Global health efforts need to catch up with young people

Adolescent health globally has worsened over the last 25 years as the positive gains from health efforts have been outpaced by rapid population growth in low-income countries facing the world’s worst health challenges.

There are now 1.8 billion adolescents in the world, up 20 per cent since 1990. But of these, 430 million or 24 per cent, now suffer from iron deficiency (anaemia), an increase of 74 million. And in a health crisis that is uniquely serious across all countries, some 324 million young people are overweight or obese, a number that’s doubled in just 25 years.

But while the first ever comprehensive attempt to measure the health and wellbeing of adolescents makes sobering reading, it has given the world a unique roadmap to improving adolescent health.

“For some countries we have made tremendously good progress in adolescent health, but as a global community we simply haven’t kept pace with the need,” says Dr Peter Azzopardi, who has led the global effort to finally put numbers against global adolescent health indicators.

The results are now published in The Lancet medical journal.

“For very good reasons, global health programming and policy has focused on child and maternal health to address high child and maternal mortality. But when it comes to adolescents we have just assumed that they’re relatively healthy. As a result we either haven’t collected the data, or when we have, we haven’t systematically reported on it. But the time really is now for focusing on adolescent health”.

“Investments in adolescent health can bring a triple dividend – healthier adolescents now, healthier adults, and a healthier next generation,” says Dr Azzopardi, health researcher at the Burnet Institute, Murdoch Children’s Research Institute and the University of Melbourne.

One of the key insights from the data is that global health efforts need to be better prioritised and targeted.

The report shows that in wealthier countries the emphasis needs to be on addressing adolescent health risks like substance use, binge drinking and obesity, but in low income countries a key priority still needs to be on improving the social determinants of health like education, access to contraception and tackling high rates of child marriages and teen pregnancies.

“This is really important to understand because it is the wealthier countries that have largely set the adolescent health agenda and their focus has been on health risks.

“But the data is telling us that we need to broaden our lens and improve the social determinants of health in these other countries, as well as respond to the disease burden and injury.”

Back in 2016 The Lancet Commission set out 12 indicators of global adolescent health (for 10 to 24 year-olds) covering health outcomes, risks and social determinants. They were:

• Health Outcomes: Communicable diseases, non-communicable diseases, injuries
• Health Risks: Anaemia, tobacco smoking, alcohol binge drinking and overweight and obesity
• Determinants: Child marriage, adolescent pregnancies, access to contraception, secondary school completion, and access to employment, education or training

This latest report has now put the numbers on those indicators.

A key challenge for the researchers was finding data that was comparable across countries and filling in the gaps in information. To deal with this The Lancet researchers used modelled data to harmonise available information and fill in the gaps, creating a consistent global picture for the first time.

The results allowed the researchers to group countries into three groups - each with a distinct adolescent health profile.

The first group (typically including high and middle-income countries like the US, China and Australia) were countries where the adolescent health burden is predominantly comprised of non-communicable diseases.

The second group of countries were those where, in addition to non-communicable diseases, adolescents faced high rates of injury and included countries like Russia, Brazil and Kazakhstan.

Finally there are the countries where in addition to these health issues, adolescents faced high rates of communicable, maternal and nutritional disease. These countries are mainly sub-Saharan Africa, India, Pakistan and parts of South East Asia and the Pacific.

“This is a useful way to break up the world because it can better guide the sorts of health programs needed in each country group,” says Dr Azzopardi.

In measuring health outcomes the researchers used disability-adjusted life years per 100,000 people (DALYs), which is an estimate of healthy life years lost to a condition.

For example, among US adolescents only 500 DALYs per 100,000 are lost to communicable, maternal and nutritional diseases, but the non-communicable disease burden is about 9,500 per 100,000.

In India, lost DALYs to communicable diseases is much larger at around 5,000 DALYs per 100,000, while the loss from non-communicable diseases remains high at around 8,000 DALYs per 100,000.

The health risks of both countries are also very different. Rates of anaemia among adolescents are much larger in India at 54 per cent among females and 37 per cent among males, compared with just seven per cent and 2.3 per cent respectively in the US. But in the US about 44 per cent of adolescents are overweight or obese compared with just 10.5 per cent in India.

Similarly, in the US the proportion of 15 to 19-year-olds binge drinking at least once in the last 12 months is 33 per cent among males and 13 per cent among females, compared with India where rates of binge drinking are just three per cent and one per cent respectively.

“By taking a broad look at adolescent health and wellbeing, including the outcomes and the factors driving them, we can guide health intervention in a truly integrated way,” says Dr Azzopardi.

Dr Azzopardi hopes the indicators will be a platform for improving data collection and analysis across the world to better inform health policies, both internationally and in-country.

But he says improved data will depend on better engaging with adolescents, including exploring new ways of collecting data through digital platforms.

“Our usual way of collecting data from health systems and household level surveys isn’t going to cut it with adolescents. We need make better use of technology and digital platforms, because that’s where young people are.”

“And we need to remember that if we want a prosperous and secure world we need to ensure the health of our adolescents because it is healthy adolescents that drive socio-economic development.

“If we don’t invest in young people we are setting ourselves up for instability and insecurity.”

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