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Annex II. B1: Leading causes of death in adolescents aged years in the Americas in 43 countries reporting , with number of deaths and age-adjusted rates per ,, by sex. C1: Leading causes of death in youth aged years in the Americas in 43 countries reporting , with number of deaths and age-adjusted rates per ,, by sex. By , end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1, live births and under-5 mortality to at least as low as 25 per 1, live births.

By , end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases.

By , reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being. Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol. By , ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes.

Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all. By , substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination. Strengthen the implementation of the World Health Organization Framework Convention on Tobacco Control in all countries, as appropriate.

Support the research and development of vaccines and medicines for the communicable and non-communicable diseases that primarily affect developing countries, provide access to affordable essential medicines and vaccines, in accordance with the Doha Declaration on the TRIPS Agreement and Public Health, which affirms the right of developing countries to use to the full the provisions in the Agreement on Trade Related Aspects of Intellectual Property Rights regarding flexibilities to protect public health, and, in particular, provide access to medicines for all.

Substantially increase health financing and the recruitment, development, training and retention of the health workforce in developing countries, especially in least developed countries and small island developing States. Strengthen the capacity of all countries, in particular developing countries, for early warning, risk reduction and management of national and global health risks.

Source: Reduce the percentage of adolescents between the ages of 13 and 15 who have consumed one or more alcoholic beverages during the last 30 days. Reduce the specific fertility rate of adolescents aged years old annual number of live births per 1, females Increase the proportion of adolescents 13—15 years of age who engage in regular physical activity.

Related to suicide, these should focus on strengthening effective leadership and governance; providing comprehensive, integrated, and responsive services in community-based settings; implementing strategies for prevention; and strengthening information systems, evidence, and research. Policy options outlined in the WHO Global Strategy to Reduce the Harmful Use of Alcohol also support suicide prevention, including policies related to drinking-driving countermeasures, reducing the affordability of alcohol, reducing the exposure to all forms of alcohol marketing, reducing the access to purchasing and drinking alcohol.

Sustainable and long-term surveillance of suicide cases and of hospital presentations due to suicide attempts and self-harm provide critical information for prevention, intervention, and treatment.

Adequate, prompt, accessible treatment for mental and substance-use disorders can reduce this risk of suicidal behavior. Implementing health-literacy policies and practices throughout health systems and institutions is also key.

Restriction includes legislation to limit access to pesticides, firearms, and medications commonly used in suicide, and safer storage and disposal of each, as well as environmental interventions to prevent suicide by jumping.

Media guidelines should stress: avoidance of detailed descriptions of suicidal acts, sensationalism, or glamorization and oversimplification; use of responsible language; minimizing the prominence of suicide reports; and educating the public about suicide and available treatments. Online suicide prevention strategies include self-help programs and professionals engaging in chats or therapy with suicidal individuals.

Text messaging is an alternative, particularly when the Internet is not accessible. Awareness-raising campaigns aim to reduce stigma and promote help-seeking and access to care. Different types of exposure e.

At the local level, awareness raising can target specific vulnerable populations. These interventions should be tailored and targeted toward groups that are most at risk of suicide in particular settings.

For example, interventions targeting lesbian, gay, bisexual, transgender, and intersex LGBTI adolescents should focus on addressing risk factors such as mental disorders, substance abuse, stigma, prejudice, and individual and institutional discrimination.

For people in a position to identify whether someone may be contemplating suicide e. Crisis helplines are public call centers that people can turn to when other social support or professional care is unavailable or not preferred. Helplines can be in place for the wider population or may target certain vulnerable groups, e.

The WHO mhGAP intervention guide recommends comprehensively assessing everyone presenting with thoughts, plans, or acts of self-harm. The guide advises asking any person over 10 years of age who is experiencing a priority mental, neurological, or substance use disorder—or chronic pain or acute emotional distress—about his or her thoughts, plans, or acts related to self-harm and suicide. This involves training primary-health-care workers to recognize depression and other mental and substance-use disorders and to perform detailed evaluations of suicide risk.

Training should take place repeatedly over years and should involve the majority of health workers in a country. Repeated follow-up by health workers for patients discharged after suicide attempts, as well as community support, are low-cost, effective interventions that are easy to implement. Follow-up can include postcards, telephone calls, or brief in-person visits. Raising the legal drinking age to 21 years reduces drinking, driving after drinking, and alcohol-related crashes and injuries among youth.

Set a lower permitted blood alcohol concentration limit 0. Enforce blood alcohol concentration limits, e. Establish penalties and stiff sanctions for driving under the influence of alcohol.

Promote seat-belt laws for all vehicle occupants, including in back seats. When laws requiring seat-belt use are enforced, rates of use increase and fatality rates decrease. Although most countries now have such laws, half or more of all vehicles in low-income countries lack properly functioning seat belts. Create mandatory helmet laws for two- and three-wheeled vehicles including tricycles and others , and enforce them. Establish a required safety standard for helmets that are effective in reducing head injuries.

There is still little information on the effectiveness of these relatively new driving interventions. However, countries prohibit the use of hand-held phones; 34 prohibit hands-free phones; and 42 prohibit text messaging.

Limits should be enforced in such a way that drivers believe there is a high chance of being caught if they speed. Where countries have changed their speed limits, but have taken little action to enforce them, there have been very limited benefits.

A graduated licensing system phases in younger driver privileges over time, such as first having an extended learner period involving training and low-risk, supervised driving, then a license with temporary restrictions, and finally a full license. Reducing hours, days, or locations where alcohol can be sold, as well as reducing demand through appropriate taxation and pricing mechanisms, are cost-effective ways to reduce drink-driving among young people.

Ban the sale of alcohol at gas stations and along major highways, as these are risky to any driver, including young drivers. Make unsafe behavior less attractive, e. Examples include infrastructural engineering measures e. Standardize formal emergency medical services, including equipping vehicles with supplies and devices for children as well as adults. Where no prehospital trauma care system exists: teach interested community members basic first aid techniques; build on existing, informal systems of prehospital care and transport; and initiate emergency services on busy roads and high-frequency crash sites.

Improve the organization and planning of trauma care services in an affordable and sustainable way in order to raise the quality and outcome of care. Improve services in health care facilities and community-based rehabilitation to minimize the extent of disability after injury, and help adolescents with persistent disability to achieve their highest potential. Make drinking and driving less publicly acceptable; alert people to the risk of detection and arrest, and the consequences; and raise public support for enforcement.

Mass media campaigns linked to other approaches to speed management raise awareness about the dangers of speeding, and gain greater public support for new legislation, stricter enforcement, and stronger penalties. Public campaigns about seat-belt laws can target adolescents, to increase awareness and change risk-taking social norms.

Educate adolescents about the benefits of wearing helmets on two-wheeled vehicles, by using peer pressure to change youth norms regarding helmet acceptability and to reinforce helmet-wearing laws. Programs that provide helmets at reduced or no cost enable adolescents with little disposable income to use them. Distribution can be taken to scale through the school system. Promote use of daytime running lights; reflective or fluorescent clothing; light-colored clothing and helmets; and reflectors on the back of vehicles.

Promote front, rear, and wheel reflectors; bicycle lamps; reflective jackets or vests; and helmets. Promote white or light-colored clothing for visibility; reflective strips on clothing or articles such as backpacks; walking in good lighting; and walking facing oncoming traffic; enacting and enforcing laws on public intoxication; urging pedestrians to abide by road signs and signals, and the rules of the road, to promote a culture of safety.

Programs may require new legislation, additional police to supervise implementation, public awareness campaigns, and more elaborate monitoring systems.

Grants may cover direct costs e. For areas with high levels of violence, situational crime prevention includes a security assessment, a stakeholder analysis, and a planning process involving communities, local governments, and housing, transport, and other sectors. These strategies offer vouchers or other incentives for residents of economically impoverished public housing complexes to move to less impoverished neighborhoods. Police resources are deployed in areas where crime is prevalent.

Mapping technology and geographic analysis help identify hotspots based on combined crime statistics, hospital emergency records, vandalism and shoplifting data, and other sources. Drug control may focus on reducing drug demand, drug supply, or both. Most interventions require substantial technical capacity within health services and the police force.

Teachers are trained to recognize and explain bullying to students, what to do when it occurs, effective relationship skills, and skills for bystanders. Specialists work with students involved in bullying. School policies and procedures also may be established, and parents may be trained. Community leaders are engaged to convey a strong message that gang violence is unacceptable.

Police involvement, vocational training, and personal development activities may also be included. The systematic use of police-community partnerships and problem-solving techniques identifies and targets underlying problems, to alleviate violence.

One necessary precondition is a policing system that is legitimate, accountable, nonrepressive, noncorrupt, and professional. Another precondition is good relations among the police, local government, and the public.

Home visiting programs monitor and support families while there is a high risk of maltreatment e. Peer mediators may be nominated by a class and receive hours of training on how to mitigate peer conflicts and seek help if needed.

Other students may also be trained in conflict resolution skills. School-based or after-school participatory activities address the characteristics of caring and abusive relationships; how to develop a support structure of friends; communication skills; and where and how to seek help in case of sexual assault.

These age-specific programs help adolescents to understand and mange anger and other emotions, show empathy for others, and establish relationships. They involve classroom sessions over several years.

Structured leisure time activities can include cognitive and academic skills development; arts, crafts, cooking, sports, music, dance, and theater; activities related to health and nutrition; and community and parental engagement. Adolescents are targeted through mass media, after-school lessons, or private tutoring to help them keep up with school requirements and prevent them from dropping out of school.

Vocational training for at-risk youth can have a meaningful impact on violence prevention if integrated with economic development and job creation. It is important to ensure the capacity of training institutions, available technical equipment, existing cooperation with businesses, and sustainable financing models. Volunteer mentors receive training on adolescent development, relationship building, problem solving, communicating, and specific concerns e.


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