The age-old demand by teenagers for cash “bribes” from their parents for good behaviour is gaining unexpected credibility. From Brazil and Mexico to Tanzania and Malawi, governments are exploring payments to adolescents to reward healthy practices.
“Conditional cash transfers” typically offer money in exchange for proof that young people remain in education, go for periodic health checks, or can demonstrate through negative test results that they have not contracted a sexual infection.
It is no coincidence that much of this innovation has taken place in developing countries, where surging youth “bulges” in the population and high prevalence of ill health are driving efforts to find new solutions.
They come at a time of intensifying debate over ways to boost health promotion and disease prevention in a particularly vulnerable age group.
Studies suggest that adolescents face a risk of injury or death that is two to three times greater than in childhood, the result of increased risk-taking as they become more autonomous and exposed to peer pressure.
Greater freedom and rising income levels can bring fresh dangers. With short-term benefits often masking longer-term consequences, they face threats from sexually transmitted diseases, smoking, drinking and obesity.
Not all the trends are negative, however. Rising global income levels alongside improved medical interventions are extending life expectancy.
The development of vaccines, and programmes to increase their adoption, are expanding benefits from childhood years into adolescence.
That includes the recent introduction of injections to prevent sexually transmitted HPV, the main cause of cervical cancer. Meningitis and flu immunisation programmes are also spreading into teenage groups. As for other age groups, greater awareness and prevention programmes have helped reduce the number of new infections of HIV over the past few years.
“Nudging” – small incentives to encourage positive behaviour through such changes as smaller glasses to reduce alcohol intake, or greater availability of fresh fruit – has received much attention.
Social media offer new opportunities to reach adolescents directly. Programmes such as YoungAfricaLive, for instance, use mobile and online technology mixed with entertainment to disseminate health education.
Yet there are concerns that in some groups, much health education has reached the limits of its impact. In the UK, for instance, the number of cases of chlamydia – a proxy for unprotected sex – is rising, with 238,000 cases identified in 2012 of which 70 per cent were aged under 25.
Some groups, including men who have sex with men, are practising particularly high-risk behaviour – something attributed in part to the declining fear of a “death sentence” from HIV with the advent of antiretroviral therapy, as well as the “disinhibition” effect of drugs and alcohol which increases tolerance for risk.
Innovation by the tobacco industry – with the advent of electronic cigarettes that may stimulate fresh interest in smoking of all sorts – and the food industry – with “low fat” products that are high in sugar – has presented potential new threats.
Risking Your Health, a review by the World Bank, highlighted the value of taxation and legislation including age restrictions on the purchase of alcohol and tobacco, alongside controls on labelling and advertising and bans on smoking in public places.
Not all such measures have succeeded. “ Fat taxes” to tackle obesity – the non-communicable pandemic of the 21st century – have so far failed to win widespread support.
Frank discussion in schools, and the provision of advice that is swift, confidential and free, have an important role. As today’s youth become tomorrow’s adult policy makers, they will have plenty on the agenda to improve health further for future generations.
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