At 1.8 billion strong, the current generation of 10 to 24 year olds is the largest in human history. Approximately 90 percent of these adolescents live in less developed countries. This poses an unprecedented challenge for health systems and social policies which largely struggle to meet the unique needs of young people, according to a new Lancet commission.

The United Nations projects that the number of adolescents in the world will continue to grow steadily before peaking towards the end of this century. The success or failures of the health system on this demographic will echo for decades as each generation’s young people become tomorrow’s leaders.

The commission organized by The Lancet consists of 30 leading experts from 14 countries and two adolescents who advocate for health issues, led by the University of Melbourne, University College London, London School of Hygiene and Tropical Medicine, and Columbia University Mailman School of Public Health.

They seek to reframe adolescence as a “huge opportunity” rather than a “big problem.” Today’s adolescents will not only act as the beneficiaries of the 17 Sustainable Development Goals to be achieved by 2030, but will indeed become the primary drivers of change over the next decade and a half.

“Adolescents and young people are our best chance to achieve radical change for a prosperous, healthy, and sustainable world,” writes United Nations Secretary-General Ban Ki-moon in a commentary.

Investing in adolescents leads to a “triple dividend” bringing “benefits during adolescence, across the life course, and into the next generation,” says the commission. For example, girls who get enough to eat during adolescence are less likely to encounter obstructed labor and obstetric fistula when they become pregnant, and their children are less likely to have low birth weight or be born prematurely.

Three Broad Categories

As with any global health task, it is impossible to evaluate the needs of an entire generation without considering contextual and cultural differences. The Lancet Commission places countries into three categories to better understand the different problems facing young people.

More than half of adolescents live in multi-burden countries. These countries are characterized by “high levels of all types of adolescent health problems, including diseases of poverty (HIV and other infectious diseases, undernutrition, and poor sexual and reproductive health), injury and violence, and non-communicable diseases (NCDs).” There are also pervasively high rates of “adolescent fecundity and high unmet needs for contraception, particularly in unmarried, sexually active adolescents.” These countries are largely located in sub-Saharan Africa and South Asia.

One in eight adolescents lives in injury excess countries. “High persisting levels of unintentional injury or violence and high adolescent birth rates” characterize these countries, mostly found in South America.

And more than a third of adolescents live in NCD predominant countries. The main issues facing adolescents in these countries, mostly concentrated in North America and Europe, are “mental and substance use disorders and chronic physical illness.”

Better data on individual communities is vital to reveal the best solutions for specific communities – for example that account for cultural, religious, and traditional differences – write the authors, but that data is largely unavailable.

Sexual and Reproductive Health – and Beyond

One thing that is universal is that importance of “multi-component and intersectoral” approaches, writes the commission.

Building a clinic that provides contraception is fruitless unless adolescents are seeking them, which is in part dependent on them receiving accurate information about contraceptives and family planning. It takes a coordinated effort of “high quality health-worker training, adolescent-friendly facility improvements, and broad information dissemination via the community, schools, and mass media to drive demand,” according to the authors.

There is in fact a great need for sexual and reproductive health care in many countries where adolescents make up large portions of the population. “In many countries the age of onset of sexual activity has remained similar while the age of marriage and first pregnancy has risen substantially,” writes the commission. This leaves adolescents vulnerable to sexually transmitted infections and unintended pregnancy for a longer period of time.

The commission calls for improvements in education regarding proper contraceptive use, contraceptive benefits, and greater access to contraceptive services, particularly long-acting reversible contraception, or LARCs. LARCs have an extremely low failure rate and prevent unintended pregnancy due to user errors commonly associated with other contraception methods (i.e., condoms and oral contraceptives).

Historically, a large proportion of programs, policies, and funding aimed toward adolescents have been focused on sexual and reproductive health. However, the health needs of adolescents are more complicated and multi-faceted than just safe sex and pregnancy.

Nutritional deficiencies, chronic infections, such as HIV, and chronic physical illnesses, such as type 1 diabetes, congenital heart disease, and obesity, all affect large numbers of young people and will continue to do so as they age. It is urgent that context-specific and adolescent-driven health programs begin to address these issues more in order to secure the health of this generation – and generations to come.

Children with malnourished or obese mothers and with mothers who live in polluted or high stress environments can experience genetic alterations that prepare the fetus to “thrive” in a harmful post-natal environment. For example, children of mothers who smoked cigarettes while pregnant are often born small for gestational age. Essentially, the genes of the fetus adapt to prepare for adverse conditions when the mother is experiencing problems herself.

A Virtuous Cycle

The global health community has largely overlooked adolescents, according to the commission, but it is abundantly clear – due in no small part to today’s extraordinary demographics – that adolescent health and wellbeing has an impact on everyone.

On a global scale, adolescents are crucial in achieving the SDGs by 2030. On an individual level, ensuring the health of the current generation will result in a healthier, more capable next generation of citizens, workers, and leaders, which will in turn be able to give their children a healthier start.

A crucial but often overlooked part of effective adolescent health programs is their involvement in planning and executing them. When adolescents are given input, control, and responsibility, they are more likely to “contribute to decisions about their personal, family, social, economic, and political development,” says the commission. Such engagement also builds confidence and a sense of civic responsibility and community, which results in further youth engagement, creating a virtuous cycle.

There are 1.8 billion adolescents who have the capacity to make serious change and it is crucial “they have the resources to do so,” writes the commission.