What can academic researchers contribute to advancing adolescent wellbeing?BMJ 2022; 379 doi: https://doi.org/10.1136/bmj.o2543 (Published 27 October 2022) Cite this as: BMJ 2022;379:o2543
- John S Santelli, professor of population and family health1,
- Gwendolyn Rosen, research and teaching assistant1,
- Fred M Ssewamala, William E Gordon distinguished professor2
Imagine a world in which 6 year olds had to rely on “specialised parents”—one for each of their basic needs: shelter, food, nutrition, education, health, and so on. While a few resilient children might cope, many would fail to integrate the efforts of their specialised parents, leading to potentially calamitous results. Those of us working in academic healthcare and health promotion are familiar with these types of isolated, specialised ways of working and realise that, although they are well intentioned, there might be better approaches. Siloed thinking and services do not suit the complex, diverse lives of young people at age 6 or 16.
Fortunately, more promising approaches can be adopted. Over the past decade, a series of authoritative reports have focused on adolescent health and attempted to express the holistic nature of adolescent wellbeing.1234The BMJ’s collection on adolescent wellbeing, developed in conjunction with the Partnership for Maternal, Newborn, and Child Health, reiterates and extends a positive vision of adolescent wellbeing and the importance of investing in this vision (www.bmj.com/adolescent-wellbeing).5678910 Connectedness, competence, resiliency, autonomy, positive youth development, readiness to learn, and agency are the key concepts that can help us build a holistic, positive vision of wellbeing for adolescents.5678910 Policies and programmes that centre on the adolescent, account for social determinants, embrace the diversity of adolescent identities, consider the financial stability of families,11 and consider the emerging capacities of young people have the potential to capture the complexity of wellbeing so that adolescents can thrive.
Advocating for adolescent wellbeing requires us to think about the systems serving adolescents and consider how to integrate them. Adolescents are often forced to seek separate services (eg, health and mental health counselling, academic counselling or guidance, legal advice, financial literacy sessions) from separate agencies and systems (schools, mental health agencies, primary care centres, specialised youth provision centres, social service agencies). This level of specialisation ignores the fact that adolescents’ problems often cross over services and agencies or systems. Adolescence is a critical period for health and development with biological, cognitive, psychological, and social transitions occurring simultaneously. While seeking autonomy, adolescents remain dependent on adults, families, communities, schools, healthcare, music, sports, and many other institutions and systems. As the collection in The BMJ shows, these systems need to work in harmony to centre the adolescent and the multisectoral nature of their lives.
Getting more from academic input
What can the academic research community bring to this effort? Academics do some things very well. We excel with big ideas: conceptualising issues, building theory, and imagining alternatives, along with the more prosaic academic work of identifying risk and protective factors, uncovering disease mechanisms, measuring determinants, processes, and outcomes, and testing new interventions. Academic researchers have contributed to developing the rationale for adolescent health programmes (“case for investment”), to creating pilot programmes, and to developing methods and processes to empower youth advisers globally. We bring all of these to bear in critiquing public policies and programmes based on scientific understanding.12
The five domains of adolescent wellbeing set out in the collection5 are based on decades of social, behavioural, and medical sciences research which developed key concepts and collected the data to describe how these domains affect wellbeing across life.13141516 The academic community, of course, is also essential to training the next generation of researchers, policy makers, community leaders, and practitioners supporting health and wellbeing. What, how, and how much are all questions we are prepared to answer.
We do some things poorly. Building political consensus, creating social change, and promoting wellbeing using human rights frameworks have historically been a challenge for the academic research community. The academic disciplines (eg, medicine, economics) provide great insights but also impose disciplinary blinders, making us, at times, ill equipped to implement integrated, holistic approaches. Researchers are also embedded within disciplinary cultures and belief systems that may not reflect the reality on the ground and often ignore the belief systems and values of the populations they study. Often, the populations studied are different in multiple ways from the academic researchers studying them. In the darkest moments of academic history, these biases have caused great harm to research participants.1718 Ideas can powerfully build support for change, but they are insufficient on their own. With notable exceptions, academic researchers often fail to see the ethical, human rights, and moral implications of their work. Questions about why and how we should value are not innate to the academic sphere.
The science behind adolescent health will have little impact if good ideas are not spread effectively to policy makers, programme developers, and those who work directly with young people. Moreover, for any good ideas to take hold, academic researchers will have to meaningfully involve the adolescents being studied as part of the research teams. Academics may have the skills and understanding needed to help build a new vision for adolescent wellbeing, but they also must build bridges to those interested in advocating for changing the world. Importantly, academics must look beyond publishing research as the final step in their processes. Adolescent research should not be done simply for publication, but for documented effect on adolescent wellbeing.
While it is (sometimes) true that good ideas attract political support, researchers need to become more proactive. To improve adolescent wellbeing, researchers will need to work with advocates, policy makers, communities, and adolescents themselves in multiple ways to build the future for young people. We are good at expounding ideas grounded in science, but we need to practise our listening skills to better turn ideas into action.
Good adolescent health and wellbeing will be achieved only if all of us, including adolescents themselves, are engaged fully with the intersectoral, multidimensional, and diverse nature of adolescent wellbeing. We should not forget that communities and adolescents understand the issues facing them better than outsiders; we, as academics, must commit to asking ourselves how we can best support communities in the fight to improve adolescent wellbeing.
Competing interests: We have read and understood BMJ policy on declaration of interests and declare the following: JSS has NIH funding to conduct research on HIV in Uganda and does a variety of work for professional organisations, health journals, and groups advocating for adolescent health. GR is a content writer and has done consultancy work for Evvy, a women’s health company with an at-home test for the vaginal microbiome. She is expecting payment for consultancy work as an independent contractor, not affiliated with her academic institution. FS has NIH funding to conduct research on HIV in Uganda among adolescent youth and their care giving families. He serves on the editorial board of Journal of Adolescent Health and is editor in chief of Global Social Welfare. He is also a member of several health focused academic organisations.
Provenance and peer review: Commissioned; not externally peer reviewed.
This article is part of a collection proposed by the Partnership for Maternal, Newborn, and Child Health. Open access fees were funded by the Bill and Melinda Gates Foundation. The BMJ commissioned, peer reviewed, edited, and made the decision to publish these articles. Emma Veitch was the lead editor for The BMJ.
This is an Open Access article distributed under the terms of the Creative Commons Attribution IGO License (https://creativecommons.org/licenses/by-nc/3.0/igo/), which permits use, distribution, and reproduction for non-commercial purposes in any medium, provided the original work is properly cited.