Comparative insights and shared directions for adolescent health: a commentary on three international papers.

Writers and commentators now speak of “the global village” as a fact rather than as a metaphor for slowly emerging interconnections across geographic and cultural divides. In reality, the shared nature of threats to health and well-being (for young people as well as for other populations) has been long-recognized by students of public health and political economy. At the systems level, medical sociologists have written for decades about the “convergence hypothesis”: the observation that despite variations in organization, financing and political contexts, all modern health care systems face similar and profound challenges to their operations and effectiveness [1]. These stem from changing patterns of morbidity and mortality coupled with the lags in moving scientific understandings about prevention, protection and promotion into full and effective implementation. The three papers in this issue of Journal of Adolescent Health from Pierre-Andre Michaud of Switzerland [2], Kristina Berg-Kelly of Sweden [3], and George Patton, Lyndal Bond, Helen Butler and Sara Glover of Australia [4] similarly remind us that despite variations in social setting and in models of public health and adolescent health services, the contemporary health needs of young people amplify more the shared challenges facing all who work with and on behalf of youth than any cultural or geographic differences between us. As Michaud emphasizes, essential to our success is the embrace of youth involvement in setting priorities for prevention and promotion efforts. This requires an understanding of prevailing norms and beliefs that will surely enhance or erode any effort to improve population-level health. While not saying it directly, his caution is against hubris, the arrogant pride that has compelled many to fashion interventions in the name of others, but without an insider’s perspective or the active engagement and leadership of those most affected by the intervention itself. This insight has been a truism for labor organizers and community organizers for a long, long time; it can predict the success or failure of political and social movements that have either fizzled or exploded into vibrancy because of the presence (or absence) of deep understanding of the life experiences of the “target population” along with their intrinsic leadership of efforts on their own behalf [5]. Both Berg-Kelly and Patton and colleagues examine national and local experience with school health as a vehicle for addressing the wide range of health issues among young people. Their historical and contemporary descriptions illustrate well how school-wide interventions can be employed to improve goodness of fit: the synchrony between the health needs of youth on the one hand, and the systems of prevention, promotion and care designed to address those needs on the other [6]. Their affirmation of schools as the vehicle for enhancing youth health is grounded in three contemporary understandings: (a) threats to adolescent health stem from From the Division of General Pediatrics and Adolescent Health. National Teen Pregnancy Prevention Research Center University of Minnesota, Minneapolis, Minnesota. Address correspondence to: Dr. Michael D. Resnick, University of Minnesota, Dvision of General Pediatrics and Adolescent Health, National Teen Pregnancy Prevention Research Center, 200 Oak Street SE, Minneapolis, MN 55455-2002. JOURNAL OF ADOLESCENT HEALTH 2003;33:213–214