Transforming our future starts with an investment in adolescent health today

Professors George Patton and Susan Sawyer are an academic power couple, having led global research on adolescent health for 25 years. They and their colleagues have greatly advanced the understanding of adolescence and its effects on health across the life course.

Professor George Patton & Professor Susan Sawyer AM

Professor George Patton (MBBS 1978, MD 1990) is Professor of Adolescent Health Research at the University of Melbourne. Based at the Melbourne Children’s Campus, he co-leads the Murdoch Children’s Research Institute’s Adolescent Health Group.

Professor Susan Sawyer AM (MBBS 1985, MD 1995) is Director of the Royal Children’s Hospital’s Centre for Adolescent Health and Geoff and Helen Handbury Chair of Adolescent Health in the University of Melbourne’s Department of Paediatrics.

GEORGE

I grew up in Melbourne’s leafy eastern suburbs and went to Xavier College. Unlike Susan I had no family connection with medicine but early on had some inkling of a world beyond Australia. My father led an early drive for Australian manufacturers to invest in Asia and my mother was a mad-keen collector of European art and craft. I landed in medicine at the University of Melbourne and spent six years trying to work out where my real interests lay. It’s probably no surprise that I headed to the UK after internship to spend 10 years in London with a brief stint in Germany.

In the UK, I trained in psychiatry at the Royal Free, Tavistock Clinic, University College and Maudsley Hospitals, doing a lot of work with adolescents and young adults: drug and alcohol dependence, student health, eating disorders, family therapy, and intellectual disability. Professor Anthony Mann from the then Institute of Psychiatry was a fabulous mentor who took me into epidemiology, which has remained at the core of my research.

Looking back, it is clear how these different threads took me to research in adolescent health. When I came back to Melbourne, the Centre for Adolescent Health had just been established led, by now Professor Emeritus Glenn Bowes AO, another generous mentor. That was in the early 1990s when we were beginning to recognise adolescence was changing and with it came new problems in mental health and drug use. Until that time, we believed that adolescents would grow out of these problems,

a view that led to a benign but problematic neglect of young people in research, policy and practice.

The Centre and the University have provided a great base for my work.

It extends from domestic research to projects with partners in India, China, Japan, South Africa, Bangladesh as well as the UK and US. Quite honestly, this is where together the group, and the University of Melbourne, has led the world in adolescent health.

Susan and I often joke that she has become more like a psychiatrist and me a paediatrician. We complement each other. She is more people oriented and I am more focused on getting the task done. I take leadership around the technical and research side and Susan around education, training and mentorship of the next generation of clinicians. It’s

not a conventional leadership structure – we have given up trying to draw the organisational chart for years – but it works. We both have partnerships and advisory roles across the UN system, with leading universities and the World Bank.

The world today is very different for this generation. The journey to adulthood was already a lot more difficult but the indirect consequences of the pandemic are going to make things much harder. Every generation of adolescents meets a new set of challenges with their own creativity, but it is still important that we ensure this isn’t a lost generation.

That means different thinking from governments. We often talk about financial capital, but that ultimately depends on human capital and for any country that lies in the capabilities of its young people. A big challenge for our university is how we make that investment in the capabilities of this next generation facing the formidable challenges of a post-COVID world.

SUSAN

My family made an early ‘tree change’ when we moved from Melbourne to a 1500-acre property in north east Victoria when I was in grade six. My early interests in agriculture and veterinary science finally morphed into medicine, which saw me follow in my mother’s footsteps (Dr Barbara Sawyer (nee Stuart), MBBS 1955). In retrospect, I learnt a lot about adolescence through moving from Preshil, a pretty alternative primary school, to Wodonga High School. It was a major cultural change, as was the year I spent as an exchange student in Japan after Year 11.

After graduating from medicine, I started my paediatric training at the Royal Children’s Hospital (RCH). I specialised in respiratory paediatrics, and my higher degree focused on the new challenges faced by adolescents with cystic fibrosis. That coincided with the establishment of the Centre for Adolescent Health in 1991, and my emerging interest in adolescent health and medicine was fostered by its director, Professor Glenn Bowes AO.

After postdoctoral studies at Harvard, I returned to an academic appointment in the Department of Paediatrics in late 1995, which saw me juggling adolescent health and respiratory medicine. I remember when I returned from Boston thinking that George was the research boffin in the basement.

I didn’t come across him much in my day to day role early on, but we have worked closely together for the past 20 years, effectively running the Centre for Adolescent Health together, initially with George at the helm (1999-2005) and then me.

The first decade of our work in adolescent health focused on adolescents in Australia. George and Glenn started the first longitudinal study of adolescent health and wellbeing, which proved highly influential. Beyond expanding the adolescent medicine clinical service at the RCH, I set about mainstreaming the teaching and training of adolescent health and medicine locally and then to develop the pathway for accreditation of specialist training in Adolescent and Young Adult Medicine within the Royal Australasian College of Medicine.

Our work has helped shape wider views about the significance of investing in adolescence, not just in high-income countries like Australia but also in low and middle-income countries and importantly, by the various UN agencies. The Lancet Commission on Adolescent Health and Wellbeing is an example of this joint leadership as is our MOOC on Global Adolescent Health.

We married eight years ago. In the context of our personal relationship, one can perhaps push harder or explore themes more deeply than one might be prepared to do with other work colleagues. Working together has taken each of us to places that otherwise, individually, I think we might not have gone. I don’t think we disagree on any of the big things. It’s rather a sense of a different perspective that we each bring.

The acute health impacts of COVID-19 are disproportionately experienced by older Australians but the potential for long-term scarring from interruption to education and employment will be carried by adolescents and young adults throughout their lifetimes. There will need to be a new set of policies that respond to these challenges. Without focused investment, we will see deepening of the existing inequities between those who are better resourced and those who are vulnerable or marginalised.

Yet, the agility with which our governments and communities have engaged in responding to COVID-19 is also exciting. The world’s young people will have high expectations about how this same level of collaboration can be brought to even larger existential threats, like climate change. A continued openness of spirit will be needed. It’s going to be a very interesting period ahead of us.

To hear more about Professor Susan Saywer’s work tune into the Chiron podcast: