Adolescent health: boys matter too

Abstract

It has been a good year for adolescents. Many global health reports and initiatives now mention adolescents. So also does the latest UN Population Fund's State of the World Population 2015 report, released on Dec 3. Shelter from the Storm: a transformative agenda for women and girls in a crisis-prone world reminds us that there are 26 million women and adolescent girls in their childbearing years in need of humanitarian assistance worldwide. During the past 2 years or so, adolescents have been increasingly included in the women's and child health agenda, culminating in UN Secretary-General Ban Ki-moon's updated Global Strategy for Women's and Children's Health into the Global Strategy for Women's, Children's and Adolescents' Health (2016–2030), presented on Sept 26 at the General Assembly. In its foreword, he states that adolescents are included “because they are central to everything we want to achieve, and to overall success of the 2030 Agenda”. This is a much needed and welcome extension of global attention to an age group that has long been neglected and now constitutes about 25% of the world's population. In many cases, however, the emphasis is on adolescent girls, especially in discussions about contraception, sexual and reproductive health, child marriage, and education. Although such a focus might be understandable (The Lancet argued a year ago that we should be putting women, children, and adolescent girls at the centre of sustainable development), adolescent boys are an important, and neglected, part of the equation. One might argue that girls are often disadvantaged, that early marriage and childbearing have serious negative consequences on health and educational attainment, and that the health of the adolescent girl also affects her children. This is all true. But to achieve adolescent health and wellbeing as a basis for sustainable development, economic prosperity, and stable peaceful societies, we need to also focus on adolescent boys for two main reasons. First, adolescent boys have a different risk profile to girls for both immediate health issues and causes of deaths, and for risk factors related to diseases, mortality, and disabilities later in life. Alcohol, tobacco, and drug use are more common in boys than in girls, with immediate and long-term consequences, and interlinked effects on violence and injuries. Mental health disorders, although not more common than in girls, are often not recognised by parents, teachers, or peers. Boys—like men—are less likely to seek help early. Self-esteem, an important predictor for continuing health and wellbeing, is eroded by high youth unemployment in many countries with a further vicious circle of alcohol and substance abuse, and mental disorders, and the potential for engagement in destructive activities. The digital revolution has brought further unknown factors into play. Boys are more likely than girls to engage in excessive gaming with ensuing sleep deprivation, less physical activity, and greater exposure to marketing of unhealthy products. Additionally, whether or not excessive computer-based activities have a negative effect on the ability to form positive and stable relationships remains unknown. Second, adolescent boys should be part of global health discussions about contraception, family planning, and sexual and reproductive health, as well as about the importance of education for both boys and girls. Adolescents of both sexes need to understand the importance of delaying childbirth and how they can achieve this together. They need to understand and acknowledge that the way the adolescent brain works in both girls and boys means that decisions made are dependent on immediate circumstances with little regard for future consequences and are highly influenced by peer pressure. Risk avoidance and mitigation strategies need to take this relatively recent insight into account. If boys can be included and educated appropriately, progress in the area of sexual and reproductive health—although more immediately relevant to adolescent girls—might have greater long-term effects. 2016 will see even more emphasis on adolescent health and wellbeing—and rightly so. A forthcoming Lancet Commission will argue strongly for comprehensive attention to the health and wellbeing of adolescents and will report concrete recommendations. The start of the Sustainable Development Goal era needs adolescents at the centre. Those who are adolescents now—boys and girls—will be decision makers in 2030 and beyond. While we need positive discrimination of women in many areas, it would be a mistake to extend this to adolescents. Boys matter too and are in danger of being left behind. The urgency of a sociocultural approach to adolescent men's health risk behavioursAdolescent men's health is a global concern.1 Most reports and consensus focus on individuals' health risk behaviours—eg, tobacco consumption, binge drinking, and drug consumption, among others.2 In addition to this approach, we need to incorporate a sociocultural dimension into adolescent men's health. Full-Text PDF