Building transformational intergenerational partnerships for adolescent wellbeingBMJ 2022; 379 doi: https://doi.org/10.1136/bmj.o2539 (Published 27 October 2022) Cite this as: BMJ 2022;379:o2539
Adolescents want a future in which they are supported towards a healthy transition into adulthood, with a whole society approach centred on their lived reality. This requires policy making and programming to go beyond meeting essential needs and to remove the multiple barriers (social, structural, legal) that limit achievement of full potential and holistic wellbeing. It is also important to focus on adolescents’ right to self-fulfilment, equitable opportunity, agency and autonomy, and positive development. As young leaders and government allies, we call on policy makers, youth centred agencies, and key stakeholders to deliver more meaningfully for adolescents—recognising diversity and the needs of those most at risk of being left behind.
Engaging adolescents as equal stakeholders in decision making and agenda setting is important, recognising them as experts in defining their own wellbeing. Frequently, wellbeing interventions are developed from the perspective of adults, without meaningful participation of adolescents in design, implementation, or evaluation,1 leading to services that are not accessible or truly responsive to their needs.2 Adolescents are frequently regarded as respondents, audiences, or beneficiaries, or provide tokenistic validation of supposedly youth focused policies and programme efforts, which unsurprisingly then lack effectiveness and impact.
Young people from the UN Major Group for Children and Youth and the Partnership for Maternal, Newborn, and Child Health recently led a series of consultations with adolescent and youth representatives (including some of the signatories to this open letter), to explore their views on how the UN H6+Adolescent Wellbeing Definition and Conceptual Framework,3 could be translated into effective programming. The consultations found that adolescents recognise wellbeing to be multi-dimensional, transcending physical health and encompassing the totality of their lived experience and evolving capacities.4 The range of issues that adolescents thought were important to tackle was broad, including education, finances, employment, sexual health, self-esteem, body image, identity, spirituality, social issues, mental health, healthy relationships, personal development, and finding purpose.
Importantly, adolescents also expressed the critical need to place rights at the heart of any new wellbeing agenda, guiding the implementation of policy and programmatic responses. In a world where adolescents’ rights are constantly under threat—from the right to make choices about their own bodies to their right to grow up in a safe and healthy environment—we must seize this opportunity to promote adolescent rights, remove legal and structural barriers, and mitigate opposition blocking their wellbeing.
Approaches to wellbeing can and must encompass the whole lived experience and changing capacities of adolescents, with a focus on intersectional approaches that recognise the complex ways in which identity and inequality shape experience. In particular, the effects of structural, personally mediated, and internalised racism,5 class divides, misogyny, homophobia, xenophobia, ableism, and other forms of discrimination cannot be overstated.6 Throughout our consultations, many adolescents spoke about personal challenges of navigating racial and ethnic identities and the effects of these on physical, mental, and emotional wellbeing. Others emphasised how exposure to poverty, inequality, and social exclusion affected adolescents in their communities.
Securing the wellbeing of the next generation requires sustained, consolidated approaches at policy, programmatic, normative, and budgetary levels. As such, intergenerational co-leadership and transformational partnerships between governments and young people must be fostered to deliver a better, safer, and sustainable world for this and future generations of adolescents. To achieve this, spaces must be created and strengthened for engagement of adolescents of all ages, in all their diversity and at all levels. National and subnational platforms for increased and equitable adolescent engagement must be built into policy design and implementation.
Adolescent and youth led organisations are crucial partners in delivering the future we want and must be supported through flexible, sustainable funding. The 1.8 Billion Young People for Change campaign and the upcoming Global Forum for Adolescents in 2023 strive to enable this. Through digital technology and offline channels, young people are mobilising around the world to champion an Agenda for Action for Adolescents, which includes specific actions to be taken by governments, donors and foundations, programme implementers, and other key stakeholders to support adolescent wellbeing.
Crucially, adolescent wellbeing should be positioned as a holistic human rights and social justice priority, not just a single policy issue. Innovative partnership and co-leadership with young people have to be the driving forces, at both policy and programmatic levels, to promote collaboration across sectors and agencies to eliminate silos and to improve access to services. Adolescents should be meaningfully empowered and involved in the inception, planning, design, delivery, and evaluation of programmes; they should be critical partners in decisions around issues such as governance, development, resource allocation, and use. Governments must champion the wellbeing of the next generation and work closely with young people to design meaningful youth led accountability mechanisms to ensure that commitments are met and that no adolescent is left behind.7
Signatories to this open letter: Lucy Fagan, social affairs policy officer, UN Major Group for Children and Youth and Chair, Commonwealth Youth Health Network; Maria José Cisneros Cáceres, focal point, migration youth and children platform and researcher, Ohhh! Foundation; Richard Dzikunu, action learning lead, YIELD Collective Action Learning Hub; David Imbago-Jácome, project manager, YIELD Collective Action Learning Hub, and board member, Partnership for Maternal, Newborn, and Child Health; Ishu Kataria, global coordinator, Young Professionals Chronic Disease Network, and senior public health researcher, RTI International; Meheret (Mimi) Melles-Brewer, technical officer, Partnership for Maternal, Newborn, and Child Health; Mellany Murgor, non-communicable disease focal point, UN Major Group for Children and Youth, and Africa director, Young Professionals Chronic Disease Network; Rosario del Pilar Diaz Garavito, executive director, Millennials Movement; Sahil Tandon, research associate, David and Lucile Packard Foundation, vice chair (Strategic Advocacy Committee), Partnership for Maternal, Newborn, and Child Health, and board member, Young Experts: Tech 4 Health; Saad Uakkas, North Africa regional coordinator, African Youth Initiative on Climate Change; Karla Berdichevsky, director general, National Center for Gender Equity and Reproductive Health, Ministry of Health, Mexico; Meena Gandhi, senior health adviser, Maternal and Newborn Health, Foreign, Commonwealth, and Development Office; Pascalle Grotenhuis, ambassador for women’s rights and gender equality, Netherlands Ministry of Foreign Affairs; Zoya Ali Rizvi, deputy commissioner, Ministry of Health and Family Welfare, Government of India; Ambra Yirenkyi, director, Administration of the School Feeding Programme, Ministry of Gender, Children, and Social Protection, Ghana; Helga Fogstad, executive director, Partnership for Maternal, Newborn, and Child Health
Provenance and peer review: Commissioned, not peer reviewed.
Competing interests:LF declares a non-financial interest as a member of the UN Global Action for Measurement of Adolescent Health (GAMA) Advisory Group. DIJ is employed at an independent Adolescent and Youth Sexual and Reproductive Health and Rights Initiative hosted by Rutgers International. All other authors declare no competing interests.
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.
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