London School of Hygiene & Tropical Medicine

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. 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. Today they also face new challenges, including rising levels of obesity and mental health disorders, high unemployment, and the risk of radicalisation.

The authors warn that the costs of inaction are enormous, and the 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.

The Commission brings together 30 of the world's leading experts from 14 countries and two young health advocates, led by the London School of Hygiene & Tropical Medicine, University of Melbourne, University College London and Columbia University Mailman School of Public Health. Researchers from the School involved in the Commission include Professor David Ross (now at the World Health Organization), Professor Vikram Patel and Dr Jane Ferguson.

Adolescents aged 10-24 years represent over a quarter of the population, 89% of whom live in developing countries. Although global health efforts have been successful in improving the health of children under five in the past few decades, this has not been matched by a similar response in older age groups.

Global mortality has fallen for young people aged 10-24 years since 1990, but 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, published alongside the Commission. The analysis reveals that:

• HIV/AIDS, road traffic accidents, and drowning caused a quarter of deaths in 10-14 year olds globally in 2013
• Diarrhoeal and intestinal infectious diseases, lower respiratory infections, and malaria contributed to 21% of deaths
• Road traffic accidents (14.2% and 15.6%), self-harm (8.4% and 9.3%), and violence (5.5% and 6.6%) were the leading causes of death for 15-19 year olds and 20-24 years olds respectively
• Depression resulted in the largest amount of ill health worldwide in 2013, affecting more than 10% of 10-24 year olds
• This was followed by the rising burden of skin and subcutaneous diseases (9.9%) like acne and dermatitis

The fastest-growing risk factor for ill health in young people aged 10-24 years over the past 23 years is unsafe sex. Alcohol remains the world's leading risk factor for ill health in young adults aged 20-24 responsible for 7% of the disease burden, followed by drug use accounting for 2.7%.

Video: Chiedza's song - A story from Zimbabwe in support of the Lancet Commission on Adolescent health and wellbeing

Most of these health problems are preventable and treatable, and the authors stress that tackling them will also bring huge social and economic benefits.

The Commission highlights that adolescence is a critical time of formative growth and brain development second only to infancy. Most health problems and lifestyle risk factors for disease in later life also emerge during these years, such as mental health disorders, obesity, smoking and 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, and adolescents aged 10-24 years have the poorest healthcare coverage of any age group.

The authors make several recommendations to improve prospects for adolescent health and wellbeing, including 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.

Publication

• Our future: a Lancet commission on adolescent health and wellbeing, 9 May 2016

Related links

• MARCH Centre (The Centre for Maternal, Adolescent, Reproductive and Child Health)
• HAYA Research Unit (Healthy Adolescents & Young Adults)