JOLJRihJALOF ADOLESCENT HEALTH 1992;13:342-344
CONFERENCE PROCEEDINGS
Keynote Address at the Fifth Congress of the International Association for Adolescent Health OLIKOYE RANSOME-KUTI,
MINISTER
OF HEALTH,
In May 1989, the 42nd World Health Assembly of the World Health Organization chose as the topic for its Technical Discussion, “The Health of Youth”. I was honored to be the General Chairman at the discussion, which attracted eminent scholars and service providers in this field from every part of the world. Needless to say, it was an experience I will never forget. At the discussion, the problems of youth were discussed in depth, and the Assembly passed a resolution calling all nations to action to ensure healthy development of youth everywhere. I believe that, through this Congress, the International Association for Adolescent Health is taking up the challenge posed by the World Health Organization to ensure that needs and problems of youth and adolescents do not continue to be neglected. Life is a continuum from birth to old age with changes in personality occurring continuously. At every point in time, each person is a product of past experiences, which, largely dictate the state of mental, physical, and psychological well-being. Over the past 30 years, the high mortality rates of childhood have gradually been brought under control. The institution of services such as the expanded program on immunization, oral rehydration therapy for diarrhoea, growth monitoring, family planning, and, above all, primary health care-the vehicle for carrying these services to the people where they live and work-has prevented millions of childhood Fromthe Federal Minist? of Health, tagos, Nigeria. AddresS @mt requests to: Olikoye Ransome-Kuti,Minister of Health, Federal Ministry of H&h, P.M.& 12525, lkoyi, Lagos, Nigerk This paperW(ISpresented at the 5th Congress of the Intwmtionat .&o&ion for Adokent Health, Iuly 3-6, 1992, Montreux, SWll?dlnd. Manuscriptaccepted September 20,1991.
342 1034-139x.w$5..00
FEDERAL
PUBLIC
OF NIGERIA
deaths. However, many emerge from childhood as youths bearing the mental, physical, psychological, and social scars of that most hazarous period. Healthy development as youths, therefore, depends on a foundation of a well-nourished and nurtured childhood relatively free from these serious onslaughts. Adolescence is the period of transition from childhood to adulthood. It can either be one of turbulence or of orderly adjustment. What it is to be is determined by the internal and external milieu in which the transition takes place. Our aim must be to make that transition as natural as it is supposed to be by reducing or removing all those inimical forces working against a wholesome development. Of the world’s population 30%, that is, one and one-half billion people, are now between the ages of 10 and 24 years, of whom, more than 80% live in developing countries; more than one-half of the people of the world are below the age of 25 years with unimaginable implications for population growth. In all societies, the preparation of the youth for adulthood is designed to fit every individual into its adult society. It is thus undertaken in accordance with age-long customs, culture, and tradition which ensure the stability and survival of societies within their environment. Sometimes, the beginning and, often, the end of the period, are marked either by subjecting the youths to rituals, some of great severity, such as adult circumcision, or one of tokenism, such as marriage ceremony. Great changes have, however, occured iF many traditional societies owing to colonialism, modern education, migration from rural to urban areas, rapid and efficient travel and communication, tourism, and trade. These changes have eroded traditional social controls and support systems that guide youths toward adult-
8 Society for Adolescent Medicine, 1992 -__. f’ublfsfiedby Ek&er science lJublishmgCo., Inc., 655 Avenue of the Americas,New York, NY 10010
July 1992
hood. Family structures are destabilized by the weakening of traditional marriage and the extended family systems. Youths are thereby deprived of guidance, leadership, and good examples even at I ,me. Armed with education based on a foreign i-V culture and often in a foreign language, youths successfully challenge those community cultural norms that had molded their society for centuries. By this means, they rob parents and adults of the authority to direct their development; thus, there is social tension, disruption, and instability, and the ensuing struggle for youths to conform may have a tremendous effect on their health. Adults in every capacity are role models for youths. The circumstances that led many countries, particularly developing countries, to a state of bankcruptcy and to adopt the structural adjustment program are partly due to a leadership d.evoid of integrity and honesty. It serves to corrupt the youth who do not fail to notice that the acquisition of wealth often follows these demeaning practices. Youth is a time for questioning values and attitudes of parents and society and asf experimenting with alternatives. For this process to be successful, youths need the sensitive support and guidance of their parents and other adults. So can their peers exert pressure for good or for ill. Because of uncertainties about their own identity and about the future, they form deep attachments with others of their own age. The need to compete with their peers and at the same time to win social approval are both very strong and place individuals in situations of extreme conflict. The need is felt to express one’s self as an individual and also to conform with peers. Some of the powerful feelings thus created are being experienced for the first time and may lead to a certain bewilderment. Most will cope with the changes in themselves and the new types of behavior not expected of them, but some will react to stress in an unhealthy way for which they will need help. That pressure from their peers to conform can be resisted with family support and timely intervention. The youth is relatively free from illness and death. For this reason, many national health systems fail to provide adequately for their health care; often, they are either too old for the pediatrician or too young for the physician, but the maintenance of good health among them is essential for normal development. Because of a decrease in the mean age at menarche and an increase at marriage, young females, in particular, are vulnerable to such problems as premarital pregnancy, induced abortion, child-
KEYNOTE ADDRESS
343
birth out of wedlock, and sexually transmitted diseases. Many other societies force them into marriage at a tender age with terrible mental and physical consequences. Youths may be subjected to abnormal pressures by parents, educators, and employers expecting from them a much higher level of performance than they can achieve. It often ends in a failure or even mental health problems. Ambitious parents are known to push their children into high status courses whether or not they have any interest in or aptitude for the subject. In some polygamous societies, which have no old-age pension, the only security for a woman may be the earning power of her children. The pressure is on youths “to grow up fast,” “ to excel, achieve, compete successfully, and bear adult responsibilities,” without an opportunity for dialogue which countenances their views. In many cultures, youths are expected to inflict problems on themselves or cause problems for others. Opportunities for dialogue often degenerates into sessions where youths are dictated to and from whom compliance is demanded. Avenues for youths to participate in the affairs that touch their lives or the society in which they live are closed to them, and so they erupt. In many developing countries, unemployment among the youth has reached alarming proportions. The structural adjustment program adopted by developing countries seems to promote this situation; moreover, the school system often fails to provide youths with the skills needed for employment, particularly in the private sector of the economy. Unemployment, particularly if prolonged, may lead to a loss of self-esteem, psychological stress, and a state of hopelessness, which can drive them into antisocial pursuits, such as street fighting, political thuggery, drug pushing, and armed robbery. This is particularly so because adolescents naturally explore and experiment as part of their normal development which may sometimes carry some risk. There are already many attempts throughout the world to guide the energies and creativity of youths so that they develop into well-adjusted adults contributing effectively and constructively to the community in which they live. For these interventions to succeed, they must ensure the active participation of youths and nongovernmenia: organizations. The l?ed Cross and YWCA have developed projects involving young women in education about family life, Offerhg Support to teenage mothers, and also informing young people about the negative consequences of sexual activity.
344
RANSOME-m
The youths themselves identified problems, such as ‘not receiving sincere and accurate information about sex from parents“ about “the process of personal physical and psychological change;” this comes as no surprise as discussion about sex and physical maturities is taboo in many cultures. It is surprising that although mothers will ensure that their daughters acquire cooking and domestic skills, they are reluctant to entrust them with the skills to cope with sexual matters. There is a need to learn about the process of maturation from childhood to adulthood as influenced by various cultures. There is clearly a disruption of traditional social development in many countries emerging from colonial rule; until a restructuring Of social systems takes place out of an amalgamation of traditional values and those foreign, youths will be caught in a conflict of values and a system that lacks direction. Conferences such as these provide an opportunity to create a global atmosphere in which attention can be given to the development of adolescents, their conflicts and fears listened to, and an orderly solution prescribed, based on a knowledge of the society. A study of family structure and function in every society must be intensified so that damaged families can be identified early and methods of repair determined and instituted. In many developing countries, scant attention is given to the problems of families-this must have enormous consequencies for the development of youths. The contribution of youths to the health of the family must be determined and deliberate steps taken to ensure that they are permitted to make them in an atmosphere of understanding and respect. The health sector needs to define its role more dearly in preserving the health of youth. The ambivalence demonstrated thus far by the health sector in this matter is due mainly to the fact that mortality and organic morbidity among the youth is usually very 10~ and does not call for a major effort by the health sector to preserve their lives; but as health is defined by the World Health Organization as ‘a state of mental, physical and social well-being and not the absence of disease,” we must surely recog-
JOURNAL OF ADOLESCENT HEALTH Vol. 13, No. 5
nize the immense social and mental morbidity sometimes occuring during adolescence and take appropriate steps to reduce or abolish them. These steps must be taken at the community level using the principles of community care developed, advocated, and propagated by the World Health Organization for many years-relevance, accessibility, availability, acceptability, affordability, appropriate technology, and community participation. These principles, particularly those of relevance, acceptability, and participation, take on a new meaning and significance when applied to the problems of adolescents. The health sector must sharpen its skills to deal effectively with psychosocial and behavioral problems, as has been done for organic ones; it must make health facilities a place that welcomes rather than deters young people, and the mode of participation needs to be developed which permits adolescents to identify their health needs, prescribe solutions, and manage their implementation. What is needed is a revolution in thought and deed by the present generation of health-care providers and the same in the training of those in the future. The energy, creativity, and enthusiasm of youths must be recognized nationally, directed constructively, and harnessed for community development. The participation of youths in sports must be given priority in every country; success at sports hardly depends on bribery or having influential connection in high places but on individual and team dedication, commitment, and hard work. It builds character, honesty, and a strong personality-qualities which adults may often fail to exhibit as example and role models for youths. We must launch a world-wide crusade to save adolescents from the social and economic turmoii surrounding them, to give them the skills to control and direct their internal conflicts, and so enable them to grow into well-adjusted adults able to contribute effectively and confidently toward the solution of health problems in their community. The time to act is now, but you, the International Association for Adolescent Health must blaze the trail for others to follow.
CONFERENCE PROCEEDINGS
Keynote Address at the Fifth Congress of the International Association for Adolescent Health OLIKOYE RANSOME-KUTI,
MINISTER
OF HEALTH,
In May 1989, the 42nd World Health Assembly of the World Health Organization chose as the topic for its Technical Discussion, “The Health of Youth”. I was honored to be the General Chairman at the discussion, which attracted eminent scholars and service providers in this field from every part of the world. Needless to say, it was an experience I will never forget. At the discussion, the problems of youth were discussed in depth, and the Assembly passed a resolution calling all nations to action to ensure healthy development of youth everywhere. I believe that, through this Congress, the International Association for Adolescent Health is taking up the challenge posed by the World Health Organization to ensure that needs and problems of youth and adolescents do not continue to be neglected. Life is a continuum from birth to old age with changes in personality occurring continuously. At every point in time, each person is a product of past experiences, which, largely dictate the state of mental, physical, and psychological well-being. Over the past 30 years, the high mortality rates of childhood have gradually been brought under control. The institution of services such as the expanded program on immunization, oral rehydration therapy for diarrhoea, growth monitoring, family planning, and, above all, primary health care-the vehicle for carrying these services to the people where they live and work-has prevented millions of childhood Fromthe Federal Minist? of Health, tagos, Nigeria. AddresS @mt requests to: Olikoye Ransome-Kuti,Minister of Health, Federal Ministry of H&h, P.M.& 12525, lkoyi, Lagos, Nigerk This paperW(ISpresented at the 5th Congress of the Intwmtionat .&o&ion for Adokent Health, Iuly 3-6, 1992, Montreux, SWll?dlnd. Manuscriptaccepted September 20,1991.
342 1034-139x.w$5..00
FEDERAL
PUBLIC
OF NIGERIA
deaths. However, many emerge from childhood as youths bearing the mental, physical, psychological, and social scars of that most hazarous period. Healthy development as youths, therefore, depends on a foundation of a well-nourished and nurtured childhood relatively free from these serious onslaughts. Adolescence is the period of transition from childhood to adulthood. It can either be one of turbulence or of orderly adjustment. What it is to be is determined by the internal and external milieu in which the transition takes place. Our aim must be to make that transition as natural as it is supposed to be by reducing or removing all those inimical forces working against a wholesome development. Of the world’s population 30%, that is, one and one-half billion people, are now between the ages of 10 and 24 years, of whom, more than 80% live in developing countries; more than one-half of the people of the world are below the age of 25 years with unimaginable implications for population growth. In all societies, the preparation of the youth for adulthood is designed to fit every individual into its adult society. It is thus undertaken in accordance with age-long customs, culture, and tradition which ensure the stability and survival of societies within their environment. Sometimes, the beginning and, often, the end of the period, are marked either by subjecting the youths to rituals, some of great severity, such as adult circumcision, or one of tokenism, such as marriage ceremony. Great changes have, however, occured iF many traditional societies owing to colonialism, modern education, migration from rural to urban areas, rapid and efficient travel and communication, tourism, and trade. These changes have eroded traditional social controls and support systems that guide youths toward adult-
8 Society for Adolescent Medicine, 1992 -__. f’ublfsfiedby Ek&er science lJublishmgCo., Inc., 655 Avenue of the Americas,New York, NY 10010
July 1992
hood. Family structures are destabilized by the weakening of traditional marriage and the extended family systems. Youths are thereby deprived of guidance, leadership, and good examples even at I ,me. Armed with education based on a foreign i-V culture and often in a foreign language, youths successfully challenge those community cultural norms that had molded their society for centuries. By this means, they rob parents and adults of the authority to direct their development; thus, there is social tension, disruption, and instability, and the ensuing struggle for youths to conform may have a tremendous effect on their health. Adults in every capacity are role models for youths. The circumstances that led many countries, particularly developing countries, to a state of bankcruptcy and to adopt the structural adjustment program are partly due to a leadership d.evoid of integrity and honesty. It serves to corrupt the youth who do not fail to notice that the acquisition of wealth often follows these demeaning practices. Youth is a time for questioning values and attitudes of parents and society and asf experimenting with alternatives. For this process to be successful, youths need the sensitive support and guidance of their parents and other adults. So can their peers exert pressure for good or for ill. Because of uncertainties about their own identity and about the future, they form deep attachments with others of their own age. The need to compete with their peers and at the same time to win social approval are both very strong and place individuals in situations of extreme conflict. The need is felt to express one’s self as an individual and also to conform with peers. Some of the powerful feelings thus created are being experienced for the first time and may lead to a certain bewilderment. Most will cope with the changes in themselves and the new types of behavior not expected of them, but some will react to stress in an unhealthy way for which they will need help. That pressure from their peers to conform can be resisted with family support and timely intervention. The youth is relatively free from illness and death. For this reason, many national health systems fail to provide adequately for their health care; often, they are either too old for the pediatrician or too young for the physician, but the maintenance of good health among them is essential for normal development. Because of a decrease in the mean age at menarche and an increase at marriage, young females, in particular, are vulnerable to such problems as premarital pregnancy, induced abortion, child-
KEYNOTE ADDRESS
343
birth out of wedlock, and sexually transmitted diseases. Many other societies force them into marriage at a tender age with terrible mental and physical consequences. Youths may be subjected to abnormal pressures by parents, educators, and employers expecting from them a much higher level of performance than they can achieve. It often ends in a failure or even mental health problems. Ambitious parents are known to push their children into high status courses whether or not they have any interest in or aptitude for the subject. In some polygamous societies, which have no old-age pension, the only security for a woman may be the earning power of her children. The pressure is on youths “to grow up fast,” “ to excel, achieve, compete successfully, and bear adult responsibilities,” without an opportunity for dialogue which countenances their views. In many cultures, youths are expected to inflict problems on themselves or cause problems for others. Opportunities for dialogue often degenerates into sessions where youths are dictated to and from whom compliance is demanded. Avenues for youths to participate in the affairs that touch their lives or the society in which they live are closed to them, and so they erupt. In many developing countries, unemployment among the youth has reached alarming proportions. The structural adjustment program adopted by developing countries seems to promote this situation; moreover, the school system often fails to provide youths with the skills needed for employment, particularly in the private sector of the economy. Unemployment, particularly if prolonged, may lead to a loss of self-esteem, psychological stress, and a state of hopelessness, which can drive them into antisocial pursuits, such as street fighting, political thuggery, drug pushing, and armed robbery. This is particularly so because adolescents naturally explore and experiment as part of their normal development which may sometimes carry some risk. There are already many attempts throughout the world to guide the energies and creativity of youths so that they develop into well-adjusted adults contributing effectively and constructively to the community in which they live. For these interventions to succeed, they must ensure the active participation of youths and nongovernmenia: organizations. The l?ed Cross and YWCA have developed projects involving young women in education about family life, Offerhg Support to teenage mothers, and also informing young people about the negative consequences of sexual activity.
344
RANSOME-m
The youths themselves identified problems, such as ‘not receiving sincere and accurate information about sex from parents“ about “the process of personal physical and psychological change;” this comes as no surprise as discussion about sex and physical maturities is taboo in many cultures. It is surprising that although mothers will ensure that their daughters acquire cooking and domestic skills, they are reluctant to entrust them with the skills to cope with sexual matters. There is a need to learn about the process of maturation from childhood to adulthood as influenced by various cultures. There is clearly a disruption of traditional social development in many countries emerging from colonial rule; until a restructuring Of social systems takes place out of an amalgamation of traditional values and those foreign, youths will be caught in a conflict of values and a system that lacks direction. Conferences such as these provide an opportunity to create a global atmosphere in which attention can be given to the development of adolescents, their conflicts and fears listened to, and an orderly solution prescribed, based on a knowledge of the society. A study of family structure and function in every society must be intensified so that damaged families can be identified early and methods of repair determined and instituted. In many developing countries, scant attention is given to the problems of families-this must have enormous consequencies for the development of youths. The contribution of youths to the health of the family must be determined and deliberate steps taken to ensure that they are permitted to make them in an atmosphere of understanding and respect. The health sector needs to define its role more dearly in preserving the health of youth. The ambivalence demonstrated thus far by the health sector in this matter is due mainly to the fact that mortality and organic morbidity among the youth is usually very 10~ and does not call for a major effort by the health sector to preserve their lives; but as health is defined by the World Health Organization as ‘a state of mental, physical and social well-being and not the absence of disease,” we must surely recog-
JOURNAL OF ADOLESCENT HEALTH Vol. 13, No. 5
nize the immense social and mental morbidity sometimes occuring during adolescence and take appropriate steps to reduce or abolish them. These steps must be taken at the community level using the principles of community care developed, advocated, and propagated by the World Health Organization for many years-relevance, accessibility, availability, acceptability, affordability, appropriate technology, and community participation. These principles, particularly those of relevance, acceptability, and participation, take on a new meaning and significance when applied to the problems of adolescents. The health sector must sharpen its skills to deal effectively with psychosocial and behavioral problems, as has been done for organic ones; it must make health facilities a place that welcomes rather than deters young people, and the mode of participation needs to be developed which permits adolescents to identify their health needs, prescribe solutions, and manage their implementation. What is needed is a revolution in thought and deed by the present generation of health-care providers and the same in the training of those in the future. The energy, creativity, and enthusiasm of youths must be recognized nationally, directed constructively, and harnessed for community development. The participation of youths in sports must be given priority in every country; success at sports hardly depends on bribery or having influential connection in high places but on individual and team dedication, commitment, and hard work. It builds character, honesty, and a strong personality-qualities which adults may often fail to exhibit as example and role models for youths. We must launch a world-wide crusade to save adolescents from the social and economic turmoii surrounding them, to give them the skills to control and direct their internal conflicts, and so enable them to grow into well-adjusted adults able to contribute effectively and confidently toward the solution of health problems in their community. The time to act is now, but you, the International Association for Adolescent Health must blaze the trail for others to follow.
