Chakraborty S, Sagar S, Patil P. Placing youth at the forefront of tackling non-communicable diseases. Harvard Public Health Review. 2021; 28.
Non-communicable diseases (NCDs) is an umbrella term used to describe a cluster of diseases, namely, cardiovascular and chronic Respiratory complications, cancer, diabetes and mental health conditions. The World Health Organisation (WHO) estimates that nearly 71% of all deaths worldwide (41 million people) can be attributed to inadequate and untimely intervention for Non-communicable diseases. Out of the 41 million people affected, the most vulnerable groups placed at the epicentre to face the repercussions of the growing impacts of NCDs are children, young people, people of lower socio-economic status (SES) and those belonging to lower and lower-middle income countries (LMICs). Young people constitute a major demographic widely affected by NCDs yet remain underrepresented in their say on tackling NCDs across local, regional, national and global levels. Through this perspective piece, we propose several recommendations to ensure more effective and widespread inclusion of young people in policymaking related to NCDs.
The World Health Organisation (WHO) estimates that nearly 71% of all deaths worldwide (41 million people) can be attributed to inadequate and untimely intervention for Non-communicable diseases. Out of the 41 million people affected, the most vulnerable groups placed at the epicentre to face the repercussions of the growing impacts of NCDs are children, young people, people of lower socio-economic status (SES) and those belonging to lower and low-and-middle income countries (LMICs). The prevalence of non-communicable diseases (NCDs) globally is disconcerting. 1.7 million deaths annually among young people are attributable to NCDs. Despite significant burden of NCDs among the youth, they continue to be under-represented in policy formulation and implementation. 2 out of 3 countries do not consult young people as part of their policy-building processes. With the advent of the internet, the youth have increased access to information and networking avenues. Therefore, nations armed with a high population of young individuals, especially LMICs, stand to reap benefits from effectively engaging them.1,2,3,4,5,6
Youth involvement in Policy Formation and mainstreaming youth policies
Effective policies concerning the youth require their direct input and meaningful participation. Their experiences and knowledge must be consolidated in the formation, implementation and surveillance of health policies. Active participation fosters a sense of ownership which is essential for inclusion and development. Youth participation may be sought through establishment of online and offline forums. Training programs can be utilized as catalysts and incubators for leadership roles. We suggest sensitising the youth regarding involvement in policy formation. Some ways to achieve this could be by engaging youth in policy evaluation internships, masterclasses and hosting knowledge acquisition platforms. Mobilising trusted youth influencers from various communities can encourage young people to become more actively involved in envisioning reform in existing policies. An example of a youth-inclusive policy discussion was the use of the Get Heard Toolkit, launched in 2004. Merseyside, a county in North-West England, was chosen as the area for a case study analysis, being one of the most disadvantaged areas of England. Using a Get Heard Toolkit to structure discussions involving 320 participants representative of various genders, age groups, geographical situation and status of employment, 40 workshops were held to generate responses from participants with experience of social exclusion. Young participants of the workshop, identified to be in danger of becoming NEET (not in Education, Employment or Training) shared their feedback on lack of support for issues related to mental health and substance abuse. These discussions then helped shape the 2006-08 UK NAPSI (National Action Plans on Inclusion).7,8 This particular example can be replicated in similar geographies, for the inclusion of young voices in mainstream policy discussions.
Youth involvement in policy making is often limited to them being recipients of information or as nodal points for dissemination of information. Their opinions are infantilized and inadequately addressed in mainstream policy formation. While young people are engaged in informal politically relevant activities such as activism, they tend to be underrepresented in formal political bodies. Youth tokenism and its prevention must be considered in this regard. Objective evaluation processes for youth participation need to be formed and implemented to rule out quasi-participation of young people.
The presence of youth wing within decision-making bodies could provide a platform for the youth to directly voice their opinions on health policies and the prevailing healthcare scenario, allowing issue-based alliance formation. A powerful youth network connecting people across age groups within the youth could ensure that there are senior former members to function as champions for strengthening youth capacity building in healthcare policies.9
Reaching Youth Across the Spectrum of Society
Young people are not a homogenous group and thus require interventions to be inclusive of the entire spectrum of youth from diverse gender, race, sexual identities and other backgrounds. Online interventions contingent on access to the internet, tend to push the marginalized youth further towards the peripheries. It is imperative to strategically highlight the voices of underrepresented youth demographics such as women, marginalised youth and LGBTQ+ communities through acceptance and empowerment. There is a growing need for incorporating youth specific policies into the mainstream policy framework by governments of several countries, especially LMICs.10
Educating Beyond the Curriculum
Often, awareness regarding NCDs and the concerning policies is limited in its dissemination to healthcare professionals and those directly involved in formulating policies. However, conversations about NCDs should be normalized beyond the curriculum and permeate everyday conversations. As outlined by the WHO (World Health Organization) Global action plan on NCDs, there is a need to disseminate knowledge and share information based on scientific evidence. We urge the incorporation of information about national and global NCD policies through formal as well as informal means of education.11
Policies on Mental Health
Suicides are the second most common cause of death among the ages of 15-29 years. However, data regarding deliberate self-harm is clouded by social stigma and medicolegal factors. Estimates suggest that for each death due to suicide, there are 20 other suicide attempts. Even in the face of glaring statistics, most countries do not have a stand-alone strategy for suicide prevention. Approximately half of the suicides occur in low and low-and middle-income countries, however, a mere 10% of these countries have a specific strategy adopted by the government for suicide prevention.12,13 Evidence-based suicide prevention measures need to be emphasised with the goal of generating awareness and eliminating social stigma regarding seeking professional help. Counselors and trained mental health professionals must be appointed by administrative boards across schools, colleges, higher education institutions, academies and other places frequented by young people under the supervision of local or regional supervisory bodies.
Substance Abuse and NCD Interventions – Examples That Lead the Way
Consumption of alcohol and other substances is another common cause of untimely death among 15-24 year olds.14 The causes of death can be attributed to accidents, suicides, or even homicides committed under the influence of substances. Consumption of alcohol has also been reported to cause increased acts of violence and aggression, thereby resulting increased rates of indulgence in crime among the youth. The Americas and Europe are ranked highest in the world for consumption of alcohol.15 Rates of mortality due to violence and homicide among 10-29 year olds are skewed towards middle-income countries like Columbia (84.4 per 100,000 population) to less than 1 per 100,000 in high-income countries like Japan and France.16 The WHO has taken significant steps, especially in the EU (European Union) to combat substance use. For example, over the last two decades, with the help of the Action Plan on Youth Drinking and Heavy Episodic Drinking (2014-2016). It consisted of 6 action points targeting reduction in – 1) heavy episodic or binge drinking, 2) accessibility and availability of alcoholic beverages for youth, 3) young peoples’ exposure to marketing and advertising of alcohol, 4) alcohol-related harm during pregnancy, 5) ensuring safe and healthy environment for the youth and finally, 6) supporting monitoring and research which led to the developed of a toolkit with evidence-based guidelines and recommendations.17 The mhGAP (WHO Mental Health Gap Action Program) is another program aimed at increasing services for neurological, substance use and mental illnesses, specifically in low- and middle-income countries.18
In the absence of concrete measures to tackle NCDs, it is estimated that 15 million individuals will die prematurely each year, a majority of which will include young people.19 Examples of policies, actions plans or interventions that are youth-centric and involve young peoples’ participation, especially those belonging to underrepresented communities, must be referenced for strategic planning and development in the future. Investment in and effective engagement of young people as core stakeholders in policy planning processes is imperative to ensure a sustainable future for the attainment of Universal Health Coverage, where no one is left behind.
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