How can communication help stop teenagers dying?
Health Adviser, BBC Media Action
While the election of Tedros Adhanom Ghebreyesus as the next director general of the World Health Organization (WHO) has been accompanied by some controversy, I’ve been heartened by one of his top five priorities for when he assumes his new post. Dr Tedros has pledged to put the wellbeing of adolescents, alongside women and children, at the very centre of global health and development.
This ambition reflects the times we live in. The organisation Dr Tedros will soon lead has revealed that more than 3,000 adolescents (10 to 19 year olds) die every day from mostly preventable causes. The top five killers in 2015 were road accidents, lower respiratory infections (like pneumonia and bronchitis), self-harm, diarrhoeal diseases and drowning.
Look deeper and you’ll see differences by country, age and sex
These mortality trends hit certain parts of the world and particular segments of society harder than others. Over two-thirds of these teenage deaths happen in the Global South, mainly countries in Africa and South East Asia. Teenage boys are more likely than girls to drown, who instead have a lot to fear from pregnancy-related complications. Younger adolescents lose their lives to lower respiratory infections. As they get older, they’re more likely to die at someone’s hands – including their own.
Clearly, adolescents are not a homogenous group. They face different risks that reflect the rapid physical, sexual and emotional changes, which are the hallmark of the teenage years. Not only that, they must also contend with challenges that stem from the roles they are given by the societies, communities and families they live in. To ensure that communication responses are as relevant as possible, these should be fine-tuned to suit the age group and gender of particular concern.
Thinking beyond the Global North
In addition to recognising that the needs of an 18-year-old girl as distinct from those of a 10-year-old boy, we also need to be careful not to assume that ‘Western’ afflictions aren’t more universal.
To take just one example, we now know that suicide isn’t just a serious public health problem among older adolescents living in the Global North. Almost half of teenagers who take their own lives globally do so in lower middle income countries in South East Asia: over 10% of 13 to 15 year olds in Thailand, Timor Leste and the Maldives say they've tried to kill themselves.
And yet services and support are often scarce in these settings. Even when support is available, teenagers and their families are unlikely to seek help because mental health is poorly understood and not openly discussed.
Talking about self-harm and portraying it with sensitivity, whether through drama, street theatre, factual programmes or through face-to-face conversations, can address gaps in people’s knowledge and their fear of stigma. Getting people informed and talking about these issues can in turn make it as normal to seek treatment for mental illness as getting a cast for a broken arm.
Fortunately, countries are starting to make progress in this area. India recently launched its first mental health campaign specifically targeted at young people. Ethiopia’s 2012-16 national mental health strategy – supported by Dr Tedros when he was his country’s health minister – marks the need for targeted mental health prevention and support programmes for adolescents.
So what can media and communication do to help?
The WHO report helpfully runs through the evidence on how to keep adolescents alive and well, sharing 50 case studies from across the globe to help inspire us all. However, the unique role that media and communication can play, whilst mentioned, isn’t well explored. This is where organisations like ours can fill in the gaps.
Let’s take pregnancy as an example of an area where Media Action and other NGOs like it can make a big difference. Some girls get pregnant because they plan and want to have a baby. But considerable numbers of girls don’t know how to avoid getting pregnant and if they do, they often face many obstacles in getting a hold of contraception. In addition, many very young adolescents have their first sexual experience due to coercion rather than choice. Given the risks of pregnancy, especially at a young age, this lack of awareness and autonomy is incredibly worrying. Fortunately, the media can help inform young people and empower them to act on what they know.
A number of media programmes around the world are tackling these challenges, like our very own Tikambe (Let’s Talk!) in Zambia and Dosh Unisher Mor (Crossroads at 10-19) in Bangladesh. Both shows provide an honest and safe space for adolescents to ask questions and voice their misgivings about safer sex, allowing them to make informed choices about effective contraception. They can also be directed towards trusted services and sources of support. Recent but unpublished research shows that listeners of Tikambe were more likely to: know more about contraception, have visited a health centre and feel more supported by the key people in their lives when it came to sexual health.
On the communication front, the WHO has looked into replicating a decade-long British strategy, which ultimately led to a halving in teenage pregnancy rates over 16 years, in other countries. The communication part of the strategy normalised conversations about sexual health between adolescents and their parents, showing that communication can help pave the way to record lows in teenage pregnancies.
But we’re just scratching the surface of what media and communication can achieve for teenagers around the world. Given the myriad of threats facing young people today, it’s vital that we leverage all manner of approaches to help them cope. Fortunately for the generations coming up, these challenges are far from insurmountable; media and communication can be a key part of the toolbox of preventative measures.