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Currently, young people comprise the largest cohort in the history of the world and the Region.
Education has been identified as one of the structural determinants for adolescent health. Education beyond the primary level has been associated with health benefits across the life course, including lower male injury mortality, lower female fertility, improved adult health, and increased survival of future children 2. In all countries except Paraguay and Guatemala, more girls are enrolled in secondary school than boys.
Net secondary school enrollment by sex and country, last available year. The main causes of adolescent death in the Americas are external, with homicide, suicide, and traffic fatalities being the leading causes in most countries.
The regional age-adjusted mortality rates for adolescents calculations based on data from 26 countries with available data for and indicate that the overall adolescent mortality rate has increased among males and decreased among females.
Among both males and females, homicide and suicide increased as a cause of codogo and land traffic accidents decreased Table 1, Figures 2, 3, 4.
Survey data comentaddo that adolescent males commit suicide more frequently, but adolescent females attempt suicide at higher rates than males 3. Age-adjusted mortality rates perpopulation for adolescents aged 10—19 years, by sex and cause of death, — 26 countries reporting.
Crude homicide rates for adolescents ages 10—19 years by country and sex, last available year. Crude suicide rates for adolescents ages 10—19 years by country and sex, last available year. Crude mortality rates due to land transport accidents for adolescents ages 10—19 years by country and sex, last available year.
Findings from the Global Burden of Disease study indicate that the leading causes of disability-adjusted life years DALYs for adolescents have shifted since 4. Intestinal nematode infections, lower-respiratory infections, and diarrheal diseases dropped substantially in rank between andwhile skin diseases, anxiety disorders, asthma, and drug use disorders rose.
Anemia, skin diseases, motales, conduct disorders, and road injuries are the five leading causes for DALYs in the age group 10—14 years; and interpersonal violence, road injuries, skin diseases, depressive disorders, and anxiety disorders are the leading causes in the age group years.
The leading risk factor for DALYs for the years age group is malnutrition, and for the age group years the leading risk factor is alcohol and drug use 5. Good nutrition is an essential element of good health in adolescents; it improves school and educational performance, supports stronger immune systems, reduces the risk of disease across the life course, and in the event of pregnancy, it reduces the risk of adverse maternal and neonatal outcomes.
The available data on anemia, overweight, and obesity indicate that adolescents in the Americas face the double burden of malnutrition, characterized by under-nutrition along with overweight and obesity 3. Percentage of adolescent girls with anemia in selected countries, — Demographic Health Surveysaccessed November ; Argentina: Encuesta Nacional de Micronutrientes. Considering the association between consumption of sugary drinks and fast food, physical exercise, and the risk of noncommunicable diseases NCDthe substantial number of young adolescents aged who report frequently consuming soda and fast food is a major concern Figure 7.
Bibliographie américaniste – Persée
Percentage of overweight or obese adolescent girls aged 13—15, selected countries. Consumption of soda and fast food by adolescents aged 13—15, selected countries. The moralds of substances by adolescents is gguillen only a public health concern because of the contribution to DALYs and the negative behavioral consequences associated with intoxication.
There is a growing body of evidence from neuroscience indicating that the use of psychoactive substances during adolescence, particularly heavy use, may have implications across the life course due to the effect on brain development.
Psychoactive substances may generate neural adaptations that increase the risk for substance use disorders in adulthood. In addition, adolescent alcohol and marijuana users have shown changes in brain structure and functions, including lower brain volume in several regions of the brain, and reduced white matter integrity, which are associated with optimal cognitive, behavioral, and emotional development 6, 7. There are substantial variations between countries of the Region in the use of tobacco, alcohol, and psychoactive substances.
The percentage of current tobacco users among adolescents aged years ranged from comentaddo. With the exception of Argentina, more male students than female students reported recently using tobacco 8 Figure 8.
Current tobacco use among adolescents 13—17 years, by sex in selected LAC countries, last available year. Past-month use among secondary school students ranged from 7. In Argentina, Paraguay, and Saint Vincent and the Grenadines, this age group also reported high levels of alcohol use, i.
Heavy episodic drinking HED or binge drinking among boliviwno appears to be increasing; at the last survey, eight countries reported higher percentages of HED among secondary students compared to previous surveys. Lucia, Trinidad and Tobago, and Uruguay all reported an increase; only Canada and Ecuador reported a decline 9. Marijuana is the most commonly used psychoactive substance among adolescents, after tobacco and alcohol. Lifetime marijuana use among twelfth grade students ranged from 1.
In most countries of the Region, reported marijuana use is significantly higher among males, with about twice as many males as females having used marijuana within the past year. The use of other psychoactive substances remains relatively low among adolescents in the Region. Among secondary school students, use of inhalants in the past month ranged from 0. Adolescence is a gui,len life stage for sexual and reproductive health SRH due to boloviano rapid physical, hormonal, and emotional changes during puberty, including menarche for girls and their new biological capacity to reproduce.
Good adolescent SRH requires fostering of a positive, respectful, and responsible approach to sexuality and sexual relations; the possibility of having pleasurable and safe sexual experiences free of coercion, discrimination and violence; and the freedom to responsibly decide if, when, and how often to reproduce. Promoting and protecting adolescent SRH includes ensuring optimal access to information and education and appropriate health services, including access to safe, effective, affordable, and acceptable contraception; and protection from coerced and forced sex.
Undesired outcomes include sexually transmitted diseases, HIV, unplanned pregnancies, and unsafe abortions, all of which can have repercussions that extend beyond adolescence across the life course, spilling over into the next generation. Adolescent fertility rates in Canada and the United States are below the global average and have been declining steadily over the past decade. On the other hand, LAC has the second highest adolescent fertility rate in the world: Trends over time indicate that the adolescent fertility rate remained stagnant in LAC from tofollowed by a slow comehtado trend in the following 15 years.
In comparison, the global and North American trends show a sharper decline Figure 9.
2006 – Asociacion de Estudios Bolivianos / Bolivian Studies
In contrast, there has been a marked guollen in the mogales fertility rate in LAC from 3. Figure 8 illustrates the slow descent in fertility rates among adolescents compared with adult women during the year period of Figure United Nations Population Division. Age-specific fertility rates by major area, region and country, Age-specific fertility rates by major area, region and country, — There are substantial variances in the adolescent fertility rate between and within countries.
Central America has the highest adolescent fertility rate, followed by South America. At the country level, the estimated adolescent comsntado rates range from Analysis of adolescent fertility by level of education and wealth quintiles highlights the inequities within countries, showing that girls with lower education and from families in the lower wealth quintiles, and particularly indigenous girls living in rural settings, are disproportionately affected by early pregnancy Figure 10 11, 12, Encouragingly, the data show increasing trends in comprehensive HIV knowledge and condom use with nonregular partners in the Region Adolescence and the social determinants of health.
The Lancet ; Comentaco American Health Organization. The health of adolescents and youth in the Americas. The effect of alcohol consumption on mirales adolescent brain: Luciana M, Feldstein Ewing S. Introduction to the special issue: Developmental Cognitive Neuroscience ; Report on tobacco control for the region of the Americas. Organization of American States. Report on drug use in the Americas Global trends in adolescent fertility, —, in relation to national wealth, income inequalities, and boiviano expenditures.
Journal of Adolescent Health ;60 2: Demographic and Health Surveys Programme. United Nations Population Fund. The state of world population AIDS info online database [Internet]; Equity in health is a cardinal expression of social justice, attained when every individual has the opportunity to reach his full health potential and no one is excluded or hindered from reaching that potential because of his social status or other socially determined circumstances.
This ethical imperative is accompanied by a political imperative, since today it is recognized that social equity is a prerequisite for good governance. Thus, equity guil,en a political objective that consists of creating equal opportunities for health and well-being.
Indeed, without social equity, sustainable human development cannot be guaranteed 1. Aspiring to equity in health, including universal access to health and civip health coverage, implies altering the underlying distribution and role of the social determinants of health—that is, the circumstances in which individuals are born, grow, mrales, work, and age and the broader array of forces and ,orales that affect those circumstances, such as the global, national, and local distribution of wealth, power, and resources.
Transformational action that addresses the social determinants of health and promotes equity in health requires, norales the one hand, abandoning public health practices based on the risk-factor paradigm, in which the individual and behavior are the focus, while, on the other hand, adopting a more codigl approach to public policy that empowers individuals and communities to exercise control over their circumstances—a multidisciplinary and essentially intersectoral approach under the principle of Health in All Policies.
Guaranteeing the universal right to health will remain simply an aspiration if the profound social inequalities behind the health gaps in the Region are not addressed. Empirical studies offer clear proof that the population groups with the worst health outcomes in the countries of our Region also are those that demonstrate the tangible expressions of socioeconomic inequality, including low income and consumption levels, poor housing, job bolviano, limited access to quality health services, fewer educational opportunities, inadequate access to water and sanitation services, marginalization, exclusion, and discrimination, among other adverse social and health situations 3,4.
One possible explanation for this could be a certain myopia in the policies designed and implemented, even in those consistent with the universal right to health. According to Garcia-Subirats et al.
According to these authors, the inequalities in the two countries illustrate the close connection between use of the health services and the design of each health system 6.
For example, and delving a bit further into the matter, bridging gender gaps in health implies unmasking and addressing explicit and, especially, implicit, discrimination or bias in their various forms, which make public policies ineffective for women. The combination of gender based discrimination and the material constraints imposed by poverty and the consequences of other social bliviano such as living in a neglected geographical area or belonging to an ethnic group subject to social discriminationwill lead to significant health service access barriers even to services in the public sector for certain women.
In other words, the different forms of discrimination, which tend to fuel each other intersectionality and, in practice, affect certain women, become real obstacles to taking advantage of public policies that, in theory, could benefit them.
The causality between socioeconomic and health inequalities runs in both directions: Notwithstanding the historical structural impact of harmful colonial legacies, tremendous social injustice, and profound socioeconomic inequities 3the Region of the Americas, and Latin America in particular, enjoyed macroeconomic growth for much of the period —, characterized by a reduction in poverty, extreme poverty, and inequality in income distribution—a period that has come to be known as the temporary window of the Millennium Development Goals MDGs.
As documented in this publication and its preceding edition 7the Region consolidated undeniable gains in health, meeting several of the targets set for MDG 4 child mortalityMDG 6 incidence of infection with the human immunodeficiency virus [HIV], tuberculosisand MDG 7 access to safe drinking water.
Despite the impressive overall improvements, a regional look at health through the window of the MDGs paints a different and more troubling picture when examined through the lens of equity. Achievement of——or progress toward——the health-related MDGs has not generally been accompanied by a systematic reduction in social inequalities in health, especially relative inequality, which tends to be the most sensitive indicator for determining the impact of policies targeting population segments at greatest social disadvantage to ensure that no one is left behind.
An eloquent—and dramatic—example is illustrated for MDG 5 maternal mortality in Figure 1, which looks at the maternal mortality situation through the lens of equity. Inequalities in maternal mortality in the Americas, by human development quartiles in the MDG period — Prepared by the authors using WHO data in the public domain.