Invest in adolescent health & transform global health for generations

Professors George Paton and Susan Sawyer lead an International Lancet Commission on adolescent health, and present a major report on 20th July 2016 which recommends that investing in adolescent health and wellbeing could transform global health for generations to come.

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“Young people are the world’s greatest untapped resource,” says UN Secretary-General Ban Ki-moon.

“The Lancet Commission is a powerful reminder that there is more to do to meet the unique needs of adolescents. And the compelling findings of the Commission must serve as an important wake-up call to individuals, organisations, and governments to support a new approach,” says Melinda Gates

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 being presented in Melbourne on Wednesday 20th July, 2016. 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.

The Commission’s findings should be a wake-up call for major new investment in the largest generation of adolescents in the world’s history (1.8 billion) that will yield a triple dividend of benefits—today, into adulthood, and for the next generation of children.

“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.

The Commission brings together 30 of the world’s leading experts from 14 countries 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.

Adolescents aged 10–24 years represent over a quarter of the population (1.8 billion), 89% 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.

Most health problems and lifestyle risk factors for disease in later life also emerge during these years (eg, mental health disorders, obesity, smoking, unsafe sex). But because adolescence is generally thought to be the healthiest time of life, young people have attracted little interest and too few resources. Indeed, adolescents aged 10–24 years have the poorest health-care coverage of any age group.

The Commission finds that some of the most effective actions to improve adolescent health and wellbeing lie in sectors beyond health services (Commission, table 6) “The single best investment we can make is guaranteeing access to free, quality secondary education,” explains Professor Patton. “Every year of education beyond age 12 is associated with fewer births for adolescent girls and fewer adolescent deaths for boys and girls. A healthy, educated workforce has the potential to shape a country’s economic prospects.”

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 Adolescents’ 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.

Melinda Gates from The Bill & Melinda Gates Foundation adds, “My children’s generation is better equipped to expand the limits of human possibility than any that has gone before. But while responsibility for their health and wellbeing lies with everyone, accountability currently rests with no one. Bill and I are personally committed to advancing the adolescent health agenda through the work of our foundation, in partnership with governments and the international community. For too long adolescents have been the forgotten community of the health and development agenda. We cannot afford to neglect them any longer.”

The Commission was funded by the Bill & Melinda Gates Foundation, with smaller contributions from the MacArthur Fundation, The University of Melbourne, Murdoch Childrens Research Institute and Australia India Institute.