Caribbean

The archipelago of the Caribbean islands is made up of hundreds of islands divided into several countries: Independent English-Speaking Post-Colonial Territories; Independent Spanish-Speaking Territories; Dutch Islands; French Islands; UK Overseas Territories; Belize and Guyana (not Islands, but share similar history). The total population, including Cuba, is 9 million people and PAHO estimates that 20% of those are adolescents.

Challenges for adolescents and young adults in the Caribbean are linked to the inequalities found between wealthy ex-pat residents from former colonial powers and the local population and cultural factors. The healthcare system infrastructure is not universally well-developed, and access is a problem for those with limited incomes. There is an emphasis on 18 as the age of majority and adulthood, which is relevant to the provision of confidential services. As there is a general trend of transfer from paediatric to adult services at age 16, this creates a ‘black hole’ in access for 16- and 17-year-olds. There is a paucity of adolescent health specialists and advocates; it is difficult to find healthcare staff who will manage adolescent cases for fear of retribution in small communities. Investment is inconsistent and very little teen-focused primary care exists.

Adolescence as a concept is not well defined nor understood in the cultural context of the region. Cultural and religious traditions make it difficult to openly discuss sensitive topics like sexual and reproductive health, gender identity and sexual orientation. There are high rates of interpersonal violence, intergenerational abuse, intra-familial sexual abuse and substance use.

Countries in the Caribbean region are characterised as a mix of ‘Injury excess’ and ‘NCD burden predominant’ by the Lancet Commission on Adolescent Health and Wellbeing. Adolescence as a concept is not well understood. 

Migration into the Caribbean from South America is significant. The geographical position of the islands and their proximity to Central and South America lead to problems in the shipment of illegal tender and human trafficking. 

The Caribbean Association for Adolescent Health is working to provide the advocacy that is needed to influence the political will in the region. There are some new initiatives that show a way forward: Barbados and St Vincent are early adopters of the WHO AA-HA! Guidance; Trinidad has a primary care teen clinic and Jamaica has a tertiary teen clinic. The primary goal is to engage Ministries to further develop such initiatives.

Latin America

Latin America generally refers to territories in the Americas where the Spanish or Portuguese or French languages prevail: Mexico, most of Central and South America, and in the Caribbean, Cuba, Jamaica, the Dominican Republic, Haiti, and Puerto Rico. Latin America is, therefore, defined as all those parts of the Americas that were once part of the Spanish, Portuguese and French Empires. In IAAH, Latin America refers to the mainland continent countries of Central and South America, as the Caribbean forms a separate region which includes Latin American and other countries.

Countries in the region are characterised as a mix of ‘Injury excess’ and ‘NCD burden predominant’ by the Lancet Commission on Adolescent Health and Wellbeing. The mortality rates for young men aged 20-24 are significant and constant over time. Causes of mortality for young men aged 10-19 and 20-24 is assault/homicide whereas for young women of the same age it was road traffic injuries. Top disease burden causes also include iron deficiency anaemia, skin diseases, mental health problems and asthma.

The Pan American Health Organization (PAHO) has an adolescent and youth regional strategy and plan of action for 2010-18. Its goals reflect the main challenges for adolescents and youth in the region:

• Reduce adolescent and youth mortality
• Reduce unintentional injuries
• Reduce violence
• Reduce substance use and promote mental health
• Ensure sexual and reproductive health
• Promote nutrition and physical activity
• Combat chronic diseases
• Promote protective factors

There is a focus on violence; alcohol and other substances; mental health, and nutrition. Alongside this, there is a commitment to promote positive adolescent and youth health and development with a focus on: health promotion; sexual and reproductive health; mental health; resilience; agency and empowerment. The use of integrated, multisector action is central to meeting these objectives, recognizing the importance of equity and human rights; social determinants of health and the need for a lifecourse approach. Longstanding active regional associations are the Latin-American Association of Pediatrics (ALAPE) and the Confederation of Adolescents and Youth of Ibero-America, Italy and the Caribbean (CODAJIC).

East Asia

The IAAH East Asian countries are China, Japan, Mongolia, North Korea, South Korea and Taiwan. China and Mongolia make up most of the land of East Asia. The Korean Peninsula extends off mainland China. Japan is an archipelago of volcanic islands, and Taiwan is an island off the east coast of China. There are 1.6billion people living in East Asia.

As Chinese civilization existed about 1,500 years before other East Asian civilizations emerged into history, Imperial China had much influence culturally, economically and politically on its neighbouring countries. Each country now speaks its own language, and carries its own unique culture. During the Cold War, The Korean peninsula was divided into two rival states, North and South Korea. In 1949, after losing control of mainland China in the Chinese Civil War, the Republic of China government withdrew to Taiwan. Taiwan is not a UN member now.

Countries in the East Asia region are characterised as a mix of ‘Injury excess’ and ‘NCD burden predominant’ by the Lancet Commission on Adolescent Health and Wellbeing. Three of the 4 top causes of mortality for adolescents in this region relate to injury – transport injuries (1), unintended injuries (2) and self-harm/interpersonal violence (4). The top disease producing burden in East Asia is mental health and substance use issues (17.6%), followed by NCDs (16.3%).

‘Strategic directions for improving adolescent health in South-East Asia Region (The 4S Framework)’ was developed by WHO in 2011:

• Strategic information: Improving the collection, analysis, interpretation and dissemination of data that are required for advocacy, policies and programmes
• Supportive policies: Synthesizing, disseminating and contributing to the evidence base for policies (and programmes) that have an impact on the health and development of adolescents
• Strengthening services: Increasing young people's access to, and use of appropriate health services and commodities that respond to a number of priority health conditions
• Strengthening collaboration with other sectors: Mobilizing and supporting other sectors to maximize their contributions to adolescent health and development, both what they can do to strengthen the health sector response and what the health sector can do to support their actions

There are a number of professional organisations with a keen interest in adolescent health in East Asia – regional and national paediatric societies, regional and national child and adolescent psychiatry organisations and 3 dedicated adolescent health organisations - The Child and Adolescent Health Section of the China Preventive Medicine Association, the Japan Society of Adolescentology, and the Taiwan Society for Adolescent Medicine and Health.

Europe

The European continent contains over 50 countries, some of which act as a federation called the European Union EU. Different groupings of countries in Europe share language, history, religion and culture – the continent as a whole, however, shows much diversity. Countries in Western Europe are generally of high income; those in the East show upper and lower middle incomes.

Member states of the European Union have a common framework of legislation and standards, and reciprocal use of healthcare services by their citizens. Whilst national governments are responsible for providing healthcare, EU member states co-operate on matters of public health (e.g. food labelling, screening programmes), response to diseases (e.g. vaccine purchase) and access to care (e.g. common European Health Insurance Card and sharing good practice).

Most countries in the European region would be characterised as ‘NCD burden predominant’ by the Lancet Commission on Adolescent Health and Wellbeing. Health risk behaviours predisposing to NCDS, such as smoking and obesity, are widespread.

The health of adolescents in Europe has been studied for over 30 years through the Health Behaviours in School-aged Children (HBSC) research network, through teams based in the majority of European countries. Whilst the absolute comparability of the surveys in each country might not be perfect, they give a very good indication of trends and variation across the region in health-related behaviours. The domains studied are:

• social context (relations with family, peers and school)
• health outcomes (subjective health, injuries, obesity and mental health)
• health behaviours (patterns of eating, toothbrushing and physical activity)
• risk behaviours (use of tobacco, alcohol and cannabis, sexual behaviour, fighting and bullying)

Migration into and around the region is significant. Young people are a significant proportion of asylum-seeking or economic migrants. There are very real risks of CSE and trafficking, and many families are separated. Lone young men may also be at risk of abuse and neglect. Many young people also move around the continent to access higher education and professional employment opportunities and to gain the mind-broadening experience of foreign travel.

Oceania

Oceania comprises Australia, Aotearoa New Zealand (NZ) and many archipelagos comprising the Pacific Islands (including Fiji, Micronesia, Tuvalu and the Cook Islands). Adolescents and young adults aged 10-24 comprise 4.8 million (19%) of the population of Australia (25 million) and 983,000 (20%) for New Zealand (4.9 million).

Culturally, Australia and NZ have a shared history of resettlement from Europe and the tension between these settlers and their aboriginal people. Many of the Pacific Islands align with NZ because of their geographical proximity, although some align with France because of their colonial history.

Countries in the Oceania region are characterised as ‘NCD burden predominant’ by the Lancet Commission on Adolescent Health and Wellbeing. Health challenges affecting their adolescents and young adults include obesity/overweight – affecting 30% of 10-17 year olds, 33% of 18-24 year old females and 44% of 18-24 year old males in Australia, and 29% (low deprivation areas) - 50% (high deprivation areas) of youth in NZ. In both countries, 11% of this population reported daily smoking in 2013. Harmful drinking was reported by 23% of youth in Australia and 23% in NZ. Mental health issues are also prevalent. In a recent national survey Australian youth reported a mental health issue in the preceding 12 months, and the symptoms of clinically significant depressive symptoms have been recorded for 16% of NZ girls and 9% of NZ boys. Prevention of NCDs is also a focus for these countries. HPV immunisation is one strategy for cancer prevention among both boys and girls – in Australia, where HPV immunisation is part of the national immunisation scheme and is conducted through schools, 80.1% of girls and 75% of boys aged 15 were immunised in 2015. In NZ, 54% of 12 year-old girls were immunised, with different rates among population groups, including 62% among Maori girls and 73% among Pacific Islander girls. Immunisation of boys started in 2017 and data are not yet available.

The Australian Association for Adolescent Health Ltd (AAAH Ltd) has the vision to bring “young people and professionals together to promote the health and wellbeing of adolescents and young adults throughout Australia, through local, national and international connections and collaborations”. Its strategic goals include youth engagement, effective use of social media, advocacy work and networking through conferences.

The Society of Youth Health Professionals Aotearoa New Zealand (SYHPANZ) supports doctors, nurses, and allied health professionals working within the youth health & development scope of practice in Aotearoa New Zealand. Networking with a diverse range of services, and knowledge brokering to provide research and resources to youth-focused health professionals is a major activity.

There are very few associations in the Pacific Islands, but Fiji is currently developing a national adolescent health policy.

Middle East / North Africa (MENA)

The IAAH Middle East / North Africa (MENA) region comprises a sizeable swathe of the African and Asian continents, stretching from Mauritania on the West Coast of Africa through to Iran in the East and Somalia at its most Southern point. Turkey is the northern gateway between Europe and the MENA region. The total population of the region is estimated as 540 million, of whom over 100 million are adolescents and young adults.

Countries in the MENA region are diversely characterised as ‘Multi-burden’, ‘Injury Excess’ and ‘NCD Predominant’ by the Lancet Commission on Adolescent Health and Wellbeing. This reflects different stages of country development and the damage to the infrastructure of some previously thriving countries by prolonged armed conflict. There are groups of countries who have similar cultural and religious backgrounds within the region. Most of the MENA countries are predominantly Muslim by faith, but there are also many Christians in a number of Arab countries. All societies have the same cultural and traditional norms regardless of religion.

Challenges to the health and wellbeing of adolescents in this region include morbidity and mortality due to early, forced child marriage; violence; injuries; mental health problems; substance use; communicable and non-communicable diseases.

Five countries in the region are particularly known for active organisations and/or individual specialists in adolescent health: Egypt, Iran, Lebanon, Saudi Arabia and Turkey. The active societies are the Saudi Society for Adolescent Health (established 2012), the Egyptian Society for Adolescent Medicine (established 2014) and the Arab Coalition for Adolescent Medicine (established 2014).

A recent meeting in the Region supported by the Omani National Government and IAAH resulted in the ‘Muscat Declaration’[NC1] . The numerous and wide-ranging resolutions in this declaration include commitments to address: the neglect of youth in humanitarian and fragile settings; comprehensive school-based adolescent health services; developing expertise in research and data collection; the safety and identity of women through combating gender-based violence, forced early marriage and trafficking; improving mental health; increasing physical activity; working with families, and promoting a culture of evidence-based development of policies, programs, plans, services and initiatives targeting adolescents and youth.

Europe

The European continent contains over 50 countries, some of which act as a federation called the European Union EU. Different groupings of countries in Europe share language, history, religion and culture – the continent as a whole, however, shows much diversity. Countries in Western Europe are generally of high income; those in the East show upper and lower middle incomes.

Member states of the European Union have a common framework of legislation and standards, and reciprocal use of healthcare services by their citizens. Whilst national governments are responsible for providing healthcare, EU member states co-operate on matters of public health (e.g. food labelling, screening programmes), response to diseases (e.g. vaccine purchase) and access to care (e.g. common European Health Insurance Card and sharing good practice).

Most countries in the European region would be characterised as ‘NCD burden predominant’ by the Lancet Commission on Adolescent Health and Wellbeing. Health risk behaviours predisposing to NCDS, such as smoking and obesity, are widespread.

The health of adolescents in Europe has been studied for over 30 years through the Health Behaviours in School-aged Children (HBSC) research network, through teams based in the majority of European countries. Whilst the absolute comparability of the surveys in each country might not be perfect, they give a very good indication of trends and variation across the region in health-related behaviours. The domains studied are:

• social context (relations with family, peers and school)
• health outcomes (subjective health, injuries, obesity and mental health)
• health behaviours (patterns of eating, toothbrushing and physical activity)
• risk behaviours (use of tobacco, alcohol and cannabis, sexual behaviour, fighting and bullying)

Migration into and around the region is significant. Young people are a significant proportion of asylum-seeking or economic migrants. There are very real risks of CSE and trafficking, and many families are separated. Lone young men may also be at risk of abuse and neglect. Many young people also move around the continent to access higher education and professional employment opportunities and to gain the mind-broadening experience of foreign travel.

Europe

The European continent contains over 50 countries, some of which act as a federation called the European Union EU. Different groupings of countries in Europe share language, history, religion and culture – the continent as a whole, however, shows much diversity. Countries in Western Europe are generally of high income; those in the East show upper and lower middle incomes.

Member states of the European Union have a common framework of legislation and standards, and reciprocal use of healthcare services by their citizens. Whilst national governments are responsible for providing healthcare, EU member states co-operate on matters of public health (e.g. food labelling, screening programmes), response to diseases (e.g. vaccine purchase) and access to care (e.g. common European Health Insurance Card and sharing good practice).

Most countries in the European region would be characterised as ‘NCD burden predominant’ by the Lancet Commission on Adolescent Health and Wellbeing. Health risk behaviours predisposing to NCDS, such as smoking and obesity, are widespread.

The health of adolescents in Europe has been studied for over 30 years through the Health Behaviours in School-aged Children (HBSC) research network, through teams based in the majority of European countries. Whilst the absolute comparability of the surveys in each country might not be perfect, they give a very good indication of trends and variation across the region in health-related behaviours. The domains studied are:

• social context (relations with family, peers and school)
• health outcomes (subjective health, injuries, obesity and mental health)
• health behaviours (patterns of eating, toothbrushing and physical activity)
• risk behaviours (use of tobacco, alcohol and cannabis, sexual behaviour, fighting and bullying)

Migration into and around the region is significant. Young people are a significant proportion of asylum-seeking or economic migrants. There are very real risks of CSE and trafficking, and many families are separated. Lone young men may also be at risk of abuse and neglect. Many young people also move around the continent to access higher education and professional employment opportunities and to gain the mind-broadening experience of foreign travel.

Europe

The European continent contains over 50 countries, some of which act as a federation called the European Union EU. Different groupings of countries in Europe share language, history, religion and culture – the continent as a whole, however, shows much diversity. Countries in Western Europe are generally of high income; those in the East show upper and lower middle incomes.

Member states of the European Union have a common framework of legislation and standards, and reciprocal use of healthcare services by their citizens. Whilst national governments are responsible for providing healthcare, EU member states co-operate on matters of public health (e.g. food labelling, screening programmes), response to diseases (e.g. vaccine purchase) and access to care (e.g. common European Health Insurance Card and sharing good practice).

Most countries in the European region would be characterised as ‘NCD burden predominant’ by the Lancet Commission on Adolescent Health and Wellbeing. Health risk behaviours predisposing to NCDS, such as smoking and obesity, are widespread.

The health of adolescents in Europe has been studied for over 30 years through the Health Behaviours in School-aged Children (HBSC) research network, through teams based in the majority of European countries. Whilst the absolute comparability of the surveys in each country might not be perfect, they give a very good indication of trends and variation across the region in health-related behaviours. The domains studied are:

• social context (relations with family, peers and school)
• health outcomes (subjective health, injuries, obesity and mental health)
• health behaviours (patterns of eating, toothbrushing and physical activity)
• risk behaviours (use of tobacco, alcohol and cannabis, sexual behaviour, fighting and bullying)

Migration into and around the region is significant. Young people are a significant proportion of asylum-seeking or economic migrants. There are very real risks of CSE and trafficking, and many families are separated. Lone young men may also be at risk of abuse and neglect. Many young people also move around the continent to access higher education and professional employment opportunities and to gain the mind-broadening experience of foreign travel.

Sub-Saharan Africa

There are 54 sovereign countries recognised by the United Nations in Africa. Forty-seven countries in Africa belong to the Africa region of the WHO while the northern African countries belong to the East Mediterranean region. The African Union has an area of around 29 million km2 (11 million square miles). Geographically, Africa has widely diverse terrain, including the world's largest hot desert (the Sahara), huge jungles and savannas, and the world's longest river (the Nile). Africa also has a rich diversity of languages and ethnicities with an estimated 1250-3000 languages spoken across the continent. Other primary languages, spoken largely as a result of the colonial history include English, Arabic, French, and Portuguese. The World Bank classifies most African countries as low-income countries, while only one country, Seychelles, is classified as a high-income country.

The total population of Africa is estimated at more than 1.25 billion, with a growth rate of more than 2.5% per annum. Africa is experiencing youth bulge in her population structure and has a higher proportion of youth compared to any other continent; Africa is, thus, the world’s youngest continent. WHO estimates that adolescents constitute approximately 23% of the African population. The African region of WHO was estimated to have 224 million adolescents at the end of 2015, and the number is projected to double by 2050.

Sub-Saharan African countries are considered “multi-burden” nations by the Lancet Commission on Adolescent Health and Wellbeing – characterised by a high burden of HIV and other sexual and reproductive health problems, infectious diseases, and nutritional deficiency. Africa is the epicenter of the AIDS pandemic and the continent has a higher burden of young people living with HIV than any other area. Africa also has the highest rate of teenage pregnancy in the world. Young girls in Africa have a high level of vulnerability to sexual and gender-based violence and sexual and reproductive rights violation, including child marriage, female genital cutting, and intimate partner violence. The risk of NCDs is also currently rising among adolescents and young people in Africa with the increasing adoption of a sedentary life style and non-traditional high calorie diet.

Compared to its share of the adolescent world population, Africa contributes a disproportionally high level of adolescent mortality. Unlike the trend in most other parts of the world, adolescent mortality is on the increase. According to the African Regional Office of WHO, the adolescent mortality rate increased from 5.6 per 100 population in 2000-2005 to 6.4 per 100 population in 2011-2015. HIV is the leading cause of death among adolescents in Africa; maternal-related causes account for the highest number of deaths among young women after HIV. Cultural factors, low health literacy, poor health-seeking behaviour - as well as inequitable availability of appropriate health services - are major contributory factors to the poor adolescent health status in Africa. Low political commitment to the adolescent health agenda and inadequate investment in their education, health and social development are underlying factors for the poor adolescent health picture in the African region. 

Sub-Saharan African

There are 54 sovereign countries recognised by the United Nations in Africa. Forty-seven countries in Africa belong to the Africa region of the WHO while the northern African countries belong to the East Mediterranean region. The African Union has an area of around 29 million km2 (11 million square miles). Geographically, Africa has widely diverse terrain, including the world's largest hot desert (the Sahara), huge jungles and savannas, and the world's longest river (the Nile). Africa also has a rich diversity of languages and ethnicities with an estimated 1250-3000 languages spoken across the continent. Other primary languages, spoken largely as a result of the colonial history include English, Arabic, French, and Portuguese. The World Bank classifies most African countries as low-income countries, while only one country, Seychelles, is classified as a high-income country.

The total population of Africa is estimated at more than 1.25 billion, with a growth rate of more than 2.5% per annum. Africa is experiencing youth bulge in her population structure and has a higher proportion of youth compared to any other continent; Africa is, thus, the world’s youngest continent. WHO estimates that adolescents constitute approximately 23% of the African population. The African region of WHO was estimated to have 224 million adolescents at the end of 2015, and the number is projected to double by 2050.

Sub-Saharan African countries are considered “multi-burden” nations by the Lancet Commission on Adolescent Health and Wellbeing – characterised by a high burden of HIV and other sexual and reproductive health problems, infectious diseases, and nutritional deficiency. Africa is the epicenter of the AIDS pandemic and the continent has a higher burden of young people living with HIV than any other area. Africa also has the highest rate of teenage pregnancy in the world. Young girls in Africa have a high level of vulnerability to sexual and gender-based violence and sexual and reproductive rights violation, including child marriage, female genital cutting, and intimate partner violence. The risk of NCDs is also currently rising among adolescents and young people in Africa with the increasing adoption of a sedentary life style and non-traditional high calorie diet.

Compared to its share of the adolescent world population, Africa contributes a disproportionally high level of adolescent mortality. Unlike the trend in most other parts of the world, adolescent mortality is on the increase. According to the African Regional Office of WHO, the adolescent mortality rate increased from 5.6 per 100 population in 2000-2005 to 6.4 per 100 population in 2011-2015. HIV is the leading cause of death among adolescents in Africa; maternal-related causes account for the highest number of deaths among young women after HIV. Cultural factors, low health literacy, poor health-seeking behaviour - as well as inequitable availability of appropriate health services - are major contributory factors to the poor adolescent health status in Africa. Low political commitment to the adolescent health agenda and inadequate investment in their education, health and social development are underlying factors for the poor adolescent health picture in the African region. 

Sub-Saharan African

There are 54 sovereign countries recognised by the United Nations in Africa. Forty-seven countries in Africa belong to the Africa region of the WHO while the northern African countries belong to the East Mediterranean region. The African Union has an area of around 29 million km2 (11 million square miles). Geographically, Africa has widely diverse terrain, including the world's largest hot desert (the Sahara), huge jungles and savannas, and the world's longest river (the Nile). Africa also has a rich diversity of languages and ethnicities with an estimated 1250-3000 languages spoken across the continent. Other primary languages, spoken largely as a result of the colonial history include English, Arabic, French, and Portuguese. The World Bank classifies most African countries as low-income countries, while only one country, Seychelles, is classified as a high-income country.

The total population of Africa is estimated at more than 1.25 billion, with a growth rate of more than 2.5% per annum. Africa is experiencing youth bulge in her population structure and has a higher proportion of youth compared to any other continent; Africa is, thus, the world’s youngest continent. WHO estimates that adolescents constitute approximately 23% of the African population. The African region of WHO was estimated to have 224 million adolescents at the end of 2015, and the number is projected to double by 2050.

Sub-Saharan African countries are considered “multi-burden” nations by the Lancet Commission on Adolescent Health and Wellbeing – characterised by a high burden of HIV and other sexual and reproductive health problems, infectious diseases, and nutritional deficiency. Africa is the epicenter of the AIDS pandemic and the continent has a higher burden of young people living with HIV than any other area. Africa also has the highest rate of teenage pregnancy in the world. Young girls in Africa have a high level of vulnerability to sexual and gender-based violence and sexual and reproductive rights violation, including child marriage, female genital cutting, and intimate partner violence. The risk of NCDs is also currently rising among adolescents and young people in Africa with the increasing adoption of a sedentary life style and non-traditional high calorie diet.

Compared to its share of the adolescent world population, Africa contributes a disproportionally high level of adolescent mortality. Unlike the trend in most other parts of the world, adolescent mortality is on the increase. According to the African Regional Office of WHO, the adolescent mortality rate increased from 5.6 per 100 population in 2000-2005 to 6.4 per 100 population in 2011-2015. HIV is the leading cause of death among adolescents in Africa; maternal-related causes account for the highest number of deaths among young women after HIV. Cultural factors, low health literacy, poor health-seeking behaviour - as well as inequitable availability of appropriate health services - are major contributory factors to the poor adolescent health status in Africa. Low political commitment to the adolescent health agenda and inadequate investment in their education, health and social development are underlying factors for the poor adolescent health picture in the African region. 

Sub-Saharan African

There are 54 sovereign countries recognised by the United Nations in Africa. Forty-seven countries in Africa belong to the Africa region of the WHO while the northern African countries belong to the East Mediterranean region. The African Union has an area of around 29 million km2 (11 million square miles). Geographically, Africa has widely diverse terrain, including the world's largest hot desert (the Sahara), huge jungles and savannas, and the world's longest river (the Nile). Africa also has a rich diversity of languages and ethnicities with an estimated 1250-3000 languages spoken across the continent. Other primary languages, spoken largely as a result of the colonial history include English, Arabic, French, and Portuguese. The World Bank classifies most African countries as low-income countries, while only one country, Seychelles, is classified as a high-income country.

The total population of Africa is estimated at more than 1.25 billion, with a growth rate of more than 2.5% per annum. Africa is experiencing youth bulge in her population structure and has a higher proportion of youth compared to any other continent; Africa is, thus, the world’s youngest continent. WHO estimates that adolescents constitute approximately 23% of the African population. The African region of WHO was estimated to have 224 million adolescents at the end of 2015, and the number is projected to double by 2050.

Sub-Saharan African countries are considered “multi-burden” nations by the Lancet Commission on Adolescent Health and Wellbeing – characterised by a high burden of HIV and other sexual and reproductive health problems, infectious diseases, and nutritional deficiency. Africa is the epicenter of the AIDS pandemic and the continent has a higher burden of young people living with HIV than any other area. Africa also has the highest rate of teenage pregnancy in the world. Young girls in Africa have a high level of vulnerability to sexual and gender-based violence and sexual and reproductive rights violation, including child marriage, female genital cutting, and intimate partner violence. The risk of NCDs is also currently rising among adolescents and young people in Africa with the increasing adoption of a sedentary life style and non-traditional high calorie diet.

Compared to its share of the adolescent world population, Africa contributes a disproportionally high level of adolescent mortality. Unlike the trend in most other parts of the world, adolescent mortality is on the increase. According to the African Regional Office of WHO, the adolescent mortality rate increased from 5.6 per 100 population in 2000-2005 to 6.4 per 100 population in 2011-2015. HIV is the leading cause of death among adolescents in Africa; maternal-related causes account for the highest number of deaths among young women after HIV. Cultural factors, low health literacy, poor health-seeking behaviour - as well as inequitable availability of appropriate health services - are major contributory factors to the poor adolescent health status in Africa. Low political commitment to the adolescent health agenda and inadequate investment in their education, health and social development are underlying factors for the poor adolescent health picture in the African region. 

Middle East / North Africa (MENA)

The IAAH Middle East / North Africa (MENA) region comprises a sizeable swathe of the African and Asian continents, stretching from Mauritania on the West Coast of Africa through to Iran in the East and Somalia at its most Southern point. Turkey is the northern gateway between Europe and the MENA region. The total population of the region is estimated as 540 million, of whom over 100 million are adolescents and young adults.

Countries in the MENA region are diversely characterised as ‘Multi-burden’, ‘Injury Excess’ and ‘NCD Predominant’ by the Lancet Commission on Adolescent Health and Wellbeing. This reflects different stages of country development and the damage to the infrastructure of some previously thriving countries by prolonged armed conflict. There are groups of countries who have similar cultural and religious backgrounds within the region. Most of the MENA countries are predominantly Muslim by faith, but there are also many Christians in a number of Arab countries. All societies have the same cultural and traditional norms regardless of religion.

Challenges to the health and wellbeing of adolescents in this region include morbidity and mortality due to early, forced child marriage; violence; injuries; mental health problems; substance use; communicable and non-communicable diseases.

Five countries in the region are particularly known for active organisations and/or individual specialists in adolescent health: Egypt, Iran, Lebanon, Saudi Arabia and Turkey. The active societies are the Saudi Society for Adolescent Health (established 2012), the Egyptian Society for Adolescent Medicine (established 2014) and the Arab Coalition for Adolescent Medicine (established 2014).

A recent meeting in the Region supported by the Omani National Government and IAAH resulted in the ‘Muscat Declaration’[NC1] . The numerous and wide-ranging resolutions in this declaration include commitments to address: the neglect of youth in humanitarian and fragile settings; comprehensive school-based adolescent health services; developing expertise in research and data collection; the safety and identity of women through combating gender-based violence, forced early marriage and trafficking; improving mental health; increasing physical activity; working with families, and promoting a culture of evidence-based development of policies, programs, plans, services and initiatives targeting adolescents and youth.

Latin America

Latin America generally refers to territories in the Americas where the Spanish or Portuguese or French languages prevail: Mexico, most of Central and South America, and in the Caribbean, Cuba, Jamaica, the Dominican Republic, Haiti, and Puerto Rico. Latin America is, therefore, defined as all those parts of the Americas that were once part of the Spanish, Portuguese and French Empires. In IAAH, Latin America refers to the mainland continent countries of Central and South America, as the Caribbean forms a separate region which includes Latin American and other countries.

Countries in the region are characterised as a mix of ‘Injury excess’ and ‘NCD burden predominant’ by the Lancet Commission on Adolescent Health and Wellbeing. The mortality rates for young men aged 20-24 are significant and constant over time. Causes of mortality for young men aged 10-19 and 20-24 is assault/homicide whereas for young women of the same age it was road traffic injuries. Top disease burden causes also include iron deficiency anaemia, skin diseases, mental health problems and asthma.

The Pan American Health Organization (PAHO) has an adolescent and youth regional strategy and plan of action for 2010-18. Its goals reflect the main challenges for adolescents and youth in the region:

• Reduce adolescent and youth mortality
• Reduce unintentional injuries
• Reduce violence
• Reduce substance use and promote mental health
• Ensure sexual and reproductive health
• Promote nutrition and physical activity
• Combat chronic diseases
• Promote protective factors

There is a focus on violence; alcohol and other substances; mental health, and nutrition. Alongside this, there is a commitment to promote positive adolescent and youth health and development with a focus on: health promotion; sexual and reproductive health; mental health; resilience; agency and empowerment. The use of integrated, multisector action is central to meeting these objectives, recognizing the importance of equity and human rights; social determinants of health and the need for a lifecourse approach. Longstanding active regional associations are the Latin-American Association of Pediatrics (ALAPE) and the Confederation of Adolescents and Youth of Ibero-America, Italy and the Caribbean (CODAJIC).

Europe

The European continent contains over 50 countries, some of which act as a federation called the European Union EU. Different groupings of countries in Europe share language, history, religion and culture – the continent as a whole, however, shows much diversity. Countries in Western Europe are generally of high income; those in the East show upper and lower middle incomes.

Member states of the European Union have a common framework of legislation and standards, and reciprocal use of healthcare services by their citizens. Whilst national governments are responsible for providing healthcare, EU member states co-operate on matters of public health (e.g. food labelling, screening programmes), response to diseases (e.g. vaccine purchase) and access to care (e.g. common European Health Insurance Card and sharing good practice).

Most countries in the European region would be characterised as ‘NCD burden predominant’ by the Lancet Commission on Adolescent Health and Wellbeing. Health risk behaviours predisposing to NCDS, such as smoking and obesity, are widespread.

The health of adolescents in Europe has been studied for over 30 years through the Health Behaviours in School-aged Children (HBSC) research network, through teams based in the majority of European countries. Whilst the absolute comparability of the surveys in each country might not be perfect, they give a very good indication of trends and variation across the region in health-related behaviours. The domains studied are:

• social context (relations with family, peers and school)
• health outcomes (subjective health, injuries, obesity and mental health)
• health behaviours (patterns of eating, toothbrushing and physical activity)
• risk behaviours (use of tobacco, alcohol and cannabis, sexual behaviour, fighting and bullying)

Migration into and around the region is significant. Young people are a significant proportion of asylum-seeking or economic migrants. There are very real risks of CSE and trafficking, and many families are separated. Lone young men may also be at risk of abuse and neglect. Many young people also move around the continent to access higher education and professional employment opportunities and to gain the mind-broadening experience of foreign travel.

Oceania

Oceania comprises Australia, Aotearoa New Zealand (NZ) and many archipelagos comprising the Pacific Islands (including Fiji, Micronesia, Tuvalu and the Cook Islands). Adolescents and young adults aged 10-24 comprise 4.8 million (19%) of the population of Australia (25 million) and 983,000 (20%) for New Zealand (4.9 million).

Culturally, Australia and NZ have a shared history of resettlement from Europe and the tension between these settlers and their aboriginal people. Many of the Pacific Islands align with NZ because of their geographical proximity, although some align with France because of their colonial history.

Countries in the Oceania region are characterised as ‘NCD burden predominant’ by the Lancet Commission on Adolescent Health and Wellbeing. Health challenges affecting their adolescents and young adults include obesity/overweight – affecting 30% of 10-17 year olds, 33% of 18-24 year old females and 44% of 18-24 year old males in Australia, and 29% (low deprivation areas) - 50% (high deprivation areas) of youth in NZ. In both countries, 11% of this population reported daily smoking in 2013. Harmful drinking was reported by 23% of youth in Australia and 23% in NZ. Mental health issues are also prevalent. In a recent national survey Australian youth reported a mental health issue in the preceding 12 months, and the symptoms of clinically significant depressive symptoms have been recorded for 16% of NZ girls and 9% of NZ boys. Prevention of NCDs is also a focus for these countries. HPV immunisation is one strategy for cancer prevention among both boys and girls – in Australia, where HPV immunisation is part of the national immunisation scheme and is conducted through schools, 80.1% of girls and 75% of boys aged 15 were immunised in 2015. In NZ, 54% of 12 year-old girls were immunised, with different rates among population groups, including 62% among Maori girls and 73% among Pacific Islander girls. Immunisation of boys started in 2017 and data are not yet available.

The Australian Association for Adolescent Health Ltd (AAAH Ltd) has the vision to bring “young people and professionals together to promote the health and wellbeing of adolescents and young adults throughout Australia, through local, national and international connections and collaborations”. Its strategic goals include youth engagement, effective use of social media, advocacy work and networking through conferences.

The Society of Youth Health Professionals Aotearoa New Zealand (SYHPANZ) supports doctors, nurses, and allied health professionals working within the youth health & development scope of practice in Aotearoa New Zealand. Networking with a diverse range of services, and knowledge brokering to provide research and resources to youth-focused health professionals is a major activity.

There are very few associations in the Pacific Islands, but Fiji is currently developing a national adolescent health policy.

Oceania

Oceania comprises Australia, Aotearoa New Zealand (NZ) and many archipelagos comprising the Pacific Islands (including Fiji, Micronesia, Tuvalu and the Cook Islands). Adolescents and young adults aged 10-24 comprise 4.8 million (19%) of the population of Australia (25 million) and 983,000 (20%) for New Zealand (4.9 million).

Culturally, Australia and NZ have a shared history of resettlement from Europe and the tension between these settlers and their aboriginal people. Many of the Pacific Islands align with NZ because of their geographical proximity, although some align with France because of their colonial history.

Countries in the Oceania region are characterised as ‘NCD burden predominant’ by the Lancet Commission on Adolescent Health and Wellbeing. Health challenges affecting their adolescents and young adults include obesity/overweight – affecting 30% of 10-17 year olds, 33% of 18-24 year old females and 44% of 18-24 year old males in Australia, and 29% (low deprivation areas) - 50% (high deprivation areas) of youth in NZ. In both countries, 11% of this population reported daily smoking in 2013. Harmful drinking was reported by 23% of youth in Australia and 23% in NZ. Mental health issues are also prevalent. In a recent national survey Australian youth reported a mental health issue in the preceding 12 months, and the symptoms of clinically significant depressive symptoms have been recorded for 16% of NZ girls and 9% of NZ boys. Prevention of NCDs is also a focus for these countries. HPV immunisation is one strategy for cancer prevention among both boys and girls – in Australia, where HPV immunisation is part of the national immunisation scheme and is conducted through schools, 80.1% of girls and 75% of boys aged 15 were immunised in 2015. In NZ, 54% of 12 year-old girls were immunised, with different rates among population groups, including 62% among Maori girls and 73% among Pacific Islander girls. Immunisation of boys started in 2017 and data are not yet available.

The Australian Association for Adolescent Health Ltd (AAAH Ltd) has the vision to bring “young people and professionals together to promote the health and wellbeing of adolescents and young adults throughout Australia, through local, national and international connections and collaborations”. Its strategic goals include youth engagement, effective use of social media, advocacy work and networking through conferences.

The Society of Youth Health Professionals Aotearoa New Zealand (SYHPANZ) supports doctors, nurses, and allied health professionals working within the youth health & development scope of practice in Aotearoa New Zealand. Networking with a diverse range of services, and knowledge brokering to provide research and resources to youth-focused health professionals is a major activity.

There are very few associations in the Pacific Islands, but Fiji is currently developing a national adolescent health policy.

Oceania

Oceania comprises Australia, Aotearoa New Zealand (NZ) and many archipelagos comprising the Pacific Islands (including Fiji, Micronesia, Tuvalu and the Cook Islands). Adolescents and young adults aged 10-24 comprise 4.8 million (19%) of the population of Australia (25 million) and 983,000 (20%) for New Zealand (4.9 million).

Culturally, Australia and NZ have a shared history of resettlement from Europe and the tension between these settlers and their aboriginal people. Many of the Pacific Islands align with NZ because of their geographical proximity, although some align with France because of their colonial history.

Countries in the Oceania region are characterised as ‘NCD burden predominant’ by the Lancet Commission on Adolescent Health and Wellbeing. Health challenges affecting their adolescents and young adults include obesity/overweight – affecting 30% of 10-17 year olds, 33% of 18-24 year old females and 44% of 18-24 year old males in Australia, and 29% (low deprivation areas) - 50% (high deprivation areas) of youth in NZ. In both countries, 11% of this population reported daily smoking in 2013. Harmful drinking was reported by 23% of youth in Australia and 23% in NZ. Mental health issues are also prevalent. In a recent national survey Australian youth reported a mental health issue in the preceding 12 months, and the symptoms of clinically significant depressive symptoms have been recorded for 16% of NZ girls and 9% of NZ boys. Prevention of NCDs is also a focus for these countries. HPV immunisation is one strategy for cancer prevention among both boys and girls – in Australia, where HPV immunisation is part of the national immunisation scheme and is conducted through schools, 80.1% of girls and 75% of boys aged 15 were immunised in 2015. In NZ, 54% of 12 year-old girls were immunised, with different rates among population groups, including 62% among Maori girls and 73% among Pacific Islander girls. Immunisation of boys started in 2017 and data are not yet available.

The Australian Association for Adolescent Health Ltd (AAAH Ltd) has the vision to bring “young people and professionals together to promote the health and wellbeing of adolescents and young adults throughout Australia, through local, national and international connections and collaborations”. Its strategic goals include youth engagement, effective use of social media, advocacy work and networking through conferences.

The Society of Youth Health Professionals Aotearoa New Zealand (SYHPANZ) supports doctors, nurses, and allied health professionals working within the youth health & development scope of practice in Aotearoa New Zealand. Networking with a diverse range of services, and knowledge brokering to provide research and resources to youth-focused health professionals is a major activity.

There are very few associations in the Pacific Islands, but Fiji is currently developing a national adolescent health policy.