Revista Adolescência e Saúde

Revista Oficial do Núcleo de Estudos da Saúde do Adolescente / UERJ

NESA Publicação oficial
ISSN: 2177-5281 (Online)

Vol. 14 nº 4 - Oct/Dec - 2017

Article Update Imprimir 

Páginas 8 a 15

Cultivating Connectedness and Equity: A Call to Action by the Global Community for Adolescent Health

Cultivando Conectividad y Equidad: Un Llamado a la acción de la Comunidad Global de Salud de los Adolescentes

Cultivando conectividade e equidade: um chamado à ação da comunidade global de saúde dos adolescentes

Autores: Tamera Coyne-Beasley

Departments of Pediatrics, Division of General Pediatrics and Adolescent Medicine, University of North Carolina, Chapel Hill, North Carolina.

Departments of Pediatrics, Division of General Pediatrics and Adolescent Medicine, University of North Carolina
Chapel Hill, North Carolina

PDF Portuguese      

How to cite this article

The Society for Adolescent Health and Medicine (SAHM) is the largest and most important multidisciplinary health care organization for adolescents and young adults in the world. Each of us has intrinsic value, unique abilities and incredible talents to improve the physical, psychological, and well-being of all teenagers and young adults; to understand and share with each other methods of improving health care, health promotion, education and research; to defend adolescents and young adults; and support, interconnect, collaborate and nurture our relationships and friendship, and care for each one of us. We are also here to reaffirm our commitment to address discrimination, intolerance, violence and hatred directed at any group, irrespective of their ethnicity, culture, sexual orientation, nationality, age, gender or gender identity. in the United States, around the world1. It is through this commitment, our mission and our defense that we can improve the psychosocial, physical health and well-being of all adolescents and young adults. For SAHM members who can not be with us at this year's annual conference, their absence will be felt, but they will have our support and we will maintain permanent contact.

The theme of this year's conference is "Cultivating Connections: The Importance of Relationships in Adolescent and Young Adult Health." We are privileged that one of the pioneering experts in connection, be the former president of SAHM, Dr. Michael Resnick. The connection refers to a sense of institutional proximity to the wider social world or with other individuals, and is characterized by feelings of affection, relevance, reliability, value and respect2. This definition encompasses the nature and quality of connections, both within and among the multiple levels of social ecology, which include relationships between adolescents and young adults with family, friends, school, community, institutions, and society. Dr. Resnick also states that these connections may be intimate with moral and spiritual significance3.

Why do adolescents and young adults need a connection with other individuals, with family, community and society? It is because of these connections and relationships that our teenagers and young adults discover, develop, and define their social, cultural, and moral identities. In this way, it is a critical moment of communication of messages of altruism, inclusion, acceptance and optimism. Connections, including spiritual ones, are also important since health and well-being are relevant because they are protective factors against a series of health risk behaviors2,3. Support connections are associated with better physical and mental health outcomes, resulting in improved general health and resistance to stress and disease.The connection of individuals and their families to the community and society can also broaden the sense of belonging or "importance" to a group4. Unrelated connections or social environments can lead to conflicting coping, stress and disease behaviors2,3,5. While peer connections are of great importance in adolescence, the relationship between father, child and family still has a high impact on adolescents4. Although adolescence can be an independence phase, many of them still want a closer relationship with their parents or other adults, such as health professionals, relying on their support and guidance.

The importance of the family connection is demonstrated in an exhibition at the Museum of the Red Cross in Geneva, Switzerland. It states that human beings are social beings defined by their links to each other. When these connections are broken, they lose some of their identity and autonomy. Giving and receiving news and meeting loved ones are even more essential elements of stability during crisis situations. We perceive the loss of connections through crises of mass incarceration and immigration policies. Both issues expressed the concerns of SAHM members.

Mass incarceration is increasing in the United States. The United States is the country with 5% of the world population, but also 25% of the prisoners of the world6. The inmates are also disproportionately black ethnicity6. In 2016, SAHM issued a position statement on juvenile justice systems recommending a change in the pattern of resources that address the background of high-risk criminal behavior7. SAHM also recommended that resources for the construction of privatized for-profit prison complexes be diverted to crime prevention. Incarceration and detention have also become prominent features of some immigration policies.

Threats to the connection through immigration policies are illustrated in the Photovoice project conducted with teenagers Latinos8. They were asked to photograph "What I want my doctor to know about my life". In a community forum, our Latino teens asked community participants what feelings were remembered when they looked at your photo. When a photo of a police car was shown, some forum participants said they felt "safe". Some African-American participants said they were afraid of their safety, as some Latin American teenagers expressed fears of going home after school for fear of finding that their mother or father had been deported. Concerns about safety, fear, justice, and discrimination transcend the socioeconomic and educational realm, so that as an African-American woman and doctor I also feel concern for the safety of my adult son and daughter. There are thousands of teenagers and young adults like mine who, despite their talents, strengths and contributions, are vulnerable every day because they are judged by the color of the skin and not by the content of their character. We must continue to support and nurture the healthy connection at all levels of social ecology and encourage communities and societies to care for all their citizens .

The connection has become a dynamic process and a new dimension emerges. The connection is now also defined as the degree to which people are connected by technology, such as the Internet, e-mail and social networks9. In that sense, our connection and communities have become global. As technological advances continue to become an integral aspect of our adolescents' culture, education, and social life, we see a host of new opportunities for adolescents to connect, communicate, and interact with one another10. Through real-time technology and social digital media, our teenagers and young adults are increasingly shaped by our local, national and global connection. Thus, concern is to much important, not only for what is happening on our side, but also for what is happening globally.

The greater involvement of SAHM in global teenage affairs does not mean that we will abandon the internal domestic challenges and opportunities that are within the local countries or communities in which we operate. We want to support SAHM members to work locally, regardless of the country they are in, and support in strengthening efforts to improve the overall health of adolescence. Our goal is to collaborate and learn ways to improve the health and well-being of all young people.

There are many similarities between us, regardless of our country of origin. No matter where we reside, we are all part of a global society, and global health refers to all of us. Our teenagers and young adults share the same developmental traits and similar concerns. Young people, born and living in Asia, Africa, North America, South America, Antarctica, Europe or Australia, all begin as children and must navigate through puberty through adolescence and youth, often encountering challenging conditions.

Adolescents and young adults are impacted by their connection to others, to institutions and to society. All teens want to be loved, respected and cared for and have met their basic needs for food, clothing, shelter and security. Teens and young adults are one of the most neglected generations in the world. However, this is changing. This has to change! Now, we have for the first time the largest generation of teenagers and young adults in human history, and they are demanding more attention and action. Some of the organizations that lead this increase in global attention and action are the United Nations (UN), the World Health Organization and the Lancet Commission. According to the Lancet Commission, we now have 1.8 billion individuals between the ages of 10 and 24, representing 25% of the world's population11.

The Lancet Commission says that we must transform our views on adolescents and young adults into a framework of youthful resilience and positive development and think of them not as a major problem but as a great opportunity. This generation of teenagers and young adults can transform our future; there is no more urgent task in global health to ensure that they have the resources to do so11.

Major challenges for teens and young adults around the world within their own contexts include youth unemployment, armed conflicts, the promotion of unhealthy lifestyles and obesity, less stable families, environmental degradation and mass migration11. Armed conflict can lead to mass migration and refugee crises. Refugees are defined by the UN as being forced to flee their country because of persecution, war or violence. They are afraid to ethnic issues, religion, nationality, political opinion or membership of a particular social group12. They are recognized under UN statutes as deserving of protection. We are all vulnerable to needing help from one of our neighbors or allies of the world. Adolescent refugees and young adults are particularly vulnerable to missed connections and abuse, such as human trafficking. To help, we must cultivate connections and build bridges with our neighbors, not walls. We must break down the walls that separate us. Who are our neighbors? Our neighbors are the people placed in our path with whom we have the opportunity to exchange and help.

One opportunity is to address the different health challenges faced by adolescents around the world. The Lancet Commission classifies the three main burdens for adolescents, grouped by regions11. Most of the world's adolescent population (51 per cent) comes from countries like India and Africa, with many infectious diseases and lacking preventive vaccines, malnutrition and full of sexual and reproductive health needs. The Lancet Commission refers to these conditions as poverty11.Thirty-seven percent of the world's teenage population comes from countries like Australia and North America, which are burdened with noncommunicable diseases categorized as physical disorders, mental health disorders, and substance use disorders. Twelve percent of the world's teenage population comes from countries that suffer from prejudice in Central and South America and parts of Europe, where violence, including armed conflict, self-mutilation, suicide and unintentional injuries, including road traffic accidents, predominate as major causes of morbidity and mortality11,12.

The leading causes of mortality worldwide for adolescents and young adults aged 10 to 24 years are also described in the Global Burden of Disease study13. Overall, among men and women aged 15-24, the two leading causes of global death are traffic injuries and self-mutilation / suicide, respectively; between 10 and 14 years of age, are HIV / AIDS and traffic injuries13.

Other causes of death include interpersonal violence, drowning, intestinal infectious diseases, tuberculosis and lower respiratory rates. There are some differences by gender. Among women aged 15-24 worldwide, the main cause of death is self-harm or suicide; For women aged 10 to 14, the main cause of death is HIV / AIDS. Overall, among men aged 10 to 24 years, the main cause of death are traffic accidents13. US data. indicate a similar epidemiology between US mortality and the Global Burden Disease study, among adolescents and young adults between 10 and 24 years of age, car accidents and suicide are the leading causes of death 14 . The similarities in morbidity and mortality across the world can lead to the development of common strategies.

The Lancet Commission recommends five strategies that can be practiced to create opportunities and improve the health and well-being of adolescents and young adults around the world. These strategies include (1) universal access to comprehensive health care that includes mental health; (2) provide access to free and quality secondary education for men and women; (3) protect the rights to health and education of adolescents; (4) promote healthy environments, including clean water; and (5) establish national committees youth to teens and young adults can be engaged to participate actively in the development programs for their benefit and the benefit of their communities11. We must create opportunities for all young people to engage not only the leaders we already know, those with advantages or privileges, but also those who may not be traditionally involved in these efforts. Youth of color, indigenous youth, LGBTQ youth, young people with disabilities, poor and homeless youth, and youth in youth detention or refugee centers often have the greatest health needs and must be included. As a reflection of society, in any country, there are marked differences in health and inclusion among different regions and within different adolescent groups with poverty, gender and social marginalization being important determinants. The need to create equity and eliminate macro and microaggression in adolescents and their providers is the subject of the next SAHM position paper, led by the Diversity Committee. To create equity in health and wellness, it is not just to do the same for all teenagers, but to give everyone what they need to have access to the same opportunity. Patrimony is about justice. Sometimes our differences and our stories can create barriers to participation, and for this reason we must first ensure fairness before we can enjoy the equality15.

Improving the equity, health and well-being of adolescents and young adults is crucial because of the triple dividends it provides. First, it helps adolescents directly, and secondly, it allows them to develop positive skills and the health habits they need to transition into a healthy adulthood. Third, since the health, well-being and social environment of adolescents and young adults also affects the children they will have, such investment in them will increase the health of their children and future generations11.

Increased investment and care in adolescents and young adults is also demonstrated in the UN Global Strategy on Women, Children and Adolescents' Health16. The three broad themes of this strategy are to survive, thrive and transform.SAHM has an important role to play in the UN Global Strategy to ensure that our adolescents and young adults around the world not only survive by ending preventable deaths but also thrive by ensuring optimal health and well-being. We can join forces to transform the world by expanding enabling environments so that by 2030 we can live in a world where every adolescent, in each scenario, realizes his rights to physical, mental and well-being, and has social and economic opportunities equitable16.

Our investment in adolescents and young adults is critical because these are potentially the most powerful agents of change to improve their own health, improve equity and social justice, and achieve successful and sustainable societies16. Our adolescents and young adults have grown with more diversities and global connections between cultures than previous generations and will be more diverse than ever before by 203017. Many teenagers and young adults have cultivated global connections and communities through social networks. Teens and young adults are curious, involved and innovative. They challenge the status quo , accelerate progress, and promote human potential. We have a unique opportunity to focus efforts on this age group previously neglected in a way that is beneficial to adolescents, society, and perhaps even to the health of our planet11. Our teenagers and young adults give us great reasons to be optimistic, to have hope and a lot of faith!

So, you may be wondering, what are some of the things that SAHM can do, and what are some of the things I plan to do during my presidency, to give teens and young adults the opportunities they need and improve their health and welfare? We can cultivate, defend and strategize.

Grow crops

According to our conference theme, we will continue to cultivate our connections and partnerships with local, national and international organizations as well as individuals dedicated to adolescent health. Internationally, we are particularly interested in strengthening our connections with the International Adolescent Health Association, the UN, the Lancet Commission and the World Health Organization. With the leadership of the Executive Board of SAHM and its International Area, SAHM reviewed and provided comments and contents for the Global Acceleration Action for Adoption Health Action Guidance document, also known as AA-HA! We will also strengthen our connections by cultivating others with employees concerned with the overall health of adolescence. SAHM's international travel award is another important initiative to cultivate our connections and relationships with scholars and professionals from middle and low income countries. I would also like to cultivate connections with the Confederation of Adolescents and Youth of Latin America, Italy and the Caribbean, CODAJIC.

We will also expand our cultivation of connections through the use of social media, including quick responses to appropriate issues that involve the concern of our associates. For example, SAHM is using social media, especially Twitter , and the Internet at this meeting to enhance and cultivate our connections and inform our association. We will also disclose educational resources, as an extraordinary teen curriculum developed by the Education Committee and the Board of Directors, and expand training and discussion groups online for health professionals to teenagers in high countries, middle and low income. We will also work to promote the use of language and terms that are in use by the population, which are inclusive and sensitive to other countries.


As SAHM leaders, we appreciate and respond to requests from members to defend and respond to acts of discrimination, injustice and violence. We will continue to do so through our newspaper under the exceptional leadership of Dr. Charles Irwin, quick responses, press releases, position statements and signatures with other organizations. Our organizational capacity and the daily or weekly appearance of alarming tweets or problems will not allow us to respond to everything, but we will respond strategically and in partnership with others. We will even ask you to get involved and educate your local and national lawmakers. Our press release prior to this meeting on advocacy was about protecting young transgender people. For us, no matter which bathroom young people choose to use based on their gender identity, however, we are concerned that schools create a safe and supportive learning environment. We are concerned that students may be discriminated against in a manner that may lead to stigmatization or physical and mental harm. We will continue to defend any kind of discrimination against any person, because it is unjust and unkind. We do not need to be Muslims, Jews, Blacks, women or a member of any group that is suffering discrimination to advocate for them.

In the spirit of digital media and the lessons about this year's Oscar-nominated films, in our defense we want to be as tenacious as "lions" to ensure that our youth can overcome the challenges and "walls" that are placed around them. We need to ensure that their value, dignity, diversity, talents and intelligence are illuminated in such a way that they will no longer be "hidden figures" or revealed only in the "moonlight."


This year we are going through a formal strategic process to assess and prioritize our members needs and organizational goals. We will also strengthen our organization to fulfill our mission and vision. The council hired an external facilitator through a request for proposal. The facilitator will interview various and important people from SAHM, personally during the meeting and by phone. It will also review the SAHM materials and conduct a member survey. All data generated will be synthesized and analyzed in face-to-face and telephone meetings of the Strategic Planning Task Force and the Board of Directors. Our members are at the heart of our organization, and I want everyone to be involved in the process.

There is one more thing we can do, and that is to inspire.

To inspire

We should inspire our teens and young adults to reach as far as possible and fly as high as possible.

Full of faith, courageous
it's free.
For we will uphold them, and we will uphold them,
and take care of them.
They were created with all the tools and talents they need to change
and sustain the world.
We just need you and them, to Never,
never, never,
never give up,
despite the obstacles they face.

I need you to use your connections, your clinical care, your research and your interventions, and work harder than ever. This is not a moment of condescension. We need you, and we need our teens and young people to improve our world. Our young people are one of our greatest resources. The theme of our 2018 conference will be global equity in adolescent health. At this conference we will also celebrate SAHM's 50th anniversary. It will be an exciting opportunity to reflect on our history and create a stronger future. Let's continue to cultivate connections to increase our organization and its influence on the health and well-being of adolescents, and devise strategies to make the next 50 years of the organization even bigger! I value what each professional contributes to our overall mission and celebrates all the activities of our clinical practice, teaching, research and advocacy, as collectively, this allows SAHM to have the best chances of truly transforming the lives of adolescents and adults young.


This statement was originally published in the Journal of Adolescent Health - Volume 61, Issue 3 , September 2017, Pages 392-395 - and we obtained authorization to translate it into Portuguese and publish it here. The original publication is at


1. Adolescent Health. SAHM Issues Statement on Orlando Tragedy. Available at: Accessed March 1, 2017.

2. Resnick MD. Protective factors, resiliency and healthy youth development. Adol Med State Art Rev 2000;11:157 e64.

3. Bernat DH, Resnick MD. Connectedness in the lives of adolescents. In: DiClemente RJ, Santelli JS, Crosby RA, eds. Adolescent Health: Understanding & Preventing Risk Behaviors. New York: Jossey-Bass; 2009: 37 6-89.

4. Bernat D, Resnick MD. Healthy youth development: Science and practice. J Public Health Manag Pract 2006;(Suppl.):s10-6.

5. Whitlock J, Wyman PA, Moore SR. Connectedness and suicide prevention in adolescents: Pathways and implications. Suicide Life Threat Behav 2014; 44:246-72.

6. Guerino P, Harrison PM, Sabol WJ. Prisoners in 2010 (Revised). Washington, DC: Bureau of Justice Statistics; 2011.

7. International Youth Justice Systems. Promoting youth development and alternative approaches: A position paper of the Society for Adolescent Health and Medicine. J Adolesc Health 2016;59:482-6.

8. Lightfoot AL, Thatcher K, Simán FM, et al. What I wish my doctor knew about my life: Using photovoice with immigrant Latino adolescents to explore barrier to healthcare. Qualitative Social Work. doi: 10.1177/ 1473325017704034.

9. von Dijck J. The culture of connectivity; a critical history of social media. New York, NY: Oxford University Press; 2013.

10. Allen KA, Ryan T, Gray DL, et al. Social media use and social connectedness in adolescents: The positives and the potential pitfalls. Aust J Educ Developmental Psychol 2014;31:18-31.

11. Patton GC, Sawyer SM, Santelli JS, et al. Our future: A Lancet commission on adolescent health and wellbeing. Lancet 2016;387:2423-78.

12. USA for UNHCR. The UN Refugee Agency. Available at: http://www. Accessed April 24, 2017.

13. Kassebaum NJ, Bertozzi-Villa A, Coggeshall MS, et al. Global, regional, and national levels and causes of maternal mortality during 1990-2013: A systematic analysis of the global burden of disease study 2013. Lancet 20 14;384:980-1004.

14. CDC's Web-based Injury Statistics Query and Reporting System (WISQARST). Available at: Accessed March 1, 2017.

15. Levitan J . T he d ifference b etween e ducational e quality, e quity a nd j ustice a nd w hy i t m atters. Am J Education Forum. May 2, 2016. Available at: nd-justice-and-why-it-matters-by-joseph-levitan/. Accessed January 7, 2017.

16. United Nations Secretary-General. The global strategy for women's, children's and adolescents' health (2016-2030): Survive thrive trans- form. 2015. Available at: Accessed March 1, 2017.

17. Peterson SJ. American demography 2030: Bursting with diversity, yet a baby bust. Urbanland, 2015. Available at: Accessed February 28, 2017.

Presidential Address, delivered by Dr. Tamera Coyne-Beasley , during the opening event of the Society for Adolescent Health and Medicine (SAHM), held in New Orleans, United States, on March 8-11, 2017.
adolescencia adolescencia adolescencia
GN1 © 2004-2019 Revista Adolescência e Saúde. Fone: (21) 2868-8456 / 2868-8457
Núcleo de Estudos da Saúde do Adolescente - NESA - UERJ
Boulevard 28 de Setembro, 109 - Fundos - Pavilhão Floriano Stoffel - Vila Isabel, Rio de Janeiro, RJ. CEP: 20551-030.