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Opinion Adolescent Wellbeing

Four powerful reasons for increasing investment in adolescents and their wellbeing

BMJ 2022; 379 doi: (Published 27 October 2022) Cite this as: BMJ 2022;379:o2526

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  1. David A Ross, consultant1,
  2. Howard S Friedman, technical specialist2,
  3. Darren Welch, former executive committee chair3,
  4. Natasha S Kaoma, chief executive officer4,
  5. Rajesh Bhushan, board vice chair and secretary, health and family welfare35,
  6. Bruce Rasmussen, director6
  1. 1Child Health Initiative of the Federation Internationale de l’Automobile (FIA) Foundation, London, UK
  2. 2Technical Division, United Nations Population Fund, New York, USA
  3. 3Partnership for Maternal, Newborn, and Child Health (PMNCH), Geneva, Switzerland
  4. 4Copper Rose, Lusaka, Zambia
  5. 5Health and Family Welfare, Government of India, Delhi, India
  6. 6Victoria Institute of Strategic Economic Studies, Victoria University, Melbourne, Australia
  1. Correspondence to: D A Ross dross.rbridge{at}

We cannot afford to ignore the needs of this growing sector of the population, argue David Ross and colleagues

Adolescents worldwide receive less public health investment per capita than other age groups.12 This would be reasonable if adolescents’ needs for investment were lower than those of other age groups, but this is not the case. The first two decades of a person’s life are when they are learning the most and when values and behaviours are set for subsequent adult life.3 Investing during adolescence will reap both short term and long term rewards for the adolescent themselves and for society.

Failure to invest in crucial demographic groups is one reason for the prediction that few sustainable development goals (SDGs) will be met by 2030, according to the United Nations in its SDG report of July 2022.4 Investment in adolescents and their wellbeing should be increased, therefore, for four powerful reasons.

Firstly, investing in adolescents is not one policy option among many; it is a basic duty of governments to address adolescent wellbeing as a human rights imperative.5 For example, few would argue that adolescents do not have a right to information and services to promote their health, education, safety, and protection. Compared with adults, adolescents, and especially young adolescents, are less empowered to demand their rights in most societies—they do not yet have full legal adult decision making authority, and they are not infants or young children whom adults are more inclined to support. Given this, governments and adults have a duty to support their wellbeing and to empower them to realise their rights6: 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.

A second justification for additional investment is the effect of ongoing global demographic and epidemiological transitions. Adolescents currently comprise 16% of the global population and 23% of the population of low income countries.7 In low income countries, their numbers nearly doubled from 390 million in 1980 to 761 million in 2020 and are expected to total well over 800 million by 2030.8

Ignoring the wellbeing of this large segment of the population and the demographic dividend that they can contribute to the future wealth and welfare of their societies would be a huge mistake. The adverse consequences of the climate emergency and the changing nature of work, with higher skill requirements and fewer entry level jobs, have increased the urgency of equipping this rapidly growing segment of the population with skills and other capabilities.

Globally, the mortality rate in infants and children under five has been decreasing more rapidly than that in adolescents (aged 10-19).9 Already, in high income countries the annual mortality rate in young children aged 1-4 years is much lower, at 21/100 000, than in adolescents aged 15-19, at 37/100 000.10 Globally, the importance of road traffic injury, suicide, and non-communicable diseases as a cause of death in adolescents is increasing.10 Young child mortality remains important, but the increasing relative importance of mortality among older adolescents deserves attention. Furthermore, adolescent morbidity has barely declined since 1990.11 Despite this, major causes of morbidity have evolved, with burdens from injuries, mental illness, and non-communicable diseases increasing, while those owing to infectious diseases have decreased.11

Thirdly, investing in adolescents and their wellbeing makes sound economic sense because many of the benefits of those investments are not only immediate, but also endure for the rest of their lives.1213 Estimates suggest that economic returns of $5-10 for every dollar invested are common, with ratios well above 10 for some interventions focused on adolescent wellbeing.12

Finally, investing in adolescents and their wellbeing strengthens the human capital (accumulated knowledge, skills, and health) of a country, and hence the country’s wealth, potential for future development, and for ending extreme poverty and creating more inclusive societies.1415 As Bundy and colleagues have written: “The latest World Bank analyses show that the skills and knowledge acquired during school age and adolescence are crucial to human capital.”16 Adolescents and youth are often at the forefront of constructive action and activism, demonstrated in campaigns to avert the climate crisis.17 Meaningfully engaging with them to tackle problems such as the climate emergency, violence, pollution, and environmental degradation, is essential.18

We argue that these four reasons justify investing more in adolescent wellbeing to deliver substantial social and health benefits both to adolescents themselves, and to society more widely—particularly if investments are coordinated to reap the potential for synergistic, mutually reinforcing investments, thereby contributing to the achievement of the SDGs.


We thank Anshu Mohan of PMNCH, Rachael Hinton, consultant to PMNCH, and Joy Phumaphi of the African Leaders Malaria Alliance (ALMA) and co-chair of PMNCH´s Partner Engagement in Countries Committee for very useful comments on earlier versions of this opinion piece. We also thank Peter Sheehan, Kim Sweeny, and John Symons of Victoria University, George Patton of the University of Melbourne, and Donald Bundy of the London School of Hygiene and Tropical Medicine for thinking that has contributed to the section on the economic case for investment in adolescents and their wellbeing. This article is the view of the authors and may necessarily represent the views, decisions, or policies of the World Health Organization, Unicef, or Unesco.


  • This article was amended on 27 October to correct the job title of Rajesh Bhushan.

  • Competing interests: We have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.

  • Provenance and peer review: Commissioned; not externally peer reviewed.

  • This article is part of a collection proposed by the Partnership for Maternal, Newborn, and Child Health. Open access fees were funded by the Bill and Melinda Gates Foundation. The BMJ commissioned, peer reviewed, edited, and made the decision to publish these articles. Emma Veitch was the lead editor for The BMJ.

This is an Open Access article distributed under the terms of the Creative Commons Attribution IGO License (, which permits use, distribution, and reproduction for non-commercial purposes in any medium, provided the original work is properly cited.