GlobalStrategyforWomen’sChildren’sandAdolescents’HealthTargets—alignedwiththeSDGs
SURVIVEEndpreventabledeaths
• Reduceglobalmaternalmortalitytolessthan70per100,000livebirths
• Reducenewbornmortalitytoatleastaslowas12per1000livebirthsineverycountry
• Reduceunder-5mortalitytoatleastaslowas25per1000livebirthsineverycountry
• EndepidemicsofHIV,tuberculosis,malaria,neglectedtropicaldiseasesandothercommunicablediseases
• Reduceby1/3 prematuremortalityfromNCDs andpromotementalhealthandwell-being
TRANSFORMExpandenablingenvironments
• Eradicateextremepoverty
• Ensurethatallgirlsandboyscompletefree,equitableandgoodqualitysecondaryeducation
• Eliminateallharmfulpracticesandalldiscriminationandviolenceagainstwomenandgirls
• Achieveuniversalandequitableaccesstosafeandaffordabledrinkingwaterandtoadequatesanitationandhygiene
• Enhancescientificresearch,upgradetechnologicalcapabilitiesandencourageinnovation
• Providelegalidentityforall,includingbirthregistration
• Enhancetheglobalpartnershipforsustainabledevelopment
THRIVEEnsurehealthandwell-being
• Endallformsofmalnutrition,andaddressthenutritionalneedsofadolescentgirls,pregnantandlactatingwomenandchildren
• Ensureuniversalaccesstosexualandreproductivehealth-careservices(includingforfamilyplanning)andrights
• Ensurethatallgirlsandboyshaveaccesstogoodqualityearlychildhooddevelopment
• Substantiallyreducepollution-relateddeathsandillnesses
• Achieveuniversalhealthcoverage,includingfinancialriskprotection,andaccesstoqualityessentialservices,medicinesandvaccines
Adolescents'HealthChallenges
Sources:HealthfortheWorld’sAdolescents.2014www.who.int/maternal_child_adolescent/topics/adolescence/second-decade &others
Sources:TrendsinMaternalMortality,1990-2013;LevelsandTrendsinChildMortality,Report2014.
Women'sHealthChallenges
Children'sHealthChallenges
Sources:TrendsinMaternalMortality,1990-2013;LevelsandTrendsinChildMortality,Report2014.
RiskFactors• TobaccoUse• UnhealthyDiet• PhysicalInactivity• HarmfulUseofAlcohol
• HPVInfection• AirPollution• Genderbasedviolence/intimatepartnerviolence• EarlyMarriage
8 9 10 10 11 11 12
0
5
10
15
20
25
WesternPacific
EasternMediterranean
South-EastAsia
Global Europe Americas Africa
Percentageofyouth13-15yearsoldwhowereofferedfreecigarettesamples
Source:GlobalYouthTobaccoSurvey
Youthareprimarytargetsofsamplingandvalueincentivespromotedbythetobaccoindustry
Obesity• Adolescentobesitystronglypredictsadultobesityandassociated
morbidity,thecaseisevenstrongerwhenconsideringthematernalandintergenerationalhealthrisksofobesityinyoungwomen.
• Adolescentshavegreaterautonomyaroundfoodchoicesandaremorelikelytoeatoutofthehome,whichoftenleadstolesshealthyfoodchoices.Exposuretomediainfluencesandsusceptibilitytoprocessedfoodmarketingalsoincrease.
• Preventionofoverweightandobesitythroughtaxationofunhealthyfoods,restrictionoffastfoodadvertising,andpromotionofphysicalactivityinschoolandinthecommunity.
Cervicalcancer
• 270000deathseachyearworldwide.• About80%ofthecervicalcancersworldwideoccurinlow-income
countries• HPVvaccinationtobecost-effectiveandparticularlybeneficialinlow-
incomecountries,whichdonothaveaccesstogovernment-fundedcervicalscreeningprogrammes.Additionally,thebenefitofHPVvaccinationishighestamongwomenwithlowincomes.
IntimatePartnerViolence
• Thehealthconsequencesofintimatepartnerviolenceincludethoserelatedtophysical(eg,injuryordisability),sexualandreproductive(eg,HIV/AIDS),andmental(eg,anxietyordepression)health,aswellasdeath(eg,maternalmortalityorhomicide).
• 29%ofever-partneredgirlsaged15-19yearshavebeensubjectedtophysicaland/orsexualviolencebyacurrentorformerintimatepartner
Disease/injuryresultingfromviolence Effectsize(95%CI)
Unipolardepressivedisorders OR=1.97(1.56to2.48)
Alcoholusedisorders OR=1.82(1.04to3.18)
Suicide OR=4.54(1.78to11.61)
Intergenerationallink- Earlylifeprogrammingisnowthoughttobeimportantintheaetiology of
obesity,type2diabetes,andcardiovasculardisease,openingupthepossibilitythatthesecommondiseasescouldbepreventedbyachievingoptimalfetalandinfantdevelopment.
- Mountingevidencelinkingmaternalobesityduringpregnancytoobesityinthechildren
- Maternalsmokinghasbeenlinkedtoanincreasedriskofobesityinthechildren
- Childmarriage
GestationalDiabetes• TheriskofdevelopingGDMincreasessignificantlywithincreasesinpre-
pregnancyBMI.RiskofGDMinoverweightwomen(BMI25.0–29.9)increasedmorethantwofoldandinobesewomen(BMI30.0–34.9)andseverelyobesewomen(BMI35.0–39.9),approximately3.5- and8.5-fold.
• ThepresenceofGDMincreasestheriskofeitherrestrictedorexcessfetalgrowth(macrosomia),fetaladiposity,predispositiontoobesitythroughoutlife,impairedglucosetolerance,T2DM,andmetabolicdisordersintheinfant.
Life-yearsgainedfrominterventions
Life-yearsgainedfrominterventionstargetingNCDs
Lowincome
Lower-middleincome
Upper-middleincome
Total
Alladolescents 0.9m 3.6m 1.4m 5.9m
Maleadolescents
10–14years 0.1m 0.2m 0.1m 0.4m
15–19years 0.3m 1.3m 0.5m 2.1m
Femaleadolescents
10–14years 0.1m 0.2m 0.1m 0.4m
15–19years 0.5m 1.8m 0.7m 3.0m
HumanpapillomavirusvaccinationprogrammeDeathsduetocervicalcanceraverted(overlifetimeofadolescentstreated)
1.9m 2.5m 0.7m 5.1m
AccesstoServices• Adolescentsandyoungadultshavethepoorestlevelofuniversalhealth
coverageofanyagegroup• Barriers
– Externaltohealthservices• Legalframeworksgoverninghealthactions• FinancialbarriersandOut-of-pocketcosts• Culturalandcommunityattitudes,e.g.provider’sattitudesandbeliefs
– Developmentalcontextofadolescence• Increasingdesireforprivacyandconfidentiality,withembarrassment,shame,andfearofbeingjudgedrestrictingaccesstohealthcare.
• Concernisthattheirparentswillbeinformedaboutsensitiveissues,e.g.insuranceclaimsanditemised bills
AccesstoServices– cont.– Increaseswhen
• livingwithdisabilitiesorchronicillnesses• livinginremoteareasorcaughtupinsocialdisruptionfromnaturaldisastersorarmedconflicts
• stigmatizedandmarginalizedbecauseofsexualorientation,genderidentityorethnicity
• institutionalized,orexposedtodomesticviolenceorsubstanceabuseinthefamily
• exploitedandabused• married,orwhomigrateforworkoreducationwithoutfamilyorsocialsupport
• Multi-sectorapproach
Toolsetc.• AA-HA!
http://apps.who.int/iris/bitstream/10665/255415/1/9789241512343-eng.pdf?ua=1
• H6toolkithttp://www.everywomaneverychild.org/h6-toolkit/
• APracticalToolkitforYoungPeopletoAdvocateforImprovedAdolescentHealthandWell-beinghttp://www.who.int/pmnch/knowledge/publications/advocacy_toolkit.pdf?ua=1
• HPV,HIVandcervicalcancer,leveragingsynergiestosavewomen’sliveshttp://www.unaids.org/sites/default/files/media_asset/JC2851_HPV-HIV-cervicalcancer_en.pdf