Investing in adolescent health and wellbeing could transform global health for generations to come, says major report — ScienceDaily

Decades of chronic neglect and underinvestment have had serious adverse effects on the health and wellbeing of adolescents aged 10 to 24, according to a major new Lancet Commission on Adolescent Health and Wellbeing launched in London on May 10, 2016. Two-thirds of young people are growing up in countries where preventable and treatable health problems like HIV/AIDS, teenage pregnancy, unsafe sex, depression, injury and violence remain a daily threat to their health, well-being and life chances.

Evidence shows that behaviors that begin in adolescence can determine health and well-being for a lifetime. Today, adolescents also face new challenges, including rising levels of obesity and mental health disorders, high unemployment and the risk of radicalization.

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

The Commission’s findings should be a wake-up call for a 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 our entire future. There is no more urgent task in global health than ensuring they have the resources to do so. to invest urgently in their health, education, livelihoods and participation,” says the Commission’s lead author, Professor George Patton, from the 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 to 24 represent more than a quarter of the population (1.8 billion), 89% of whom live in developing countries. Their number is expected to reach about 2 billion by 2032. Adolescence is a critical period of formative growth and brain development after infancy. “Puberty sets off a cascading process of brain development and emotional change that continues into the mid-twenties. It brings a different and more intense engagement with the world beyond an adolescent’s immediate family. processes shape an individual’s identity and the capacities he/she takes on later in life, and profoundly shape lifelong health and well-being,” says Professor Patton.

Most health problems and lifestyle risk factors for disease later in life also appear during these years (eg, mental health problems, obesity, smoking, unprotected sex) . But because adolescence is generally considered the healthiest period of life, young people have attracted little interest and too few resources. Indeed, adolescents between the ages of 10 and 24 have the lowest healthcare coverage of any age group.

Although global health efforts have succeeded in improving the health of children under 5 over the past few decades, this has not been accompanied by a similar response in older age groups. Although global mortality has fallen among young people aged 10 to 24 since 1990, the pace of the decline has been slower than among younger children, particularly among men, according to a major new international analysis of the results of the Global Burden of Disease (GBD) project led by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, Seattle, USA, published alongside the Commission.

IHME analysis reveals that HIV/AIDS, road traffic accidents and drowning caused a quarter of deaths among 10-14 year olds globally in 2013, diarrheal and intestinal infectious diseases, infections of lower respiratory tract and malaria contributing an additional 21%. death. Road accidents (14.2% and 15.6%), self-harm (8.4% and 9.3%) and violence (5.5% and 6.6%) were the main causes of deaths among 15-19 year olds and 20-24 year olds respectively.

Depression led to the highest number of health problems worldwide in 2013, affecting more than 10% of 10-24 year olds, followed by the growing burden of skin and subcutaneous diseases (9.9%) such as acne and dermatitis.

The fastest growing risk factor for poor health among young people aged 10 to 24 over the past 23 years is unprotected sex. Alcohol remains the leading global risk factor for poor health among young adults aged 20-24, responsible for 7% of the disease burden, followed by drug use accounting for 2.7%.

“Our data shows a clear need to redouble efforts to improve health and reduce the burden of disease among young people. Continued inaction will have serious consequences for the health of this generation and the next,” warns the Lead author Ali Mokdad, Professor of Global Health at IHM. “Most of these health problems are preventable and treatable and solving them will also bring enormous social and economic benefits. unique to each country. Future work needs to examine the effect and cost-effectiveness of such interventions.”

The Commission finds that some of the most effective actions to improve the health and well-being of adolescents take place in sectors other than health services. “The best investment we can make is to ensure access to free, quality secondary education,” says Professor Patton. “Each year of education beyond age 12 is associated with fewer adolescent births and fewer adolescent deaths among boys and girls. A healthy, educated workforce has the potential to shape a country’s economic prospects.”

Engaging young people in transforming their well-being, personal development and health is crucial, say the authors. Digital media and new technologies offer remarkable opportunities to engage and empower young people to drive change. There is also an urgent need to ensure that all young people have opportunities and access to universal health coverage, regardless of age, gender, sexual orientation, marital and socio-economic status, especially the marginalized.

“Young people are the world’s greatest untapped resource,” UN Secretary-General Ban Ki-moon says in a linked comment. “Adolescents can be essential driving forces in building a dignified future 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 capacities at over the next 15 years, we can ensure the success of the SDGs. To me, the acronym ‘SDGs’ also stands for ‘Sustainable Development Generation’, and sustainability means engaging future generations today.”

The Commission’s authors make several recommendations to improve the outlook for adolescent health and wellbeing, echoing those of the Global Strategy for Women’s, Children’s and Adolescents’ Health launched in September 2015 – leading to the urgent need expand access to free secondary education; take seriously laws that empower and protect adolescents, such as guaranteeing 18 as the minimum age of marriage; and continue to gather better evidence for action, particularly around mental health and violence. Other recommendations include the collection and reporting of a minimum set of priority indicators for adolescent health reflecting disease burden and risk factors, and for strong and transparent health governance and accountability. teenagers.

Because adolescent health varies from country to country and within countries, different interventions will be needed to meet the unique needs of each country. The Commission therefore groups countries into three categories – multiple burden countries, excess injuries and non-communicable diseases – to help donors and national governments assess the best set of interventions.

Melinda Gates of the Bill & Melinda Gates Foundation adds, “My children’s generation is better equipped to push the boundaries of human possibility than any that came before. But while the responsibility for their health and well-being lies with everyone, the responsibility currently lies 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 on the health and development agenda. We can’t afford to neglect them any longer.”

Key global findings from the GBD document:

  • While global efforts to improve the health of children under 5 have led to major improvements among young people, the leading causes of death among young people aged 10 to 24 have changed remarkably little from 1990 to 2013, with traffic accidents, self-harm, violence and tuberculosis remaining in the top five.
  • Maternal disorders were the leading cause of death among young women in 2013, responsible for 17% of deaths among women aged 20-24 and 11.5% among girls aged 15-19.
  • The main risk factors for death among young people aged 10 to 14 have not changed in the past 23 years, with unsafe water, unsanitary sanitation and hand washing remaining among the top three. Diarrheal and intestinal diseases are still responsible for 12% of deaths among girls aged 10-14.
  • Injuries, mental health issues, common infectious diseases, and sexual and reproductive health issues are major health issues among young people.
  • Among males (18.8%) and females (15.6%) aged 10-14, iron deficiency is the leading cause of poor health (years lived with disability (YLD) — this is i.e. time spent in less than optimal health), while depressive disorders are the leading cause of poor health among women aged 15-19 and 20-24.
  • The two main contributors to global health loss for both sexes are mental health disorders and road traffic accidents (measured in terms of disability-adjusted life years (DALYS) – the proportion of years of healthy life lost due to illness rather than death).
  • These causes of health loss differed by sex: for men, road accidents were ranked among the top four contributors to all age groups, while women lost much more health to the deficiency of iron and depression than their male counterparts.
  • Unprotected sex has become a key risk factor for loss of health (DALY) among men and women aged 15 to 19, rising from 13th place in 1990 to 2nd place in 2013.

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