identity, become more independent and emotionally mature. The “cascade of hormonal, physical, psychological, and behavioral changes” (Cameron, 2003) that marks this stage of life inevitably has implications for health. Research over the last few decades has shown that these implications depend, to a great extent, on the social environment (Boyden, Ling, and Myers, 1998; Bronfenbrenner and Morris, 1998). In other words, the transition to healthy adulthood is dependent on the contexts in which it occurs—parents, other family members, peers, teachers, and other significant adults all play an important role, as do the communities in which young people live (Steinberg and Morris, 2001). The significance of context has become clearer in recent research that points to the many ways in which normative views of healthy childhood and adolescence vary across societies and over time (Boyden, Ling, and Myers, 1998; Caldwell et al., 1998).

Across all societies, however, physical and social gender differentiation are key features of this phase of the life cycle. Boys and girls are treated differently from birth onward, but puberty marks the beginning of a widening divide (Mensch, Bruce, and Greene, 1998). After puberty, young men and women’s opportunities and experiences increasingly diverge in ways that are reflective of societal gender norms and expectations, and these differences can have direct implications for young men’s and women’s health as well as for health-related behaviors. While less true than in the past, young women often live more physically circumscribed lives than young men after puberty. Thus they may be relatively more “protected” than young men from some risks, such as dangerous work conditions, violence and military conflict, and road-related accidents, but they face other risks, such as early pregnancy and childbearing and gender-based violence, that are sex-specific. Furthermore, because of their greater “protection,” young women may have fewer opportunities to develop the negotiating skills and the knowledge they need to protect and preserve their health and remain healthy as adults.

This chapter examines the transition to a safe and healthy adulthood in developing countries in the context of a range of rapid global transitions in health patterns and health services. For most individuals, adolescence has always been and remains a relatively healthy period of life. At any phase of the epidemiological transition in which societies experience a decline in the importance of infectious diseases and a rise in the importance of chronic conditions, death rates are at their lowest point from ages 10 to 14 and are often relatively low from ages 15 through 24 as well, particularly in countries in which obstetric care is adequate. The panel’s view of a successful transition to adulthood, however, encompasses a view of health that is broader than survival and in which success includes the best possible mental and physical health and the knowledge and means to sustain health during adulthood.



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