| dc.description.abstract | Twenty-five years into South Africa’s constitutional democracy provides an opportunity to take stock of the social
and structural determinants of adolescent health. Those born in democratic South Africa, commonly known as the
‘Born Frees’, are perceived to be able to realise equal rights and opportunities, yet many factors constrain their lives.
In bringing together approaches to understanding context in health policy and systems research and the social
determinants of health, the paper develops a conceptual framework to guide the narrative review examining the
key contextual social and structural determinants of adolescent health in South Africa. Illustrative examples drawing
from 65 papers from public health and the social sciences describe and link these determinants across micro, meso
and macro levels of society, their global determinants, and their intersections with compounding axes of power
and inequality.
At a micro level individual adolescent sexual and gender identities are expressed through multiple and evolving
forms, while they experience growing autonomy and agency, they do so within a broader context characterised by
regressive social norms, gender inequality and other intersecting power relationships. At the meso level, organisational
and sectoral determinants shape adolescents health and rights, both in being supportive, but they also replicate the
biases and inequalities that characterise South African society. In addition, the macro level national and global
determinants, such as the structural colonial and apartheid legacies, shape adolescents' health. Despite constitutional
and other legislative rights, these determinants and compound economic, geographic, gender and other intersecting
inequalities. | en_US |
