ORIGINAL ARTICLE

 

Sustainable practices as actions to promote adolescent health

 

 

Sabrina Alaide Amorim Alves^I; Italla Maria Pinheiro Bezerra^II; Grayce Alencar Albuquerque^III; Edilma Gomes Rocha Cavalcante^III; Maria do Socorro Vieira Lopes^III

^IPrograma de Pós-Graduação em Enfermagem, Universidade Regional do Cariri - URCA, Ceará, CE, Brasil, Bolsista CAPES;
^IIPrograma de Pós-Graduação em Políticas Públicas e Desenvolvimento Local. Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória (EMESCAM) - Vitória (ES), Brasil;
^IIIPrograma de Pós-Graduação em Enfermagem, Universidade Regional do Cariri - URCA, Ceará, CE, Brasil

Correspondence

 

 

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ABSTRACT

INTRODUCTION: Adolescence is characterized as a period of socio-historical construction, with manifestations strongly influenced by the socio-economic, political, and cultural factors of the environment where the adolescent lives. Thus, emphasis on the elaboration and construction of policies that direct to health-promoting practices
OBJECTIVE: To analyze the sustainable practices used to strengthen health-promoting actions for adolescents in line with the Sustainable Development Goal 3
METHODS: Integrative review, carried out in the period of January 2020. The crossing was carried out on the CAPES Journals Portal, using the health descriptors: Sustainable Development, Health Care, Adolescent, Sustainable Development Indicators, in the databases MEDLINE, LILACS, Web of Science, Scielo. He listed as inclusion criteria: complete works, available and in Portuguese, English, and Spanish. Exclusion criteria: articles that do not provide abstracts, editorials, theoretical reflections, duplicate studies, experience reports, reviews, monographs, and abstracts in the annals of events. All crossings were performed in a foreign language, English, using the Boolean operator AND. The final sample consisted of 12 articles
RESULTS: It points to the implementation of sustainable practices to the adolescent public that can break with punctual and fragmented health care, emphasizing the expansion of practices aimed at access to health services that can actually meet their real health needs, income generation programs, and adoption of healthy eating, equity in health services and health education. It shows that the implementation of sustainable practices presents itself as a tool to achieve health promotion and as a paradigm shift in adolescent health care
CONCLUSION: There was a need for health policies and actions for adolescents that can contribute to the development of health care aimed at health promotion. Thus, it evidences the need for disruption of specific health practices focusing only on the disease, making it a challenge to develop sustainable practices for adolescents regarding changes in actions in a health-promoting perspective

Keywords: adolescents, sustainable development, health promotion. ODS3.

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Authors summary

Why was this study done?

The study was carried out in order to analyze the sustainable practices used to strengthen health-promoting actions for adolescents aligned with the SDG 3, given that there are gaps in the assistance provided to adolescents' health according to the assumptions of health promotion.

What did the researchers do and find?

The researchers conducted an integrative review using the following databases MEDLINE, LILACS, Web of Science, Scielo in order to analyze what sustainable practices are being carried out to strengthen health-promoting actions for adolescents aligned with SDG 3, being the final sample composed of 12 articles. Points out that among the main sustainable practices are: access to health services, mint, and sexual and reproductive health policies, income generation program, implementation of public health policies, a program aimed at adopting healthy eating, equity in services health and health education.

What do these findings mean?

It was revealed that even though there are such sustainable practices that enable the development of health-promoting actions for the adolescent public, he observes that the implementation of these practices is limited to biomedical assistance. The implementation of sustainable practices to the adolescent public must value their choices in order to make them subjects with affirmations of autonomy, powerful to develop actions and postures to produce models of being healthy.

 

INTRODUCTION

Adolescence is understood as a period characterized by changes of a biological, psychological, and socio-behavioral nature, that the act of making decisions by causing repercussions in the course of their lives, generating specific needs regarding the care related to their health-disease process¹.

However, it understands the need to implement health policies aimed at adolescents that may indicate changes in paradigms related to the health-disease process. So that the process of reorienting the health care model provided to this population can take place through a more comprehensive and holistic approach².

The fragmented view of health services for adolescents leads to restricted and specific health actions, with a focus on curative care. The understanding of the health needs of this group tends to consider not only the social determinants of health but how these intervene in the health condition, making it possible to reorient practices consistent with the assumptions of health promotion³.

In this context, a study points out that the creation of policies for adolescent health care must start from the assumptions that the social determinants of health directly affect the reach of health-promoting practices. They are emerging the need for the recognition of social, political, ethnic, racial, economic, and gender aspects that strongly determine the distribution of resources, access, and opportunity regarding the health conditions of the adolescent group⁴.

In order to promote measures that seek to reduce the inequities existing among population groups in 2015, the United Nations (UN) presents the 17 Sustainable Development Goals (SDGs) as ways to achieve dignity in the next 15 years, by means of goals that seek to reinforce the multilateral commitment to the eradication of a set of social problems that still afflict humanity^5-6.

The implementation of SDG targets represents an opportunity to promote health, at all ages, among these most vulnerable groups in terms of their health condition, such as adolescents, through the recognition of health as a key element for human development, with vast and multidimensional social determinants of the group in conditions vulnerable to health⁷.

In this direction, the development of sustainable practices in line with SDG 3 for the adolescent group represents an opportunity for the creation and improvement of public policies, programs, and government actions that expand the rights of adolescents at all levels of government, making them become autonomous regarding the recognition and development of sustainable practices^8-9.

Since the development of sustainable practices has impacts on health and that adolescents can be multipliers of information and health-promoting actions, the study aimed to analyze sustainable practices used to strengthen health-promoting actions for adolescents aligned with the Sustainable Development Goal 3.

 

METHODS

It is an integrative review, with the definition of the theme and formulation of the objectives and the guiding question; literature search and establishment of criteria for inclusion and exclusion of studies; categorization of studies; evaluation of studies; interpretation of results and presentation of the review/synthesis of knowledge¹⁰.

For the formulation of the research question, the PVO strategy was used (P - population, context and/or problem situation; V - variables; O - outcome). Thus, the following structure was considered: P - adolescents; V- sustainable practices; O - health-promoting actions. Thus, the following guiding question was elaborated: What sustainable practices have been used to strengthen health-promoting actions for adolescents in line with the SDG 3?

The search strategy stage was carried out through the CAPES journals portal (Coordination for the Improvement of Higher Education Personnel), in the databases of the Online Medical Literature Search and Analysis System (MEDLINE), Latin American Literature and Caribbean in Health Sciences LILACS), Web of Science, and the Scielo library.

To arrive at publications on this theme, we sought to select studies using the health descriptors (DeCs): "Sustainable Development", ''Health Care", "Adolescent", and "Sustainable Development Indicators". Crossings of search terms with descriptors were used, with the following search strategies: Sustainable Development AND Health Care AND Adolescent and Sustainable Development AND Sustainable Development Indicators AND Adolescent. All crossings were performed in a foreign language, English, using the Boolean operator AND.

The search for the studies was carried out in January 2020. Inclusion criteria were: complete works, available and in Portuguese, English, and Spanish. Exclusion criteria: articles that do not provide abstracts, editorials, theoretical reflections, duplicate studies, experience reports, reviews, monographs, and abstracts in the annals of events.

With the intention of reducing probable systematic errors or bias in the measurement of studies due to mistakes in the interpretation of results and in the design of the studies, the research was carried out by two reviewers simultaneously and independently in order to guarantee methodological rigor and reliability of results.

The crossing in the CAPES Journal Portal resulted in 471 items. Afterward, we individually read the titles and abstracts of the studies found. There were 81 articles left to read the entire material. Of these, 06 not available online (free), 08 did not meet the inclusion criteria, of which 30 met the inclusion criteria. The 30 studies were saved in a folder, using a code (ex: A01, A being an article, and 01, order number).

The second stage of the selection corresponded to the fluctuating reading of the 30 complete documents, of which 06 duplicate articles were found, 08 articles did not respond to the study's questioning. Thus, the final corpus constituted a sample of 12 articles; figure 1 shows the flowchart of the article selection process.

Table 1 presents a code, where each article received a number (A1 to A12), authors and year, objective, method, conclusion, and novelty of the study. The thorough analysis of the articles in full also made it possible to recognize how the articles address the development of sustainable practices aimed at promoting health to the adolescent public, and the practices and code of the articles are presented in table 2.

 

RESULTS

To present the results of the articles found, which passed through the inclusion and exclusion criteria, based on the theme "sustainable practices aimed at promoting health to adolescents", were presented in tables (table 1, table 2). Table 1 presents publication characteristics (code, authors and year, title, objective, method, conclusion, and novelty of the study).

In the analyzed articles, there is a predominance of international publications with sustainable practices for the promotion of adolescent health. In relation to the only national publication (1%), the study presents the development of educational actions in environmental health with adolescent students as a tool for the implementation of sustainable practices aimed at health promotion. They were proving the lack of national studies that address the issue in question. The analyzed articles were published between the years 2008 and 2019, with the year 2019 predominating, corresponding to 50%. The study did not use a time frame, despite the implementation of the Sustainable Development Goals (SDGs) in 2015. Since, before the SDGs, the Millennium Development Goals (MDGs) contemplated environmental issues.

Regarding the design of the studies, there are several: one (8.33%) ecological study, one (8.33%) longitudinal studies, two (16.66%) cross-sectional studies, four (33.33%) qualitative articles with use interviews, action research, and intervention and four (33.33%) derived from quantitative studies.

Regarding the sustainable practices developed for the adolescent public, aimed at promoting health actions (table 2), the studies show the need for universal health coverage^11-16 capable of developing strategies that meet the real health needs of adolescents. These strategies point to a set of interventions aimed at mental health¹², sexual and reproductive health^13-14,17 that can address sustainable practices guided by the principles of equity, responsibility, quality, and multi sectionality, in line with the goals of the SDG 3.

Equity in health services¹⁸ identified as a sustainable practice seeks to break down barriers to access multisectoral policies and programs regarding sustainability. The development of public health policies¹⁹ expresses the need to raise awareness among adolescents about behavioral changes and healthy lifestyles, with the disruption of curative health practices. In terms of income generation programs²⁰, it relates to the development of practices that allow adolescents access to education, income, and health through policies that can reduce the social inequities faced by this population.

The implementation of healthy eating programs for adolescents allows changes that go beyond the adoption of healthy habits raises consumption policies, and purchases of healthy foods²¹. The realization of health education²² is presented as a sustainable practice capable of empowering adolescents in decision-making in relation to greater participation in their health-disease process, thus minimizing health risks and promoting health-promoting practices.

 

DISCUSSION

In general, sustainable practices aimed at adolescents must identify and recognize the social determinants of health as a factor that interferes with the health-disease process. However, there is a need for policies and actions aimed at adolescents that can actually meet their health needs. Starting from a collective dimension, which can understand how the social representation of this group can interfere in the execution of health-promoting actions^23,24.

The process of building these policies should directly affect the identification of social determinants of health, which resigns to reduce social, political, ethnic, and racial disparities that substantially interfere in the distribution of access to opportunities and, consequently, to health services^4,19.

In this perspective, the elaboration of public health policies directed at the adolescent population must be guided towards achieving the goals of SDG 3, considering adolescence as a window of opportunities for the development of sustainable practices that can promote behavioral changes in relation to their health^25,26.

In this perspective, health becomes an indicator of the progress of nations in reaching sustainable development²⁷; however promoting health at all ages inserts benefits that extend across generations. Thus, SDG 3 brings the recognition of being a key element for human development, with vast and multidimensional social determinants for groups in conditions vulnerable to health⁷.

The SDGs are pointed out as a possibility to make the principle of indivisibility of human rights a reality when they demand the practical realization of economic, social, and cultural rights, even in realities so different from countries considered developed and developing. Thus, by setting goals and deadlines for achieving them, the SDGs can represent yet another impulse for the realization of human rights and an attempt to break the stance of the indefinite postponement of universalizing the benefits of the right to development for all⁶.

Highlight for comprehensive care on the part of health policies to the adolescent public, as they will constitute the future productive and economically active population in the country. Public policies in adolescence must surely be achieved in view of the fact that positive or negative impacts on this portion of the population will have consequences in the future for a long period of time²⁸.

However, the need for equitable health care is revealed, which can offer care according to the diversity of health needs of these adolescents. Thus, ensuring health practices that go beyond a biological approach, in this light including the need to understand the social context in which these subjects are inserted^18,29.

Among the main barriers related to the adolescent's access to health services, this is the difficulty of the group to find care, in the quality of care offered, in the distance from the health service, in addition to the lack of service provision, which is restricted to care. Focused only on the following themes: sexuality, teenage pregnancies, and physical changes. However, it is necessary to break with this curative view, implying the need to recognize inequalities and barriers regarding access to health services^18,26,29,30.

The need to identify the social determinants of health allows us to examine the relationship that these conditions have with regard to interference with the achievement of the goals of the SDG health to adolescents. They are highlighting greater synergies between health and other sectors, capable of providing the execution and implementation of policies aimed at other sectors to achieve these goals, namely: education, income generation, and programs aimed at healthy eating^20,21,31.

The socioeconomic inequities faced by adolescents, inequalities that bring together the social determinants of health, and the models of social stratification, include non-access to work and income substantially interferes in spheres that impede access to health services, affecting the quality of life of this (a) teenager. Thus, social stratification places this group in a position of vulnerability, promoting barriers with regard to facing challenges related to health and sustainable development^5,32.

The elaboration and construction of public health promotion policies for the adolescent public must seek to ensure positive impacts on their health condition since this population must be seen as a window of opportunities for being healthy and productive in adulthood²⁵.

The highlight for health education practices as a strategy that promotes sustainability and should be focused on interventions focused not only on the disease but on actions that can promote the development of an autonomous and critical adolescent in relation to their health condition. Demanding the need for health policy articulations, at all levels and with other sectors, such as the school environment⁴.

The school environment is understood as a facilitating space for the development and strengthening of sustainable practices, characterized by the integration between health and education, through joint actions between health sectors, schools, and society. In this light, the school should be recognized as a privileged setting for implementing health promotion strategies that can provide adolescents with individual and social skills to deal with aspects related to the health-disease process^22,26,33,34.

Health education for adolescents in schools represents a strategy for reorganizing health practices, allowing exchanges of experiences and reflections, in order to build health knowledge and habits and health-promoting practices. Promoting active subjects in the care process and with social expression and representativeness^35,36.

It is pointed out that such practices must be understood from the perspective of health promotion, providing actions with a broader perspective regarding the identification and recognition of the social determinants of health as a factor that directly affects the health-disease process. He observed that among the main sustainable practices, emphasis on access to health services, mint and sexual and reproductive health policies, income generation program, implementation of public health policies, the program aimed at adopting healthy eating, equity in health services, and health education. However, for such practices to be achieved, the need for multisectoral actions and policies emerges so that it can promote quality of life for the adolescent public.

Thus, the development of sustainable practices seeks to break specific and fragmented actions regarding adolescent health, emerging the implementation of health policies that can break with predominant hegemonic health models in relation to adolescent health care.

Among the advances in knowledge, it is evident that it is necessary to make progress regarding the development of health-promoting practices aimed at the adolescent public, in a perspective of understanding the plurality of elements related to the health-disease process. In addition, the study reveals that sustainable practices aligned with SDG 3 increase adolescent's ability to act to improve their quality of life and health. As a perspective in the field of public health, it points to the reorientation of health care as a health-promoting practice, which must respond to the social health needs of adolescents.

 

CONCLUSION

From the results found in the study, it can be concluded that the main sustainable practices aimed at adolescents were access to health services, mental, sexual, and reproductive health policies, income generation program, implementation of health policies, programs for the adoption of healthy food, equity in services and health education. The implementation of sustainable practices influences the achievement of health quality in order to offer equitable assistance with social transformation. However, it highlights a challenge, given the predominance of characteristics of curative practices in the current health model, without considering the determinants and conditions that the health-disease process is associated with, thus favoring the development of risk behaviors by adolescents.

Author Contributions

Sabrina Alaide Amorim Alves - conception and design of the study, analysis and interpretation of data, writing of the article. Italla Maria Pinheiro Bezerra - orientation, research supervision, critical review, and approval of the final version of the manuscript. Grayce Alencar Albuquerque - critical review of the article. Edilma Gomes Rocha Cavalcante - critical review of the article. Maria do Socorro Vieira Lopes - orientation, research supervision, critical review, and approval of the final version of the manuscript.

Funding

The study did not have funding.

Acknowledgments

To CAPES (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior/Coordination for the Improvement of Higher Education Personnel) for granting a scholarship to Sabrina Alaide Amorim Alves.

Conflicts of Interest

We declare that there are no conflicts of interest.

 

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Correspondence:
Sabrina Alaide Amorim Alves
sabrina1995amorim@gmail.com

Manuscript received: April 2021
Manuscript accepted: June 2021
Version of record online: Julho 2021