Noncommunicable Disease Prevention and Adolescents

"Adolescence is a time of rapid physical, neurological, social, and sexual development marked by the growing significance of peer networks, individual behavioral choices, and increased risk-taking behavior. It is also a pivotal period for the development of NCDs..."

In advance of the 2018 United Nations Third High-Level Meeting on the Prevention and Control of Non-communicable Diseases (NCDs), this paper outlines evidence, opportunities, and actions for prioritising and accelerating NCD prevention among adolescents. According to the World Health Organization (WHO), although nearly 35% of the global burden of disease has its origins in adolescence, and more than 3,000 adolescents (10-19 years of age) die every day, mostly from NCDs, intentional and unintentional injuries, and other preventable causes, adolescents have largely been overlooked in global discussions on NCDs. Developed by Spark Street Consulting and funded through a grant made by the AstraZeneca Young Health Programme (YHP) in partnership with Plan International United Kingdom (UK), this paper aims to make the case for national governments to commit to investment in adolescents. Specifically, it argues that the global prevention and control of NCDs is critical both for achieving Target 3.4 of the Sustainable Development Goals (SDGs) and for achieving other SDG targets; thus, increased consideration of the needs of adolescents and groups that have been traditionally disadvantaged is critically needed.

Following an introduction, the paper presents the global context and risk factors among adolescents. NCDs, principally cardiovascular diseases, cancers, diabetes, and chronic lung diseases, account for 70% of all deaths globally, with preponderance of those dying prematurely from preventable NCDs (86%) living in low- and middle-income countries. Among adolescents, a substantial share of the global NCD burden is due to mental illnesses. Many NCDs are also associated with behaviours that are initiated and established in childhood or adolescence, including tobacco and alcohol use, unhealthy diets, and sedentary lifestyles. The paper examines each of these in turn, also exploring the social, environmental, and commercial (e.g., marketing of unhealthy products) determinants of risk contribute to the adoption of unhealthy behaviours, impairments in physical and mental well-being, and the development of NCDs.

Next, the paper looks at prevention of NCDs among adolescents in terms of:

• Interventions such as HPV vaccination among adolescent girls (aged 9-13 years) to prevent cervical cancer.
• Platforms - e.g., expansion of service delivery platforms that provide NCD prevention services in schools and through community-based approaches. Given that in many countries young people spend a large proportion of their time at school, preschools, primary schools, and secondary schools are well positioned to promote healthy behaviours through school policies; school-based health education programmes and interventions to promote healthy eating and physical activity, including participation in sports; and through the modeling of healthy behaviours. Plan says that learning from countries that have implemented multi-sectoral actions to address the social determinants of NCDs will be an important component in developing integrated and context-specific interventions and programming.
• Strategies and approaches, including:
  • A life course approach.
  • An integrated, comprehensive, and standards-driven approach that moves beyond adolescent pregnancy and HIV to address the full range of adolescents' health and development needs.
  • A multi-sectoral and multi-stakeholder approach that includes broad public sector engagement across health, education, youth development, trade and finance, and urban planning, as well as civil society and the private sector to address behavioural, social, and environmental determinants of risk.
  • An inclusive youth development and empowerment approach that enhances the literacy of adolescents, including health literacy, and creates meaningful and formal opportunities for adolescent participation in the planning and implementation of adolescent programming, including through mentorship and training activities.
• Policy and regulatory action that limits or prevents exposure to NCD risks in adolescence, such as regulating how alcoholic drinks are targeted at the younger market and banning tobacco advertising.

Finally, priority areas for action are outlined in these four areas: policies and regulations; data, financing, and accountability; programmes; and adolescent participation. On the latter area, Plan recommends these actions:

• Ensure that national policy frameworks recognise the importance of adolescent participation and leadership in national planning processes through the establishment of formal mechanisms for participation, including inclusion and outreach to adolescents from key vulnerable groups.
• Create forums, structures, and processes to institutionalise adolescent participation and leadership in national and sub-national dialogues and planning processes about young people's health and well-being, including NCD risk reduction.
• Strengthen adolescent competencies and leadership in NCD prevention through sustained training and mentorship opportunities.