Public policy issues affecting the health care delivery system of adolescents.

Policymakers are at an important crossroad in pursuing viable solutions to the dilemma of preventing and treating adolescent health problems. A variety of coordinated and comprehensive approaches will be needed to resolve these complex and often entrenched problems. In the absence of a national policy for children and youth, it is important that those concerned with these issues join efforts at the community, local, state, and national levels to move the policy agenda forward. As an interim step, it is necessary to work on building and evaluating model programs that will influence the development of new policy directions. Both efforts are needed to address the complex array of problems facing adolescents today. The future of adolescent health will be determined by a variety of factors, including public policy. Of particular importance in shaping public policy are four factors: (1) the American character, including ideas and attitudes that are the basis of politics and policy; (2) the pluralism that characterizes the process, including the relationship between government and the private sector and the dominant role of the private sector; (3) the federal system that distributes authority among various levels of government (federalism); and (4) incrementalism, which is the step-by-step process that characterizes the development of policies. Of particular importance in terms of adolescent health are the ideas and attitudes about adolescence and adolescents; the basic ideas that affect policies broadly; and the concepts of federalism, pluralism, and the role of the private sector in dealing with domestic social issues. Although the field of adolescent health continues to advance, many complex problems that have their origin in biological, behavioral, and sociocultural factors remain. Of particular importance are problems associated with lower socioeconomic status. The problems will not yield to the single-issue, categorical approach of the past but will require comprehensive strategies involving the health, education, income maintenance, job training, employment, and social service sectors. Public policies must support these integrated, coordinated approaches, and health providers concerned with adolescent health can and must play a vital role in this process.