Healthy youth development: getting our priorities right

What does promotion of “healthy youth development” really mean? We are referring to an intentional, deliberate process of providing support, relationships, experiences and opportunities that promote positive outcomes for young people, most broadly viewed as enhancing the capacity to be happy, healthy and successful.1,2 We do this by promoting protective factors in the lives of young people. “Protective factors” refers to the events, opportunities and experiences that promote confidence and competence, and protect young people from harm.3 By the end of the 20th century, researchers in the field of youth development had identified key protective factors that appear to promote emotional and physical wellbeing, and help young people avoid dangerous, self-destructive behaviour. The systematic study of these protective factors (which include a combination of internal capacities and external supports) builds on the pioneering efforts of investigators who sought to understand resistance, thriving and success in the face of marked social challenge and adversity.4-8 The research revealed the importance of feeling a strong sense of connectedness: to parents, to family, to other pro-social, supportive adults, as well as the protective effects of feeling connected to school, and experiencing a sense of spirituality — a sense of connectedness to a creative life force in the universe.9

We further discovered that these protective factors are robust and meaningful for different groups of young people both within countries, and across nations. In the past few years, we have seen a growing body of evidence that suggests that the experiences of connectedness with others stimulate reward mechanisms in the deepest parts of the brain. From research conducted on laboratory animals, to brain development studies of adolescents and young adults, there is evidence emerging that we are biologically created to connect socially with others, and to seek meaning and purpose in our lives. Building on a long-established literature in psychiatry and child development focusing on the primacy of bonding and attachment,10 the new research describes this phenomenon as “hardwired to connect”.11

But this exciting work is still very much in progress. Even with these advances in scientific evidence, we have far more questions than answers.

Very importantly, we believe that this process of promoting healthy youth development cannot be left simply to chance. Young people are developing in a world where changes in communication, technology, economics, culture, politics, the environment, education, and demographics are creating challenges, vulnerabilities and opportunities unlike ever before. We are now witness to a generation that is more multicultural than its predecessors, due in large measure to the astounding speed of communications and travel. We are compelled to think in broad ecological terms — to consider that community context is affected by a changing national context, which in turn is influenced by the changing global context. The creation of a global society means that the process of development and transition to adulthood is no longer a matter solely of individual choices, peer and family influences.12

Globalisation (the intertwining of our futures, the linking of our destinies with each other) has helped to create a more favourable international political climate in some settings. This includes the rise of democratic social institutions and growing opportunities for young people to participate in civil society and in politics. In some contexts, globalisation has led to financial deregulation that has allowed the growth of market economies and the spreading of resources to a wider number of people. However, across and within many nations, the rise of the global economy has created alarming levels of inequality in income and opportunity, and has led to a clash of traditional and modern cultures.12

While there is great variation within countries, income per capita has risen dramatically in places such as India, China and Pacific Asia. There has been a pattern of less change in per capita income in Latin America, and discouraging and dangerous economic decline in the former Soviet Union, in parts of Central and Eastern Europe and across sub-Saharan Africa. In 24 sub-Saharan economies, the per capita income is lower today than it was 20 years ago; in 12 countries, it is below its 1960 level. And in China, India and Indonesia, where we have seen the most dramatic gains from globalisation, income inequality has widened for those outside of particular cities and economic development zones.12

Throughout the 20th century, in most parts of the developing world, life expectancy at birth rose, from around 41 years to almost 64 years of age. With the exception of countries with very high prevalence of HIV/AIDS, youth in developing countries now enter their adolescence healthier than ever before. Healthy individuals become better students, more active community members, more attractive marriage partners, and more productive workers than those who suffer from poor health. But there are still multiple threats globally to young people’s healthy development. In sub-Saharan Africa, the greatest immediate threat to adolescent health is the HIV/AIDS pandemic. For young women in the developing world, maternal mortality and the negative consequences of pregnancy, abortion and childbearing continue to create appalling health consequences. This is especially true because adolescents who give birth at an earlier age tend to be rural, less educated and impoverished, magnifying the negative health consequences of early pregnancy and childbearing.12

Other major changes in the health environment that threaten the healthy development of young people, especially in developing nations, include the aggressive marketing of tobacco to youth, particularly by corporations in Japan and the United States.13 Worldwide, we see problems of easy access to illicit drugs, the growing incidence of traffic-related injuries and fatalities due to the sheer increase in the number of automobiles, and the expanding network of roads. For some nations, war and militia violence are the most immediate threats to the lives and health of young people, for boys, as soldiers, and for girls, as victims of rape and other violence.12

What must individual nations and groups of nations do to promote the ideals and goals articulated by our worldwide organisations that champion healthy youth development? Entities such as the World Health Organization and the United Nations, through their congresses and position papers, express some of our most noble and idealistic thoughts about what our young (indeed, all human beings) need to live meaningful, healthy and productive lives (eg, the Convention on the Rights of the Child; the Disease Early Warning System). At the time of this writing, the nations of the world had convened to consider the Millennium Development Goals, a set of measurable goals and targets designed to address the world’s most compelling human development problems.14 These goals were adopted by world leaders in September 2000, and the international community committed itself to eight development targets by the year 2015. The goals recognise the need to accelerate the pace of development in the poorest nations. They are particularly pertinent, as young people growing up in profound economic disadvantage simply cannot achieve their full potential if they have only their families (or themselves) to support and care for them. In short, healthy adolescent development cannot be the responsibility of parents and family alone. The forward-looking language of the UN’s Millennium Development Goals recognises this insight when it proposes that the well-resourced nations adopt the following priorities, to:

• Reduce by half extreme poverty and hunger (extreme poverty is usually defined as US$1.00/day in per capita household consumption; this currently includes about a quarter of the world’s population).

• Achieve universal primary education.

• Empower women, and promote equality between women and men.

• Reduce by two-thirds the mortality rate among children younger than 5 years.

• Reduce maternal mortality by three-quarters.

• Reverse the spread of diseases, especially HIV/AIDS and malaria.

• Ensure environmental sustainability.

• Create a global partnership for development, with targets for aid, trade and debt relief.

Some of these goals involve greater attention and commitment to young people. But, as providers, educators and advocates whose primary focus is the wellbeing of youth, we must be guided by a more specific and clear set of goals that drive our actions and priorities. What are the fundamentals that young people need to survive and thrive in this dynamic time of change? We face this question with a great sense of respect for local tradition, cultural values, and the variation that is part of the human experience. And yet, in this time of global interconnectedness, we are able to identify deep, fundamental needs for all young people. These include:

• Good mental and physical health, including reproductive health, plus the knowledge and skills required to promote health during adulthood;

• Positive social values and relationships with peers, and a strong sense of connectedness with caring, competent adults that allow young people to develop a sense of identity, and to grow as responsible, contributing members of their community and the larger society;

• Good preparation for adult life and adult roles, which includes gaining a high-quality education, acquiring the motivation, skills and opportunity to enter the work force, and learning to be a caring and responsible friend, partner, and spouse;

• The capacity to make effective choices through the development of a sense of competence and confidence; and

• The capacity to enjoy life and experience a sense of wellbeing.

Raising our voices means, for many, stepping outside of the role of service provider, researcher or educator, and moving boldly into the domain of advocacy. Effectiveness requires persistence, whether in the form of news interviews, editorials, letters, or direct interactions with decision-makers. We amplify our voices by working in concert with our professional organisations, which take official positions on issues affecting young people through declarations, position papers and direct civic action. And we strengthen the efforts of organisations that truly promote youth leadership by joining our voices and resources to theirs, advocating for the principle, so clearly articulated by the Oxfam International Youth Parliament,15 that those affected by policies (including young people) should be involved in decision-making in ways that are democratic, representative and inclusive.

The obstacles are formidable. We know that the world’s nations will find it easier to retreat from the millennium targets for 2015 rather than tirelessly pursue these goals, which, if enacted, will have an unprecedented positive effect on the world’s most impoverished citizens.

Knowing this, we must act.

What a difference it makes to our youth when they have places of quality and compassion that care about their healthy development — when our schools and communities are places of welcome that prepare them for a future full of options. What a difference it makes when young people have opportunities for active engagement and valued contribution. What a difference it makes when there are imaginative advocates who refuse to see adolescents only as a set of risk factors and problems. This is the kind of imagination and advocacy we need.

Our youth deserve this from us; and we cannot afford to do otherwise.