APPROACH AND METHODOLOGY
The Young Health Programme is AstraZeneca's global long-term community investment initiative with a broad focus to help young people in need around the world to deal with the health problems they face and improve their chances for a better life in the future.
As part of this program, the partnership is making a commitment to reduce non-communicable diseases (NCDs) . The NCD Commitment will 1) advocate for better provision of health information and services for young people 2) develop on the ground community programs and 3) improve scientific research on youth health. The three components will be fully integrated and symbiotically linked. For example, insights from the community programs will inform the research which will provide crucial evidence on the barriers to these groups accessing health. Outcomes from both the community programs and scientific research will feed into the advocacy agenda showing the clear need for change and evidence of success on the ground where interventions have been successful in driving behavioral change.
Advocating for Better Provision of Health Information and Services
Despite the importance of adolescent health measures in addressing NCDs, adolescents are rarely on the agenda when issues of NCDs are being discussed. As part of the AstraZeneca Young Health Programme, the John Hopkins Bloomberg School of Public Health (JHBSPH) is undertaking a series of activities to bring the issues of NCDs/NCCs into sharper focus and to develop a global research and policy agenda for the next decade.
In conjunction with the NCD Child Alliance, the International Pediatrics Association, and the American Academy of Pediatrics, JHBSPH is preparing an advocacy document to present the case for increased attention to adolescent contributions to adult NCDs. This document will be presented at the time of the High Level meeting of the UN General Assembly, September 2011.
Scientists, policy makers and program planners will come together in an 'Emerging Issues Consultation' to review the most current research on a range of youth related issues in order to guide research, policy and program agendas related to impacting youth NCDs/NCCs over the next decade. A key driver for the consultation is that over the past decade there has been an explosion of research on adolescent neurodevelopment, the biology of addictions and the epigenetic influences on health and disease. However, much of this research has yet to be incorporated into youth health programming and policy especially in low and middle income countries.
On the Ground Community Programs
The community programs are located across the globe and will eventually reach at least 15 countries. They address health issues that are most pertinent to that local area and risk factors for NCDs are a key focus. At least one of the following play a significant role in each program running or planned to date; prevention of mental health disorders and development of self-esteem; alcohol, smoking and other substance use: good nutrition and exercise: delayed pregnancy until full maturity: the importance of prioritizing health and access to health information and services. The educational element of these community programs and the behavioral change they encourage has the potential to impact the burden of NCDs for these young people in the future and to effect behavior change that will benefit their children, leaving a lasting legacy.
The programs in India, Brazil and Zambia are implemented by Plan International. In these countries, Plan has appointed local NGOs to implement the work on the ground based on their local networks and subject matter expertise. In other countries, local AstraZeneca companies have done research on the unmet health needs for young people in their country and based on this, selected the most appropriate NGO partner to work with.
The local programs are diverse because they focus on the needs of the young people in that geography but they share a common focus on enabling behavioral change through education and training. The types of activities vary from peer-to-peer education schemes, street plays and school campaigns in developing countries to on-line interventions, health assessments and mental well-being initiatives in countries like the UK, Sweden and Canada. Some programs are very significant in terms of scale and resources whilst others are smaller and focused on the specific health requirements of a high need group.
Scientific research on adolescents
Through research, the program will build understanding of the health needs of the most disadvantaged youth across the world and look particularly at the barriers to these groups accessing health.
The research program, the Wellbeing of Adolescents in Vulnerable Environments (WAVE study), will focus on very disadvantaged youth in the poorest areas of six cities of the world: Baltimore, MD; Ibadan, Nigeria (this site is funded by the Gates Foundation); Johannesburg, South Africa; New Delhi, India; Rio de Janeiro, Brazil; and Shanghai, China. This will build a unique understanding of their health needs and explore innovative solutions such as the use of mobile technologies to deliver health information and health services. Research outcomes will be used to update the community programs, inform health providers and health workers in the field of adolescent health about the needs of disadvantaged young people and direct the improvements in health provision and health monitoring for young people, including addressing those behaviors that have a direct impact on the later development of NCDs.
IMPLEMENTATION, TIMELINE, AND DELIVERABLES
This is a long-term investment program that aims to make a sustainable difference. Both quantitative and qualitative measures are in place to continuously assess the impact of the program. The NCD component is part of a larger program to help half a million young people in need around the world deal with the health problems they face. All the local programs focus on NCDs to some extent - some exclusively and some in addition to non-NCDs. Therefore the commitment to directly affect 250,000 young people is a conservative estimate as the lasting impact is likely to be larger.
July - December 2011
The NCD publications and advocacy will commence with the launch of the advocacy document 'Presenting the case for the consideration of adolescent health in tackling the global problem of NCD's'
The emerging issues consultation will take place in October of 2011 and publications will follow at the end of 2011 and early 2012.
A series of follow-on activities are planned during 2012 to move a global agenda forward to action. This will include; publication of the proceedings of the Emerging Issues Consultation in a globally recognized peer reviewed journal, meetings in Geneva and New York of the donor community and interested parties.
Country programs will progress from the initial planning and sensitization phase to implementation and consolidation of local activities.
The program in Zambia will launch in September and will concentrate on improving the health and well-being of girls and boys in the Chadiza district. They will do this through empowering and working with adolescents and creating a supportive environment in the local community for young people's health.
From October, the partners expect the addition of one new local country program per month. One of the countries launching at the end of 2011 will be the USA.
In November, the first phase of the WAVE study will report based on in-depth interviews with young people on what it means to be an adolescent in the community and other questions about health and well-being. Interviews take place also with providers and directors of youth-serving organizations about the issues facing youth in the community. This research will be presented as photo- essays documenting community health issues through youth-led photography sessions. Community mapping will also be conducted by the young people themselves to obtain an accurate picture of their communities, including the resources available to young people.
Research outputs and publications will be used to support further advocacy opportunities. In early 2012, publications from a round-table conference on emerging issues in adolescent health will report, covering obesity, addiction and drug misuse, violence, depression and self-harm.
The findings from the WAVE study, available in 2013, will be used as a platform for action on the health needs of disadvantaged urban adolescents around the world.
During 2012 the partners expect a new local country program to launch every 6 to 8 weeks until there are a total of at least 15 local programs.
All programs will report outputs every 6 months from which figures will be collated and shared publically on an annual basis, at least. From the end of 2013, they expect to start receiving the first impact reports from those programs that have run for three years, describing the difference the program has made to health status and behavior. This will feed into the research and advocacy agenda to ensure a continuous loop of feedback and integration across the three program components.
The WAVE study will complete its main research phase in late 2012, with reporting and publication expected in 2013. The results will be used to plan further research with planning and design occurring in 2013 and study activity expected during 2014.
2015 and beyond
The program is designed to ensure sustainability beyond 2015 by recruiting and selecting peer educators from the communities themselves to enable the transfer of ownership to local communities and health providers. This is consolidated by evidence based research and advocacy to have a long term impact on young health programming and policy.
NCDs, such as cardiovascular disease, stroke, diabetes, and cancer, are leading causes of mortality and morbidity. NCDs cause 36 million deaths per year globally, and over half of the deaths related to NCDs are associated with behaviors that begin or are reinforced during youth. The health habits that develop during youth establish patterns of behaviors that persist for the remainder of their lives and are often hard to change. For example, among obese youth, 70% have at least one risk factor for cardiovascular disease by the age of 20. However despite this, adolescents are rarely on the agenda when issues of NCD are being discussed.