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Adolescent and Young Adult Health in the Arab Region: Where We Are and What We Must Do

2015; Elsevier BV; Volume: 57; Issue: 3 Linguagem: Inglês

10.1016/j.jadohealth.2015.06.010

1879-1972

Fadia AlBuhairan,

Adolescent and Pediatric Healthcare

See Related Articles p. 252, 263Throughout much of the world, the popular impression of the Arab region is of desert, turmoil, instability, and a lack of security. But to those more familiar with the region and its people, the impression is of the fundamental importance and value of family, tradition, generosity, and religion. Although the political upheavals that the region has witnessed in recent years are concerning to all, adolescents and young adults may have the most at stake. The region has a youthful population, with about 20% of the population aged 10–19 years and about 60% aged younger than 25 years [[1]UNDPArab human development report 2009:Challenges to human security in the Arab countries. United Nations Development Programme and Regional Bureau for Arab States, New York2009Google Scholar]. But it is only recently that these countries have recognized that the transitional state of adolescence exists in their societies. Traditionally, Arab society views one as a child or an adult, with that transition generally occurring abruptly and usually defined by puberty [[2]AlBuhairan F. Areemit R. Harrison A. Kaufman M. Adolescent psychosocial development and evaluation: Global perspectives.in: Özdemir Ö. Complementary Pediatrics. 2012Crossref Google Scholar]. The changing social context with respect to, for example, attainment of higher education or delay in marriage and consequent changes or delays in responsibilities have resulted in an increasing gap between childhood and adulthood and the introduction and prolongation of adolescence. These social changes, however, have not been synchronized with the requisite development of health services and care. For the most part, health care in the Arab region remains child or adult focused, with the age cutoff being somewhere between 12 and 14 years [[2]AlBuhairan F. Areemit R. Harrison A. Kaufman M. Adolescent psychosocial development and evaluation: Global perspectives.in: Özdemir Ö. Complementary Pediatrics. 2012Crossref Google Scholar]. See Related Articles p. 252, 263 The Arab region is heterogeneous in terms of the economies, infrastructure, resources, and geographies of its various countries. Some countries are very well developed and have modern, technology-enabled government systems, whereas others are underdeveloped, with many more lying somewhere along the continuum. The region is composed of the 22 states of the Arab League, all sharing a common language and many similar cultural values. Although some may not yet realize it, the region's “youth bulge” represents a demographic opportunity. Despite the very limited adolescent- and young adult–focused health care services in the region, these governments will soon realize that their adolescents and young adults are assets and that investing in their health and well-being will positively impact economic development. The diversity in the region is also reflected in the health status of its adolescents and young adults. Wide disparities exist between the health of adolescents in high-income countries of the region and that of adolescent refugees from areas of armed conflict or occupation. To address the status of adolescent health in the region comprehensively, one must take into account these disparities and those in education and access to health care services. In other words, it is critically important to identify, understand, and address the social and political determinants of adolescent and young adult health. There are areas of the Arab region where access to education and health care services is taken for granted. In other areas, net school enrollment has declined because of conflict or destruction of schools, and health care access has been denied because of infrastructure loss or interference at checkpoints in occupied areas [[3]United NationsChildren and armed conflict: Report of the Secretary-General. General Assembly Security Council, New York, NY2007Google Scholar]. Many refugees and individuals in areas of conflict live below the poverty line, experiencing food insecurity and unsanitary conditions. Malnutrition and outbreaks of communicable diseases that were previously controlled or eradicated are now being witnessed among these populations [[4]Sharara S.L. Kanj S.S. War and infectious diseases: Challenges of the Syrian civil war.PLoS Pathog. 2014; 10: e1004438Crossref PubMed Scopus (132) Google Scholar]. Limited opportunities for some of these adolescents and young adults have negatively impacted their quality of life, with some resorting to health risk behaviors for survival [[5]Khouri R.G. Lopez V.M. A Generation on the Move: Insights into the Conditions, Aspirations and Activism of Arab Youth. Issam Fares Institute for Public Policy and International Affairs. American University of Beirut, Beirut, Lebanon2011Google Scholar]. In this issue of the Journal of Adolescent Health, Obermeyer et al. [[6]Obermeyer C.M. Bott S. Sassine A.J. Arab adolescents: Health, gender, and social context.J Adol Health. 2015; 57: 252-262Google Scholar] reviewed the existing literature on the health status of adolescents in the Arab region. The authors focus on four conditions and risks that are prevalent in the region and discuss adolescent health in the context of some important social elements. Data collected before the recent spread of conflict and political instability in the region have shown that the overall leading cause of death across all ages is ischemic heart disease, the third leading cause for disability-adjusted life years (DALYs) for males is road injuries, and the second leading cause for DALYs for females is major depressive disorder [[7]Mokdad A.H. Jaber S. Aziz M.I. et al.The state of health in the Arab world, 1990-2010: An analysis of the burden of diseases, injuries, and risk factors.Lancet. 2014; 383: 309-320Abstract Full Text Full Text PDF PubMed Scopus (225) Google Scholar]. Applying a life-course approach to health, Obermeyer et al. focus on the status of overweight/obesity and related lifestyle behaviors, tobacco use, transport injuries, and mental health disease, as these are all conditions or behaviors that are largely initiated during adolescence and shape adult health [[8]WHOHealth for the world's adolescents: A second chance in the second decade. World Health Organization, Geneva, Switzerland2014Google Scholar]. Of particular importance is the fact that mental and behavioral disorders account for the largest proportion of DALYs (>20%) among adolescents aged 15–19 years in the Arab region, a rate that is higher than the global average for the same age [[6]Obermeyer C.M. Bott S. Sassine A.J. Arab adolescents: Health, gender, and social context.J Adol Health. 2015; 57: 252-262Google Scholar]. Although gender disparities exist globally, with females suffering from mental health problems more than males, the gender gap is even wider among adolescents in the Arab region; mental and behavioral disorders contribute to 19.2% of DALYs among males and 24.9% among females [[6]Obermeyer C.M. Bott S. Sassine A.J. Arab adolescents: Health, gender, and social context.J Adol Health. 2015; 57: 252-262Google Scholar]. With current regional crises, the burden of poor mental health among adolescents and young adults is expected to be even higher today [[8]WHOHealth for the world's adolescents: A second chance in the second decade. World Health Organization, Geneva, Switzerland2014Google Scholar]. Similarly, although mortality rates for adolescents and young adults in the region have generally declined, they have increased in war-torn countries of the region [[5]Khouri R.G. Lopez V.M. A Generation on the Move: Insights into the Conditions, Aspirations and Activism of Arab Youth. Issam Fares Institute for Public Policy and International Affairs. American University of Beirut, Beirut, Lebanon2011Google Scholar]. For those countries that are relatively stable, the status of adolescent health is similar to that of developed countries across the globe, with some of the same prevalent conditions and risk factors for chronic noncommunicable disease. Regional evidence on adolescent sexual health is very limited, as it is a topic that many shy away from. In Arab society, sexual activity is only permitted within the context of a marital relationship, and any sort of sexual activity, whether consensual or forced, is considered taboo. Several factors, such as increasing numbers of young people achieving higher education or the increasing costs of marriage coupled with very high unemployment rates, have contributed to a delay in age of marriage. Young people must continue to observe society's expectation that they remain celibate for a longer period of time. Obermeyer et al. [[6]Obermeyer C.M. Bott S. Sassine A.J. Arab adolescents: Health, gender, and social context.J Adol Health. 2015; 57: 252-262Google Scholar] describe the status of regional sexual health issues based on the limited evidence that exists. Thus, the article's findings probably represent a modest reflection of the actual status; at a minimum, it is clear that providing adolescents with widespread sexual education is a necessary step for this evolving population. But without comprehensive evidence on the status and needs of populations in conflict zones, we cannot obtain a full picture of the status of adolescent and young adult health in the Arab region. Numerous countries in the region have experienced recent conflict; several are experiencing ongoing conflict. Recent reports have stated that 12.3 million Arab children and adolescents are out of school [[9]UNICEFRegional report on out-of-school children. UNICEF MENA Regional Office, Amman, Jordan2015Google Scholar]. This is a major regression; previous reports had shown significant decreases in school dropout rates in the region. Such situations breed frustration, ill health, and a vicious cycle of further violence. Even those fortunate enough to find refuge externally may now be residing in host countries that are themselves experiencing an increased burden on their own health care systems. Youth identities in the region are evolving within their changing societies and are impacted by both local and foreign values [[5]Khouri R.G. Lopez V.M. A Generation on the Move: Insights into the Conditions, Aspirations and Activism of Arab Youth. Issam Fares Institute for Public Policy and International Affairs. American University of Beirut, Beirut, Lebanon2011Google Scholar]. Young people identify with their local cultures, including family and religion, but with the abundance of accessible media outlets, they have also become influenced by global youth culture. Like the rest of the world, the region has witnessed an exponential growth in social media use, especially among young people and women [[10]Dubai School of GovernmentThe role of social media in Arab women's empowerment.Arab Social Media Report. 2011; 1: 1-25Google Scholar]. Despite many governmental restrictions on freedom of expression, youth have been politically active on social media. There is an increasing interest in migration, either intra- or extra-regional. Interest in emigration increases with higher educational level [[11]Silatech and Gallup IncThe Silatech index: Voices of young Arabs. Silatech and Gallup Inc, 2009Google Scholar]. As a region with some of the world's highest unemployment rates, emigration may be viewed as an appropriate reaction, but “brain drain” in the Arab region has itself been shown to be a reason for young people choosing to emigrate [[12]Özden C. Brain drain in Middle East & North Africa—The patterns under the surface. Population Division, Department of Economic and Social Affairs, United Nations Secretariat, Beirut2006: 15-17Google Scholar]. The status of adolescent health in the Arab region is a multidimensional, complex matter. Many of the overall determinants of health can only be fully understood if addressed collectively, but disparities and local contexts mean that we must be able to prioritize according to local needs. We need to capitalize on some existing elements in the region, whereas in other areas, new initiatives must be launched. For some young Arab people, schools are a safe haven where health needs might be addressed; for others, school is a remote thought, and the priority is finding basic needs for survival. Because family is of utmost value in the region, it is critical that we maximize the protective role and effect of families. As our young people take charge of their future, they are increasing their civic engagement and mobilization. They are social media savvy. If we provide young people with the necessary space, they will build a movement to improve their own health. Concurrently though, Arab countries must build a regional professional capacity in adolescent health, beginning at the undergraduate level and continuing through professional training. Research culture should be promoted to trainees as an opportunity to learn about the needs of young people. It is time that the region's health services were differentiated and specialized to encompass all age groups, including adolescents and youth; a life-course approach will be critical to the provision of appropriate care and services. Our health systems must also include marginalized adolescents and young adults, including refugees, the institutionalized, or those with disabilities. These improvements will necessarily involve addressing gender issues and other sensitive topics, such as sexuality and substance use. Opening these doors will require not just the support of the general public but also of professionals and institutional review boards. The Arab region will need surveillance systems and the means for systematically monitoring trends in health [[13]AlBuhairan F.S. Tamim H. AL Dubayee M. et al.Time for an adolescent health surveillance system in Saudi Arabia: Findings from ‘Jeeluna’.J Adolesc Health. 2015; 57: 263-269Abstract Full Text Full Text PDF Scopus (59) Google Scholar]. Most importantly, adolescents and young adults need to be included and permitted to voice their thoughts and concerns, and we as a region need to listen. Time for an Adolescent Health Surveillance System in Saudi Arabia: Findings From “Jeeluna”Journal of Adolescent HealthVol. 57Issue 3PreviewWith the increasing burden of noncommunicable disease, adolescence is viewed as an opportune time to prevent the onset of certain behaviors and promote healthy states. Although adolescents comprise a considerable portion of Saudi Arabia's population, they have received insufficient attention and indicators of their health status, as a first step in a prevention cycle are unavailable. This study was carried out with the aim of identifying the health risk behaviors and health status of adolescents in Saudi Arabia. Full-Text PDF Open AccessArab Adolescents: Health, Gender, and Social ContextJournal of Adolescent HealthVol. 57Issue 3PreviewThis article reviews the evidence about adolescent health in the Arab world, against the background of social, economic, and political change in the region, and with a particular focus on gender. For the literature review, searches were conducted for relevant articles, and data were drawn from national population- and school-based surveys and from the Global Burden of Disease project. In some parts of the Arab world, adolescents experience a greater burden of ill health due to overweight/obesity, transport injuries, cardiovascular and metabolic conditions, and mental health disorders than those in other regions of the world. Full-Text PDF