Comparison Of Health Issues Among Children And Adolescents In Developing And Developed Countries

Discussion

Discuss about the Comparison of Health Issues Among Children and Adolescents in Developing and Developed countries.

Through sustained efforts, the world is making notable progress towards the attainment of better standards of health and well-being. Regardless, disparities in health status do exist across different regions of the world. Children, adolescents and the youth as a whole who make up close to two billion of the world’s population (as of 2014) are also faced by these shifting dynamics (Gupta, et al., 2014). An example provided by the WHO is such a case in which most children and adolescents in Europe are doing well health-wise compared to their counterparts in countries such as India and Nigeria who have much lower health standards (WHO, 2017). Close to seventy percent of young people who live in the developing world experience greater challenges in social, economic and health spheres compared to those living in industrialized countries (Fatusi & Hindin, 2010). The current generation of young people is growing in a world transformed by diverse dynamics of economic challenges, HIV/AIDS, digital communication, globalization, migration, climate change and other forces. These forces add to the challenge of economic, physical, social and physical transitions which typify the life of young people.

This essay discusses some of the issues faced by children and adolescents worldwide. It offers a comparison of health issues faced by this population in both the developed and developing world. Current health issues in both worlds are discussed and compared to the situation of their counterparts. In the last part of the essay, recommendations are made on the  situations discussed.

Access to Quality Health Care

The health and wellbeing of children and adolescents partially depends on their access to healthcare services. Regardless of the better outlook of the world’s young people; current challenges (economic and social) draw attention to the challenges faced in young people’s health and the corresponding requirement for health services. Changes in economic status, family structures, and geographic migration, which places children and adolescents in the need for health services due to the conditions that are as a result of hunger, neglect, poor housing and violence (Hagan, Shaw, & Duncan, 2008). It is common knowledge that children in poor countries of the developing world have less access to health services compared to those in economically-advantaged countries (Peters, Bloom, Garg, & Hafizur, 2008).

A significant body of literature confirms that most children in the developing world have inadequate access to healthcare from which they could benefit. Children in developing countries are less likely to access and benefit from effective health care compared to their counterparts in the developed world (O’Donnell, 2007). For the children in the developing countries, two scenarios exist to the accessibility problem. The first scenario pertains supply; good quality, effective care may not be availed by the responsible authorities. Second, it is on the demand side in which the children may not be able to utilize the services meant to benefit them. both are interrelated in most cases. In the developing world, poor quality of health care rarely arouses interest from the public. Increased demand, obviously induces the provision of quality care (O’Donnell, 2007). Therefore, solving the problem of accessibility calls for attending to both the demand and supply equations. The unsolved issues of demand and supply further worsens the current picture in which lots of people do suffer from preventable health problems which range from communicable diseases to childbirth complications and malnutrition, just because they are poor.

Nutrition: Malnutrition and Obesity

Diverse variances in the health status between children of the poor living in the developing and those better-off living in developed countries can be highlighted by examining the accessibility of healthcare in the latter group. Industrialized countries enjoy an excellent coverage of health care facilities. Therefore, the issue of accessibility is no longer on the issue of supply and demand but the actual utilization. Insurance coverage among citizens of these countries is above par. Millions of citizens in developed countries benefit from insurance coverage, which translates to better accessibility of healthcare. However, disparities in the utilization of health care services can somewhat be attributed to lack of insurance coverage in some proportions of the populations. For instance, race is often used as a proxy for socioeconomic status in some states such as the U.S. Drawing from Pui, Boyet, Hancock, and Pratt, (1995), the mortality rate among black US paediatric cancer patients was higher compared to the rest. A possible explanation that can be drawn from this example is that this group had inferior care, which to some extent can be attributed to differential insurance coverage (Pui et al, 1995). In industrialized countries, there is a possibility that insured children and adolescents from low socioeconomic status get an inferior quality of care compared to those from families whose parents uphold the value of medical care (Currie, 2000).

Summing it up, the accessibility of healthcare for children and adolescents in either world is dependent on the family’s socioeconomic status (SES). SES is an indicator of both education, income and employment status (Katterl, 2011). SES is related to health, particularly, it impacts the utilization of healthcare services (Welch, 2000). Regardless, a significant proportion of those in industrialised countries have improved access to health care compared to those in third-world countries. This is owed to disparities in the availability and distribution of health professionals, equity and efficiency of health care policies, and accompanying costs (both direct, indirect and opportunity costs) (Katterl, 2011).

Childhood and adolescence stand out as the most important periods in man’s life (Biro & Wien, 2010). Most of the diseases acquired through these periods are often carried into adulthood or may act as risk factors for diseases at adulthood (Park, Falconer, Viner, & Kinta, 2012; Biro & Wien, 2010; Sandhu, et al., 2008). Obesity and overweight are serious health problems as they affect more than the growth and development of children and adolescents, but also do increase the likelihood of developmental problems such as cognitive dysfunction, psychological disorders m and the timing of puberty. Malnutrition and obesity alike are a concern as they both induce health problems which are almost the same. Hypothetically, obesity is more of a problem of developed countries whereas malnutrition is more of a problem of the developing world. Unluckily, due to the changing dynamics of developing countries, there is a decline of malnutrition and an influx of obesity. This trend is attributed to the improvement in living conditions of some proportions of populations of these countries. As it stands, the developing world carries a disproportionate burden of either nutrition problem. Thus, obesity stands out as a serious public health concern globally.

Malnutrition problems such as anaemia and protein-energy malnutrition among children may delay physical and brain development (Kant & Graubard, 2013). In developing countries, the common causes of malnutrition in this population are inadequate food intake, lack of nutrient-rich foods and unhealthy dietary habits (Zhai, Dong, bai, Wei, & Jia, 2017). Malnutrition at childhood and adolescence is manifested as stunting and it is attributed to a myriad of factors which are closely interconnected with living conditions and the ability to meet basic needs.  (Monteiro, et al., 2010). Thousands of children residing in developing countries often do not meet their full growth potential, and this translates to considerable consequences on academic performance and a corresponding transfer of the resulting poverty to succeeding generations (Grantham-McGregor, Landman, & Desai, 1983).On the other hand, many industrialised countries do report a high prevalence of obesity among children (Liang & Mi, 2012). For instance, in the US, the prevalence increased from 5.2% to 16.5% in a span of 20 years. For children and adolescents, the prevalence ranges between 15 and 17% (Fryar, Carroll, & Ogden, 2013).

China can be used to illustrate the shifting dynamics of obesity in developing countries. Whereas the prevalence of stunting and wasting has reduced by more than 30% in a span of 15 years, the prevalence of obesity and overweight in the population under study increased by over 115% within 20 years (National Health and Family Planning Commission , 2015). Confirmed by WHO, childhood obesity continues to increase in developing countries, and it will be a major problem in the future (WHO, 2016). In the current times, developing countries are characterized by intense demographic and technological changes with accompanying changes in lifestyles and dietary intakes. Such changes indicate the process of nutritional transition, which is characterized by, on one hand, diseases caused by communicable agents and deficiencies such as anaemia, and on another hand diseases caused by non-transmissible chronic conditions such as obesity and diabetes mellitus (Monteiro, et al., 2010).

Developed countries are doing well when it comes to upholding rights of children and adolescents as compared to their counterparts. Most children in Europe and US enjoy a higher level of implementation of their human rights compared to their counterparts in the developing world. Nevertheless, obstacles to the enjoyment of these rights do exist. Outstandingly, the US and UK fail to embrace human rights and equality for children to some extent (Children’s Rights Alliance for England (CRAE). The two countries are leading when it comes to the incarceration of children (BBC, 2004). To a greater extent, this action contravenes the UN’s convention on the Rights of the Child. On the other end of the spectrum, those in developed regions of the world also do suffer discrimination as a group. The unique needs of children are sometimes not upheld in the community, within the family and schools, and during service provision. Especially, disadvantaged groups of children such as those with disabilities, those suffering from abuse, and those from vulnerable groups suffer an acute and unacceptable rights abuse (Daly, Ruxton, & Schuurman, 2015).

Children in developing countries are characterized as being in vulnerable situations due to poverty, as they are less likely to know about their fundamental rights. Close to two billion children and adolescents live in the developing country. According to German Development Cooperation, a third of these children live in absolute poverty (German development cooperation, 2016). These children lack basic children’s and adolescents’ rights, are unable to access education and health care, and most of them won’t get an opportunity to participate in the society. The high level of poverty among these children has a negative impact on their overall health. In an effort to make ends meet, most children’s rights are abused in the process. An ideal example is on child labour. Child labour means that children aged below 18 years are forced to work in order to obtain funds for daily living. Child workers are common in Sub-Saharan Africa, South Asia, and Latin America. They can be found working in dangerous sites such as quarries, mines, and factories, could be working as house servants, or can be found selling merchandise on streets. A significant proportion works in the agriculture sector as it is the major part of the economy of the developing countries. It is, however, important to note that child labour is not restricted to the developing countries. There are also cases of working children in industrialized countries such as Ukraine and Turkey. 

Children and adolescents are more prone to exposure to violence, crime, and victimization, as compared to adults (Finkelhor, Turner, Ormrod, Hamby, & Kracke, 2009). Experiences of violence and victimization can lead to lasting harm (both mentally, emotionally and physically), regardless of the affected child or teenager being a direct victim or witness. Health problems attributable to violence and victimization include but not limited to regressive behaviours, depression, anxiety, attachment problems. Delinquency, cognitive and academic problems, and involvement in child welfare and juvenile systems, which also happen to have some elements of violence experiences (Margolin & Elana, 2004). According to Margolin and Elana (2004), children are also prone to community violence which also has the same devastating effects.

Research on child abuse indicates that children prone to violence and victimization are those in vulnerable groups such as those living in deprived areas (developing countries included), are asylum seekers, or those with vulnerabilities (disabled) (Daly, Ruxton, & Schuurman, 2015). The girl child is especially prone to gender-based violence. Extreme forms of violence such as sexual exploitation and trafficking, child labour, female genital mutilation and the impact of armed conflicts have been meted on children, especially those in developing countries who are characterized by such challenges.

Whereas children in developing countries are at risk of being exposed to physical, sexual and psychological violence and victimization in their homes and schools, their counterparts in developed countries are more of at risk of such acts in the communities, abuse in care and justice systems, and at workplaces. Nevertheless, drawing an example of European countries, high levels of domestic violence do exist. This is regardless of the fact that most of these countries have banned physical punishment. Notably, most European states have accepted (both socially and legally) physical punishment (Daly, Ruxton, & Schuurman, 2015).  It is, therefore, justified to conclude that violence and victimization exist across both developed and developing countries, but the latter has a greater burden.

Adolescents in either world are prone to experimentation and risk-taking. The consequences of such behaviours are not always the most desirable ones. Adolescents in the developing world are often disadvantaged due to the fact that most humanitarian emergencies do occur here, and most of their sexual and reproductive health needs are likewise unmet. Most adolescents in these countries are prone to marrying early and having more premarital sex (IAWG on the Role of Community Involvement in ASRH, 2007). There is a large unmet need for contraceptives in these countries, with the evident outcome of pregnant adolescents, and the accompanying risks of morbidity and mortality resulting from complications during pregnancy or at birth (UNFPA, 2009). Adolescents in developed countries have a far less burden of this problem. This could be attributed to the availability of supportive programs and frameworks.

The WHO reports that over two million adolescents are living with HIV/AIDS (WHO, 2016). A significant proportion of which are in Africa, Asia, and South America. Most adolescents in these regions lack information on how to protect themselves, lack access to condoms, are drug abusers, have limited access to HIV testing and counselling, and a lack of HIV treatment services. Even though the STI/HIV-AIDS pandemic is a worldwide problem, the problem is more pronounced in developing countries.

The first recommendation to address the above-mentioned issues lies in education and public awareness. To improve the health of children and adolescents, governments, and public agencies have the task of raising awareness of the issues among the general public group and special groups. This will promote recommendations for the provision of high-quality and health services appropriate for this group, alongside other viable solutions.

On the issue of child and adolescent rights, building capacity of WHO, regional and national organs should be improved to enhance the application of the UN Convention on the Rights of the Child. Likewise, national frameworks for the protection of children and human rights especially for girls should be increased as they are more prone to abuse, violence, victimization and exploitation

To reduce child morbidity and mortality, specific actions which can be taken include working to improve accessibility to healthcare, investing more in child-specific interventions such as immunisation, investing more in the prevention of transmissible diseases such as STIs and HIV/AIDS, and lastly, strengthening of sustainable health systems for the provision of quality health care to both children and adolescents.

Tackling the issue of obesity will require a more proactive approach other than public education. There is the need for investment in public health strategies and medical interventions. Programs and policies such as the screening for dyslipidaemia at childhood and adolescence should be spread across both developing and developed countries, without the former waiting till it is too late.

Viable recommendations to resolve could be either direct and indirect. Direct interventions may include exclusive breastfeeding, fortification of foodstuffs ad micronutrient supplementation. On the other hand, indirect interventions that can help meet the nutritional needs of this group may include the introduction of social protection programs and the adaptation of agricultural production to specific populations.

References

BBC. (2004, November 29). UK ‘violating children’s rights’. Retrieved from BBC News: https://news.bbc.co.uk/2/hi/uk_news/4051079.stm

Biro, F., & Wien, M. (2010). Childhood obesity and adult morbidities. The American journal of clinical nutrition, 1499-1505.

Currie, J. (2000). Child health in developed countries. In M. V. Pauly, T. G. Mcguir, & P. P. Barros, Handbook of Health Economics (pp. 1054 -1089). New York: Elsevier.

Daly, A., Ruxton, S., & Schuurman, M. (2015). Challenges to children’s rights today: What do children think. Strasbourg: Council of Europe.

Fatusi, a. O., & Hindin, M. J. (2010). Adolescents and youth in developing countries: Healthand development issues in context. Journal of Adolescence, 499-508.

Finkelhor, D., Turner, H. A., Ormrod, R., Hamby, S., & Kracke, K. (2009). Children’s exposure to violence: A comprehensive national survey. Wahington, DC: U.S. Department of Justice.

Fryar, C., Carroll, M., & Ogden, C. (2013). Prevalence of overweight and obesity among children and adolescents: United States,1963-1965 Through 2011–2012. . New York: Division of Health and Nutrition Examination Surveys.

German development cooperation. (2016). Children’s and adolescents’ rights. Retrieved from Deutsche Gesellschaft fur internationale Zusammenarbeit (GIZ) Gmbh: https://www.giz.de/expertise/html/11804.html

Grantham-McGregor, S., Landman, J., & Desai, P. (1983). Child rearing in poor urban Jamaica. Child: Care, Health and Development, 57-71.

Gupta, M. D., Engerharn, R., Levy, J., Luchsinger, G., Merrick, T., & Rosen, J. E. (2014). The State of World Population 2014. New York: UNFPA. Retrieved from https://www.unfpa.org/sites/default/files/pub-pdf/EN-SWOP14-Report_FINAL-web.pdf

Hagan, J., Shaw, J., & Duncan, P. (2008). Guidelines for Health Supervision of Infants, Children and Adolescents. Illinois: The American Academy of Pediatrics.

IAWG on the Role of Community Involvement in ASRH. (2007). Community Pathways to Improved Adolescent. Washington Dc and New York: Inter-agency Working Group.

Kant, A., & Graubard, B. (2013). Family income and education were related with 30-year time trends in dietary and meal behaviors of American children and adolescents. Journal of Nutrition, 690-700.

Katterl, R. (2011). Socioeconomic status and accessibility to health care services in Australia. Retrieved from Research Roundup: https://www.phcris.org.au/publications/researchroundup/issues/22.php

Liang, Y.-J., & Mi, J. (2012). Trends in general and abdominal obesity among Chinese children and adolescents 1993–2009. Pediatric Obesity, 7(5), 355-364. doi:10.1111/j.2047-6310.2012.00066.x

Margolin, G., & Elana, G. (2004). Children’s exposure to violence in the family and community. Current Directions on Psychological Science, 152-155.

Monteiro, C. A., M. H., Conde, W. L., Konno, S., Lovadino, A. L., Barros, A. J., & Victora, C. G. (2010). Narrowing socioeconomic inequality in child stunting: the Brazilian experience, 1974–2007. Bulletin of the World Health Organization, 305-311. doi:10.2471/BLT.09.069195

National Health and Family Planning Commission . (2015). 2015 report on Chinese nutrition and chronic disease. Beijing: National Health and Family Planning Commission .

O’Donnell, O. (2007). Access to health care in developing countries: breaking down demand side barriers. Cadernos de Saúde Pública, 23(12), 2820-2834. Retrieved from https://dx.doi.org/10.1590/S0102-311X2007001200003

Park, M., Falconer, C., Viner, R., & Kinta, S. (2012). The impact of childhood obesity on morbidity and mortality in adulthood: a systematic review. . Obes Rev., 985-1000.

Peters, D. H., Bloom, G., Garg, A., & Hafizur, R. M. (2008). Poverty and Access to Health Care in Developing Countries. Annals of the New York Academy of Sciences, 1136(1), 191-171.

Pui, C., Boyet, J., Hancock, M., & Pratt, C. M. (1995). Outcome of treatment for childhood cancer in black as compared with white children. The St Jude Children’s Research Hospital experience, 1962 through 1992. JAMA, 633-7.

Sandhu, N., Witmans, M., Lemay, J., Crawford, S., Jadavji, N., & Pacaud, D. (2008). Prevalence of overweight and obesity in children and adolescents with type 1 diabetes mellitus. Journal of Pediatric Endocrinolgy and Metabolism, 631-40.

UNFPA. (2009). Adolescent Sexual and Reproductive Health Toolkit for Humanitarian settings. New York: UNFPA.

Welch, N. (2000). Understanding of the Determinants of Rural. Melbourne: National Rural Health Alliance.

WHO. (2016, May). Adolescents: health risks and solutions. Retrieved from World Health Organization: https://www.who.int/mediacentre/factsheets/fs345/en/

WHO. (2017). Child and Adolescent Health. Retrieved from World Health Organization: https://www.euro.who.int/en/health-topics/Life-stages/child-and-adolescent-health/child-and-adolescent-health

Zhai, L., Dong, Y., bai, Y., Wei, W., & Jia, L. (2017). Trends in obesity, overweight, and malnutrition among children and adolescents in Shenyang, China in 2010 and 2014: a multiple cross-sectional study. BMC Public Health, 17. doi: 10.1186/s12889-017-4072-7