Meeting the health needs of young people.

The health needs of young people have been receiving increased attention in recent years. In the UK this has arisen partly because of government initiatives, such as Health of the Nation, Health of the Young Nation, the Young People’s Health Network, and so on. However, on the international scene more health professionals are speaking out about this age group and about its special characteristics. Until recently it was generally assumed that the health needs of young people were less pressing than the needs of other groups in society. Teenagers were seen as being a relatively healthy lot, and that therefore, although there were clearly special groups within the age cohort, the adolescent population as a whole did not need to be considered a priority in terms of health service delivery. A number of factors have changed this perception. The increased rates of suicide among young men in some countries in the 1980s and early 1990s put the spotlight on the mental health needs of young people, while a continuing concern over the rates of teenage pregnancy has highlighted the need for better sexual health services for this group, as has the rising incidence of various types of sexually transmitted infections in the past few years. A further factor that has fuelled debate over the health needs of this age group is the growing body of research that identifies the obstacles faced by young people in their quest of health advice and treatment. Research findings show that there are a number of factors that either inhibit young people from going to the doctor, or that create anxiety among those who do attend. There is uncertainty over policies concerning confidentiality, diYculty in making appointments, and a sense that few GPs have any interest in teenage problems. Findings such as these have led health professionals to think more deeply about how to provide a service for teenagers that is user friendly. In addition to these activities public attention has also been drawn to the question of inequalities in health, and to the disadvantages suVered by particular groups of young people. Research has shown that teenagers growing up in poverty experience markedly poorer health than those living in aZuent circumstances. Similarly young people looked after by the state, as well as those in custody and other residential facilities, are at especially high risk in health terms. As these groups are less able to access health services in any event, there is an even greater urgency in attending to the provision of appropriate services. It is of course encouraging that more attention is being paid to health service provision for young people in our society. However, there is a long way to go before the fact that the needs of young people diVer from those of children or adults is recognised, accepted and understood. We should be clear that adolescence as a particular stage of development has associated with it characteristics that aVect health needs. Puberty and the rapid physical changes inherent in this phase lead to concerns about normality and pace of change. A lack of self confidence and hypersensitivity about one’s body leads to timidity about seeking information and advice in the early adolescent years. Anxiety about independence, and the need for privacy, means awkwardness over relationships with parents. This in turn means that confidentiality is at a premium. These few examples will suYce to show how the characteristics of a developmental stage should influence the nature of the service oVered. Unfortunately there is still much work to do before this knowledge is universally translated into service delivery. While it is essential not to generalise about attitudes between the generations, we should not ignore the fact that some adults do hold attitudes about young people that hinder the provision of sympathetic and appropriate services. Two attitudes may be mentioned here. In the first place it is not unusual for adults to think of young people as being diYcult to communicate with. There are skills needed to communicate well with young people, but these can and should be learnt, so that any obstacles can be overcome with a little forethought and planning. The second attitude has to do with risk taking. It is commonly believed that young people are more likely than adults to take risks with their health, and this can lead to a less than sympathetic response to some health problems. All professionals working with this age group need to examine how they feel about young people, and look closely at their attitudes to adolescent behaviour. It is now time to turn to some action that could be taken to improve health services for young people. Firstly, let us look at training, as this is a topic mentioned above. There is no doubt at all that more training is needed for those working in the primary health care sector on the needs of adolescents. Such training should cover the particular developmental characteristics of this stage, but should also focus on communication skills, on multi-disciplinary working, and on forging closer links with community agencies such as schools, youth clubs, and local employers. Young people’s needs could be met more eVectively if greater eVort was put into publicising local services. Clear information sheets should be available in all settings where young people gather, so that any local health initiative becomes widely known to all in the community. We know that teenagers learn of services more frequently through word of mouth than by any other means. However, without written details, disseminated through eye catching posters and other means, the word of mouth process can never get underway in the first place. We need also to focus on parents, and to think through how mothers and fathers of teenagers can be engaged in improving the health of their children. Parents of teenagers need a better range of information about health matters, as well as more knowledge of topics such as drugs, smoking, and alcohol, all of which are key issues for young people. Parents also need to be encouraged to communicate with their teenagers on health topics. Few realise how important good communication in the home can be in the reduction of risk and in the development of harm minimisation strategies. Parents have a central part to play, and yet we put hardly any resources at all into assisting them to play that central part. The use of new technology should also be seen as a valuable tool in health promotion and as a means of delivering good quality information to a wide range of young people. There is an exciting move to develop web sites designed to provide such information, such as the www.teenagehealthfreak.co.uk web site recently established by the British paediatricians Ann McPherson and Aidan Macfarlane. There seems little doubt that the internet will increasingly oVer a medium through which a variety of health related services can be provided. In considering how to improve health services for young people we have left to last perhaps the most important of all means—the creation of specialist teen services. There are a J Epidemiol Community Health 2001;55:532–533 532