Why is adolescents’ health a human rights issue?
Adolescents, individuals aged between 10 and 19 years, face a myriad of threats to their right to health including violence, sexual assault, exploitation, trafficking, harmful traditional practices, migration, radicalization, recruitment into gangs or militias, self-harm, substance abuse and dependence, and obesity. At the same time, adolescents face multiple barriers to health services, including: restrictive laws, unavailability of contraception or safe abortions; failure to ensure privacy and confidentiality; parental notification requirements; provision of services in a manner that is disrespectful, hostile, judgemental or lacking sympathy; and discrimination against particular groups of adolescents, including those with disabilities, those living and working on the streets or in the sex trade and those from historically marginalized groups.[1]
What are the relevant sources?
The human rights of adolescents including the right to be free from coercion and discrimination, to be protected from all forms of violence, and to enjoy the highest attainable standard of physical and mental health are enshrined in international human rights law.
- The Convention on the Rights of the Child (CRC) provides a comprehensive and legally binding framework to address the right to health of adolescents under age 18.
- The International Convenant on Economic, Social and Cultural Rights (ICESCR) provides a legally binding human rights framework for all adolescents.
- The International Convenant on Civil and Political Rights (ICCPR) protects the right to life, freedom from torture, freedom from arbitrary arrest and detention, right to due process and fair trial, the right to individual liberty in the forms of freedom of movement, speech, religion, association, family rights, nationality and privacy.
- General Comments No.4 and No. 5 of the Committee on the Rights of the Child protect the right of adolescents to enjoy the highest attainable standard of health.
Other conventions that specifically address adolescents’ rights are:
- The Convention on the Elimination of All Forms of Racial Discrimination (CERD).
- The Convention on the Elimination of All Forms of Discrimination against Women (CEDAW).
- The Convention against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment (CAT).
- The Convention on the Protection of Migrant Workers and their Families.
- The Convention on the Rights of Persons with Disabilities.
What are the relevant issues related to adolescent health?
As mentioned above, adolescents face a myriad of risks to their right to health. These risks include:
Violence – According to UNICEF, an adolescent is killed by an act of violence every seven minutes.[2] Research conducted by UNICEF showed that 82,000 adolescents died during the 12 months of 2015 alone. Nearly 60% of these deaths were due to homicide while the remaining 30% were caused by armed conflict. While only about 6% of the world’s adolescents live in the Middle East and North Africa, more than 70% of adolescents who died in 2015 due to collective violence were living in this region – with mortality rates having risen dramatically since 2011.
Latin America and the Caribbean is the only region that has seen an increase in homicide rates among adolescents aged 10 to 19 since 2007. Slightly less than 10% of the world’s adolescents live in the region, but nearly half of all homicides among adolescents in 2015 occurred there. The five countries with the highest homicide rates among adolescents (the Bolivarian Republic of Venezuela, Honduras, Colombia, El Salvador and Brazil) are home to only 1 in 20 of the world’s adolescents, yet more than 1 in 3 adolescent homicides occur in these countries.
Migration – The reasons why children migrate are often multi-layered, but according to the UN human rights council, one of the most common factors is the violation of the human rights of children and the threat of violence in their country of origin. The UN has found there are three main categories of unaccompanied children: 1) those separated from their family during the move; 2) those who began their journey unaccompanied and are now traveling with a group of people; and 3) those who have interrupted their journey due to lack of resources such as migrant teenagers found in urban areas of Greece and Italy. The UN states that unaccompanied children are particularly vulnerable to all types of abuse, exploitation, trafficking, enrolment by criminal gangs and violence.
In addition, the UN has noted increasing forced displacement of children and youth, which refers to threats and violence that push adolescents to migrate. Some countries, such as Honduras, recognize forced displacement as the primary cause of migration while others, like Colombia, report that many adolescents left their country of origin to escape violence but have not applied for refugee status.[3]
Discrimination – The Special Rapporteur on the Right to Health has noted that adolescence itself is often a basis for discrimination, with many adolescents treated as dangerous or hostile, incompetent to make decisions, incarcerated, exploited or exposed to violence as a direct consequence of their age. Health-care providers may perpetuate discrimination against adolescents when they deny them health services or contraceptive supplies or treat them poorly, which can make adolescents reluctant to seek the health-care they need. Adolescents belonging to marginalized groups or sectors, such as girls, racial or ethnic minorities, indigenous populations, lesbian, gay, bisexual, transgender and intersex adolescents, refugees and adolescents with disabilities, face a heightened risk of exclusion.[1]
Economic Exploitation – The International Labour Organization estimates that 218 million children and adolescents between 5 and 17 years are involved in child labour globally, including 73 million who are engaged in hazardous work that jeopardizes their health or safety.
The most hazardous work is especially prevalent among 15-17 year olds.[4] The industries that exploit children and adolescents are often tied to the global economy. For example, Amnesty International published a report in 2016 that described how 40,000 children and adolescents in the Democratic Republic of Congo work in the cobalt mines for 12 hours per day without the most basic of protective equipment, such as gloves, work clothes or facemasks to protect them from lung or skin disease to earn a daily wage of $1.[5] In 2015, Human Rights Watch documented the harm caused to 16- and 17-year-olds who work long hours as hired labourers on US tobacco farms, exposed to nicotine, toxic pesticides, and extreme heat. Nearly all of these teenagers suffered symptoms consistent with acute nicotine poisoning – nausea, vomiting, headaches, or dizziness – while working on tobacco farms.[6]
Human trafficking and sexual exploitation – Human trafficking and sexual exploitation are major global health and human rights problems, with reported victims in more than 152 countries.[7] Violence and psychological manipulation are common, and victims are at increased risk of injury, infectious diseases, substance misuse, untreated chronic medical conditions, malnutrition, post-traumatic stress disorder, major depression and other mental health disorders, homicide, and suicide.[8]
What can health workers do?
Health workers are in a unique position to help adolescents. For example, the Special Rapporteur on the Right to Health confirms that health workers can help ensure adolescents have access to confidential, adolescent-responsive and non-discriminatory health information, services and goods. Health workers can also establish dedicated clinic times and alternative locations for adolescents, particularly helpful for sexual and reproductive health services.[1]
Sexual abuse – In new guidelines published in 2017, the World Health Organization (WHO) states that health workers are in a unique position to provide an empathetic response to children and adolescents who have been sexually abused. According to the WHO, this type of response from health workers can go a long way in helping survivors recover from the trauma of sexual abuse. The 2017 guidelines explain how to ensure adolescents’ safety, offer choices and respect the wishes and autonomy of children and adolescents. These guidelines also include recommendations for post-rape care and mental health as well as approaches to minimizing distress in the process of taking medical history, conducting examination and documenting findings.
Human trafficking, exploitation and other forms of abuse – Similarly, an article in the medical journal Pediatrics outlined the ways that health workers can recognize human trafficking, exploitation and other forms of abuse. Aside from recognizing adolescents in distress, health workers can also take immediate action so that the adolescent is removed from danger and linked with the support he or she will need to recover.
This page was written by Tara Ornstein in November 2017.
Notes
[1] Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. UN Human Rights Council: 32nd Session. Geneva, 2016.
[2] UNICEF. A Familiar Face: Violence in the Lives of Children and Adolescents. New York, 2017.
[3] United Nations. Global issue of unaccompanied migrant children and adolescents and human rights. Human Rights Council. New York, 2016.
[4] International Labor Organization. Child Labor Fact Sheet. Geneva, 2017.
[5] Amnesty International. This is What We Die for: Human Rights Abuses in the Democratic Republic of Congo Power the Global Trade in Cobalt. London, 2016.
[6] Human Rights Watch. Teens of the Tobacco Fields: Child Labor in United States Tobacco Farming. New York, 2015.
[7] United Nations Office on Drugs and Crime. Global report on trafficking in persons. Vienna, 2014.
[8] Greenbaum, J, et al. Child Sex Trafficking and Commercial Sexual Exploitation: Health Care Needs of Victims. Pediatrics, 2015.