Intended for healthcare professionals

Rapid response to:

Editorials

Mental health of children and young people during pandemic

BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n614 (Published 10 March 2021) Cite this as: BMJ 2021;372:n614

Read our latest coverage of the coronavirus outbreak

Rapid Response:

Uniting for adolescents during Covid-19 and beyond

Dear Editor

The current generation of adolescents is the largest ever, with 1.2 billion people aged 10-19 years worldwide. They are at risk of inheriting a world blighted by climate change and scarred by covid-19. Although they have been spared the most severe direct effects of the pandemic, the indirect effects on their wellbeing are devastating.[1 2] Many adolescents are experiencing disruptions to their access to health, education, and preventive services, and the pandemic has further exacerbated inequalities.[1] The pandemic is changing everything for adolescents and youth, as they experience the transitions that will define their future wellbeing: completing education, moving into the workforce, and forming life partnerships.

Even before covid-19, adolescents and young adults faced multiple and intersecting challenges to their wellbeing. These challenges include social injustice and inequalities (such as those related to gender, gender identity, and inclusion), insufficient social protection, inadequate mental health, poor sexual and reproductive health, and an inability to exercise their rights resulting in unintended pregnancies, HIV, and all forms of malnutrition. Adolescents and young adults are also experiencing a crisis of connection to family, community, and society, with increasing numbers living on the streets or dropping out of school.[3 4] Between 2003 and 2015, development assistance for adolescent health accounted for only 1.6% of total development assistance for health,[5] despite a third of the total global burden of disease estimated to have roots in adolescence.[6] Mental health problems affect 10-20% of adolescents, and many more experience symptoms that diminish wellbeing.[7] Furthermore, this is the age at which the gender inequalities that underlie and pose major barriers to wellbeing emerge clearly and is when programmes can transform these inequalities.

When adolescents move into young adulthood, many face unemployment or unstable employment, and girls in many countries are often expected to take on the burden of unpaid care work at home. In 2017, 34% of young women and 10% of young men aged 15-24 years were not in employment, education, or training, with more pronounced disparities in northern Africa and southern Asia.[6 8] Even among employed adolescents and young adults, an increasing proportion have poor job security, variable weekly earnings, and minimal or no health or social security coverage.[8]

These examples show that, as a global community, we have paid insufficient attention to the multidimensional and intersectional nature of adolescent wellbeing and the importance of the transition to young adulthood. People have too often wrongly assumed that, as long as adolescents are given a formal education and access to basic healthcare, their wellbeing will take care of itself. Efforts to support adolescent wellbeing have tended to be piecemeal, with different sectors focusing exclusively on their own areas of expertise and sometimes losing sight of the overall objective of promoting adolescents’ rights and wellbeing.

In 2019, for a more concerted and collaborative approach to adolescents’ wellbeing, an unprecedented coalition of governments, United Nations agencies, non-governmental organisations, and academic institutions—working closely with adolescents and young people—committed to a call to action for adolescent wellbeing.[9] Underpinning this call to action is a new agreed definition and conceptual framework for adolescent wellbeing to inform policies and programming.[10] The framework emphasises the importance of integrating five interconnected domains in adolescent programming: 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.

We invite everyone—decision makers, policy makers, civil society, service providers, educators, donors, innovators, and, most importantly, adolescents themselves—to support this call to action. Together, we can ensure that it results in concrete policies, integrated programmes, and sustained investments for adolescent wellbeing.

A global summit on adolescent wellbeing in 2023 was a key recommendation of the call to action. The summit will provide a powerful platform to drive forward our collective efforts for a gender transformative, multifaceted, and multisectoral response to adolescent wellbeing, with a focus on strengthening financing, policies, services, and accountability. The summit aims to contribute to ensuring that today’s adolescents are empowered to solve the problems they are inheriting.

Adolescents, youth, and youth led organisations are at the heart of this initiative and will continue to be so. But we all have a part to play in achieving these goals if we are to deliver a more equitable and inclusive world for this and future generations.

Authors

1. Helen Clark, Partnership for Maternal, Newborn & Child Health (PMNCH), Board Chair, former Prime Minister of New Zealand, Auckland, New Zealand
2. Tedros Adhanom Ghebreyesus, Director-General, World Health Organization, Switzerland
3. Anne-Birgitte Albrectsen, Chief Executive Officer, Plan International, UK
4. Jorge Alcocer, Secretary of Health, Government of Mexico, Mexico
5. Errol Alden, President, International Pediatric Association, USA
6. Audrey Azoulay, Director-General, United Nations Educational, Scientific and Cultural Organization (UNESCO), France
7. Saul Billingsley, Executive Director, FIA Foundation, UK
8. Robert W Blum, Professor, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, USA
9. Rajesh Bhushan, Secretary Health and Family Welfare, Government of India, India
10. Winnie Byanyima, Executive Director, UNAIDS, Switzerland
11. Rodrigo Alberto Carazo Zeledon, Permanent Representative of Costa Rica to the United Nations
12. Annabel Erulkar, Country Director, Population Council, Ethiopia
13. Lucy Fagan, Global Focal Point- SDG 3, UN Major Group for Children and Youth, UK
14. Adesegun Fatusi, Vice Chancellor, University of Medical Sciences, Nigeria.
15. Henrietta H. Fore, Executive Director, UNICEF, USA
16. Stefan Germann, Chief Executive Officer, Fondation Botnar, Switzerland
17. Karina Gould, Minister of International Development, Government of Canada, Canada
18. David Imbago, Vice-President for Development, International Youth Health Organization, Ecuador
19. Jessica Kahn, President, Society Adolescent Health and Medicine, USA
20. Natalia Kanem, Executive Director, United Nations Population Fund (UNFPA), USA
21. H.E. Uhuru Kenyatta, President of the Republic of Kenya
22. Zoleka Mandela, Global Ambassador, Child Health Initiative and Founder, Zoleka Mandela Foundation, South Africa
23. Phumzile Mlambo-Ngcuka, Executive Director, UN Women, United States
24. Wendy Morton, Minister for European Neighbourhood and the Americas. Foreign, Commonwealth & Development Office (FCDO), UK
25. George Patton, Professor, Centre for Adolescent Health and the Murdoch Children's Research Institute, University of Melbourne, Australia
26. Gogontlejang Phaladi, Executive Director, Pillar of Hope Project, Botswana
27. Susan M Sawyer, President, International Association of Adolescent Health, Australia
28. Kevin Watkins, Chief Executive Officer, Save the Children, UK
29. Jayathma Wickramanayake, UN Secretary General’s Envoy on Youth, USA
30. *Anshu Mohan, Senior Technical Officer, Country Engagement, Partnership for Maternal, Newborn & Child Health (PMNCH), Switzerland

* Corresponding author

References

1 The Lancet. Generation coronavirus? Lancet 2020;395:1949. PubMed doi:10.1016/S0140-6736(20)31445-8
2 Ford T, John A, Gunnell D. Mental health of children and young people during pandemic. BMJ 2021;372:n614. PubMed doi:10.1136/bmj.n614
3 Organisation for Economic Cooperation and Development. HC3.1 homeless population. 2020. https://www.oecd.org/els/family/HC3-1-Homeless-population.pdf.
4 Unicef, Unesco Institute for Statistics. Monitoring education participation: framework for monitoring children and adolescents who are out of school or at risk of dropping out. 2016. http://uis.unesco.org/sites/default/files/documents/monitoring-education...
5 Li Z, Li M, Patton GC, Lu C. Global development assistance for adolescent health from 2003 to 2015. JAMA Netw Open 2018;1:e181072. PubMed doi:10.1001/jamanetworkopen.2018.1072
6 World Health Organization. Adolescent health epidemiology. https://www.who.int/maternal_child_adolescent/epidemiology/adolescence/en/.
7 Wesselhoeft R, Sørensen MJ, Heiervang ER, Bilenberg N. Subthreshold depression in children and adolescents - a systematic review. J Affect Disord 2013;151:7-22. PubMed doi:10.1016/j.jad.2013.06.010
8 International Labour Organization. Where do the world’s NEETs live? 2020. https://www.ilo.org/global/about-the-ilo/multimedia/maps-and-charts/enha....
9 Child Health Initiative. PMNCH, Plan international, UNFPA, Unicef, WHO, UN Major Group for Children and Youth. Adolescents 2030: a call to action for adolescent wellbeing. https://www.adolescents2030.org/
10 Ross DA, Hinton R, Melles-Brewer M, et al. Adolescent wellbeing: a definition and conceptual framework. J Adolesc Health 2020;67:472-6. PubMed doi:10.1016/j.jadohealth.2020.06.042

Competing interests: SB is an employee (executive director) of the FIA Foundation (UK registered charity No 1088670), a trustee of International Road Assessment Programme (registered charity No 1140357), and a member of the steering committee of the United Nations Road Safety Fund. LF declares a non-financial interest as member of the World Health Organization Global Action for Measurement of Adolescent Health advisory group on adolescent health measurement. JK is president of the Society for Adolescent Health and Medicine (unpaid) and receives funding from the US National Institutes of Health (NIH). She was previously an investigator in primarily NIH funded research studies (vaccine clinical trials) that received funding from Merck for the costs of vaccine and antibody testing, though she and her institution did not receive any funding. ZM is founder of the Zoleka Mandela Foundation and global ambassador of the Child Health Initiative. All other authors declare no competing interests.

31 March 2021
Helen Clark
board chair and former prime minister of New Zealand
29 other authors; see text for details
Partnership for Maternal, Newborn, and Child Health (PMNCH), World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland