WHO(World Health Organization)
The world now has more young people than ever before – of the 7.2 billion people worldwide, over 3 billion are younger than 25 years, making up 42% of the world population. Around 1.2 billion of these young people are adolescents aged between 10 and 19 years.
Adolescence is a critical time of life. It is a time when people become independent individuals, forge new relationships, develop social skills and learn behaviours that will last the rest of their lives. It can also be one of the most challenging periods.
In this turbocharged neurological, physical, and emotional transition from childhood to adulthood, young people face a range of health risks. They are often exposed to harmful products such as tobacco, alcohol and drugs, they face greater risks of violence (including homicide) and road traffic injuries than in childhood, and can experience devastating mental health issues such as depression, anxiety, self-harm, substance abuse and addiction to video games, as well as eating disorders and suicide. Young people can also face sexual health issues such as sexually transmitted diseases or teenage pregnancy.
Many of these issues are linked to wider societal determinants and social norms. For example, pressures to conform to ideals about body image, normalization of recreational drinking in media, social exclusion, challenges in accessing support services, coupled with rapid physiological and neurological changes and the urge for exploration and experimentation, can make it hard to cope with the varied challenges that today’s youth will almost certainly encounter.
Youth voices from around the world
Depending on where they live in the world, young people may face an even wider range of threats to their health, including racial or gender discrimination or violence, human rights violations, conflict or social disruption from natural disasters, being overweight or obese, female genital mutilation (FGM), forced child marriages or sexual exploitation and abuse.
The numbers are striking: about 3000 adolescents die every day; in 2016, more than 1.1 million adolescents aged 10-19 lost their lives, mainly to preventable causes such as road injuries, complications of pregnancy or giving birth, or because of HIV/AIDS.
Prioritizing adolescent healthAdolesccents quote Kanem
Adolescent health is starting to attract the attention it deserves, and is increasingly prominent in global health initiatives. This includes the Global Strategy for Women’s, Children’s and Adolescents’ Health, areas such as mental health (young people’s mental health is the theme of 2018’s World Mental Health Day on 10 October) and management of sexually transmitted infections (growing rates of infections in adolescents was much discussed at the 2018 International AIDS conference in Amsterdam).
Yet, a comprehensive approach to adolescent health is often lacking, with this critical age group very much at risk of being left behind in the development agenda. “For a long time there has been an assumption – sustained by critical gaps in data – that adolescents are healthy. Most of them indeed are, but much less so than we used to think. Data show that the considerable gains from investments in maternal and child health programmes are not sustained in adolescence: the reduction in child mortality was not mirrored by a similar reduction in adolescent deaths,” says Dr Princess Nothemba (Nono) Simelela, WHO’s Assistant Director-General for Family, Women, Children and Adolescents.
“Youth are central partners and collaborators because of their inherent strength to create change. WHO remains committed to meaningfully engage youth in our work and to implement youth lens in our planning and actions,” says Ms Diah Saminarsih, WHO’s Advisor on Gender and Youth.
In 2017, WHO and other UN partners launched a major initiative called Accelerated Action for the Health of Adolescents (AA-HA!) to change the way countries tackle adolescent health. The AA-HA! guidance calls for a systematic inclusion of adolescents’ expectations and perspectives in health planning processes.
“With this guidance, we wanted countries to have an AA-HA! moment – not only as in, ‘aha, now I know what the problem is’, but also as in, ‘aha, now I know what the solution is’,” explains Dr Valentina Baltag, at the Department of Maternal, Newborn, Child and Adolescent Health, at WHO, who helped develop the guidance. “The guidance is not only about facts and figures to show where to invest, but is also a compilation of the most up-to-date, tangible information from research and practice on what works.”
Partners such as UNICEF, UNAIDS and UNFPA were critical in developing the guidance. “Health is made at home and is a result of many sectors’ direct or indirect interventions,” says Dr Stefan Peterson, Chief of Health at UNICEF. “The AA-HA! guidance sets out a broad approach to addressing the various aspects of adolescent health, helping governments to design comprehensive responses that meet the needs of adolescents and their communities,” he says.
Peterson says that UNICEF is prioritizing adolescents now because “Two decades of multisectoral investment are needed to produce a healthy, educated young adult. If we only focus on the first five years of a child’s life, adolescents end up falling through the cracks. Investing in adolescent health is key to unlocking lifelong health, productivity and national prosperity.”
A new WHO report on youth, health and development launched this week articulates how adolescent global and national leadership could be institutionalized and actively supported in WHO’s work with Member States and a diverse range of partners, including groups led by young people, to embed engagement with young people in every aspect of the health ecosystem.
WHO’s work on adolescence
The report refers to young people as a “powerhouse of human potential” and describes strategic opportunities to meaningfully engage them in transforming health and sustainable development. Young people can be critical agents of change, it says, if they are allowed to be part of the conversation in a fundamental way.
“With over 40% of the world’s population under the age of 24 years, young people have to be part of any meaningful solution to the world’s challenges—and this is their right. Ensuring young people’s meaningful, safe and effective engagement for health and sustainable development is a matter of urgency for Member States, WHO and partners, and young people themselves,” says Dr Shyama Kuruvilla, in WHO’s department for Family, Women’s and Children’s Health.
Gender differences
As boys and girls enter adolescence, health risks become increasingly skewed along gender lines. Some of the differences are biological, such as complications from teenage pregnancy or being at risk of being infected with human papillomavirus (HPV) that can lead to cervical cancer later in life – but many are shaped by societal gender norms such as expectations on girls to get married or on boys to earn an income at an early age.
Violence is one of the biggest threats that young people face – and much of this violence happens between peers. In the past year alone, one billion children worldwide – over half of all young people aged 2–17 years – have experienced emotional, physical or sexual violence. Both boys and girls experience high levels of violence, and policies developed need to be appropriate for the types of violence faced. 40% of 13-15 year olds were involved in a physical fight in the past 12 months.
Violence has a strong gender component: one in five girls under the age of 20 report experiencing sexual violence, compared to 8% of boys. Girls are more likely to experience sexual or physical violence from partners, or be forced into child marriage, trafficking, child labour, or genital mutilation.
Boys are more likely to be both victims and perpetrators of homicide, involving weapons such as firearms and knives: homicide is among the top five causes of death in adolescents, and males comprise over 80% of victims and perpetrators. Boys are also more likely to be in road traffic accidents, which can cost them their lives.Social and economic inequalities always have a detrimental effect on health, and nowhere is this more apparent than with young people.