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Adolescent Health Services: Missing Opportunities
Beyond defining the adolescent population, the committee recognized the importance of defining adolescent health. A report of the NRC and the IOM defines children’s health as “the extent to which individual children or groups of children are able or enabled to (a) develop and realize their potential, (b) satisfy their needs, and (c) develop the capacities that allow them to interact successfully with their biological, physical, and social environments” (National Research Council and Institute of Medicine, 2004a, p. 4). The committee further delineated three distinct but related domains of health: health conditions, which captures disorders or illnesses of body systems; functioning, which focuses on the manifestation of health in an individual’s daily life; and health potential, which denotes the development of assets and positive aspects of health, such as competence, capacity, and developmental potential. The World Health Organization’s definition of health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity” (World Health Organization, 1948, p. 100) is consistent with the committee’s strong interest in looking broadly at health. The committee defined oral health as a part of physical health, and identified behavior as an element of health and well-being.
The committee focused on the influence of health services and settings on adolescent health while also recognizing that a broad range of individual factors—biological (demographic, genetic, special needs), behavioral (sexual activity, diet, physical activity, use of weapons, substance use), attitudinal (values and personal preferences), social environmental (peers, schools, families), and immediate context or environment (neighborhood, media, geographic location, built environment)—all affect the health of adolescents. Health services, in turn, are affected by providers (training, types, and diversity), the overall system (funding, coverage and insurance, accessibility, acceptability, content and structure of care, service models, comprehensiveness of care, confidentiality, Medicaid, the State Children’s Health Insurance Program [SCHIP], school policies), and the overall sociocultural environment (culture and values, income and inequality, the role of government, content and confidentiality, and political values).
Within this web of influences, the committee’s specific focus was on health services and settings. The committee considered health services broadly, encompassing those services provided by doctors, nurses, mental health professional, dentists, or other health care providers. These services include health maintenance visits,3 school physicals, sports physicals, dental
Defined as clinical preventive services that incorporate screening, immunizations, and counseling about potential health problems and address prevention of future illness and injury; may also be called a well-care visit, a physical examination, a well-child examination, or ambulatory care.