“A school prefect in his A/Levels (maths stream) who got into a brawl with a Grade 9 student after the latter took umbrage at being disciplined by a senior succumbed to his injuries”.“19-year-old Rasindu Gimhana was stabbed to death while on his way to a tuition class. The tragedy took place at Alevella Street in Matara. The 17-year-old student who stabbed him had claimed that Rasindu’s brother has had an argument with his girlfriend”.“22-year-old Shiromi Priyadarshani was strangled to death by her boyfriend following a heated argument between the duo over a clandestine affair the girl had. Her body was found near Sumeda Tank in Magandanamulla, Monaragala”.

These were some of news items that appeared in popular newspapers recently.Violence among youth has been a social issue in Sri Lanka that has emerged over the recent past. The advent of technology, accessibility to violence and triggers in the immediate environment are possible causative factors.But at the same time it is vital to realize that youth are the best resources a country possesses at any given time and advocating to the youth towards positive development is the best way towards smart investments of a Nation.

Young persons are usually wonderfully resilient, adaptable, curious, trustworthy, creative and resourceful. When social setting consistently provide negative messages about abilities and a limited range of desirable life options, it leads the youth to make poor choices regarding the use of their time and resources ending up in crime and violence, substance abuse, negative attitudes and poor choices leaving them with long term negative effects. But when young people are mobilized into development and policy making processes, research has demonstrated that they tend to become increasingly responsible and develop decision-making skills and positive feelings about their changing bodies while becoming more independent and begin to plan and think about the future and confident feelings about their identity.

Taking up the challenge of making a difference among the youth, The College of Community Physicians of Sri Lanka, being the foremost professional body of the Public Health Practitioners in the country, adopted the theme, “S

haping a healthy future, youth as a smart investment” for their activities between the year 2018 – 2019 in order to work through specific programmes towards empowering the youth in our country.

Office-bearers of the College Dr. Janaki Vidanapathirana Dr. Anuji Gamage and Dr. Asiri Hewamalege, explained facts regarding the rationale of their theme for the year.

Who is a “young person” according to international classification?

The United Nations, for statistical purposes, defines ‘young person’, those whom are between the ages of 15 and 24 years, without prejudice to other definitions by Member States.

World Health Organization defines young people as between 10 and 24 years of age, and adolescents as between 10 and 19 years of age. The National Youth policy in Sri Lanka defines youth as 15-24 years of age (Ministry of Youth Affairs and Skills Development 2014).

“For the purpose of discussion for this article let’s consider a person to be a “young person” with the age as 10 to 24 years to reflect on the concepts of adolescence and youth”, says Dr. Vidanapathirana.

Why are they important?

“currently young people are the largest in history at any given time and 90% of them live in developing countries like ours. Therefore it is very important to harness them into correct pathways as the future of the world will depend on their behaviour as adults. As young people they face many transitions such as change of roles, high educational demands and physical and psychological changes. Brain development of a young person continues into the beginning of the third decade of life. The reorganisation of brain during this period makes it particularly susceptible to environmental influences, both positive and negative. As youth enter this critical age and encounter resources and vulnerabilities, which are biological such genetics, epigenetics, natural endowments and environmental such as national and local policies, as well as community, school, workplace, peers, neighbourhood, and family influences, their lives are shaped by the interrelationships of these factors.

Hence this window period during person’s life is an important milestone for positive interventions that would shape attitudes and the mindset of these young people. In addition as youth’s transition to adulthood they need to have well developed self-esteem and self-efficacy skills including life skills to gear them to manage challenges faced at education and employment settings, as well as relationships with friends and family member. Failure to meet the needs of a young person can have serious short as well as long-term implications for the individual and society at large”, explains the three community physicians.

Why should resources of a country be spent on youth?

“Because It has a high return on investment”, says Dr. Vidanapathirana.

Dr. Gamage, whose speciality includes health economics explains that investment in the capabilities of the world's 1.2 billion youth is vital to prevent and mitigate the negative impacts of vulnerabilities during a period of transition from school to the wider world and employment. Providing good education, investments on health etc. are more effective for the individual and the country as a whole as investments of this nature will in turn bring about economic as well as many other benefits. Actually in comparison, Sri Lankan youth are somewhat superior to their counterparts in the Asian continent because successive governments since independence have ensured free healthcare and education. “But due to increasing social influences due to globalization much more needs to be done”, she stresses.

“Amongst prevention of initiation of risk factors, risky behaviours and promotion of healthy habits among youth is ideal to be “Prevention is better than cure”, which is one of our guiding principles for this year”, explains the three Community Physicians. “It’s timely that we focus on youth development, especially when we consider the demographic dividend. It is estimated that the onset of the demographic transition in Sri Lanka started in 1992 and would last till 2037”. The “Demographic Dividend” “Demographic window of opportunity” or “Demographic Bonus” have a positive impact on economic growth result as it is an increase in the share of young adults in the population leading to a ‘youth bulge’. From a country's perspective it is a critical period for investing in young people as the dividend, is transient. Thus, countries need to ensure timely implementation of effective policies to achieve the economic growth influenced by its demographic dividend as it creates favourable conditions for investment in human resources”, explains Dr. Hewamalege.

“In this context it’s important for a country to focus on youth investments and youth readiness. Human resources are one of the important determinants of the economic growth of a country. A healthy youth with a healthy transition to adulthood lays the groundwork for a healthy adult population, whom are productive, bringing greater resources and income to its own families and higher level of economic growth for nations.”

Why do we need to invest on youth averting disease?

Youth development should be an ongoing growth process in which the country engages to help meet their basic personal and social needs to be safe, feel cared for, be valued, be useful, be spiritually grounded, and to build skills and competencies which allow them to function and contribute in their daily lives. Evidence suggest that investments in health and education will not only transform the overall quality of lives of adolescents in resource-poor settings, but will also generate high economic and social returns for a country. Lack of timely investments on young people would force a country to face academic failure, drug use, teen pregnancy, juvenile crime, lack of workforce readiness and much more risky behaviour. Although it is proven that Return on Investments (ROI) is high in investing for youth and children most low and middle income countries have failed to give due considerations to this.

Any country would perceive youth to be healthy. As such young people have attracted little interest and too few resources. Countries must invest on prevention and promotion of health amongst young people as much of the disease burden of adult life is preventable given they are addressed timely and as it is also a fundamental right. Considering adolescents prevention is cost-effective, given the long duration over which benefits will be reaped and adolescents’ greater openness to change than adults. Given the opportunity and information about their future health, the return of investments could be potentially enormous.

Where and on what should we invest?

It is seen from the above evidence that Return of Investments (ROI) are high especially in low income countries and also that investment to increase the extent and quality of secondary schooling is more expensive than other interventions but the ROI is the highest, but will also generate high economic returns, especially in low income countries.

The direct monetizable effects are enhanced labour productivity and utilization, increased adult work force, reduced cost of medical care and increased tax revenue. The effects not easily monetized are increased education, averted youth unemployment, averted diseases, averted crime etc.

The effects that are difficult to value monetarily are increased social capital, averting infertility, enhanced national security and improved social esteem. Therefore the costs of inaction are too great to ignore.

It is obvious that health is a key investment area considering young people. Health is a Broad topic of which the WHO defines as, “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”.

Since “health” is a vast and diverse area we need to prioritise the health needs of the young people based on evidence such as disease burden, and cost-effectiveness of interventions. Evidence suggest mental health issues, Non Communicable Diseases and related risk factors and risks of negative Sexual and Reproductive health issues adds to the disease burden of young people.

As part of our theme this year, we are taking these priority issues head on through various programmes such as conducting life skills development programmes for youth in different geographical situations around the country, supporting the government agenda of ensuring that sustainable development goal ending AIDS by 2030 is met even earlier in Sri Lanka by 2025 through many supportive programmes around the country, conducting many mental health well-being programmes among vulnerable populations, mobilizing the media for health awareness are just a few of many”, explains the President of the College, Dr. Janaki Vidanapathirana.

The precursors of health disorders such as mental health problems, non-communicable diseases, sexual and reproductive health issues and others originate in the youth long before they manifest as suicide, substance or alcohol abuse or physical disabilities.

If proper interventions can be done during this period most of these conditions could be averted which is a would be sizeable social and economic investment. It is like building a bridge to turn a river that is flowing in one direction to another for the benefit of communities for most of their problems”, says Dr. Gamage.

“Thus it’s important that we analyse existing interventions and policies across sectors focusing on MH, NCD an SRH and provides guidance into how they can be harnessed to generate a healthy youth, which is an investment for any country. We are very hopeful that the private sector could partner with us on some of our projects as part of their social responsibility”, adds Dr. Vidanapathirana.