The imperative to advance adolescent health equity

Adolescents and young adults (people ages 10-24 years) make up approximately 20% of the US population and 24% of the world population. Adolescence and young adulthood is a time of profound growth and change (for more on this, see here and here). This includes increasing independence and sensitivity to emotional and social influences that place youth at higher risk of making potentially harmful health decisions and offers critical opportunities to develop health-promoting behaviors that build on the unique strengths of this time of life.

Cognitive development and its role on adolescent health

This period of rapid growth is especially powerful because of what is happening in the brain. Second only to the first couple years of life, adolescence is the most substantial period of brain growth across a person’s life. The brain reaches its biggest size in early adolescence but doesn’t actually finish developing until someone is in their mid-20s. The part of the brain that’s responsible for planning, prioritizing, and impulse control (sometimes called executive functioning) is the last to mature. As you can imagine, it’s hard to make good choices about your health-related behaviors if your planning, prioritizing, and impulse control skills are still under construction!

The bonus of this level of brain growth is that youth are uniquely capable of learning and integrating new information faster than almost any other age group. This means that people and systems that work to support youth have an unparalleled opportunity to help them learn the skills that will help them get on and stay on the right track for a lifetime of health-promoting behaviors.

Another important thing that happens during this time is that critical health concerns begin to appear—and stick. In addition to the brain growth we just talked about, there is also powerful emotional and psychological growth, including a move towards greater independence, that can amplify what’s going on in the brain and the body in ways that can be alternately helpful and harmful to youth. There’s a reason why many people’s favorite music is from when they were a teen–it’s the same reason why health behaviors started during this time have a tendency to persist.

Adolescent health framework leaves lasting impression

The power of this period of time explains why there is often a focus on the negative aspects of adolescence. You have probably seen more than one news story describing the dangers youth face, including those related to violence, depression, substance use, and sexual exploitation. These concerns are real and worth paying attention to but are only one part of the story. The common trope about the need to be afraid for (or afraid of) youth takes our focus away from the wonderful aspects of adolescence, including adolescents’ resilience, creativity, and drive to make the world a better place.

The excessive focus on individual risk behaviors has another limitation: it often fails to address the social structures that can drive adolescent health inequities. The research underscores the devastating toll of systemic and interpersonal forms of stigma and discrimination on youth, including:

• Racism
• Sexism
• Ableism
• Classism
• Poverty
• Heterosexism
• and transphobia

Youth of color, lower-income youth, rural youth, LGBTQ youth, and those who live at the intersections of multiple marginalized social statuses disproportionately bear the brunt of many health concerns that emerge in adolescence. Youth in these marginalized groups can be more likely to experience concerns related to substance use, disordered eating behaviors, sexually transmitted infections including HIV, unintended pregnancy, intimate partner violence, poor mental health, and suicide—depending on the kinds of barriers and social inequities they face. The responsibility for these adolescent health inequities is not on the shoulders of these marginalized youth; but instead is rightfully placed on the laws, policies, institutions, and social norms which create the conditions that increase risk among marginalized youth.

The call for adolescent health equity

An adolescent health equity approach calls on us—as individuals and communities—to take action at these structural levels, turning the lens of research and practice to think about what kinds of policy and societal interventions would reduce inequalities and improve youth wellbeing. This work cannot be done effectively without centering the priorities and needs of youth themselves. Until recently, youth voices were often not given center stage in conversations related to their own health and wellbeing. In recent years, youth leaders have made significant strides in amplifying young voices and organizing around critical health-related social issues. Some of the most prominent examples are the organizing of U.S. youth involved in the Black Lives Matter movement and March for Our Lives against gun violence and those organizing globally to address climate change.

As you can tell, adolescence is a critical period in life, filled with growth, creativity, resilience, and opportunities for the development of health-promoting behaviors. Helping youth during this crucial time demands a focus on health equity and a concerted effort to center youth voices and build on the inherent strengths of this unique period of life. Adult allies can help by advancing research and policies that address the societal structures that can adversely impact youth. They can work to support youth by treating them as equal collaborators in the creation of research, policy, and practice, which will serve to benefit their—and society’s—health now and into the future.

Allegra Gordon, ScD, MPH, is a social epidemiologist who uses quantitative and qualitative research methods to understand the mental and physical health impacts of stigma, discrimination, and gender stereotypes on the health of young people across sexual orientations and gender identities.

Kimberly Nelson, PhD, MPH, focuses on community- and population-level health implications while conducting individual-level behavioral research. Dr. Nelson’s research concentrates on psychological and structural factors associated with the transmission or acquisition of HIV/STIs among marginalized adolescents, with a particular focus on the sexual health of sexual and gender minority youth.