Social Dynamics and Health Care in Adolescence

106 Presentation SOCIAL DYNAMICS AND HEALTH CARE IN ADOLESCENCE RENÉE R. JENKINS, M.D. Director Adolescent Medicine; Associate Professor of Pediatrics and Child Health Howard University Hospital 2041 Georgia Avenue, N. W. Washington, D.C. 20060 IT IS timely THAT I address the social dynamics of the health issues facing today's adolescents. Yesterday, October 1,1990, the nation celebrated Child Health Day, an occasion that provides a national focus for discussion of issues surrounding the well-being of one of our most important resources. The focus this year was on the adolescent, and the commemorative program was entitled "Adolescent Health: Links to the Future." Child Health Day has been celebrated on the first Monday in October for the past 30 years. It was originally celebrated on May 1 st from 1928 to 1959 under a proclamation of President Calvin Coolidge and a joint resolution of Congress. In that proclamation, President Coolidge declared the protection and development of the health of children a fundamental necessity to the future progress and welfare of the nation. He also acknowledged that the conservation and promotion of chUd health placed a grave responsibility on those organizations and agencies who took up the cause of children. This year's theme of adolescent healtii echoes that challenge some 60 years later. The protection and development of the health of adolescents are fundamental necessities to the progress and welfare of this nation as we prepare for the 21st century. Health issues for the year 2000 The Year 2000 Health Objectives' which specifically target adolescents reflect for the most part health issues with which we are all too familiar. The Journal of Health Care for the Poor and Underserved, Vol. 2, No. 1, Summer 1991 ____________________________Jenkins__________________________107 major causes of death for 15- to 19-year-olds demonstrate that motor vehicular accidents are the primary killer of white males, and homicide is the primary killer of young black males (Figure 1). The increasing prevalence of the "new" morbidities—such contemporary threats as suicide, homicide, substance abuse, sexually transmitted disease, and unintended pregnancy—also dramatize the health problems of our youth.2 Almost 200,000 cases of gonorrhea were reported for 10- to 19-year-olds in 198T5; 92 percent of high school seniors reported alcohol use in 19882, and on and on. While The Year 2000 Health Objectives have very specific targets (e.g., reduce initiation of smoking to no more than 15 percent by age 20 (a 50 percent decrease); reduce unintended pregnancies to no more than 30 percent of pregnancies (a 46 percent decrease); reduce alcohol use by school children age 12 to 17 to less than 13 percent, marijuana use by youth age 18 to 25 to less than eight percent, and cocaine use by youth age 18 to 25 to less than three percent), the document is limited in its discussion of any underlying philosophy or approach to reaching these targets. Clearly these as weU as less contemporary targets addressing nutrition and physical activity have a significant underlying social dynamic. These targets will not be reached with high technology as the primary strategy. The process of designing strategies will necessitate 1) an understanding of the developmental processes of adolescence and their relevance to health behavior; FIGURE 1 1987 MORTALITY STATISTICS FOR 15- TO 19-YEAR-OLDS Source: National Center for Health Statistics, Vital Statistics of U.S., 1987, Volume II Mortality, Part A, 1990. Washington, DC Public Health Service, 1990. (DHHS pub. no. PHS-90-1101.) 108 Social Dynamics and Health Care in Adolescence 2) a recognition of the role of differing cultural, economic, and community factors to health behaviors; and 3) a continuing awareness of ongoing research and evaluation reports of successful and unsuccessful approaches to addressing the adolescent in varied settings. These strategies will include policy changes, practice changes, and continuing research driven by a host of players ideally working increasingly collaboratively as more successful strategies become apparent. For example, professionals involved in school-based clinics are organizing themselves in a more collaborative way to improve the effectiveness of that model. Child Health Day itself was sponsored by close to 20 public agencies and private organizations; the possibilities for collaborative efforts among...