Reasons for growing attention
There are many reasons for the growing attention to the health of adolescents.
Important for today and tomorrow. First, there are many adolescents, often more than 20% of a country’s population.39 Low and middle income countries have the largest proportions of adolescents, a result of the success of child survival interventions in combination with high fertility rates.
Second, as this cohort ages, the foundations laid during adolescence in terms of health, education and skills will have profound implications for social and economic development.40 41 This will be true both for countries where fertility and childhood mortality are beginning to decrease and for countries with aging populations and low fertility.
Adolescents:demographic situation, trends and projections
Third, healthy, educated, skilled adolescents are important not only for the future but also for the present. They are a key asset and resource, with great potential to contribute to their families, communities and countries. Over the years the recognition has grown that adolescents are actors in social change, not simply beneficiaries of social programmes.42 43
Graphic showing differencesA better understanding. The surge of interest in adolescent health also responds to our improved understanding of the developmental processes taking place during the second decade of life. For example, recent research has shown that the adolescent brain is still developing and that it continues to develop well into early adulthood.44 We now know much more about why and how interventions should be specifically tailored for this segment of the population.
We have also learned that, contrary to popular belief, there is a significant burden of disease during the adolescent years.45 In fact, in many countries adolescents have benefitted much less from decreases in mortality than children in the first decade of life.46
Viner R et al. 50-year mortality trends in children and young people: a study of 50 low-income, middle-income, and high-income countries. The Lancet, 2011, 377(9772):1162–1174.Recognizing neglected problems. Sexual and reproductive health problems—for example, maternal mortality and HIV/AIDS—remain a major cause of death and disease among adolescents in some regions. But it is increasingly clear that many other health problems during adolescence are important, preventable but often neglected. For example, intentional and unintentional injuries and mental health problems are major causes of mortality during the second decade.
Furthermore, many health-compromising behaviours that begin during adolescence have profound consequences for health and development during adolescence and also for long-term well-being—for example, use of tobacco, alcohol and other psychoactive substances, and the consumption of obesogenic foods.
Knowledge about determinants. We also better understand the determinants that shape health-related behaviours and underlie the health of adolescents. The same social determinants that affect all age groups affect adolescents—for example, social and economic disparities. Additionally, a range of risk and protective factors arise from adolescents’ more immediate environments of families, peers and schools and from the social values and norms surrounding them.47
The effects of determinants may be positive or negative depending on the individual and the context—for example, migration.48-50 Many risk behaviours have common determinants and are causally linked—for example, alcohol use, unsafe sex and violence.
Determinants explain why the health of adolescents differs between and within countries. Age, gender, socio-economic status, ethnicity, and urban or rural domicile all make a difference. Clarity about how different determinants affect the health of adolescents is essential for the development of appropriate and effective interventions.51
Some are more vulnerable. Some adolescents may be particularly vulnerable and so have greater needs for a range of services. These adolescents include those living with disabilities or chronic illnesses; those exploited and abused; and those stigmatized and marginalized because of sexual orientation or ethnicity; adolescents living in remote areas or caught up in social disruption from natural disasters or armed conflicts; those who are institutionalized; those exposed to domestic violence or substance abuse in the family; and adolescents without access to education, health services or social protection. Programmes need to take into consideration the heterogeneity of adolescents and specifically target the most vulnerable to achieve equity in the delivery of interventions.
A key decade in the life-course. The health problems and health-related behaviours that arise during adolescence shape adult health, with important implications for public health. For example, many of the noncommunicable diseases of the adult years arise from behaviours that start, or are reinforced in adolescence, including tobacco use, harmful use of alcohol, unhealthy diets and physical inactivity.
Graphic showing links
Similarly, adolescents’ sexual and reproductive behaviour sets the course throughout adolescence and the adult years.52 Mental health problems, such as depression and anxiety, frequently first appear during adolescence and youth but go unrecognized and untreated,53 54 with subsequent effects on adult mental health, social functioning and parenting.
A life-course perspective on adolescent health should guide the development and implementation of policies and programmes. Problems that arise during the first decade of life affect the health and development of adolescents.55 56 Adoption of health compromising behaviours during early adolescence can adversely affect overall adolescent development.57 The health and development of adolescents, in turn, has significant repercussions not only on their adult health58 but also on the health of their future children.59
Prenatal and early childhood interventions60 61 are, therefore, important for adolescent health. But this investment may be squandered if adolescent health and development do not also receive adequate attention. At the same time, the second decade may provide opportunities to undo damage done in earlier years.
Video of George Patton
Health is the basis for everything; if you want to study or work, you need to be in good physical and mental health.
female, 15-17, South Africa
Adolescents on what can be done to improve services: Improve and make it easier for young people to access services and information so that we may be more aware and up-to-date on what is good for our health.
female, 15-17, Paraguay
Health is extremely important because it has an enormous effect on our capacity to concentrate and work well. Being careless about it could be detrimental to our future.
female, 18-19, France
Health is important to me because being in a state of complete health means being able to function at my full potential, and hence being able to perform at my best and contribute as much as I can to the activities I am involved in.
female, 15-17 Switzerland
Without it (health), we cannot reach the potential of our lives that we could reach if we are healthy. Both in a state of mind and physical. Every person should be equal in that respect.
male, 15-17, United Kingdom
