– Source:The Lancet has released its second global commission report on Adolescent Health and Wellbeing. Adolescents are defined as 10- to 24-year-olds. The report builds on the first one, done in 2016. The latest report presents substantial original research that supports actions it recommends to be taken across sectors as well as at global, regional, country and local level. The co-chairs of the commission, Sarah Baird, Alex Ezeh and Russell Viner, together with the youth commissioners lead, Shakira Choonara, give a guide to the report’s findings.
What were the key findings?
The report noted significant improvements in some aspects of adolescent health and wellbeing since the 2016 report. These include reductions in:
communicable, maternal and nutritional diseases, particularly among female adolescents
the burden of disease from injuries
substance use, specifically tobacco and alcohol
teenage pregnancy.
It also found that there had been an increase in age at first marriage and in education, especially for young women.
Despite this progress, adolescent health and wellbeing is said to be at a tipping point. Continued progress is being undermined by rapidly escalating rates of non-communicable diseases and mental disorders, accompanied by threats from compounding and intersecting megatrends. These include climate change and environmental degradation, the growing power of commercial influences on health, rising conflict and displacement, rapid urbanisation, and the aftermath of the COVID-19 pandemic.
These megatrends are outpacing responses from national governments and the international community.
What’s unique about today’s cohort of adolescents?
Born between 2000 and 2014, this is the first cohort of humans who will live their entire life in a time when the average annual global temperature has consistently been 0.5°C or higher above pre-industrial levels.
At roughly 2 billion adolescents, they are the largest cohort of adolescents in the history of humanity. And this number will not be surpassed as populations age and fertility rates fall in even the poorest countries.
They are the first generation of global digital natives. They live in a world of immense resources and opportunities, with unprecedented connectedness made possible by the rapid expansion of digital technologies. This is true even in the hardest-to-reach places.
Growing participation in secondary and tertiary education is equipping adolescents of all genders with new economic opportunities and providing pathways out of poverty.
These opportunities, however, are not being realised for most adolescents. Increasing numbers continue to grow up in settings with limited opportunities. In addition, investments in adolescent health and wellbeing continue to lag relative to their population share or their share of the global burden of disease.
Investments in adolescents accounted for only 2.4% of the total development assistance for health in 2016-2021. This was despite the fact that adolescents accounted for 25.2% of the global population in that period and 9.1% of the total burden of disease. We use development assistance as a measure because, while governments also invest in adolescents, it’s difficult to account for how much this is. For example, when a government supports a health facility, it serves the entire population.
Yet, the report provides evidence to show that the return on investments in adolescent health and wellbeing is highly cost-effective and at par with investments in children.
What’s the news for adolescents in Africa?
The report recognises the special place of Africa in the global future of adolescents. It notes that, by the end of this century, nearly half of all adolescents will live in Africa.
Currently, adolescents in Africa experience higher burdens of communicable, maternal and nutritional diseases, at more than double the global average for both male and female adolescents. They also have a higher prevalence of anaemia, adolescent childbearing, early marriage and HIV infection. They are much less likely to complete 12 years of schooling and more likely to not be in education, employment, or training.
Female adolescents in sub-Saharan Africa have the highest adolescent fertility rate at 99.4 births per 1,000 female adolescents aged 15-19 (the global average is 41.8). They have also experienced the slowest decline between 2016 and 2022.
Globally, there was progress in reducing child marriage between 2016 and 2022. But in eight countries in 2022, at least one in three female adolescents aged 15–19 years was married. All but one of these eight countries were in sub-Saharan Africa. Niger (50.2%) and Mali (40.6%) had the highest proportion of married female adolescents.
The practice of child marriage is declining in south Asia and becoming more concentrated in sub-Saharan Africa. As the report notes:
it continues because of cultural norms, fuelled by economic hardships, insurgency, conflict, ambiguous legal provisions, and lack of political will to enforce legal provisions.
What should be Africa’s focus areas?
Beyond adolescent sexual and reproductive health concerns in sub-Saharan Africa, obesity is increasing fastest in the region. This illustrates the vulnerability of adolescents to the power of commercial interests.
Since 1990, obesity and overweight has increased by 89% in prevalence among adolescents aged 15–19 years in sub-Saharan Africa. This is the largest regional increase.
The absence of data on adolescents is a problem. Adolescents in sub-Saharan Africa are absent in many data systems. For example, data on adolescent mental health in sub-Saharan Africa is virtually absent.
Stronger data systems are needed to understand and track progress on the complex set of determinants of adolescent health and wellbeing.
Another area of concern is the massive inequities within countries, often gendered or by geography. While female adolescents in Kenya are experiencing substantial declines in the burden of HIV and sexually transmitted infections, adolescent males are experiencing increasing burdens. In South Africa, years of healthy life lost to maternal disorders show more than 10-fold differences between the Western Cape and North West provinces.
Where there’s been strong political leadership, remarkable changes have been seen. Take the case of Benin Republic. The adolescent fertility rate in the country declined from 26% in 1996 to 20% in 2018 and child marriage from 39% to 31% over the same period. Strong political leadership has also led to substantial reductions in female genital mutilation or cutting. This fell from 12% of girls in Benin in 2001 to 2% in 2011–12 among 15–19-year-old girls in Benin Republic. Political leadership also facilitated the expansion, by the national parliament in 2021, of the grounds under which women, girls, and their families could access safe and legal abortion.
But for every country that takes positive steps to protect the health and wellbeing of adolescents, several others regress.
The last decade has witnessed regression in several countries. In 2024, The Gambia attempted to repeal a 2015 law criminalising all acts of female genital mutilation or cutting. In 2022, Nigeria’s federal government ordered the removal of sex education from the basic education curriculum.
What are the recommended courses of action?
The report calls for a multisectoral approach across multiple national ministries and agencies, including the office of the head of state, and within the UN system.
Coordination and accountability mechanisms for adolescent health and wellbeing also need to be strengthened.
Laws and policies are needed to protect the health and rights of adolescents, reduce the impact of the commercial determinants of health, and promote healthy use of digital and social media spaces and platforms.
Strong political leadership at local, national, and global levels is essential.
The report also calls for prioritised investments, the creation of enabling environments to transform adolescent health and wellbeing, and the development of innovative approaches to address complex and emerging health threats.
It calls for meaningful engagement of adolescents in policy, research, interventions and accountability mechanisms that affect them.
Without these concerted actions, we risk failing our young people and losing out on the investments being made in childhood at this second critical period in their development.
The current adverse international aid climate is particularly affecting adolescents as much development assistance relates to gender and sexual and reproductive health. Concerted action in addressing adolescent health and wellbeing is an urgent imperative for sub-Saharan Africa.
Alex Ezeh is a fellow at the Stellenbosch Institute for Advanced Study (Stias).
Russell Viner and Sarah Baird do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.
By Alex Ezeh, Dornsife Endowed Professor of Global Health, Drexel University And
Russell Viner, Professor of Child and Adolescent Health, UCL And
Sarah Baird, Professor, George Washington University
