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Adolescent Health Measurement—A Necessary Step Toward Achieving Global Goals

      See Related Article on p.888
      This issue of the Journal of Adolescent Health includes a report on the identification of core areas for adolescent health measurement from the Global Action for Measurement of Adolescent Health (GAMA) Advisory Group [
      • Guthold R.
      • Moller A.-B.
      • Adebayo E.
      • et al.
      Priority areas for adolescent health measurement.
      ]. GAMA was established in 2018 as a World Health Organization (WHO) sponsored project, with support from other United Nations (UN) agencies and the Bill and Melinda Gates Foundation; the main goal of GAMA is to try to reach agreement across UN agencies and other stakeholders on priority indicators to monitor adolescent health [
      • Guthold R.
      • Moller A.B.
      • Azzopardi P.
      • et al.
      The Global Action for Measurement of Adolescent Health (GAMA) initiative–Rethinking adolescent metrics.
      ].
      The GAMA Advisory Group is comprised of 17 adolescent health content experts from 14 countries, includeing four young adults, ensuring that consideration of adolescent issues includes young people's voices, albeit from young professionals who were recent consumers of the health and social systems serving adolescents in their countries [
      • Guthold R.
      • Moller A.-B.
      • Adebayo E.
      • et al.
      Priority areas for adolescent health measurement.
      ,
      • Guthold R.
      • Moller A.B.
      • Azzopardi P.
      • et al.
      The Global Action for Measurement of Adolescent Health (GAMA) initiative–Rethinking adolescent metrics.
      ]. This inclusion of youth is important: today's adolescents will be adults in 2030 when the world considers whether we have achieved the global goals and targets in the Sustainable Development Goals (SDGs). The world's adolescents face significant health and societal challenges, ranging from mental health, child marriage, food insecurity and obesity, and injury to crises in education, employment, the environment, and other disruptions in their communities. As much as one third of the total global burden of disease is attributable to behavioral choices and events that occur during adolescence [
      • Guthold R.
      • Moller A.B.
      • Azzopardi P.
      • et al.
      The Global Action for Measurement of Adolescent Health (GAMA) initiative–Rethinking adolescent metrics.
      ].
      The current report from GAMA describes systematic identification of priority areas for measurement using four sources: perspectives of young adults, country priorities, disease burden, and existing measurement efforts. Content areas most frequently identified varied across the different sources. These included mental health and weight in youth representatives' opinions; reproductive health and HIV/AIDS in country policies; injury, self-harm, skin diseases, and mental health in the disease burden analysis; and reproductive health and fertility in measurement initiatives. Using an iterative process, the advisory group selected 33 core, 19 expanded, and six context-specific adolescent health measures, selected from six priority domains: policies, programs, and laws; systems performance and interventions; health determinants; health and risk behaviors; subjective well-being; and health outcomes and conditions.
      GAMA's ongoing work-plan includes mapping existing adolescent health indicators that have been or are being used to measure these 33 core measurement domains, followed by recommendations for priority indicators, and how these indicators might best be collected, analyzed, and reported on [
      • Guthold R.
      • Moller A.B.
      • Azzopardi P.
      • et al.
      The Global Action for Measurement of Adolescent Health (GAMA) initiative–Rethinking adolescent metrics.
      ]. GAMA then plans to provide implementation assistance to encourage the use of priority indicators for ongoing measurement and surveillance. This bears close attention from the adolescent health community: the impact of these recommendation at the national level will depend greatly on support and advocacy by national stakeholders within countries, as well as the response of statistical and measurement experts within countries' health and vital statistics agencies.
      GAMA's plan also faces challenges. For example, although they use the standard UN definition of ages 10–19 years as comprising “adolescence,” various agencies use many other overlapping definitions to mark the ages and developmental stages of adolescents, young adults, and youth. Both health issues and the health care and social systems in countries change dramatically over these years. And combining measures across this age range may obscure, rather than illuminate, specific needs of young people. The health care systems for adolescents increasingly have recognized that the needs of young adults are closely related to and best addressed in settings that also provide care to older teens []. In addition, as GAMA continues its work, a potential risk of focusing on existing indicators from the core domains is that outcomes may be more likely to be easily and accurately measured than behaviors, which are in turn more easily measured than health or educational systems' quality and impact. GAMA's work is done in collaboration with national governments and other measurement stakeholders in hopes of focusing efforts on areas seen as most likely to benefit from action to improve adolescent health. But these latter categories of indicators are critically important when thinking about system improvements that can benefit adolescents' lives, and this is key to engaging clinical leaders and other service providers in the policy discussions needed to promote implementation of better measures.
      The UN SDGs (Figure 1) call for action by all countries and for attention to equity and disparities within countries to end poverty, promote health, build economic growth, and address education, social protection, jobs, climate change, and environmental protection [
      • Sawyer S.M.
      • McNeil R.
      • Francis K.L.
      • et al.
      The Age of Paediatrics.
      ]. It is encouraging that there is high-level recognition of the importance of youth participation in the SDGs and highly visible youth involvement at the UN and WHO and in civil society leadership. The UN Secretary General specifically notes the importance of the 1.8 billion people between the ages of 10–24 years as agents of change, with the potential to effectively transform the world into a better place for all [
      United Nations
      Sustainable Development Goals.
      ].
      Figure thumbnail gr1
      Figure 1The 2030 Sustainable Development Goals (SDGs).
      In contrast, the measures and indicators that have made it into the SDGs are not especially sensitive to young people's needs or priorities. For example, within SDG3 (Health: Ensuring healthy lives and promoting well-being at all ages), there are 13 subgoals, almost all of which affect adolescents (Figure 2). But, as the GAMA authors note, the indicators that have been selected to track progress toward these goals do not, for the most part, include adolescents and do not provide consistent disaggregation of data by age or gender—both of which are needed to effectively measure progress for young people.
      Figure thumbnail gr2
      Figure 2SDG3 Health Goals and Targets [
      • Sawyer S.M.
      • McNeil R.
      • Francis K.L.
      • et al.
      The Age of Paediatrics.
      ].
      GAMA calls for increased attention to measurement of adolescent health and identifies gaps, including a need for better measurement of health service quality for adolescents to enable governments to track interventions and policies that address issues for adolescents in their countries. In contrast, the UN Statistical Commission and the national statistics and surveillance leaders who selected the SDG indicator measures are removed from those leading social, educational, or health systems serving young people in most countries. For the former, young people and other adolescent health stakeholders need to advocate consistently for the SDG indicators and other measurement efforts to recognize that counting health outcomes is no longer enough. These efforts must include the best available measures of access for adolescents, including those that address utilization and quality of care [,
      • Klein J.D.
      • Slap G.B.
      • Elster A.B.
      • Schonberg S.K.
      Access to health care for adolescents. A position paper of the Society for Adolescent Medicine.
      ] and that include the perspectives of youth and their families [
      • Klein J.D.
      • Slap G.B.
      • Elster A.B.
      • Cohn S.E.
      Adolescents and access to health care.
      ], so that measures used connect to improving the interventions and services that reach young people. The latter stakeholder group will more likely understand why consistent and comparable measures are needed. For these stakeholders, the challenge for GAMA will be to explain why their prescription for measurement will be better than many that have come before. One hopes that their products will include systems and services measures that will be used to improve care for young people and not just mortality and behavioral measures, which, despite being more reliable, valid, and easier to obtain, have little or no impact on improving either systems of care or young people's health [
      Child Health Initiative, PMNCH, Plan international, UNFPA, UNICEF, WHO, UN Major Group for Children and Youth
      Adolescents 2030: A call to action for adolescent well-being.
      ,
      • Ross D.A.
      • Hinton R.
      • Melles-Brewer M.
      • et al.
      Commentary: Adolescent well-being: A definition and conceptual framework.
      ].
      The Partnership for Maternal Newborn and Child Health, a WHO-recognized alliance of more than 1,000 partner organizations across 192 countries, is committed to improving women's, children's, and adolescents' health. Along with many of its member organizations, the Partnership launched a Call to Action for Adolescent Wellbeing in 2019 [
      Child and Adolescent Health Measurement Initiative
      The young adult health care survey.
      ]. This call was accompanied by a conceptual framework for well-being designed to inform policies and programming [
      Child Health Initiative, PMNCH, Plan international, UNFPA, UNICEF, WHO, UN Major Group for Children and Youth
      Adolescents 2030: A call to action for adolescent well-being.
      ]. The Call's priorities are to (1) engage and empower adolescents; (2) go beyond the health sector, launching a powerful multisectoral response; and (3) strengthen political commitment and funding through a Global Summit on Adolescents in 2023 [
      Child and Adolescent Health Measurement Initiative
      The young adult health care survey.
      ]. This third priority calls for increasing the level and effectiveness of spending on adolescent well-being to provide all adolescents with “mandatory, prepaid pooled funding for services that comprehensively address adolescent needs.” GAMA's measurement prescriptions are a necessary step but alone will not be sufficient toward reaching these goals. Success will also require a focus on the implementation of effective care systems for youth, successful advocacy by our adolescent health community, and all nations' commitments to funding and action to improve the lives of young people.

      Funding Sources

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