Vital need for improving teen health care

A recent report draws attention to the urgency of addressing the challenges of providing continuing medical care to this age group.

Posted Jan. 19, 2009.

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Everyone agrees that adolescence is an awkward time, with physical and emotional growing pains marking the path from youth to adulthood.

All too frequently during these years, young people fall prey to risky behaviors, develop unhealthy habits or have chronic conditions that jeopardize their health immediately or lead to lifelong problems. Drugs, alcohol, tobacco, unsafe sex, violence, lack of exercise and poor nutrition are among the complications these developing bodies and minds might confront. And when they do, dire consequences can follow. For instance, the three leading causes of teenager deaths -- motor vehicle crashes, homicide and suicide -- are tied to negative behaviors.

That's why attention is focusing on medicine's role in helping young people through these difficulties. More than ever, experts view the teen years as a critical time for health promotion and disease prevention and understanding. But maximizing this opportunity offers significant challenges.

About 42 million, mostly healthy, people ages 10 to 19 live in the U.S., according to statistics from the National Academies and the National Research Council. At the same time, though, more than 5 million between ages 10 and 18 are uninsured or underinsured. Even those eligible for public coverage still may not be enrolled. And these young people are less likely to have medical homes for routine care. Overall, the result tends to be fragmented medicine that fails to meet patients' needs. For instance, more than a third of adolescents with behavioral problems that require treatment do not receive mental health services.

A Dec. 9, 2008, report by these two organizations highlights the health system gaps that undermine adolescent health care, offers recommendations to address them and adds to the discourse regarding how the medical needs of this population can best be met.

For its part, the American Medical Association has long been an advocate for programs that advance teen health. The AMA has developed a number of resources, including Guidelines for Adolescent Preventive Services, and a range of other initiatives. Association policies encourage collaborative efforts with health, education, school and community groups to create guaranteed access for this group to needed family support services, psychosocial services and medical services. They also support efforts that would promote creating health and social service infrastructures to help those for whom comprehensive continuing health care is unavailable. In addition, the AMA has been active regarding adolescent immunizations

These actions and policies are in sync with a fundamental theme of the report.

Adolescent patients should not be treated the same way children or adults are treated. And the care they receive -- especially in terms of prevention -- can have a lifelong impact.

The report itself urges the development of strategies to ensure that adolescents have coordinated, comprehensive and continuous health coverage -- especially those who are vulnerable to risky behavior or bad health; who are poor; who are recent immigrants; or who are in foster care. It recommends that physicians who treat teens receive detailed education about the age group's health problems, and effective treatment and health promotion approaches. The document also advances the principle that adolescents should give their own consent before their health information is shared with others, even parents. Its authors even urged policymakers, as they discuss health care reforms, to give special attention to this population's problems.

Adolescents are vulnerable -- and they are our future. They deserve greater attention from all points across the health system.

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