The importance of reducing health inequalities for adolescents and young adults

Dr Flora McErlane

By Dr Flora McErlane, Consultant Paediatric Rheumatologist at Newcastle Hospitals


Adolescents and young adults (AYA) are physiologically different to younger children and established adults. Their brains are still growing and developing, and their lives are focused around achieving a successful transition from dependent childhood to independent adult life.


Adolescent-appropriate healthcare should, therefore, be different to either child or adult-focussed care, ideally supporting these key transitions through accessible healthcare and a youth-led programme of health education.  However, this sadly isn’t the reality for young people across healthcare settings.


The Newcastle Health Innovation Partners (NHIP) Adolescent Health Project is an exciting innovation that hopes to tackle this issue. It brings together young people, adolescent health experts and systems engineers, to target and reduce health inequalities experienced by AYA with long-term health conditions.


What is systems engineering?


AYA healthcare comprises a complex network of planned and unplanned interactions between young people and healthcare providers, unfolding over multiple settings over time (a ‘complex adaptive system’). Improving the quality of AYA healthcare encounters will require innovative approaches to engaging multiple stakeholders at multiple interfaces.


Systems engineering improvement work aims to identify key interactions in complex adaptive systems where change is needed and to align the priorities of different people, systems, designs, and risks in navigating improvement. This project will focus on patient interactions at local system level (the AYA patient journey) as well as exploring the larger socio-organisational healthcare context (AYA care across Newcastle Hospitals).


What are we doing?


NHIP has funded a twelve-month collaboration between AYA hospital users, Newcastle Hospitals adolescent healthcare leads and Newcastle University systems engineers. We plan to apply systems engineering principles to AYA healthcare pathways across Newcastle Hospitals and develop feasible and effective change models, creating new opportunities to improve the experience and outcomes of AYA clinical care.


For practical reasons, this pilot project is limited to AYA aged 14 to 24 years with one of four immune mediated inflammatory conditions (inflammatory arthritis, psoriasis, inflammatory bowel disease or type 1 diabetes). These conditions share potentially modifiable triggers associated with poorer outcomes, ensuring that high quality education and healthcare, including smoking, diet, obesity, alcohol, sexual health, and oral hygiene advice, are particularly important for this group. We hope to use existing hospital data as well as healthcare professional and AYA experience data to identify “boundary spanning solutions” (Williams, 2002), such as cultivating interpersonal relationships, communication skills, political skills and an ability to understand system interdependencies.



We are grateful to NHIP for bringing our communities together and supporting our efforts to improve clinical care and outcomes for adolescents and young adults in our region.


“To grow and develop in good health, adolescents need information; opportunities to develop life skills; health services that are acceptable, equitable, appropriate and effective; and safe and supportive environments. They also need opportunities to meaningfully participate in the design and delivery of interventions to improve and maintain their health. Expanding such opportunities is key to responding to adolescents’ specific needs and rights.”


[WHO Health Topics: Adolescent Health]


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