In Their Space

I feel seen.

Three words of anonymous feedback, written in script.

Having spent another three-hour workshop session on my feet, engaging young people (16-24yrs) on the expected topics of brain development, mental wellbeing and healthy choices, (while craftily weaving in unanticipated ones like complicated grief, young adult intimacy and loneliness), those words revealed impact. They kept me on my toes with questions, comments and even accusations. I was challenged to explain how and why doctors and clinics place so much focus on early childhood yet somehow seem to forget that children grow up. Adolescents and emerging young adults need access to specific developmentally appropriate approaches to their wellbeing. This was not the collective experience.

We discussed the stats. Staggering numbers of young people are reported to endure persistent sadness or worry. Estimates project that up to 50% of young people in the Caribbean region navigate significant mental health concerns yet only half consistently access the care they need. [1] Accidents, self-harm and violence remain major causes of injury and death. Our youth are exposed to unacceptably high levels of interpersonal, community and systemic violence, with insufficient attention to the impact of grief on the life trajectories of survivors. And other hidden sources of grief. Grief that is very often overlooked. Grief that is sometimes even punished. Devastation of homes and entire communities by hurricanes and earthquakes. Disruption of education and social milestones through flooding, landslides and other climate related events. All occurring alongside significant physical, emotional and cognitive developmental changes, often with little inquiry or intervention. Rising numbers of our youth are overweight or obese, with increasing rates of chronic non-communicable diseases. That said, a minority of the group could even remember when last they had a complete (or incomplete) health check-up, or screening of any kind…

Adolescents and emerging young adults exist in numbers larger than ever before in our history, comprising almost a quarter of the population in the Caribbean. Healthy children can enter puberty before age 10. Accompanying the growth spurts, pimples and body odour are moments of significant emotional upheaval, changes to peer dynamics and rising conflict with parents as individuation and identity formation unfold. Processes which will continue well beyond a decade of their lives. On the other end, the steps required for functional independent adulthood are many. Neuroscience confirms that maturation and myelination of the pre-frontal cortex are not complete until approximately age 25. Older adolescents and emerging young adults are still completing processes of executive functioning, judgement, planning and self-management. Adolescence spans much more than the ‘teen years’. It is a unique space. A developmental space. A metamorphosis that undulates over a decade-and-
a-half, through which multiple biopsychosocial domains mature, each at a different rate and influenced by parenting, social constructs, and newer impacts of virtual connectivity and artificial intelligence. The Caribbean has a large population of adolescents and young adults, with specific healthcare requirements, risk and resiliency factors and untapped opportunities to optimize their overall wellbeing and future.

The influences on adolescent health are myriad. The food, beauty and fast-fashion industries have recognized the rapidly growing commercial market that young people (and their parents) occupy. Social media and tunnelled algorithms ensure that young people are constantly bombarded with aspirational images which translate into sales. But what of the other impacts? Targeted marketing stealthily drives youth away from our indigenous, sustaining whole foods and toward highly processed non-nutritive items, which are convenient, palatable but ultimately detrimental to health. Doctored images impact perceptions of beauty and self-esteem at a time when young people are uniquely vulnerable. Disordered eating behaviours and a largely unregulated aesthetics industry both simmer ominously below the surface. Data on these can be challenging to accurately capture. Marketing of, and access to, alcohol and vaping devices continue to occur in some settings with almost no restriction. There is much to be done.

Where was this, when I was like, 12? Relatable.

After reading those words, I reflected on the young people, residing in the Caribbean who do not have these opportunities or spaces. Safe spaces to connect, communicate and share their journeys in health, all while learning how to manage themselves and their wellbeing. The adolescents and young adults of the Caribbean who remain suspended in the purgatory space between child health services and adult systems, with relatively scarce resources directed specifically and consistently to them.

Legal, cultural and parental constructs heavily influence the very definition of adolescence, in the region and indeed everywhere. Dedicated services for young people are sparse and poorly integrated into primary care systems which frequently operate on the traditional models of ‘child’ or ‘adult’ services. Even within that, the age of transition from paediatric to adult care throughout the Caribbean region is arbitrary; and in some countries even varies by facility. For some, age 13 will find an early teen admitted to an adult ward, for others the age of transition is 16, although in both cases, these are legal children, and not adults. System change can be difficult and time-consuming, but harmony regarding the upper age limit of child and paediatric services and a consistent programme of transition to adult care will absolutely enhance the quality of care of emerging young adults.

This was great. Thanks Miss.

Miss. A title of respect, usually reserved for teachers. I accept the title with pride and a sense of great responsibility. Those on the frontlines of adolescent and young adult wellbeing understand that young people connect with healthcare providers, educators, coaches and mentors who understand the nuanced balance between guidance and supporting autonomy. Adults who meet them without judgement, aim to understand their complex emotions and recognize that their cognitive flexibility is evolving. We cannot expect of them, more than they are capable of; yet need to communicate with them in ways that support agency and decision making. There are opportunities to optimize their health education and health literacy.

School-based health programming, the literal fusion of health and education, has long been offered as a practical strategy toward enhancing adolescent health. In some countries, such structures are well established. Sadly, in many, health and life curricula are readily substituted to make way for “core subjects”; and too often, comprehensive sexuality education does not even make its way into the classroom. The stigma and pushback are tremendous. Perhaps it is time to reconsider. Surely a sustainable way to reach young people, literally where they are, is to enhance their educational experiences with evidence- based health education interventions. Using all the modern pedagogy and technology available, it is possible to support their health literacy, mental health literacy and self- management. This is very possible. This is an opportunity.

Education for providers. Despite awakened awareness of the need to improve adolescent health care delivery, our regional institutions of medical and healthcare education lag in their offerings of adolescent and young adult health in a sustainable, easily accessible way. The infusion of adolescent health modules into the core curricula of undergraduate medical and allied health education programs is not yet standard. There are many professional opportunities for training and certification, for those who opt-in and have a specific interest. Quality adolescent health care delivery is not optional. The future of our region relies on our youth. Our health education systems need to fortify training in adolescent development, healthcare and services. This is another opportunity.

Adolescent Health has a place at the table, but while we await the server to take our order, others are already well into their entrées. Movement is happening but there is more to be done. As we look forward, it should be through a lens of sustainability. There is an increasing motive force of grassroots activists, regional thought leaders and experts who continue advocacy, knowledge sharing and implementation. And youth. Conversations about health for young people must involve them at all stages. There have been academic meetings, conference events and strategic plans. The next steps should ensure that the translation of ideas and knowledge gained is decoded into actionable outputs that positively enhance the lives and future of Caribbean youth. All youth. Strategies to include vulnerable populations, those with physical, cognitive and neurodevelopmental differences. We must create spaces for them all. In pockets, some of the most vulnerable tweens, teens and emerging adults often require the services that are most elusive. Many well-intentioned initiatives start with rigour and silently fade; others remain in train but without the marketing or support to be most effective.

As the session ended, what I wanted to tell them, but forgot to say, is that there is hope. Much has happened over the last several years and the future is bright. Youth of the Caribbean continue to lend and blend culture from each island into a melting pot of globally recognized content. Popular music emanating from the region very regularly fuses the heavy basslines of dancehall, sped up to the rhythm of Bouyon while featuring staccato percussion of the steelpan. We can learn from this. Their lived experiences share more harmonious commonalities than differences. Healthcare planners and providers should collaborate even more freely, to learn from our (and their) experiences. This may reduce repeated attempts at less productive efforts from one place to another; and can support more sustained investment into initiatives that work for our youth, tailored for our context and delivered in their spaces.

All quotes and feedback were collected anonymously, and participants were aware that they could be shared.

References

The Caribbean Child and Youth Mental Health Research Study Report
CARICOM and UNICEF, 2025
https://caricom.org/documents/caricom-and-unicef-youth-mental-health-survey-report-v6/

About Author

An adolescent medicine specialist and paediatrician, her work bridges hospital clinics and communities; the science of adolescence and the art of being human. From Barbados to Trinidad & Tobago her practice is rooted in preventive care and emotional wellbeing for children, adolescents and young adults. Areas of focus include communication, grief support, and capacity building of the healthcare workforce in adolescent health. Dr. Asha Pemberton is Head of Department of Paediatrics, Sangre Grande Hospital; a clinical instructor in Child Health at the University of West Indies (UWI), St Augustine and the International Chapter President of the Society for Adolescent Health and Medicine (SAHM).