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Adolescents in a changing world The case for urgent investment Hosted by the World Health Organization Adolescents in a changing world The case for urgent investment Hosted by the World Health Organization Adolescents in a changing world: the case for urgent investment ISBN 978-92-4-009499-4 (electronic version) ISBN 978-92-4-009500-7 (print version) © World Health Organization 2024 Some rights reserved. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
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iii Contents Foreword......................................................................................................................................... viii Preface.............................................................................................................................................. ix Acknowledgements.......................................................................................................................... x Acronyms.......................................................................................................................................... xi Executive summary........................................................................................................................ xii 1. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Introduction and review – the urgency of action on adolescent well-being...........................1 1.1 Emerging conditions shaping adolescent well-being..................................................................... 1 1.2 Domains, linkages and platforms...................................................................................................... 2 1.3 Costs and benefits of the interventions........................................................................................... 5 1.4 Limitations of the economic and social modelling.......................................................................... 9 1.5 Key investment priorities...................................................................................................................10 1.6 Conclusion...........................................................................................................................................14 2. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Health investments...................................................................................................................15 2.1 A broad package of health interventions provided to adolescents.............................................15 2.2 HPV ..................................................................................................................................................... 20 2.3 TB......................................................................................................................................................... 22 2.4 Myopia................................................................................................................................................ 25 3. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Building connectedness, agency and resilience......................................................................27 3.1 Connectedness................................................................................................................................... 27 3.2 Agency and resilience....................................................................................................................... 30 3.3 Case study – connectedness, in search of economic evaluations of its impact........................ 33 3.4 Conclusion.......................................................................................................................................... 39 4. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Investing in adolescent mental health....................................................................................40 4.1 Introduction........................................................................................................................................ 40 4.2 Importance of mental health........................................................................................................... 41 4.3 Structural factors affecting mental health.................................................................................... 43 4.4 Proximal determinants..................................................................................................................... 47 4.5 Conclusion.......................................................................................................................................... 50 5. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
School feeding – one key response to malnutrition................................................................51 5.1 Introduction.........................................................................................................................................51 5.2 Recent studies and action, both locally and globally.....................................................................51 5.3 The key messages of Ready to Learn and Thrive.......................................................................... 53 5.4 Some modelling results.................................................................................................................... 54 5.5 Conclusion.......................................................................................................................................... 54 iv 6. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Education, skills and employment...........................................................................................55 6.1 School attendance and the quality of learning.............................................................................. 55 6.2 Methodology – education model.................................................................................................... 57 6.3 Results – education outcomes......................................................................................................... 60 6.4 The benefits model – methodology.................................................................................................61 6.5 Results................................................................................................................................................. 64 7. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Violence and injuries.................................................................................................................67 7.1 Introduction........................................................................................................................................ 67 7.2 IPV........................................................................................................................................................ 67 7.3 Adolescent suicide............................................................................................................................. 75 7.4 Road safety......................................................................................................................................... 76 7.5 Conclusions......................................................................................................................................... 81 8. Financing the investment in adolescent well-being...............................................................82 References.......................................................................................................................................85 Annex 1. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Additional methodological details and tables related to Chapter 1.......................100 1.
The cost of inaction........................................................................................................................... 100 2.
Validation of models.......................................................................................................................... 102 3. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Detailed methodology for health services modelling.................................................................. 103 Tables related to Chapter 1....................................................................................................................112 Annex 1: References...............................................................................................................................117 Annex 2. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Chapter 2 tables............................................................................................................ 118 Annex 2: References.............................................................................................................................. 126 List of figures Fig.
1.1 Five domains of adolescent well-being........................................................................................... 2 Fig. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
1.2 Platforms, linkages and interventions in the investment case modelling................................ 4 Fig.
3.1 Structural equation model............................................................................................................. 36 Fig.
3.2 Relationship between SEL interventions, school climate and academic performance, direct (purple) and indirect (orange) effects............................................................................................. 38 Fig. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
4.1 Adolescent* global burden by cause of disease, proportion of global disease burden, tier 2 classification level, 2019..................................................................................................................... 42 Fig.
4.2 DALY rates for the global adolescent (10–19 years) burden of disease by sex and selected cause, 2019.................................................................................................................................... 42 Fig. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
4.3 Scatter diagram of adolescent mental health DALY rate (2019) versus GNI per capita (Atlas method), 202 countries, 2018........................................................................................................... 43 Fig.
4.4 Adolescent* mental disorders by type, DALY rate, 202 countries, 2019................................. 44 Adolescents in a changing world. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The case for urgent investment v List of tables Table 1.1 The five domains and sub-domains of adolescent well-being................................................. 3 Table 1.2 Origins and development paths for eight benefit-cost models used in this report............. 6 Table 1.3 ROI from scale-up of adolescent health services, HPV vaccination, screening and treatment of cervical cancer, prevention and treatment of TB, and screening and treatment of myopia in adolescents............................................................................................................................... 7 Table 1.4 ROI from education and training interventions in 64 countries, BCRs................................... 7 Table 1.5 Summary of BCRs for mental health, parenting, health and behavioural problem prevention, school climate and school feeding interventions................................................................. 8 Table 1.6 Summary of BCRs for interventions to reduce violence and injuries in adolescents........... 9 Table 1.7 School health and nutrition programmes — a summary of the key messages of the multi-agency report Ready to Learn and Thrive (UNESCO, UNICEF and WFP, 2023)............................11 Table 2.1 Adolescent health, economic and social benefits, costs ($ million), and BCRs.....................19 Fig. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
4.5 Scatter diagram of adolescent mental health DALY rate versus youth unemployment rate, 26 LICs, 2019......................................................................................................................................... 45 Fig.
4.6 Scatter diagram of adolescent mental health, DALY rate, versus political instability/ terrorism, 193 countries, 2019.................................................................................................................... 46 Fig. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
6.1 Educational attainment by country group as defined by Filmer et al.
(2018, p59) using data from Lee and Lee (2016)...................................................................................................................... 56 Fig.
6.2 Primary school learning test scores by region, not including South Asia............................... 56 Fig.
6.3 Learning poverty, globally and by region.................................................................................... 57 Fig. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
7.1 The ecological framework, examples of risk factors at each level............................................ 69 Fig.
B7.1 Modelling framework for child marriage estimations............................................................. 70 Fig.
B7.2 Number of school completions before and after the interventions, 2035 and 2050, 70 selected countries................................................................................................................................... 71 Fig. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
B7.3 Total additional cost and economic benefits of child marriage prevention, US$ billion, 2024–2050, 70 selected countries.............................................................................................................. 71 Fig.
7.2 Road traffic injuries and fatalities, 10–19-year-olds, by income group, 2019.......................... 77 Fig. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
7.3 Rates of serious road traffic injuries and fatalities, 10–19-year-olds, by income group, 2019 per 100 000.......................................................................................................................................... 77 Fig.
7.4 Modelling framework...................................................................................................................... 78 Fig. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
7.5 Estimated BCRs of investment in road safety interventions for adolescents by gender, 77 countries, 2023–2050.............................................................................................................................. 80 Fig.
7.6 Costs, benefits and intervention type, road traffic fatalities and serious injuries, adolescents, $ million.
LHS is left hand axis, RHS is right-hand axis..................................................... 80 Fig. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
8.1 Developing countries’ increasing external public debt, median values for developing countries, 2010–2021................................................................................................................................... 83 Contents vi Table 2.2 ROI from scale-up of HPV vaccination, screening and treatment, BCRs at 3% discount rate................................................................................................................................................. 22 Table 2.3 TB in adolescents, cost per death averted, average 2023 to 2030, US$............................... 23 Table 2.4 TB in adolescents, summary of economic and social benefits, costs and BCRs, 3% discount rate................................................................................................................................................. 24 Table 2.5 Myopia in adolescents, summary of benefits and costs ($ million), and BCRs, 3% discount rate................................................................................................................................................. 26 Table 3.1 Results from SEHER lay counsellor intervention after 17 months......................................... 35 Table 3.2 Effect size of SEL programmes on academic performance, results summary.................... 37 Table 4.1 Summary, BCRs for mental health interventions in adolescents.......................................... 41 Table 5.1 Selected papers in the emerging literature on malnutrition in adolescents....................... 52 Table 5.2 School health and nutrition programmes, summary of the key messages of the multi-agency report Ready to Learn and Thrive (UNESCO, UNICEF, WFP, 2023).................................. 53 Table 6.1 List of modelled education interventions, 64 countries......................................................... 60 Table 6.2 Educational outcomes, 64 countries (excluding China)...........................................................61 Table 6.3 Parameter settings used in the education benefits model, 64 countries, 2024–2050....... 64 Table 6.4 Impact of the interventions on selected educational and economic outcomes across 64 countries, by 2050....................................................................................................................... 64 Table 6.5 Total additional cost of schooling and training initiatives, by region and country, 64 countries, 2024–35, $ billions................................................................................................................ 66 Table 6.6 BCRs of investment in interventions in education, 64 countries .......................................... 66 Table 7.1 Summary, benefit-cost ratios for interventions to reduce violence and injuries in adolescents.................................................................................................................................................... 68 Table 7.2 Projected deaths and serious injuries due to road traffic accidents in adolescents, 77 countries, 2023–2050.............................................................................................................................. 79 Table 7.3 Estimated costs and benefits of investment in road safety interventions for adolescents, net present value, 77 countries, 2023–2050, weighted BCRs, $ million......................... 80 Table A1.1 Origins, development paths and validation status for eight benefit-cost models used in this report...................................................................................................................................... 102 Table A1.2 Countries included in OHT modelling, income status......................................................... 104 Table A1.3 Interventions modelled using OHT....................................................................................... 105 Table A1.4 Unit cost of outpatient visits and inpatient days, average of delivery platforms, US dollars 2023........................................................................................................................................... 109 Table A1.5 Health worker unit costs..........................................................................................................110 Table A1.6 United States of America GDP Deflator .................................................................................110 Table A1.7 Country/territory coverage of analyses ................................................................................112 Table A2.1 Countries included in OHT modelling, income status.........................................................118 Adolescents in a changing world. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The case for urgent investment vii List of boxes Box 7.1 Estimating the economic and social benefits of reducing child marriage.............................. 70 Box A1.1 VISES reports and other papers ............................................................................................... 103 Table A2.2 Interventions modelled using OHT........................................................................................119 Table A2.2 Interventions modelled using OHT (continued).................................................................. 120 Table A2.2 Interventions modelled using OHT (continued)...................................................................121 Table A2.3 Fertility rates, females 15–19, 2023–2035............................................................................ 122 Table A2.4 Reduction in births to adolescent mothers, 2023–2035.................................................... 122 Table A2.5 Maternal, neonatal, child deaths and stillbirths averted by OHT interventions, 2023–2035.................................................................................................................................................... 122 Table A2.6 Adolescent deaths from NCDs averted by OHT interventions, 2023–2035..................... 122 Table A2.7 Reduction in anemia through OHT interventions, adolescents, 2023–2035................... 122 Table A2.8 Reduction in number of stunted children through OHT interventions, 2023–2035....... 122 Table A2.9 Reduction in prevalence of mental disorders and other NCDs through OHT interventions, female adolescents, 2023–2035...................................................................................... 123 Table A2.10 Reduction in prevalence of mental disorders and other NCDs through OHT interventions, male adolescents, 2023–2035......................................................................................... 123 Table A2.11 Adolescent health, economic and social benefits, and costs ($ million), and BCRs...... 123 Table A2.12 Return on investment from scale-up of HPV vaccination, screening and treatment, economic and social benefits, and costs ($ million), and BCRs........................................ 123 Table A2.13 Upper middle-income countries and areas eligible for TB funding from the Global Fund................................................................................................................................................. 124 Table A2.14 TB, number of adolescent deaths per 100 000 population.............................................. 124 Table A2.15 Global world population 2023 to 2023 thousands............................................................ 124 Table A2.16 TB, number of adolescent deaths averted 2023 to 2023.................................................. 125 Table A2.17 TB in adolescents, cost estimates billions 2020 dollars.................................................... 125 Table A2.18 TB in adolescents cost per death averted 2023 to 2023................................................... 125 Table A2.19 TB in adolescents deaths averted 2023 to 2035................................................................ 126 Table A2.20 TB in adolescents economic and social benefits and costs ($ million) and BCRs (3% discount rate)....................................................................................................................................... 126 Table A2.21 Myopia number of adolescent patients treated 2021 to 2030........................................ 126 Table A2.22 Myopia in adolescents benefits and costs ($ million) and BCRs (3% discount rate)..... 126 Contents viii Foreword Today’s adolescents,1.3 billion strong, are more than one-sixth of the global population. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Growing up in a world that is churning with historic transformations – political, social, economic and environmental – they have both deep concerns and high expectations for themselves and their societies.
As global leaders and advocates for human rights, we rally behind and stand with adolescents, in all their diversity.
To develop and thrive, adolescents need support, investment, and opportunities. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
This landmark report makes a critical, social and economic case for countries and communities to invest in the well-being of adolescents and girls in particular.
For countries, investing in adolescent well-being is not just a moral imperative, it’s a strategic investment in resilient communities and sustainable development. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
UNFPA, UNICEF and WHO are committed to listening to, and meaningfully engaging with, adolescents, and to advocating for the acceleration of sustainable investments in them and in their well-being. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
From ensuring their education and skills training to supporting access to quality health information and comprehensive services, including for sexual and reproductive health, to promoting mental health support and fostering safe and secure environments, we are dedicated to equipping adolescents with the knowledge, tools and resources they need to navigate the complexities of adolescence and live up to their potential with confidence and resilience. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Working together with adolescents, youth and allies, we are determined to forge a brighter future where every young person has the opportunity to realize their potential, contribute meaningfully to their communities and advance a more equitable and sustainable future for all. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Catherine Russell Executive Director, UNICEF Dr Natalia Kanem Executive Director, United Nations Population Fund (UNFPA) Dr Tedros Adhanom Ghebreyesus WHO Director-General ix Preface As we reach the halfway mark of the SDGs, the global landscape has been marred by unprecedented challenges.
Among the most affected demographics are adolescents. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Despite these adversities, adolescents have demonstrated remarkable resilience, emerging as catalysts for positive change, embodying hope, and serving as sources of inspiration for communities worldwide.
Today, adolescents make up more than 16% of the world’s population.
They are a demographic which is often overlooked or misunderstood. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
In recent years, there has been more recognition of the unique challenges to well-being confronting adolescents, and of the need to address these in development agendas, but action has been slow.
This report focuses on the imperative of investing holistically in adolescents and their well-being.
Such investments can reduce inequalities and help to protect the human rights of adolescents. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
As is evident throughout the report, the economic and social returns from a wide range of investments to address adolescent well-being are significant.
The report makes a compelling case for investing in adolescents, they are living in a world facing multifaceted crises, and they will be tomorrow’s changemakers and leaders.
The staggering cost of inaction is estimated at US$110 trillion over a period of 27 years (2024-50). | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
That amounts to 7.7% of the total GDP of those countries included in the models, which themselves include around 80% of the world’s population.
The report provides valuable insights into interventions where investments will yield high returns, including those focused on health services and multisectoral interventions, for example on HPV, TB, myopia, education and training, child marriage and road accident prevention. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
This evidence base is crucial for policymakers, practitioners, researchers, educators, donors, and civil society organizations as we map the road ahead for a better and more sustainable future.
As well, the report is a significant step forward in advocating for adolescent well-being, where adolescents have the support, confidence, and resources to thrive in contexts of secure and healthy relationships, and realizing their full potential and rights. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
It calls for more prioritisation, increased investment, and immediate action for adolescent well-being.
Finally, investing in adolescents and their well-being strengthens the human capital of a country, and hence a country’s potential for future development and for ending extreme poverty and creating more inclusive societies. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
As we embark on this journey, we eagerly anticipate the discussions and collaboration this report will catalyse, around creating futures where adolescents are empowered to thrive in a secure and healthy environment and realise their full potential and rights. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Rt Hon Helen Clark PMNCH Board Chair and Former Prime Minister of New Zealand Dr David Imbago Director, YIELD Hub and Chair, PMNCH Adolescents and Youth Constituency (2021–2024) Professor Bruce Rasmussen Director, Victoria Institute of Strategic Economic Studies, Victoria University, Australia x Acknowledgements The World Health Organization (WHO) is grateful to all those who contributed to this publication. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
This report was developed under the overall direction of Anshu Mohan of PMNCH (Partnership for Maternal, Newborn and Child Healh), with coordination from Sophie Marie Kostelecky (PMNCH) and Bhavya Nandini (PMNCH). | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The lead writers of the report are: Peter Sheehan, Bruce Rasmussen, Kim Sweeny, Neelam Maharaj, John Symons and Margarita Kumnick (Victoria University, Australia), David Ross (FIA Foundation, Germany), Anshu Mohan (PMNCH, Switzerland), Bhavya Nandini (PMNCH, India), Sophie Marie Kostelecky (PMNCH, Spain). | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
WHO contributors and reviewers WHO is grateful for the technical contributions of WHO headquarter staff nominated by WHO headquarter departments: Anshu Banerjee, Valentina Baltag, Prerna Banati (Maternal, Newborn, Child and Adolescent Health and Ageing), Melanie Bertram (Delivery for Impact), Daniel Chisholm (Mental Health and Substance Abuse), and Karin Stenberg (Health System Governance and Financing).
Reviewers from United Nations agencies. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Reviewers from United Nations agencies.
Contributors and reviewers from United Nations agencies WHO is grateful for the technical contributions of members of the Expert Consultative Group from United Nations Agencies: Anurita Bains (UNICEF, United States of America), Danielle Engel and Howard S. Friedman (UNFPA, United States of America), Troy Jacobs and Caroline Katunge Ngonze (UNAIDS, South Africa) and Moses Simuyemba (UNAIDS, Zambia). | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Technical Expert Consultative Group Patricia Akweongo (School of Public Health, University of Ghana, Ghana), Chris Armstrong (Plan International, Canada), Peter Azzopardi and Susan Sawyer (University of Melbourne and Royal Children’s Hospital, Australia), Donald Bundy (London School of Hygiene and Tropical Medicine, United Kingdom of Great Britain and Northern Ireland), Flavia Bustreo (Fondation Botnar, Switzerland), Angela Chang (Danish Institute for Advanced Study, Denmark), Lucie Cluver, Chris Desmond, Mona Ibrahim, Elona Toska and Rachel Yates (UKRI GCRF Accelerate Hub, Universities of Oxford and Cape Town, United Kingdom of Great Britain and Northern Ireland and South Africa), Manuela De Allegri (Heidelberg University, Germany), Surabhi Dogra (Second Lancet Commission on Adolescent Health and Wellbeing, India), Mark Hanson (Southampton University, United Kingdom of Great Britain and Northern Ireland), Susan Horton (University of Waterloo, Canada), Wenhui Mao and Gavin Yamey (Duke University, United States of America), Yewande Ogundeji (Health Strategy and Delivery Foundation, Nigeria), James Sale (United For Global Mental Health, United Kingdom of Great Britain and Northern Ireland), Ashrita Saran (Global Development Network, India), Agnès Soucat (Division of Health and Social Protection, Agence Française de Développement, France), Hugh Sharma Waddington (London School of Hygiene and Tropical Medicine, United Kingdom of Great Britain and Northern Ireland) and Howard White (Global Development Network, Germany). | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Other technical contributors and reviewers: WHO is grateful for the contributions of Karen Canfell, Michael Caruana, Diep Nguyen, Daniela Rivas and Katie Simms (University of Sydney, Australia), and Alison Welsh (Victoria University, Australia).
Financial support WHO acknowledges the financial support provided by Fondation Botnar and in-kind support by Victoria University. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Declarations of conflicts of interest None of the external writers, reviewers or experts on the Technical Expert Consultative Group declared any conflict of interest. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
xi Acronyms 4Rs Program on Reading, Writing, Respect and Resolution AEP Adolescence Education Programme BCR Benefit-cost ratio CBT Cognitive behavioural therapy CCT Conditional cash transfer CI Confidence interval CL Cooperative learning CMBC Child marriage benefits cost CTC Communities that care CVPP Cardiff Violence Prevention Programme DALY Disability-adjusted life year DBM Double burden of malnutrition FFT Functional family therapy FGM Female genital mutilation FHF Fred Hollows Foundation GBD Global burden of disease GDP Gross domestic product GNI Gross national income HIC High-income country HLYG Healthy life-year gained HPV Human papillomavirus IARC International Agency for Research on Cancer IBRD International Bank for Reconstruction and Development IHME Institute for Health Metrics and Evaluation ILO International Labor Organization IPV Interpersonal violence LAYS Learning-adjusted years of schooling LIC Low-income country LLMIC Low- and lower middle-income country LMIC Lower middle-income country LST Life skills training MDR-TB Multidrug resistant tuberculosis MIC Middle-income country MST Multi-systemic therapy NCD Noncommunicable disease NPV Net present value OBPP Olweus Bullying Prevention Program ODA Official development assistance OECD Organisation for Economic Cooperation and Development OHT OneHealth Tool PATHS Promoting Alternative Thinking Strategies PDFY Preparing for the Drug Free Years PHC Primary health care PLH Parenting for Lifelong Health QALY Quality-adjusted life year RCT Randomized controlled trial RMNCH Reproductive, maternal, newborn and child health ROI Return on investment SDGs Sustainable Development Goals SEHER Strengthening Evidence base on scHool-based intErventions for pRomoting adolescent health SEL Social and emotional learning SEYLE Saving and Empowering Young Lives in Europe SFP 10–14 Strengthening Families Program for Parents and Youth, 10–14 years SMD Standard mean difference SRH Sexual and reproductive health STH Soil-transmitted helminth TB Tuberculosis Triple P Positive Parenting Program UHC Universal health coverage UIS UNESCO Institute of Statistics UMHIC Upper middle- and high-income country UMIC Upper middle-income country UN H6+ PMNCH, UNAIDS, UNESCO, UNFPA, UNICEF, UN Major Group on Children and Youth, UN Women, World Bank, World Food Programme, WHO UN United Nations UNESCO United Nations Educational, Scientific and Cultural Organization UNICEF United Nations Children’s Fund UNFPA United Nations Population Fund VEM VISES Education Model VISES Victoria Institute of Strategic Economic Studies VSL Value of a statistical life WASH Water, sanitation and hygiene WHO World Health Organization YAM Youth Aware of Mental Health xii Executive summary Today’s adolescents (defined here as persons aged 10–19 years) face serious challenges in a rapidly shifting world. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
These range from the effect of population changes and age distribution, the impact of climate change on mental health and well-being, the learning crisis and the persistent inequality, violence and neglect of human rights experienced, especially by women.
The world urgently needs a new investment programme to improve the well-being of adolescents.
The cost of inaction is too high. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The cost of inaction is too high.
This investment must cover all five domains of adolescent well-being: health, connectedness, safety, learning and employability, and agency and resilience, and the linkages between them.
Investment must underpin a global programme carried out at the local level with initiatives tailored to the realities of individual countries and involving the young people themselves, allowing them to express their specific needs. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Transformative investment in three key platforms or systems is necessary: universal health coverage (UHC), including primary health care (PHC); enhanced schools that focus on learning, health, nutrition and student well-being; and support systems based in local communities.
These platforms are not only key points for programme delivery but are essential to ensuring that all adolescents are covered and that the complex linkages involved are fully realized. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The purpose of this report is to present the case for this much-needed investment in supporting adolescent well-being across the globe.
By investment we mean a planned programme of spending on interventions known to be effective in increasing adolescent well-being in all its facets.
To this end, an extensive review of the literature focused on intervention evaluations has been conducted and new modelling work has been completed. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
As is evident throughout this report, the economic and social returns from a wide range of investments to address adolescent well-being are high.
Such investments will reduce inequalities and help to protect the human rights of adolescents.
They have never been more timely, given the current state of the global demographic and epidemiological transitions and the fact that there is now a substantial body of evidence that shows selected interventions for this age group can be highly effective. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Finally, investing in adolescents and their well-being strengthens the human capital of a country, and hence the country’s potential for future development and for ending extreme poverty and creating more inclusive societies.
With many affected countries already highly indebted, large-scale support from the international community will be necessary for these investments to be undertaken on the required scale. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
At the same time, locally tailored interventions taking account of specific needs and local knowledge and expertise about effective programmes will be crucial.
The modelling presented in this report was for interventions introduced and progressively scaled up over the period 2024 to 2035.
Where the interventions were extended in time, they were held at the 2035 level through to 2050.
The key quantitative measure used for the investment case is the benefit-cost ratio (BCR). | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
This is the ratio of the value of benefits to the cost of the investments necessary to achieve those benefits.
For a wide range of investments analysed here, the BCRs are 10 or above, with much higher values in many cases.
An investment in which the benefits are 10 times the cost is a very strong one indeed.
It is not possible to estimate BCRs for some areas (for example, connectedness, agency and interpersonal violence [IPV]) because the underlying empirical work is not available. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
This does not deny their importance to adolescent well-being but rather challenges researchers to strengthen their knowledge.
The coverage of the BCR results within this report reflects the availability of studies in the literature. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
xiii Within the need for an extensive programme of investment to build the universal platforms, based on BCR studies and other evidence assembled here, we identified six priority areas: malnutrition: hunger and undernutrition, micronutrient deficiencies and overweight/obesity; mental health: both prevention and treatment; learning, skills and employment; the position of women, including reductions in child marriage and in unplanned pregnancies; the prevention of violence and injury; and the preparation of adolescents to cope with emerging realities. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Although a return of at least US$ 10 dollars for every US$ 1 spent is excellent, the cost of the full suite of investments described here are high.
Total costs to span until 2035 are estimated to approach US$ 2.8 trillion, or an average of about US$ 230 billion per annum over the 12-year period of 2024 to 2035 in present value terms.
This amounts to about 0.25% of the average projected global gross domestic product (GDP) over the period. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Large-scale and immediate investment to increase the capabilities and well-being of adolescents is now of critical importance.
This investment will empower young people to meet the challenges before them and to thrive in the decades ahead.
The cost of inaction will be very high.
We estimate that the average annual cost of inaction (the benefits foregone) over the period 2024–2050 for areas and countries studied in this report, is US$ 4.1 trillion. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
This amounts to an average of 7.7% per annum of the projected total GDP of the emerging market and developing economies, over this 27 year period.
As this report demonstrates, the returns on these investments – the returns to action – are also high, both in terms of BCRs and in terms of fulfilling human rights and reducing inequalities around the world.
The time for action is now. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The time for action is now.
Executive summary Cambodia: Disability inclusion in health, 2023 © WHO/Miguel Jeronimo Cholera outbreak in Sierra Leone, 2012 © WHO/Fid Thompson 1 1.
Introduction and review – the urgency of action on adolescent well-being 1.
Introduction and review – the urgency of action on adolescent well-being 1.1 Emerging conditions shaping adolescent well-being Many emerging features of the contemporary world are making the development process more difficult for contemporary adolescents. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Below, we summarize eight challenges arising from ongoing processes of global change.
Population trends and unplanned pregnancies.
Reflecting very different trends in birth rates, adolescent populations are projected to rise sharply in many countries (for example, by 60% by 2050 in sub-Saharan Africa) but to fall precipitously in others (for example, by 40% by 2050 in China, Republic of Korea and Japan combined). | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
At both extremes, the rate of population change will have major effects on the development process for young people.
In many countries, continuing population growth reflects an ongoing high rate of unplanned pregnancies and the continued, if declining, incidence of child marriage.
Impact of climate change. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Impact of climate change.
It is now clear that continuing climate change, manifesting both in the growing frequency of dangerous weather events and in projections of future warming, is adversely affecting adolescent mental health in many countries, and the physical conditions for young people in some regions.
As the world continues to warm, these effects are likely to become more marked and of deepening concern to younger generations.
Learning crisis. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Learning crisis.
While rates of attendance at school have risen in almost all countries, there is now evidence that the learning achieved by adolescent populations has plateaued and is far from acceptable levels in many countries.
Low levels of literacy and numeracy provide a poor base from which to address other emerging challenges.
Technological change and employment.
Both economic structures and technologies are undergoing rapid change. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Manual and routine jobs are being replaced by new technologies across the board; the service and care sectors are displacing the goods sectors, especially as sources of employment, while emerging artificial intelligence (AI) technologies imply a new era of change.
Employment will remain a major challenge for young people, especially for those without a quality education and strong skills development.
The double burden of disease. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The double burden of disease.
For some time now, the double burden of disease—a continuing burden of communicable disease combined with a rising incidence of noncommunicable diseases (NCDs)—has been a reality in many countries.
As the precursors of future NCDs, such as malnutrition, obesity and poor mental health, continue to rise among adolescents almost everywhere, the double burden of disease will continue to be a problem in low-income countries (LICs).
Continuing malnutrition. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Continuing malnutrition.
Malnutrition, which covers undernutrition, micronutrient deficiencies and obesity, remains a critical challenge for current and emerging adolescent cohorts.
Indeed, the double burden of malnutrition (DBM)—the simultaneous manifestation of undernutrition and overweight/obesity—affects most low- and middle-income countries (LICs and MICs). | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
While this report focuses mainly on one response to malnutrition, the various dimensions of malnutrition remain a key challenge for adolescents around the world.
Persistent inequality and violence.
Pronounced inequality, both within and across countries, remains a persistent, and in some respects an increasing, reality in the world.
Adolescent well-being is strongly related to socioeconomic status, whether within countries or between them. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Adolescent well-being is, on average, lower in LICs than in high-income countries (HICs) and, within a country, lower in the lower socioeconomic groups than in higher socioeconomic groups.
Increasing migration pressures.
The combination of rapid population growth in many countries and the growing impact of climate change in many regions is likely to increase migration flows in forthcoming decades. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
This applies to both cross-border and internal migration, and to both distressed or refugee flows and to voluntary migration.
Where the skills of the migrants match those of the recipient country or region, both parties are likely to benefit, but this may not be the case for refugees and distressed migrants leaving an unstable situation with limited skills.
2 Adolescents in a changing world. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
2 Adolescents in a changing world.
The case for urgent investment Adolescent well-being: Adolescents thrive and are able to achieve their full potential 1.
UN H6+ is a partnership of the United Nations Population Fund (UNFPA), United Nations Children’s Fund (UNICEF), United Nations Women, World Health Organization (WHO), the United Nations Programme on HIV/AIDS (UNAIDS) and the World Bank. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
PMNCH (Partnership for Maternal, Newborn and Child Health), United Nations Education, Scientific and Cultural Organization (UNESCO), United Nations Major Group on Children and Youth (UNMGCY), and the World Food Programme (WFP) joined the UN H6 on the UN H6+ Technical Working Group on Adolescent Health and Well-being. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
1.2 Domains, linkages and platforms 1.2.1 The five domains of adolescent well-being In planning and developing a case for investment in programmes that aim to improve adolescent well- being, the targets for such programmes must be clear.
This relates to the various domains of adolescent well-being and the linkages that exist, if any, between these domains and between the various interventions planned to impact a given domain of well-being. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Recent work by the UN H6+1 Technical Working Group on Adolescent Health and Well-being (Ross et al., 2020) has clarified the definition and five domains of adolescent well-being (see Fig.
1.1).
These are: good health and optimum nutrition; connectedness, positive values and contribution to society; safety and a supportive environment; learning, competence, education, skills and employability; and agency and resilience.
Fig. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Fig.
1.1 Five domains of adolescent well-being Each of these domains and their subdomains (see Table 1.1) are important to well-being.
Adolescence brings a maturation of all bodily systems and is a phase of sensitivity to the physical, nutritional and social environment.
During this phase, the social dimensions of well-being (connectedness, a safe and supportive environment, learning and human capital, and the development of agency and resilience) become especially important. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Adolescence is also a phase when risks, including tobacco and alcohol use, physical inactivity, poor diet, and overweight and obesity, increase the probability of contracting NCDs in later life.
The interventions must address each of the domains of well-being (Patton et al., 2016).
3 1. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Introduction and review – the urgency of action on adolescent well-being Table 1.1 The five domains and sub-domains of adolescent well-being Good health and Good health and optimum nutrition optimum nutrition Connectedness, Connectedness, positive values positive values and contribution and contribution to society to society Safety and a Safety and a supportive supportive environment environment Learning, competence, Learning, competence, education, skills education, skills and employability and employability Agency and Agency and resilience resilience > > Physical health Physical health and capacities and capacities > > Mental health Mental health and capacities and capacities > > Optimal nutritional Optimal nutritional status and diet status and diet > > Connectedness Connectedness > > Values Values > > Attitudes Attitudes > > Interpersonal skills Interpersonal skills > > Activity Activity > > Change and Change and development development > > Safety Safety > > Material conditions Material conditions > > Equity Equity > > Equality Equality > > Non-discrimination Non-discrimination > > Privacy Privacy > > Responsive Responsive > > Learning Learning > > Education Education > > Resources, life skills Resources, life skills and competencies and competencies > > Skills Skills > > Employability Employability > > Confidence Confidence > > Agency Agency > > Identity Identity > > Purpose Purpose > > Resilience Resilience > > Fulfilment Fulfilment Source: Ross et al. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
(2020).
These domains of well-being are not separate, independent aspects of adolescent well-being.
Many factors influencing adolescent development have interactive effects with one another with a complex interplay between physical and mental health, learning, sexual maturation and the connectedness, safety and supportiveness of the community context in which the adolescent matures. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Some of these aspects of health and growth during adolescence affect maternal health during pregnancy, which is a critical factor in providing a healthy start to life.
These linkages, both within and across generations, are of critical importance.
Given this complex mosaic of influences and interactions, we need an approach to adolescence that is both holistic and multidimensional.
This is especially so for young women who are particularly disadvantaged in many settings. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Many factors combine to undermine the well-being of adolescent girls in all too many countries.
These include limited education, child marriage, high and early fertility, poor access to health care and fertility control, low status within the family and the community and endemic violence toward women. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The literature increasingly recognizes that if interventions are to be effective in shaping the various domains of well-being in ways that take account of the diverse linkages between them, they need to be situated within strong platforms or systems designed for this purpose.
As noted earlier, these platforms or systems are the UHC system, enhanced schools designed to deliver multiple, reinforcing interventions and support systems at the community level. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
1.2.2 The UHC system It is vital that the health system provides UHC to adolescents and that this care is extended to emerging issues for adolescents, such as poor cardiovascular health.
This is far from the case in most countries.
With inequality heavily shaping the access that many adolescents have to good quality health care, a commitment to UHC is central to the Sustainable Development Goals (SDGs), with SDG 3.8 requiring the global achievement of UHC with financial risk protection by 2030. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
This has long been a priority of the World Health Organization (WHO) and extensive literature has outlined the need for UHC, the progress being made towards it and the pivotal role of developing PHC within UHC.
This same literature also makes clear that, in spite of progress, adolescents in many parts of the world, and especially in LICs, do not have access to many key health services. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The investment programme of 95 interventions analysed in this report would be a major step forward in providing UHC for adolescents.
1.2.3 The enhanced school platform The school is a pivotal institution for shaping adolescent development and one that receives extensive funding.
Over the past two decades, the surge in the numbers of adolescents in school in most countries has stretched schools and their funding agencies thin so that the quality of learning has often not kept pace. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
4 Adolescents in a changing world. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The case for urgent investment Key platforms Universal health coverage system Enhanced schools Community development Interventions Sexual and reproductive health Infectious diseases Nutrition Non-communicable diseases Mental health Substance abuse Retention at school Learning quality Social and emotional learning/school cluster Malnutrition Child marriage Adolescent pregnancy Road accidents Youth and parenting programs Community programs (CM, IPV, FGM) Other violence Connectedness Learning Health Domains Agency and resilience Safe and supportive environment Additionally, there is now evidence that schools are the best place for delivering other programmes that contribute to adolescent welfare. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
This includes social and emotional learning (SEL), improved nutrition, deworming and the prevention of anaemia and malaria.
Rather than distracting schools from their central educative role, there are good reasons for thinking that such programmes can assist schools in achieving their primary goals of student retention and high-quality educational outcomes. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
This approach, and the need for enhanced schools in this sense and for increased investment in them, was strongly endorsed by the 2022 Transforming Education Summit report produced by the UN (2022a).
This report also stresses the depth of inequality and disadvantage inherent in current schooling arrangements; globally, 75% of children aged 0–14 years have access to only 8.6% of global public investment in education while the 25% of children living in LICs have access to only 0.6% of this investment. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
By sharp contrast, the 25% of the world’s children aged 0–14 years living in upper-middle and high-income countries (UMHICs) have access to 91% of global investment.
In addressing the severe challenges facing adolescents noted above, the reshaping of schools into powerful, shared platforms to deliver high-quality education in conjunction with better mental and physical health and the promotion of the well-being of learners is a critical task (see Fig.
1.2). | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
1.2).
1.2.4 The community platform The other vital platform is the community development network at the local level, which can be critical to the effective implementation of interventions.
Interventions employing these networks often focus on improved parenting and address adolescent delinquency, IPV and harmful substance use, among other problem areas.
One such programme is the aptly named Communities that Care (CTC).
Studies by Kuklinski et al.
(2015) have illustrated the value of these programmes. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
This is illustrated briefly in section 1.6.4 in relation to the position of women.
Fig.
1.2 Platforms, linkages and interventions in the investment case modelling 5 1.
Introduction and review – the urgency of action on adolescent well-being 2.
It follows that the research conducted for this study was based on existing data and other evidence and did not involve any human subjects so no ethics review was required. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
1.3 Costs and benefits of the interventions In this section, we summarize some of the quantitative results of the study.
First, in section 1.3.1, we report our estimates of the costs of inaction to the countries concerned, which are the costs of doing nothing further to address the challenges facing adolescents.
Second, in sections 1.4.1 to 1.4.3, we review our findings on the BCRs for a wide range of interventions. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
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