Investing in adolescent health and wellbeing could transform global health: report

Karachi: Decades of neglect and chronic underinvestment have had serious detrimental effects on the health and wellbeing of adolescents aged 10–24 years, according to a major new Lancet Commission on adolescent health and wellbeing.

The Commission brings together 30 of the world’s leading experts from 14 countries – including Professor Zulfiqar A. Bhutta, Founding Director of the Aga Khan University’s Centre of Excellence in Women and Child Health and co-Director of the SickKids Centre for Global Child Health in Toronto – and two young health advocates, led by four academic institutions: the University of Melbourne, Australia; University College London, UK; the London School of Hygiene & Tropical Medicine, UK; and Columbia University Mailman School of Public Health, USA.

“Given the burgeoning number of young people in Pakistan, both boys and girls, it is imperative that they play an active role in national development, supported by the requisite freedoms, rights and access to education and empowerment,” said Professor Bhutta. “Only by fully engaging and supporting our youth can Pakistan achieve its full potential.”

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The report says that two-thirds of young people are growing up in countries where preventable and treatable health problems like HIV/AIDS, early pregnancy, unsafe sex, depression, injury, and violence remain a daily threat to their health, wellbeing and life chances.

Evidence shows that behaviours that start in adolescence can determine health and wellbeing for a lifetime. Adolescents today also face new challenges, including rising levels of obesity and mental health disorders, high unemployment and the risk of radicalisation.

Adolescent health and wellbeing is also a key driver of a wide range of the Sustainable Development Goals on health, nutrition, education, gender, equality and food security, and the costs of inaction are enormous, warn the authors.

“This generation of young people can transform all our futures. There is no more pressing task in global health than ensuring they have the resources to do so. This means it will be crucial to invest urgently in their health, education, livelihoods, and participation,” says the Commission’s lead author Professor George Patton, University of Melbourne, Australia.

Adolescents aged 10–24 years represent over a quarter of the population (1.8 billion), 89 per cent of whom live in developing countries. Their number is set to rise to about 2 billion by 2032. Adolescence is a critical time of formative growth and brain development second only to infancy. 

“Puberty triggers a cascading process of brain development and emotional change that continues through to the mid-20s. It brings a different and more intense engagement with the world beyond an adolescent’s immediate family. These processes shape an individual’s identity and the capabilities he/she takes forward into later life. It profoundly shapes health and wellbeing across the life-course,” explains Professor Patton.

Although global health efforts have been successful in improving the health of children under 5 in the past few decades, this has not been matched by a similar response in older age groups. Although global mortality has fallen for young people aged 10–24 years since 1990, the pace of decline has been slower than in younger children, especially for males, according to a major new international analysis of findings from the Global Burden of Disease project led by the Institute for Health Metrics and Evaluation at the University of Washington, Seattle, USA, published alongside the Commission.

The IHME analysis reveals that HIV/AIDS, road traffic accidents, and drowning caused a quarter of deaths in 10–14 year olds globally in 2013, with diarrhoeal and intestinal infectious diseases, lower respiratory infections, and malaria contributing to a further 21 per cent of deaths. Road traffic accidents (14.2 per cent and 15.6 per cent), self-harm (8.4 per cent and 9.3 per cent), and violence (5.5 per cent and 6.6 per cent) are the leading causes of death for 15–19 year olds and 20–24 years olds respectively. 

It is crucial to involve young people in transforming their wellbeing, personal development, and health, say the authors. Digital media and new technologies offer remarkable opportunities to engage and empower young people to drive change. There is also a pressing need to ensure that all young people have opportunities and access to universal health coverage regardless of age, gender, sexual orientation, and marital, and socioeconomic status, particularly the marginalised. 

“Young people are the world’s greatest untapped resource,” says UN Secretary-General Ban Ki-moon writing in a linked Comment. “Adolescents can be key driving forces in building a future of dignity for all. If we can make a positive difference in the lives of 10-year-old girls and boys today, and expand their opportunities and capabilities over the next 15 years, we can ensure the success of the SDGs. For me, the acronym “SDG” also stands for “Sustainable Development Generation”, and sustainability means engaging future generations today.”

The Commission authors make several recommendations to improve prospects for adolescent health and wellbeing echoing those of The Global Strategy for Women’s, Children’s, and Adolescent’s Health launched in September, 2015 – leading with the urgent need to expand access to free secondary education; get serious about the laws that empower and protect adolescents such as guaranteeing 18 years as the minimum age for marriage; and continue gathering better evidence for action particularly around mental health and violence.

Other recommendations include collecting and reporting on a minimum set of priority indicators for adolescent health reflecting the burden of disease and risk factors, and for robust, transparent governance and accountability for adolescent health.

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