Child Health, The Hospital for Sick Children (SickKids), to mark the 8th Annual Global Child Health Day and address the pressing issues of global adolescent health and the strategies to address them. It is time for the global health community to highlight this burgeoning global need and take urgent action.

Dr. Zulfiqar Bhutta, Robert Harding Chair in Global Child Health and Policy, Co-Director, Centre for Global Child Health.
Dr. Bhutta is one of the seven-member independent Expert Review Group (iERG) set by the UN Secretary-General in September 2011 for monitoring global progress in maternal and child health MDGs. Dr. Bhutta has also recently been appointed to the Global Alliance for Vaccines and Immunizations (GAVI) Board as the representative from global academic research organizations.

Dr. Stanley Zlotkin, Chief, Centre for Global Child Health
In his program, the Sprinkles Global Health Initiative, Dr. Zlotkin has focused on research and advocacy to control micronutrient malnutrition in children. Challenged by UNICEF to come up with a viable and reproducible solution to the problem of micronutrient malnutrition, Dr. Zlotkin and his research team developed the concept of micronutrient powders for "home-fortification" of complementary foods. With support from USAID, Canadian Institutes of Health Research (CIHR) and private foundations, he has completed multi-country research to prove the benefits of home-fortification to control micronutrient deficiencies. His current research focuses on delivery science to enhance the implementation of public health programs and products. He is known internationally as a successful social entrepreneur for his work on home fortification.

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