Teen-agers and health

September 09, 1993

Most public discussions about the health of American teen-agers center around sex and drugs. But beyond the discouraging statistics on adolescent pregnancy, sexually transmitted diseases and drug use is a broader story of medical neglect. As federal officials plan a strategic -- and overdue -- shift in efforts to curb adolescent pregnancy and sexually transmitted diseases, they should use these programs to improve health care to adolescents across the board.

Dr. Joycelyn Elders, newly confirmed by the Senate as the nation's chief medical officer, has a good grasp of the ills facing American young people. Her remarks about pregnancy and sexually transmitted diseases have offended the religious right. But as surgeon general, her ability to draw attention to controversial issues could become the catalyst for providing better health care to a group that often falls through the cracks.

Baltimore City offers a good example of how easily public attention is deflected from the broader picture. The city's school-based health clinics make news when some sex-related development catches the public eye, such as a plan to make the contraceptive implant Norplant available to girls who request it and have parental permission. But Norplant is only a small part of the clinic story. While Norplant isn't a big issue in the schools, dental problems are epidemic. Teens also worry about skin problems, growth patterns that are out-of-sync with their friends' and other common plagues of growing up. Occasionally a nurse will catch a serious problem, a heart murmur or spinal curvature that had gone undiagnosed for years.

An especially distressing sign of the pressures young people face these days is evident in the high demand for mental health services. In city schools, grief groups are an important source of emotional support for the many students who have lost a friend or family member, often to violence. Spend a day in a school

clinic and you will see that in the current health care system, even adolescents who do have medical insurance often have many unmet medical needs.

Dr. Elders is expected to head the government's new initiatives on adolescent pregnancy and sexually transmitted diseases. Her rhetoric is often provocative and controversial. But behind her pronouncements lie some old-fashioned virtues, such as the importance of personal responsibility and the need to take control over one's own body and life. To drive home that message, society needs to show young people that it's also willing to take some responsibility for them, making sure they have access to the basic services that are essential to their health and well-being. That's a far bigger challenge, but a more promising one than simply urging them to just say no.

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