Human development and age

How does age affect human development outcomes? It is widely known that the first five years of a child’s life are crucial to later development, with impacts echoing throughout life. A large amount of literature across international development topics looks at this period of life. Adolescence also involves specific needs and impacts, as young people transition from school to work, and from childhood to adulthood. In addition, as countries experience longer life expectancy and ageing populations, research and policy interest has turned towards the specific needs of older people.

Age often equates with power: children and young people may not be able to exercise influence or make decisions for themselves, and older people may be more respected but dependent on others for care. Human development for these groups may therefore be mediated through their working-age, able-bodied family members.

There is a considerable demographic transition underway globally, with youth and older people the key sectors (‘Youth’ refers to people between 15-24 years old; and ‘adolescents’ are people between 10-19). In general, there is a global shift towards older populations, particularly in higher-income countries, while low-income countries, particularly in Sub-Saharan Africa, have a youth bulge. Globally, the population aged over 60 is growing, and the world’s population is ageing rapidly (HelpAge International, 2014). Currently one in nine people is over 60, with this expected to increase to one in five by 2050 (HelpAge International, 2014). Sub-Saharan Africa has a growing adolescent population, but globally, the number of adolescents is declining (UNICEF, 2011). Sub-Saharan Africa is expected to have more adolescents than any other region in 2050. This youth bulge may result in a demographic dividend, if young people can be fully employed and contributing to the national economy. These demographic changes mean that social policy must also change in order to secure human development for all people.

There is most evidence on the specific needs of children and adolescents. Human development factors for children are well-evidenced and commonly discussed in much development literature.

The literature on adolescents almost exclusively refers to their sexualities (Kabiru et al., 2013). In the health sector this mainly addresses SRH needs, and in WASH it mainly addresses the sanitation needs of adolescent girls (covered in the Gender section of this guide, so there is no WASH section below). There is therefore a gap in the literature around the other human development issues for adolescents. There is a reasonable literature on older people’s additional health needs, but almost nothing on their specific SRH, education or WASH needs. The demographic shift signals an urgent need to consider the specific vulnerabilities and circumstances of older people in developing countries.

The references cited below overlap across the human development categories of health, sexual and reproductive health and education.

HelpAge International. (2014). Why health systems must change: Addressing the needs of ageing populations in low- and middle-income countries (HelpAge briefing). HelpAge International.
This is an analytical report of a two-year HelpAge programme piloting a range of interventions to address ageing and health in Cambodia, Mozambique, Peru and Tanzania. It confirms the perception that older people face unique health and living challenges that demand innovative solutions. It suggests: good care; health literacy; availability of essential treatments; health curriculum reform; and simultaneous bottom-up and top-down strategy.
See full text

UNICEF. (2011). The state of the world’s children 2011: Adolescence an age of opportunity. UNICEF.
This report outlines the challenges adolescents face in health, education, protection and participation, and the risks, vulnerabilities and opportunities of this pivotal stage of life.
See full text

Health

Household decisions about healthcare for children are usually made by parents or guardians, and can be strongly mediated by cultural and social factors. These include beliefs and illness perceptions, perceived severity of the illness and of the efficacy of treatment options, rural location, gender, household income and cost of treatment options (Colvin et al, 2013).

Maternal education, empowerment and status are important social determinants of child health and survival, as mothers often have primary responsibility for children’s care. Adolescent mothers are the most likely to be poor, and to pass on poverty to their children (UNICEF, 2011). Women can have restricted access to and control over resources (Richards et al., 2013) and decision making in seeking care (Colvin et al, 2013). Exposure of children to domestic violence can affect their health, growth and nutrition (Yount et al., 2011). It is important to ensure efforts to improve children’s health empower women rather than reinforcing gender inequities.

Adolescents are generally healthier than in previous generations, and accidents are the greatest cause of death for this group (UNICEF, 2011). Young people are often treated in adult health centres, but may not be responsive to their needs ‒ which include limited knowledge, distrust, fear of mistreatment, shyness, lack of money, barriers related to marital status and stigma for seeking SRH care (Kabiru et al., 2013; UNICEF, 2011). UNICEF recommends adolescent-friendly health facilities.

For older people, the burden of ill health becomes greater as they age, needing more care at home and more medical attention. The demographic shift towards an ageing population means there are fewer infectious diseases and more chronic and degenerative diseases (HelpAge International, 2014). Older people may find it difficult to travel to health centres, and may have lower incomes due to not working. They require health and social care simultaneously. HelpAge recommends a holistic continuum of care for older people, focusing on community and home-based care. Coordinating associations may help them to navigate the healthcare system. It is also essential for older people to have health literacy.

Colvin, C. J., Smith, H. J., Swartz, A., Ahs, J. W., de Heer, J., Opiyo, N., … & George, A. (2013). Understanding careseeking for child illness in sub-Saharan Africa: A systematic review and conceptual framework based on qualitative research of household recognition and response to child diarrhoea, pneumonia and malaria. Social Science & Medicine, 86, 66-78.
This systematic review synthesises qualitative evidence on factors that underpin household recognition and response to child diarrhoea, pneumonia and malaria in sub-Saharan Africa. Factors that influence household care-seeking include: cultural beliefs and illness perceptions; perceived illness severity and efficacy of treatment; rural location; gender; household income; and cost of treatment. Previous experience with health services and habit also play a role.
See full text

Richards, E., Theobald, S., George, A., Kim, J. C., Rudert, C., Jehan, K., & Tolhurst, R. (2013). Going beyond the surface: Gendered intra-household bargaining as a social determinant of child health and nutrition in low and middle income countries. Social Science & Medicine, 95, 24-33.
Can a woman’s intra-household bargaining power influence child health and nutrition? This comprehensive literature review examines the evidence of the impact of gender relations within the household on child health and nutrition. Women’s access to resources can improve health and nutritional outcomes for their children, but women do not always have control over the distribution of those resources, and can have lower levels of income than men. This decision-making process often relies on negotiation among household members, in many cases between the mothers and fathers, but also between older and younger members (such as mothers-in-law and mothers).
See full text

Yount, K. M., DiGirolamo, A. M., & Ramakrishnan, U. (2011). Impacts of domestic violence on child growth and nutrition: a conceptual review of the pathways of influence. Social Science & Medicine, 72(9), 1534-1554.
Children’s exposure to domestic violence (CEDV) predicts poorer health and development. Evidence is emerging that CEDV affects child growth and nutrition, but this is an under-studied area. Younger children are disproportionately exposed to domestic violence because they spend more time with their mothers than do older children. Prevention of domestic violence could improve child growth and nutrition.
See full text

Sexual and Reproductive Health

The literature on SRH and age mainly focuses on adolescents. Immature bodies mean adolescents are more vulnerable to STIs, HIV, and negative pregnancy outcomes). Girls are susceptible to coercive relationships with older men, and boys are societally expected to have many sexual experiences. Condom use is still not high, remaining at around a third to a half of adolescents at most recent sex, although it is increasing (Bearinger et al., 2007). Adolescents often avoid seeking healthcare for SRHR, because of long waits, distance, lack of money to cover costs, and the lack of a welcoming atmosphere (UNICEF, 2011). There is almost no literature on the SRHR needs of older people.

The health consequences of Child, Early and Forced Marriage (CEFM) include isolation and depression, risk of STIs and cervical cancer, risks during pregnancy, labour and delivery and high rates of maternal and infant morbidity and mortality (Raj & Boehmer, 2013). Adolescent pregnancy, whether inside or outside marriage, involves high health risks (UNICEF, 2011). Current research suggests HIV is not more prevalent among nations that are more affected by child marriage, although this is under debate (Raj & Boehmer, 2013). Although child marriage includes boys, girls are most affected. Policymakers need to address the social and cultural aspects of child marriage in order to mitigate the health consequences.

Other approaches for adolescent SRHR include: friendly clinical services; sex education programmes that provide developmentally appropriate, evidence-based curricula; and youth development strategies to enhance life skills, connections to supportive adults, and educational and economic opportunities (Bearinger et al., 2007). UNICEF (2011) suggest that adolescent-friendly health centres are the most effective way to encourage uptake of services.

Bearinger, L. H., Sieving, R. E., Ferguson, J., & Sharma, V. (2007). Global perspectives on the sexual and reproductive health of adolescents: patterns, prevention, and potential. The Lancet, 369(9568), 1220-1231.
What are the trends in adolescent SRHR? This paper synthesises the global findings from reviews. There are huge variations across regions and countries, but some patterns in behaviours, access to services and interventions. Young people need access to quality clinical services that offer effective treatments and vaccines, coupled with sex education that gives medically accurate information and teaches skills for negotiating sexual choices.
See full text

Raj, A., & Boehmer, U. (2013). Girl child marriage and its association with national rates of HIV, maternal health, and infant mortality across 97 countries. Violence Against Women, 19(4), 536-551.
Are nations with higher rates of girl child marriage at increased risk for poorer maternal and child health indicators and HIV? The authors used regression analysis on national indicator data from 2009 United Nations reports from 97 nations for which girl child marriage data were available. Countries with higher rates of girl child marriage are significantly more likely to contend with higher rates of maternal and infant mortality and non-use of maternal health services, but not HIV.
See full text

Education

The key educational issues for younger children are mainstreamed throughout this guide. There is increasing attention paid to adolescent and post-primary education. Adolescence is a period when school dropout is most likely: one in five adolescents are out of school globally (UNICEF, 2011). Secondary schools are often more costly and further from home. There are increasing incentives to drop out in order to work. Early entry into the labour market has associations with reduced earning potential, exploitation, and susceptibility to gang recruitment, among others (Kabiru et al., 2013). Young married girls are also very likely to drop out of formal schooling (Lee‐Rife et al., 2012). A recent systematic review suggests that an effective way of reducing CEFM is providing financial incentives for girls to stay in school (Lee‐Rife et al., 2012). Education delays marriage, pregnancy and childbearing, and school-based sex education can be effective in changing the attitudes and practices that lead to risky sexual behaviour in marriage (Lee‐Rife et al., 2012).

Kabiru, C. W., Izugbara, C. O., & Beguy, D. (2013). The health and wellbeing of young people in sub-Saharan Africa: an under-researched area? BMC International Health and Human Rights, 13(1), 11.
There are few SSA-based long-term studies on youth development that can clarify linkages between health and the social, political, and economic contexts that define the lives of African youth. Youth health and wellbeing literature mainly focuses on sexual and reproductive health. This paper briefly reviews how the literature treats the following issues in relation to young people: education, urbanisation, globalisation, HIV/AIDS and conflict.
See full text

Lee-Rife, S., Malhotra, A., Warner, A. & Glinski, A. M. (2012). What works to prevent child marriage: A review of the evidence. Studies in Family Planning, 43(4), 287-303.
This article systematically reviews 23 child marriage prevention programmes carried out in low-income countries. Most programmes included child marriage as a secondary aim. The primary focus was gender inequality, poverty or other issues. The evidence suggests that programmes offering incentives and girls’ empowerment can be effective in preventing child marriage and can foster change relatively quickly. It remains unclear whether impacts are sustained after the programme ends. Also unclear are the details of how change happens.
See full text