Improving services to allow young people to engage with their health will result in both short term and long term population health gains. Such changes must be part of a broader strategy to reduce inequalities. We suggest the following actions.
Specific public health focus on young people's health
Stop focus on single issue approaches—Public health policy, practice, and research need to develop approaches for young people that focus on common predisposing and protective factors affecting physical and mental health. This must extend beyond health to education, social services, and the justice system.
Develop separate policy for youth—Young people should be recognised as a distinct group in policy formulation and implementation. The effect of policy initiatives on young people's health should be examined specifically.
Reformulate age banding of data—The commonly provided age bandings of 5-15 years and 16-44 years in national data provide no information on trends in adolescent health.
Develop research programmes and networks in adolescent health—
Research centres have been effective in translating research based advocacy into service innovations (for example, evidence based school programmes to promote good mental health19
and education programmes for general practitioners based on research into the barriers preventing adolescents from accessing primary health care20
). The networks would also have a role in promoting and supporting training.
Refinement of health and health inequality indicators for young people
—This would allow local targets to be set for health issues such as obesity and mental health as well as the existing national target to reduce teenage pregnancy.3
Redesign of the Healthy Schools programme—
The programme needs to embed health promotion in multiple areas of the curriculum (as has been shown effective in combating obesity21
) and facilitate change in the school environment to promote mental health (as has been shown to be effective in reducing risk behaviours19
Direct engagement of young people through information technology
Introduction of “smart” cards for young people in the United Kingdom is currently under consideration. The smart card should be linked to the introduction of user held health records, which would help engage young people with their health. Cards should also be linked to improved access to age appropriate services (although cards must not be used to limit access), provision of health information, and patient led appointment booking systems.
Provide clinical services that engage young people
Young people need health services that are responsive and sophisticated yet easy to access. Staff must be highly trained in the problems facing young people and culturally competent. Services need to be designed to reduce health inequalities and promote widespread access to information through the use of information technology.1
Providing appropriate services will require improvement of existing services, provision of training across all levels of the health service, and the development of new youth health services where appropriate.
Randomised trials show that the skills needed to communicate effectively with young people can be learnt.20
Skills in adolescent health must be taught to those in training and at postgraduate level in medical, nursing, and allied professions. Brief exposure to adolescent health should be a necessary part of training of groups such as paediatricians, as currently works well in the United States.
Improve the capacity of primary care services to work with young people—Audit and implementation tools should be developed to allow general practices to provide the most important aspects of primary care identified by young people, including confidentiality, respect, privacy, easy confidential access, staff communication skills, age appropriate health promotion, and dedicated young people's clinics with flexible appointment times. Teenagers should be re-registered with practices at 14-15 years to allow them to develop a relationship with their general practitioner outside that of their parents. School health services should be strengthened and extended and explicitly linked with extension of the Healthy Schools programme.
Youth health services—New health services designed for and by young people should be provided in metropolitan areas, particularly those with high levels of deprivation. These services should provide primary care as well as sexual health, drug, and alcohol and counselling services, and should be jointly sited with social services and education provision as “one stop shops”.
Fuller engagement of young people in secondary care can be achieved through the development of specific adolescent clinics, effective management of the transition from paediatric to adult care, and promotion of self management through expert patient programmes. Specific medical inpatient services for young people should also be provided routinely wherever possible.14
Dedicated youth psychiatric services are needed to deal with early onset psychotic illnesses and substance use issues.22