The health and wellbeing of adolescents across the world has reached a tipping point, a Lancet Commission report has found, with focus on obesity, overweight, and mental disorders as significant causes for concern. Developed by 44 Commissioners across geographies and disciplines with inputs from 10 youth Commissioners, the report projects that in 2030, 42 million years of health-life will be lost to mental disorders or suicide and that 464 million adolescents will be obese or overweight.
Vis-à-vis the first human cohort that will experience the effects of climate change throughout their lives, the Lancet Commission also projected that by 2030, half of the two billion adolescents worldwide will live in multi-burden countries grappling with an excess burden of disease.
‘Listen to young people’
The Commission’s findings come at a crucial time for the human population. A 2024 study of fertility rates across 204 countries revealed that 76% of these nations will not be able to sustain their populations by 2050. The current generation of adolescents constitute about 24% of the global population, the highest in human history. Thus, measures to protect and further their health and wellbeing becomes vital for human sustenance.
“For climate change, it is essential to keep to global commitments and listen to young people and ensure they have a voice at the table. Adolescents should be at the forefront of the green economy. There is also more research needed to develop gender and age-sensitive programming to maximise climate resilience,” Sarah Baird, co-chair of the commission and professor of Global Health and Economics and vice chair of the Department of Global Health at the Milken Institute School of Public Health in the U.S., said.
The report also highlighted that the number of adolescents living in conflict-infected areas has “more than doubled” since the 1990s, adding to the economic and political instability they experience. The combined effects of conflict, migration, and environmental degradation will limit the opportunities for them, and by the end of the century 90% of the world’s adolescents are projected to be affected by these issues.
Obesity, mental health disorders
As obesity and the consequences of climate change take centerstage in this discourse, Baird said policy initiatives at the national level become crucial.
She added that undertaking initiatives like taxing sugar-sweetened beverages, increasing access to healthy food, and finding ways to promote physical activity, with an emphasis on access to green spaces, are important.
The report also highlighted the interrelatedness of these issues. The triple crises of climate change, biodiversity loss, and air, water, and soil pollution threaten both physical and mental health. Understanding the unique challenges that adolescents currently face is crucial, Yatan Pal Singh Balhara, a professor of psychiatry at AIIMS, New Delhi, said. He wasn’t involved in producing the report.
“These also include the challenges related to excessive and problematic use of technology, the internet and digital devices. Additionally, it is important to focus on building resilience among adolescents, so they are better prepared to handle the stress and challenges of life. There is a need to establish measures across all aspects of adolescence, including family, school, college, and other relevant settings. Life skills training should be an integral component of the educational curriculum,” he added.
Balhara emphasised the importance of investing in operational research in mental health to identify evidence-based models of care delivery for adolescents in the country.
India-specific challenges
The Commission presents key data on health outcomes in the form of disability adjusted life years (DALYs), a measure of the number of healthy years lost to disease, disability, or premature death based on data from the Global Burden of Disease study. For India, the DALYs attributed to communicable, maternal, and nutritional conditions are higher among both girls (5,193.2 per 100,000 population) and boys (3,723.9) than the target of 2,500 or lower per 100,000 population.
India is estimated to have 253 million adolescents between the ages of 10 and 19 years, the highest in the world. Therefore, investment in adolescent health should also increase to respond to the existing and emerging needs of this population, Surabhi Dogra, Youth Commissioner of the Lancet Standing Commission on Adolescent Health and Wellbeing, said.
Emphasising the need to focus on nutritional deficiencies, Dogra pointed to the fact that 52% of girls and 20.8% of boys in India in the 10-24 age group were found to be anaemic. “The target should be less than 10%. It is essential for the country to address the double burden of malnutrition, i.e. the coexistence of undernutrition and overnutrition.”
But there is also some positive news. The report highlighted India’s efforts to overturn penal codes related to criminalising consensual same-sex relations, include adolescent health-related topics in the medical education curriculum, and mentioned the country as an exemplar nation in adolescent sexual and reproductive health and rights.
It also cited investment in road infrastructure in two locations in Gurugram, Haryana, as an example of how road safety can help enhance adolescent health. According to UNICEF, about 220,000 children and adolescents worldwide lose their lives to road traffic injuries. The measures taken in Gurugram included a combination of safer crosswalks, dedicated areas for school students to wait and board vehicles, and measures to reduce vehicle speeds.
The way forward
In July 2024, the Government of India launched the ‘Economic Case for Investment in the Well-being of Adolescents in India’ report, which said that increasing investments towards the wellbeing of adolescents will boost the country’s economy by about 10.1% of annual GDP. India is also working towards these goals through its National Adolescent Health Strategy, whose handbook operates across six major thematic areas: sexual and reproductive health, mental health, injuries and violence (including gender-based violence), nutrition, substance misuse, and non-communicable diseases.
However, many of the action points detailed and implemented in the Strategy are related to the sexual and reproductive health theme, Rakhi Dandona, professor and director of the PHFI Injury Prevention Research Centre in New Delhi, said. Using the example of India earning its ‘exemplary’ status for adolescent sexual and reproductive health and rights, Dandona said that similar results should be seen for the other themes as well.
Dandona’s research has found that economic losses from premature adolescent death and morbidity could account for as much as 1.3% of the country’s annual GDP. This makes it vital to strengthen the Strategy to improve adolescent health and avoid the high associated economic losses, she added.
“Age and gender-specificity in the program is a must, both in action and monitoring of program outcomes.”
Baird also said that the action points in the report demand multisectoral responses, ranging from global to local contexts, and that apart from funding for collaborative work there is also a need to encourage creative mechanisms for public-private partnerships.
Sharmila Vaidyanathan is an independent writer from Bengaluru.