Child and Youth Healthy Behaviors

Healthy Behaviors as a building block in the Children & Youth conceptual framework summarizes several important areas of intervention that are particularly relevant to youth:

Programs targeting young people affected by the following issues cannot be health interventions alone, but must embrace multi-sectoral linkages with employment and education policy. For example, risky sexual behavior is likely to be inversely correlated with educational attainment while youth delinquency can be directly linked to poverty. While many of these linkages appear to be common sense, there is still a need for more in-depth research on what really causes "unhealthy" behavior and how to best address them.

Youth and Reproductive Health

Adolescents and young adults in developing countries face specific sexual and reproductive health problems, often aggravated by poverty. For example, a poor teenager is more than three times as likely to give birth as a wealthy teen and the incidence of adolescent pregnancy is highest in Sub-Saharan Africa (143 per 1,000 girls aged between 15-19 years). Teen mothers are also twice as likely as older women to die of pregnancy-related causes. About half of all HIV infections occur in youth under the age of 25, with girls and young women disproportionally affected. Reproductive health interventions are generally cost-effective and focus on:

• Improving the social and economic environment (e.g. poverty, women's education and status, lack of male involvement);
• Educating youth to increase their understanding of sexual and reproductive health issues (e.g. HIV/AIDS education), motivating them to engage in healthy behaviors;
• Providing access to health services (e.g. prenatal care and delivery care).

Youth and HIV/AIDS

An estimated 6000 youth a day become infected with HIV/AIDS – one every 14 seconds. There are 14 Million AIDS orphans worldwide, the majority of them in Sub-Saharan Africa. Unprotected sex is the primary way of transmission among young people. Survey data from several Sub-Saharan African countries report that the proportions of unmarried, sexually active women aged 15–19 who reported the use of condoms in their most recent sexual encounter ranged from two to 18 percent. 40 percent among young men from Peru who identified themselves as homosexual reported having recently engaged in unprotected intercourse.

Despite concerted efforts by governments, donor agencies, and NGOs, lack of correct information about the ways of transmission is still prevalent in many developing countries, which often translates in an inability to calculate the risks of sexual activities. The World Bank has established a partnership with the Global Fund, United Nations Children's Fund (UNICEF), and the Clinton Foundation to help developing countries buy high-quality AIDS medicines at low prices. Encouragingly so, an increasing number of countries have successfully reversed high rates of HIV infection in young people. In Uganda, Tanzania, and Zambia, HIV prevalence among young people has recently declined by half or more, primarily because of changes in behavior such as delay in first sexual experience and increased condom use. Jamaica and Brazil, countries with programs promoting information about and widespread availability of condoms, report recent large increases in the percentage of young men using condoms the first time they have sex.

World Bank is deeply committed to pursue the Millennium Development Goal of halting the spread of HIV/AIDS by 2015. One of the targets is to reduce the HIV prevalence globally among 15-24 year-olds by 25 percent by 2010. A number of projects have had a children and youth focus or aspect.

Youth and Conflict

In conflict or post-conflict countries children and youth are especially vulnerable. Over the past decade, an estimated two million children and youth have died in armed conflict. Another 5 million acquired permanent disability. Moreover, well over 300,000 child and youth soldiers are involved in armed conflicts in 49 countries. Girls and women are affected as well: rape, sexual mutilation and exploitation, trafficking and humiliation are common features of conflict zones. Countries in conflict have the highest rates of infant mortality.

Conflict often leads to a collapse of social safety nets. Basic health services and education delivery are disrupted. Employment opportunities disappear, leading to high unemployment and frustration among young people. Because of this pronounced breakdown of public service and local government, interventions need to rely on flexible instruments and non-governmental organizations to reach target groups.

Youth and Violence

Youth that engages in aggressive behavior often lives in difficult circumstances; crime rates are consistently higher among poor, marginalized, and urban youth. Youth poverty, as expressed in resource scarcity, concentrated disadvantage, and an environment that is perceived as dangerous foster asocial and violent behavior.

Youth violence, which can be classified into situational, relationship, predatory and psychopathological violence (Tolan and Guerra, 1994), is a widespread problem. Juvenile delinquency is predominantly a male phenomenon. Young men, often acting in groups, are much more likely to engage in criminal behavior than young women. Male youth homicide rates are substantially higher than female youth homicide rates.

Youth are not only offenders, but also often victims of criminal acts. Research contends that the majority of crimes against young people are committed by perpetrators belonging to the same age group as their victims.

It is also important to recall that violent behavior is not restricted to doing harm to others. According to the World Bank’s Caribbean Youth Development report, one in eight young people surveyed had attempted suicide.

In terms of interventions, studies have shown that the dictum “the earlier the better” generally holds. A preventive, multi-sectoral, and tailor-made approach targeting the young person as well as his or her environment (peers, family, educational setting) yields the best results. Preventive programs need to feature diverse elements, ranging from the provision of legal alternatives for income, over educational interventions to changes in the urban environment.

Youth and Substance Abuse

Young people, some at very early age, try out potentially addictive substances such as alcohol and tobacco. Survey data from the Organisation for Economic Co-operation and Development (OECD) countries indicates that roughly 70–90 percent of all 15–16 year-olds have used alcohol at least once. Tobacco comes in second, with 50 percent.

With the exception of cannabis, other substances are used only by small minorities. Generally, it is observed that young people worldwide are growing up in an environment that is increasingly more tolerant of substance use.

The prevalence of addiction and health damaging drug use is intimately related to the quality of family life and other social, educational and economic circumstances. Therefore, it is helpful to differentiate between mainstream youth versus youth at risk. The latter group is characterized through multiple marginalizations such as a dysfunctional family, poverty and violence and is thus more prone to develop an addiction than the former.

Prevention efforts need to take local idiosyncrasies into account as drug use patterns may vary considerably between different socioeconomic groups. Also, different approaches work for each substance: for example, youth demand for tobacco products is very price elastic, thus price increases are an effective method to prevent tobacco use. Participatory prevention approaches, involving young people themselves, are especially conducive to obtain results.