The Lancet: Globally the health of adolescents is at a tipping point; action needed to tackle rising threats to young people’s health and wellbeing

(Press-News.org) New analysis indicates that without targeted action by 2030 at least half of the world’s adolescents (over 1 billion) will still live in countries where they are at risk of experiencing poor health across many indicators, including mental health and overweight.   Over the past decade, progress in adolescent health and wellbeing has been mixed and uneven. While global rates of smoking and alcohol use have declined and educational participation - especially among young women - has increased, obesity-related diseases and mental health disorders are rising in all regions. The second Lancet Commission on adolescent health and wellbeing highlights that today's adolescents, the first generation to grow up under harsher climate conditions and the pervasive presence of digital technologies, disproportionately face emerging global health threats. Adolescents in low- and middle-income countries represent over a quarter of the population and bear a disproportionate share of the global disease burden (9.1%) - yet receive just 2.4% of global development aid.  Adolescents and youth from over 36 countries were central to the Commission. They call for young people to claim their right to be involved in shaping policies, in research, and in advancing solutions that directly affect their lives. 
By 2030, there will still be over 1 billion of the world’s adolescents (aged 10-24 years) living in countries where preventable and treatable health problems like HIV/AIDS, early pregnancy, unsafe sex, depression, poor nutrition and injury collectively threaten the health and wellbeing of adolescents, suggests a new analysis from the second Lancet Commission on adolescent health and wellbeing.

Commission co-chair, Professor Sarah Baird, George Washington University (USA) says, “The health and wellbeing of adolescents worldwide is at a tipping point, with mixed progress observed over the past three decades. Whilst tobacco and alcohol use has declined and participation in secondary and tertiary education has increased, overweight and obesity have risen by up to eight-fold in some countries in Africa and Asia over the past three decades, and there is a growing burden of poor adolescent mental health globally. Additionally, the challenges faced by the world’s adolescents are at risk of being exacerbated by emerging global issues including climate change, world conflicts and a rapid transition to a more digital world.

“Investing in the health and wellbeing of young people is crucial for safeguarding our collective future. We must prioritise investment in adolescent health and wellbeing through initiatives including those that strengthen schools to promote health and wellbeing and to ensure universal access to healthcare for adolescents. Furthermore, adolescent engagement and activism must be central to creating the social and community changes we need to foster a more just society and create a healthier planet with more opportunities for everyone.”

Insufficient and uneven progress
 
A decade since the first Lancet Commission on adolescent health and wellbeing published in 2016 [1], there have been global improvements in education, and in reducing global rates of smoking and alcohol use. However, across many areas of adolescent health, progress has been undermined by the COVID-19 pandemic and a chronic lack of funding.
 
In a novel analysis using data from the 2021 Global Burden of Disease study [2], the Commission estimates that there were nearly 1.1 billion adolescents living in countries where preventable and treatable health problems like HIV/AIDS, early pregnancy, unsafe sex, depression, poor nutrition and injury remain a daily threat to their health, wellbeing, and life chances (which the Commission terms multi-burden countries). [3] 
 
This compares to just under 1 billion adolescents living in multi-burden countries in 2016 indicating, alongside population growth, a lack of progress in addressing adolescent health. New projections suggest that, without political will, policy initiatives and financial investments, there will still be more than 1 billion adolescents living in multi-burden countries in 2030.

Limited progress is evident in several critical areas impacting adolescents. The Commission estimates that nearly one-third of adolescent girls will be anaemic globally by 2030, highlighting inadequate efforts to tackle this issue. Anaemia can cause fatigue,hinder growth and cognitive development and, in extreme cases, lead to organ damage, making it crucial to address for the wellbeing of girls.

Similarly, adolescent mental health has seen a significant decline over the past three decades in countries with available data, a trend exacerbated by the COVID-19 pandemic. In 2030, the Commission projects 42 million years of healthy life will be lost to mental disorders or suicide (2 million more than in 2015). 
 
Additional projections indicate that one-third of adolescents in high-income countries, Latin America, and the Middle East will be overweight by 2030, underscoring the shortcomings in combating adolescent obesity. In 2030, the Commission projects 464 million adolescents globally will be overweight or obese (143 million more than in 2015).

Commission co-chair, Professor Alex Ezeh, Drexel University (USA) says, “Demographic shifts will continue to drive global progress or lack thereof in adolescent health and wellbeing. Africa’s share of global adolescents will increase from under 25% currently to more than 46% by 2100. Consequently, progress in improving the health and wellbeing of adolescents in Africa will increasingly determine progress in improving the health and wellbeing of adolescents globally. This calls for targeted attention to the needs of adolescents in Africa.”

New threats to adolescent health

The Commission identifies several significant new threats to adolescent health, emphasising that young people are navigating a rapidly changing world. Emerging challenges, such as climate change and the shift towards a more digital world, are expected to have a profound impact on young people’s future health and wellbeing.

Today’s adolescents are the first generation who will live their entire life with the average annual global temperature that has consistently been 0·5oC higher than pre-industrial levels. And by 2100, 1.9 billion adolescents will live in a world that is expected to warm around 2.8oC above pre-industrial times, bringing catastrophic risks for their health such as heat-related illnesses, reduction in food and water quality and availability, and a rise in mental health conditions related to climate events.

The Commission undertook a new systematic review to identify how climate change affects adolescent mental health. The review found that both quick acting climate disasters such as hurricanes and slower acting effects such as chronic food insecurity contribute to mental health conditions in adolescents such as post-traumatic stress disorder, anxiety and depression. [4]
 
Commissioner Dr Aaron Jenkins, University of Sydney (Australia), says, “I am profoundly encouraged by our Second Lancet Commission on adolescent health and wellbeing, which embraces the ecological foundations of human wellbeing—highlighting biodiversity, environmental integrity, and climate as pivotal determinants of adolescent health. This holistic approach underscores that safeguarding our planet’s health is inseparable from nurturing the potential and resilience of young people. For the first time, we are identifying and encouraging interventions that simultaneously advance adolescent health, ecological integrity, biodiversity conservation, climate change mitigation, and social justice. This integrative co-benefit strategy not only addresses the multifaceted challenges faced by today’s youth but also paves the way for a sustainable and equitable future.”
 
Additionally, the Commission highlights how the digital transition offers adolescents new opportunities for social interaction, education, employment, and health promotion. However, many key social and emotional experiences now occur online, raising concerns about potential harm to their development and wellbeing. While the impact of the digital world, especially social media, on adolescent mental health remains highly debated with limited causal evidence, there is a need to balance early protective actions with avoiding unintended harm by overly restricting digital access.
 
Actions to address adolescent health and wellbeing
 
The Commission highlights that current funding for adolescent health and wellbeing is not proportionate with the magnitude of the challenge nor targeted to areas of greatest need. 
 
An analysis of funding undertaken by the Commission finds adolescent health and wellbeing makes up only 2.4% of global aid, despite adolescents being 25% of the world population and making up 9% of the total burden of disease. [5] 
 
The Commission’s analyses of the returns on investments in adolescence show they are on par with investments in children aged 0–9 years, and that investments in children and adolescents are associated with better returns than investments in adults. The Commission’s exploration of the challenges facing the field of adolescent health suggest that investment is hampered by the absence of global and national leadership, governance and accountability for adolescent health and wellbeing, among many other factors. 
 
This is the first global Commission to prioritise and embed meaningful adolescent and youth engagement at every stage, co-led by ten diverse Youth Commissioners - aged 23 to 35 - spanning academia, civil society, and multilateral organisations. Their lived experiences, research expertise and leadership shaped the Commission, while Youth Solution Labs run by the Commission engaged over 200 adolescents across 36 countries to identify key priorities and develop actionable recommendations.
 
Youth Commissioner Dr Shakira Choonara, says, "Young people are navigating a rapidly changing world, and through this Commission we’ve heard the diverse and alarming concerns adolescents have about their health and wellbeing. However, there are also opportunities—and we've seen firsthand and through the Commission findings how adolescents are already stepping up as active citizens and powerful agents of change, from leading advocacy and activism to co-designing policies that shape the future of human health and planetary health. I am deeply inspired by the change youth leaders are bringing to their communities and to the global landscape. Investing in and engaging with our generation will build a healthier, more empowered, and better-equipped generation of future leaders." 

Quotes from authors cannot be found in the text of the Commission but have been supplied for the press release. 
 
References:
 
[1] https://www.thelancet.com/commissions/adolescent-health-and-wellbeing 
[2] https://ghdx.healthdata.org/gbd-2021 
[3] Multi-burden countries are defined by the Commission as countries where there are more than 2,500 Disability Adjusted Life Years in adolescents per 100,000 due to communicable, maternal or nutritional diseases.
[4] See appendix 12 for the systematic review on climate change and adolescent wellbeing
[5] See appendix 7 for the analysis of development assistance for health
 
The labels have been added to this press release as part of a project run by the Academy of Medical Sciences seeking to improve the communication of evidence. For more information, please see: http://www.sciencemediacentre.org/wp-content/uploads/2018/01/AMS-press-release-labelling-system-GUIDANCE.pd

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Funding: The Commission received funding from the Gates Foundation, Human Sciences Research Council, FIA Foundation, and Exemplars in Global Health. 

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