Module 3+

• Adolescents make up ⅙ of the world's population, of which 86% live in LMIC
• Every adolescent has a fundamental right to health yet bears a large portion of the global disease burden
• 2030 Agenda for Sustainable Development

  Investment in adolescent health brings a triple dividend: 1) Benefit for adolescents now, 2) Benefit for their future adult lives, 3) Benefit for their children
• Leading causes of DALYs among 10-24 year olds

  • Globally - Mental health and substance use
  • NZ - Mental health and substance use
• Leading causes of death among 10-24 year olds

  • Globally - Transport injuries, self-harm and violence have increased
  • NZ - Self-harm and violence-related deaths are the number 1 cause of death
• Youth2000 Secondary school surveys

  1. Cross-sectional survey using random samples (RCT cross-sectional study) of secondary school students done in 2001,2007,2012 and 2019

  2. Profile the health, risks, and sources of resilience among adolescents in NZ

  3. Anonymous, confidential, and self-reported - done online using tablets
• Maori, Pasifika, and Asian students were more likely to experience difficulty accessing health care. This is also demonstrated in students living in deprived areas or living with disabilities or chronic health conditions. Students who were worried about drinking or had tried to cut down also experienced difficulties
• NZ European families are the least deprived of household deprivations, symptoms of depression and foregone healthcare. Whereas Maori and Pasifika families were the most deprived of household deprivations, symptoms of depression and foregone healthcare. LMIC African countries were also highly deprived, especially in symptoms of depression and forgone healthcare
• Inverse care law


  Good medical or social care availability tends to vary inversely with the need for it in the population served
• Personally mediated racism


  Prejudiced and discrimination based on race/ethnicity
• Perceived ethnicity


  The ethnicity others perceive one to be
• Asian perceived as Asian received the most bullying in schools. Pasifika, perceived as Pasifika, received the most discrimination from healthcare providers
• Emotional wellbeing


  • Most students have good emotional wellbeing
  • There are declines in well-being, especially among females
• Symptoms of depression


  • Most students do not have significant symptoms of depression
  • Sharp increase in proportions of students with depressive symptoms since 2012
  • Significant ethnic disparity for rangatahi
  • The gap is widening, particularly for females
  • Highest in communities exposed to socioeconomic deprivation
  • Decline in wellbeing for LGBTQ
  • High, increasing symptoms in LGBTQ since 2012
• Snowflake Hypothesis


  Over protection and low resilience due to increased parental monitoring, stress/financial strain, geopolitical polarization
• Igen Hypothesis


  Social media, the internet and smartphones are leading to poor mental health as there is an increase in perfectionism and experiences of racism and discrimination
• Doomer Hypothesis


  Impact of job insecurities, housing affordability, climate crisis, political polarisation, disinformation and misinformation
• NZ is attempting to improve mental health services; government spending has increased by 33% to improve health. However, young people are waiting longer to see mental health specialists
• Limitations


  • Recruitment bias as there is a random sample of students, but it does not include the students who have already dropped out of school
  • Causal relationships can collect data on many exposures and outcomes simultaneously, although the 'chicken and egg' problem can arise
  • Measurement biases: There is no way to tell if the anonymous, confidential, and self-reported information is not entirely reliable
  • Students with disabilities or language difficulties may not complete the survey
  • You can't help those who may need the help
• Strengths


  • They are more likely to provide honest answers as it's anonymous
  • More likely to complete the survey as they enjoyed and engaged in it, therefore, better response rates
• Maori Health; Indigenous rights is exemplified by systemic disparities: in health outcomes, in exposures to DOH, in health system responsiveness, in healthcare representation
• Non-Maori are over-represented in HI areas, which have better access and fewer barriers to health care. These are constructed through socio-economic differences and unequal distributions in neighbourhood differences that lead to Maori health inequities
• Right to Health


  1. Enshrined in International Law, 2) Extends beyond health care to pre-conditions, 3) Includes freedoms and entitlements, 4) States obliged to Respect, Protect and Fulfill, 5) Social Epidemiology links health with social justice and thus links to good government
• Health inequities are evidence of laws, policies and practices that distribute resources and opportunities in a discriminatory manner and limit full participation. Health is acknowledged as political and health policy decisions have a legal dimension rather than being purely political discretion
• Major rights-based instruments relevant to Māori health and eliminating inequities

  • Universal Declaration of Human Rights
  • ICESCR
  • Other international rights conventions
  • Te Tiriti O Waitangi
  • UN declaration on rights of indigenous people
  • NZ legislation and policies
• NZ emission sources are mostly 50% from agriculture, then transport 18%. NZ trends are not decreasing
• Globally we are exceeding planetary boundaries which are the ecological limits of the planet. We must address this to keep Earth habitable. Climate is only one boundary that currently exceeds but also biodiversity loss, nitrogen, chemical and plastic pollution
• Risks of climate change

  • Extreme weather events - Too much water can cause cyclones and consequently floods
  • Too little water can cause droughts and consequently fires
  • Heat affects many things but specifically the elderly and their ability to do outdoor work
  • Climate change increases risks of heat extremes, access to water access to food and acces to shelter. Making already vulnerable risks into extremely vulnerable
• Feedback loops: More melting increases less ice and therefore less heat is reflected back into space, therefore temp rises and more ice melts
• Actions that can both reduce greenhouse gas emissions and also improve population health

  • Plant based food has lower emissions per protein, also must have more efficient land use, and less water pollution
  • Warm and energy efficient housing avoids families needing to choose between food and heating ; decreases chest infections and asthma to which kids are easily susceptible to
  • Compact cities (urban form) have better amenities such as parks, public transport and shops
  • Travel mode shift reduces emissions: Shifting to match Wellington transport pattern could reduce both transport deaths and light vehicle CO2 emissions
  • Shifting 5% of short car trips to bike could lead to >100 deaths avoided annually, reducing emissions and improving health and economy
  • Reducing car use improves health by reducing air pollution
• NZ health professionals are aiming to change policies that are improving health → But recently increased prices of public transport and removed the smoking ban?
• How health professionals can engage in actions to address climate change

  • Personally - to be informed, healthy and climate friendly behaviours
  • Professionally - Green your institution and advocate
  • Politically - support climate change and health groups. Submissions for healthy, climate friendly policies
• Suburbs should be made easier and safer to walk around - Reducing car emissions and promoting active transport. Canada did this by making driving more expensive and returning the revenue to families especially in LMI areas
• Emerging trends and inequitable distribution in the burden and risks of HIV infection globally and in NZ


  • HIV has several modes of transmission
  • There are cheap reliable HIV-specific screening tests available - Such as screening during pregnancy
  • HIV is caused by a human immunodeficiency virus
  • There are better treatment options that improves life-expectancy
  • There is no vaccine available
• DALY globally - Most people affected are in LMIC such as sub-saharan Africa. Antiretroviral therapy (ARV) treatment is especially low in LMIC
• When the epidemic began, there is a big toll on life expectancy and mortality in African countries. Nowadays, the prevalence of new cases an deaths are going down as more interventions are put into place
• AIDS related deaths are decreasing and people are living longer with HIV due to improved treatment and access to treatment
• Nearly 15% of people with HIV do not know they have HIV and are consequently spreading it. Most people living with or at risk of HIV do not have access to HIV prevention, treatment or care. About 95% ot those affected are in LMIC
• HIV


  Human immunodeficiency virus
• HIV


  • Has several modes of transmission
  • There are cheap reliable HIV-specific screening tests available
  • There are better treatment options that improves life-expectancy
  • There is no vaccine available