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Review
, 387 (10036), 2423-78

Our Future: A Lancet Commission on Adolescent Health and Wellbeing

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Review

Our Future: A Lancet Commission on Adolescent Health and Wellbeing

George C Patton et al. Lancet.

Conflict of interest statement

Declaration of interests

All authors declare that the work of the Commission on Adolescent Health and Wellbeing was supported by the Bill & Melinda Gates Foundation (Seattle, WA, USA), MacArthur Foundation (Chicago, IL, USA), Australia India Institute (Melbourne, VIC, Australia), and the Murdoch Childrens Research Institute (Melbourne, VIC, Australia). The funding covered travel, accommodation, and meals for the Commission meetings, as well as development of background papers, project management and research assistant time. 12 authors reported grants from either the Bill & Melinda Gates Foundation, MacArthur Foundation, or the University of Melbourne, during the conduct of the study. RA received personal fees from UNDP, outside the submitted work. SMS is a member of WHO’s Technical Advisory Committee for the Department of Maternal, Newborn, Child and Adolescent Health.

Figures

Figure 1
Figure 1. Adolescents and young adults as a proportion of country population in 2013
Percentage of total country population aged 10–24 years. Data from Global Health Data Exchange.
Figure 2
Figure 2. Changing proximal social determinants of health across the life course
During adolescence, social determinants from outside the family become greater, with major influences of peers, media, education, and the beginning of workplace influences. Community and structural determinants remain consistently influential, as shown by the background shading.
Figure 3
Figure 3. Educational participation of 15–24 year olds for 188 countries
(A) Mean years of education attained in women and girls aged 15–24 years in 2013. (B) Mean years of education attained in men and boys aged 15–24 years in 2013. Data from Global Health Data Exchange.
Figure 4
Figure 4. Country-level association between adolescent birth rates and years of education in 2010–12
Each additional year of education is associated with an average of nine fewer births per 1000 adolescent girls per country. GNI=gross national income.
Figure 5
Figure 5. Association between health at 18 years of age and level of education in the Cebu cohort study, Philippines
Data from Global Health Data Exchange. *These associations were not significant.
Figure 6
Figure 6
Conceptual framework for defining health needs and actions in adolescents and young adults
Figure 7
Figure 7. Country categorisation based on adolescent burden of disease
Categorisation of countries into three groups according to adolescent burden of disease and reflecting passage through epidemiological transition. DALYs=disability-adjusted life-years. NCD=non-communicable diseases.
Figure 8
Figure 8. Country categorisation based on patterns of DALYs in 10–24 year olds
(A) Population of 10–24 year olds across country categories. (B) Total DALYs across country groups. DALY=disability-adjusted life-years. NCD=non-communicable diseases. Data from Global Health Data Exchange.
Figure 9
Figure 9. Changes in disease burden in 10–24 year olds between 1990 and 2013
Disease burden changes across the three country categories; NCD predominant, injury excess, and multi-burden. DALY=disability-adjusted life-years. SRH=sexual and reproductive health. NCD=non-communicable diseases. Data from Global Health Data Exchange.
Figure 10
Figure 10. Patterns of disease burden by age and sex across 10–24 year olds
Patterns of disease burden in different age groups across the three country categories; NCD predominant, injury excess, and multi-burden. DALY=disability-adjusted life-years. SRH=sexual and reproductive health. NCD=non-communicable diseases. Data from Global Health Data Exchange.
Figure 11
Figure 11. Summary profile of disease burden in 10–24 year olds across Chinese provinces
(A) DALYs per 100 000 19–24 year olds in 2013. (B) Annual percentage rate of change in total DALYs 2000–13. (C) Categorisation of Chinese provinces by major contributors to disease burden. (D) Contributors to disease burden in 10–24 year olds across Chinese provinces. DALY=disability-adjusted life-years. NCD=noncommunicable diseases.
Figure 12
Figure 12. Overweight and obesity in 10–24 year olds between 1990 and 2013
(A) Prevalence in 2013. (B) Annual percentage change from 1990 to 2013. NCD=non-communicable diseases. Data from Global Health Data Exchange.
Figure 13
Figure 13. Profile of adolescent fecundity
(A) Births per 1000 girls aged 15–19 years in 2010. (B) Percentage change in births per 1000 girls aged 15–19 years per year between 1990–95 and 2005–10. NCD=non-communicable diseases. Data from Global Health Data Exchange.
Figure 14
Figure 14. DALY rate from infectious diseases per 100 000 adolescents in multi burden countries
DALY=disability-adjusted life-years. Data from Global Health Data Exchange.
Figure 15
Figure 15. Health outcomes for 10–24 year olds in Nigeria
(A) DALYs per 100 000 adolescents aged 10–24 years, by cause and sex, 1990–2013. (B) Proportion of DALYs across 9 categories by sex in adolescents aged 10–24 years, 1990–2013. (C) Deaths per 100 000 adolescents aged 10–24 years per year, 1990–2013. (D) Causes of DALYs in adolescents aged 10–24 years, 2013, by sex. DALYs=disability-adjusted life years. NTD=neglected tropical diseases. PEM=protein energy malnutrition.
Figure 16
Figure 16. An overview of Nigeria’s health profiles for 10–24 year olds
Social determinants. (i) Currently married women and girls aged 15–19 years. (ii) Birth rate in adolescent girls. (iii) Mean years of education attained in adolescents aged 15–24 years. (iv) Unemployment in adolescents aged 15–24 years. (B) Health risks. (i) Overweight and obesity in adolescents aged 10–24 years. (ii) Daily tobacco smoking in adolescents aged 10–24 years. (iii) Binge drinking in the past 12 months in adolescents aged 10–24 years. (iv) Lifetime use of injectable drugs in adolescents aged 10–24 years. (v) Adolescents aged 10–24 years reporting sex before age 15 years (2004–14). (vi) Adolescents aged 10–24 years reporting condom use at last occasion of high risk sex (2004–14). (vii) Intimate partner violence in adolescents aged 10–24 years (2013). (viii) Unmet need for contraception in women and girls aged 10–24 years, married or in civil union (2009–14). DALYs=disability-adjusted life-years. NCD=non-communicable diseases.
Figure 17
Figure 17
Conceptual framework of the essential elements in meaningful youth engagement
Figure 18
Figure 18. Photovoice: using images to communicate and advocate
Photovoice is a participatory action research strategy commonly used with disadvantaged and marginalised groups. Photos are used to document personal and community issues and provide a basis for storytelling. It is a powerful tool for youth engagement, raising awareness of important aspects of the lives of adolescents. It is a useful way of levelling power differentials between adults and young participants. The strategy can be a means to catalyse community action, as the development of a story narrative facilitates the engagement of all participants in engaging in social change. It has been used across a wide variety of settings including health care (eg, young survivors of childhood cancer in South Korea), prevention and health promotion (eg, obesity prevention in the USA, reproductive health and empowerment programme targeting married adolescent girls in Ethiopia), and in youth engagement more broadly (adolescents identifying community strengths in Kenya). The images powerfully engage public interest in the daily lives and health challenges faced by young people.
Figure 19
Figure 19
Four-step accountability framework for adolescent health and wellbeing

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