Dr Kerryn Phelps, AMA President, to the Australian and New Zealand Adolscent Health Conference, VUT Conference Centre, Melbourne

As you would all appreciate, holding a vision of youth health is no easy task especially in the current economic and political climate.

Young people's health is not a high political priority, as the investment in prevention programs for adolescents does not provide a dividend for the government of the day.

This is not only a short-sighted approach to health policy but alarming when it translates to the current reality of adolescent health.

Compared to older age groups and past youth cohorts, there is an

increase in the use of illicit drugs, and there is an alarming - and growing - number of young people who smoke cigarettes and drink alcohol on a regular basis.

One in five young people are overweight or obese and there is a growing prevalence of inappropriate nutrition and physical inactivity among our youth.

The number of notifications for Chlamydia, the main sexually transmissible infection among young people, has nearly tripled in the past 10 years.

And the major burden of disease has been identified as mental disorders with at least one in four young people having clinically recognisable symptoms or behaviour.

Of course, some groups of young people - including Aboriginal and Torres Strait Islander people, youth living in rural areas, the unemployed, and those in the lowest socioeconomic group - are significantly worse off.

Indigenous people have the worst health of all Australians. The death rates for Young Aboriginal and Torres Strait Islander males is nearly three times higher than non-Indigenous youth and twice as high for Indigenous females.

These are shameful indicators of Australian health care policy.

Australia, like other western cultures, has experienced major social change over the last few decades and included changes to the structure of family, work and community.

This has resulted in a significant rise in single parenthood, greater family instability, loss of extended family support, increased reliance on formal and informal childcare arrangements, and higher rates of family violence.

Those who are disadvantaged have been found to suffer the negative effects of change the most, which is attributed to their reduced resilience and lesser capacity to access health resources.

The de-institutionalisation of health care in the 1970s saw the building of the community health movement which aimed to improve access for these disadvantaged groups and emphasised health promotion, education and personal responsibility for health.

Another dominant influence at the time were the active social movements which insisted that health issues could not be separated from the wider socio-economic context.

Aboriginal activists and the women's liberation movement were leading the way in raising community awareness of issues related to social inequality.

Through the 1980s, health was viewed increasingly as a more complex phenomenon with the increased recognition that good health was not achieved by simply changing people's behaviour.

An individual's health was seen to be affected by determinants in the environment.

This concept as it relates specifically to young people was reported to the Human Rights and Equal Opportunity Royal Commission into Youth Homelessness in 1989.

This report known as the 'Burdekin Report' revealed the extent of youth homelessness and its consequences on the health of young people in Australia.

It identified that young people were not accessing clinical services and thus their health needs were not being adequately addressed.

Prior to this report, young people were generally thought of as healthy and problems in adolescence were seen as a result of risky behaviours due to lack of parental control or supervision.

This document supported the groundswell and has been heralded as a milestone in adolescent health care.

It marked the beginning of a wider community based multi-disciplinary model of adolescent health care.

As a result, there was greater recognition that the health needs of young people were often multiple and complex in nature and the issues of access and equity gained new prominence in both youth health policy and practice.

Until this time, youth health issues were said to have been obscured by the barriers they faced in accessing mainstream health services.

As a result, the Innovative Health Services for Homeless Youth Program was established through matched Commonwealth/State funding.

These specific youth health services were modelled on the holistic conceptualisation of health as declared by the World Health Organisation.

Youth Health services embraced the concept of health as a state of complete physical, mental and social wellbeing and incorporated the issues of social justice into their policies and practice.

Housing, education, employment, discrimination and poverty were all recognised to impact on youth health, so services established networks and inter-agencies to address these issues holistically.

There is no doubt that working with young people presents challenges both to the individual and institutions.

The ability of the sector to respond to the increasing demand for services and the diverse needs of young people has been tested.

However, as most of you here would testify, there are ways to address these complexities and make a considerable impact on the lives of many young people.

Over this time, the youth sector has explored various models of service delivery and created a patchwork quilt of pilot programs stitched together by economic rationalism.

In spite of this, effective health initiatives have been developed.

At this conference, you will have the opportunity to hear about some new and innovative programs and others that have had the opportunity to prove their effectiveness over a longer period of time.

It is often said, however, that effective youth heath programs are resource intensive and clear outcomes are difficult to measure.

The importance of research and evaluation has become increasingly evident.

The contributions of organisations such as the Centres for Adolescent Health in Victoria, New South Wales and Auckland are vital in building an integrated approach to evidence based practice.

Despite the gains made in the development of adolescent health care services, the statistics on many youth health issues including smoking, drug and alcohol use, depression, suicide and self-harm remain alarmingly high.

We seem to keep building bridges but they are not strong enough

It has long been recognised by the World Health Organisation that the highest possible level of health could not be attained by the health sector alone.

The impact of social determinants on health, as we have discovered, make it paramount that health promotion and prevention is addressed in partnership with all levels of government, non-government, community, private and public organisations.

In August last year the AMA called for a Federal Government Office of Youth as a national youth health priority.

The Federal Government has recognised this need and, as you would all be aware, has appointed a Federal Minister for Children and Youth Affairs - The Hon Larry Anthony.

In a recent meeting with the new Minister, the AMA impressed on him the importance of Federal Government leadership and the need for a cross portfolio approach to youth health.

That is, a coordinated approach covering housing, education, income support, community services and juvenile justice.

If there is one message that you take from my address this morning, it is the need for a collaborative approach to youth health policy and programs.

Activities and services for young people must be provided at all levels in a coordinated and collaborative manner.

Individuals, agencies and organisations need to work together to maximise opportunity for, and effectiveness of, prevention, early intervention and treatment services and programs.

In working together, we need to be clear that, collectively, our major concern is the interests of the young people and a desire for best practice and maximum health outcomes.

We need to build better bridges in adolescent health.

These bridges must be strong enough to support the most disadvantaged young people in the community.

Recent research has left little doubt that an investment in the early childhood years has substantial benefits for both adolescent and adult health outcomes.

Longitudinal studies of early intervention programs have shown that family and education based interventions, especially in the first six years of a child's life, can impact greatly on an individual's health.

Early intervention programs have also been found to impact on adolescent risk behaviours often associated with poor health outcomes, including mental health and antisocial behaviour.

This has far reaching implications given the co-occurrence of health risk behaviours in adolescence.

Of course, this also highlights the importance of early intervention and support programs for young parents.

Given that most children and adolescents are dependent on parents, families or carers to model good health practices and provide for their health care, early intervention programs need to support the role of the primary carer if they are to be effective.

These programs also highlight the contributions made by both clinical and community based services and the importance of working collaboratively to achieve better health outcomes for our young people.

To have teachers, youth workers, paediatricians, GPs, nurses, researchers, administrators and government representatives here today is recognition of the role that each has in addressing youth health issues - and the desire which exists to address these issues collectively, as a community.

GPs, for example, are in an ideal position to provide primary health care and are increasingly focused on prevention and early intervention.

GPs can provide longevity of relationship within the family context and continuity of care, which is especially important in terms of chronic illness.

The transition from family to individual patient may present new challenges and a positive relationship between the young person and practitioner is vital.

Many GPs have recognised the importance of adapting their practices to be 'Youth Friendly' and, like many of you here, GPs have participated in a variety of training programs designed to assist mainstream health services accommodate the needs of young people into their practices.

In Western Australia, the AMA Foundation is currently running the Youth Friendly Doctor program, which consists of workshops aimed at empowering GPs and other medical practitioners with the knowledge and skills to provide a youth friendly service.

In a dynamic and interactive workshop setting, issues of family conflict, eating disorders, depression, sexual health, self-harm and suicide are discussed.

This training is complemented by the 'Dr Yes' program delivered in high schools to students from year 10 to year 12.

Medical students are trained by health professionals to conduct sessions on topics such as drugs and alcohol, suicide, depression and sexual health.

Students are also informed of their health rights and encouraged to seek out a youth friendly doctor.

Communities expect and deserve some sense of permanence and consistency in their health services.

Relationships need to be built on shared goals and recognition of the expertise of government, non-government organisations, community members and young people.

It is the expertise of our young people that is vital to achieving real gains in adolescent health.

They have the inside knowledge of how to build the better bridges to adolescent health.

There is no doubt that young people live in a world which they have little control over and which they perceive to be ruled by adults.

Because of this, it can be argued that in some situations young people are the most socially disadvantaged of all groups.

The relationship between social inequality and related health implications has been well documented. However, more research is needed to further explore the nature of the relationship as it applies to young people.

Lack of ownership and control over resources - including the direction of a young person's own life - is thought to impact greatly on their health outcomes.

Education for young people on how to navigate the health care system is essential if they are to take responsibility for their own health care and make informed health choices.

It is imperative that we are inclusive and involve young people in all aspects of their health care as an adolescent's perspective on health issues may differ dramatically to their families, communities or health care professionals.

Valuing and respecting youth, supporting youth in developing knowledge and decision making skills and creating positive futures for youth are three key elements that appear to build the capacity of youth in their transition to adulthood.

Greater involvement in both policy and program development is vital for youth to feel valued, respected and to allow them to develop essential knowledge and skills.

But we all know that building capacity or resilience in young people is more than just the acquisition of knowledge and skills.

Enriching experiences are believed to make a direct contribution to a person's reserves of strength and purpose and enable a young person to adapt, cope and even thrive in adverse conditions.

An enriched quality of life is an essential part of development in adolescence although it is often seen as a luxury that the government cannot afford.

As part of the youth health sector, it is our role to advocate for young people at every opportunity.

For the past five years, the Australian Medical Association's Youth Health Advocate Program has been working to generate awareness of important youth health issues and improve the relationship between young people and the medical profession.

This has been possible through partnerships with other organisations and currently through the generous support of the Commonwealth Bank.

Young people today face challenging health issues at a much earlier age than previous generations.

Their physical and mental well being is put to the test on a daily basis.

As a society, we must be patient and supportive and look for opportunities to nurture their positive development.

History has shown that our youth have instigated some of the most profound social change.

We must do what we can to encourage this leadership and active participation in our society.

Let's keep them healthy.

I wish you all well at this Conference as you build the better bridges to empower our young people through better health and better lives.

Thank you.