Uniting for adolescents in covid-19 and beyondBMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n719 (Published 31 March 2021) Cite this as: BMJ 2021;372:n719
- Helen Clark, board chair and former prime minister of New Zealand1,
- Tedros Adhanom Ghebreyesus, director general2,
- Anne-Birgitte Albrectsen, chief executive officer3,
- Jorge Alcocer, secretary of health4,
- Errol Alden, president5,
- Audrey Azoulay, director general6,
- Saul Billingsley, executive director7,
- Robert W Blum, professor8,
- Rajesh Bhushan, secretary of health and family welfare9,
- Winnie Byanyima, executive director10,
- Rodrigo Alberto Carazo Zeledon, permanent representative of Costa Rica to the United Nations11,
- Annabel Erulkar, country director12,
- Lucy Fagan, global focal point (SDG 3)13,
- Adesegun Fatusi, vice chancellor14,
- Henrietta H Fore, executive director15,
- Stefan Germann, chief executive officer16,
- Karina Gould, minister of international development17,
- David Imbago, vice president for development18,
- Jessica Kahn, president19,
- Natalia Kanem, executive director20,
- Uhuru Kenyatta, president21,
- Zoleka Mandela, global ambassador and founder2223,
- Phumzile Mlambo-Ngcuka, executive director24,
- Wendy Morton, minister for European neighbourhood and the Americas25,
- George Patton, professor26,
- Gogontlejang Phaladi, executive director27,
- Susan M Sawyer, president28,
- Kevin Watkins, chief executive officer29,
- Jayathma Wickramanayake, secretary general’s envoy on youth30,
- Anshu Mohan, senior technical officer, country engagement1
- 1Partnership for Maternal, Newborn, and Child Health (PMNCH), World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
- 2World Health Organization, Switzerland
- 3Plan International, UK
- 4Government of Mexico, Mexico
- 5International Pediatric Association, USA
- 6Unesco, France
- 7FIA Foundation, UK
- 8Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, USA
- 9Government of India, India
- 10UNAIDS, Switzerland
- 11United Nations
- 12Population Council, Ethiopia
- 13UN Major Group for Children and Youth, UK
- 14University of Medical Sciences, Nigeria
- 15Unicef, USA
- 16Fondation Botnar, Switzerland
- 17Government of Canada, Canada
- 18International Youth Health Organization, Ecuador
- 19Society for Adolescent Health and Medicine, USA
- 20United Nations Population Fund (UNFPA), USA
- 21Republic of Kenya
- 22Child Health Initiative, UK
- 23Zoleka Mandela Foundation, South Africa
- 24UN Women, USA
- 25Foreign, Commonwealth, and Development Office, Government of the United Kingdom, UK
- 26Centre for Adolescent Health and the Murdoch Children’s Research Institute, University of Melbourne, Australia
- 27Pillar of Hope Project, Botswana
- 28International Association of Adolescent Health, Australia
- 29Save the Children, UK
- 30Office of the Secretary General’s Envoy on Youth, United Nations, USA
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.12 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.34 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.68 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.
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.
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