The Vital Role of Accountability in Improving Adolescent Health and Well-being

By Sophie Arseneault, Jonathan D. Klein, and Jennifer Requejo on behalf of the PMNCH Accountability Working Group*

11 October 2023
Highlights
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On October 11th and 12th, stakeholders will come together at the Global Forum for Adolescents (1), a historic gathering of youth, advocates, researchers, practitioners, and decision-makers. The Global Forum’s purpose is to advance adolescent health and well-being by strengthening evidence-based political commitments, policies, and mobilization of domestic financing and official development assistance. Informed by the Adolescent Well-Being Framework, (2) findings of the ‘What Young People Want’ survey, (3) and the Global Consensus Statement on Meaningful Adolescent and Youth Engagement, (4) the programme will promote the multi-dimensional nature of adolescent well-being in our conflict-affected world, still recovering from a global pandemic.

United Nations’ Secretary-General António Guterres reported at the UN General Assembly that just 12 per cent of the Sustainable Development Goals are on track – with 30 percent stalling or having worsened in the past decade (5). Among the 1.8 billion adolescents and youth in the world today, 87 percent live in low- and middle-income countries, and a third of these live in fragile and conflict-afflicted countries (6) (See below for key facts on adolescent health). Whereas young people have been hailed as the torchbearers and architects of the 2030 Agenda, they have also borne the brunt of pandemic-induced disruptions to education; rising food insecurity, housing instability, and income scarcity; mounting mental health challenges; and the escalating impact of climate change.

Young people and experts around the world agree that adolescents thrive and can achieve their full potential when they have access to good nutrition and healthcare; high quality education and employment opportunities; a feeling of connectedness to peers, family, and community; and safety from all forms of violence (7). While it is acknowledged that disruptions to social, economic, and political systems during the COVID19 epidemic exacerbated the vulnerability of adolescents and youth, the long-term impacts remain largely unknown. Although adolescents bear a substantial proportion of the global burden of disease and injury, large data gaps and limited engagement of young people in research and planning processes hinders the development and implementation of targeted interventions to address their needs.  

Recognition of the value of youth policies for achieving sustainable development is not novel – in fact, the first global framework for youth policy development at the national and international level, the World Programme of Action for Youth to the year 2000 and beyond (WPAY), was adopted in 1995 (8). It served as a tool for monitoring and tracking youth development in key areas and has been further supported by aligned initiatives such as Youth2030 (9). However, despite a gradual increase in youth participation mechanisms in decision-making since the launch of WPAY, youth policy and programmatic efforts remain considerably underfunded. Although youth-led and youth-serving organizations are best positioned to coordinate and implement youth-targeted activities across the humanitarian-to-development continuum, the current funding landscape often falls short of reaching their transformative potential.    

The Global Forum for Adolescents marks a critical moment for the 1.8 Billion Young People for Change Campaign (10), serving as a milestone for multisectoral specific, measurable, attainable, relevant, and time-based commitments to address disparities in adolescent health and well-being by governments, civil society, private sector, and global financing partners. With seven years remaining to reach the Sustainable Development Goal targets, the Forum represents an opportunity to re-assess adolescent health-related programmes and policies at global, regional, and country levels and to advocate for greater engagement of adolescents in their design, implementation, and evaluation.  

We are all accountable to ensuring that adolescents are not left behind, that their voices inform collective action learning and best practices, and that their needs are met through sustainable commitments, investments, and interventions. We call on countries and development partners to seize this opportunity of the Global Forum to reaffirm their commitment to meaningful adolescent and youth engagement and ensure that all adolescents can survive, thrive, and have fulfilling life opportunities. Together, we can secure a better future for adolescents in this and in future generations.

References

(1) Global Forum for Adolescents. https://www.1point8b.org/.

(2) David A. Ross et al., Adolescent Well-Being: A Definition and Conceptual Framework. Journal of Adolescent Health, 2020. Vol. 67, Issue 4. https://www.jahonline.org/article/S1054-139X(20)30396-7/fulltext

(3) Partnership for Maternal, Newborn, and Child Health. What Young People Want: Interim Analysis of the World’s Largest Survey on Adolescent and Youth Well-Being. https://pmnch.who.int/resources/publications/m/item/what-young-people-want-interim-analysis-of-the-world-s-largest-survey-on-adolescent-and-youth-well-being.

(4) Partnership for Maternal Newborn and Child Health (2019). Global consensus statement on meaningful adolescent and youth engagement. Geneva: World Health Organization. Available at: https://pmnch.who.int/resources/publications/m/item/globalconsensus-statement-on-meaningful-adolescent-and-youth-engagement.  Partnership for Maternal, Newborn, and Child Health has also published a, Practical Guidance Resource to Operationalize the Global Consensus Statement on Meaningful Adolescent and Youth Engagement: https://pmnch.who.int/resources/publications/m/item/practical-guidance-resource-to-operationalize-the-global-consensus-statement-on-meaningful-adolescent-and-youth-engagement-(maye)

(5) World Health Organization, (25 April 2023). Warning Over Half of World is Being Left Behind, Secretary-General Urges Greater Action to End Extreme Poverty, at Sustainable Development Goals Progress Report Launch [Press Release]. https://press.un.org/en/2023/sgsm21776.doc.htm

(8) UN Department of Economic and Social Affairs. World Programme of Action for Youth. https://social.desa.un.org/issues/youth/wpay

(9) Youth 2030: The UN Youth Strategy. https://www.un.org/youthenvoy/youth-un/

(10) David A. Ross et al., The 1.8 Billion Campaign: Adolescents and Their Well-Being Take Center Stage. Journal of Adolescent Health, 2023. Vol. 73, Issue 4. https://www.jahonline.org/article/S1054-139X(23)00348-8/fulltext

Adolescent health and well-being – key facts

  • Close to one million adolescents died in 2021, mostly from preventable and treatable causes. (1) Causes of death and risk factors change as adolescents age and vary by sex and where adolescents live.  Maternal conditions remain a leading cause of death for adolescent girls, while road traffic injuries are a top cause for adolescent boys.  Self-harm is among the top five causes of death across regions.  (SDG Target 3.1 and 3.4) (2)
  • Globally, around 84% of adolescents of lower secondary school age are enrolled in education. Yet, 63 million adolescents of lower secondary school age are out of school.  Almost half of these adolescents live in South Asia and sub-Saharan Africa. Although more girls than boys are out of primary school, boys are slightly more likely to be out of lower and upper secondary school than girls. (SDG target 4.1) (3)
  • Marriage before the age of 18 is a human rights violation, yet millions of young girls remain at risk of becoming child brides.  Although the proportion of young women who were married as children has decreased during the past decade from nearly 1 in 4 to 1 in 5, no region is on track to reach the goal of eliminating child marriage by 2030.  (SDG target 5.3) (4)
  • Globally, only around 1 in 2 adolescent girls aged 15-19 have their demands for family planning satisfied by modern methods, and few adolescent girls make their own decisions about sexual and reproductive health (5) (6) (7)
  • WHO estimates that as much as 70% of premature deaths occurring during adulthood are the result of health-related behaviors (such as smoking, alcohol use, poor nutrition, and risky behaviors) initiated during childhood and adolescence (8)

References and data sources

  1. United Nations Inter-Agency Group for Child Mortality Estimation (UNIGME), Levels & Trends in Child Mortality:  Report 2022, Estimates Developed by the United Nations Inter-agency Group for Child Mortality Estimation, United Nations Children’s Fund, New York, 2023;
  2. Global Health Estimates 2020:  Deaths by cause, age, sex, by country and by region, 2000-2019, World Health Organization;
  3. UNICEF global database on education, 2022, based on Multiple Indicator Cluster Surveys, Demographic and Health Surveys and other national household surveys. https://data.unicef.org/adp/snapshots/education-and-learning/;
  4. United Nations Children’s Fund, Is an end to child marriage within reach?  Latest trends and future prospects, 2023 update, UNICEF, New York, 2023.
  5. United Nations, Department of Economic and Social Affairs, Population Division (2022).  World Contraceptive Use 2022.
  6. UNICEF Global Databases based on DHS, MICS, and other national household surveys, 2022.
  7. UNFPA and Hera (2019).  Research on what determines women’s ability to decide on their SRHR and the relationship between this and other aspects of their lives.  Volumes 1 and 2:  Final report, October 2019;
  8. Akseer, N., Mehta, S., Wigle, J. et al. Non-communicable diseases among adolescents: current status, determinants, interventions and policies. BMC Public Health 20, 1908 (2020). https://doi.org/10.1186/s12889-020-09988-5

* Partnership for Maternal, Newborn & Child Health (PMNCH) Accountability Working Group Members (in alphabetical order): Sana Contractor, Theresa Diaz, Lucy Fagan, Smita Gaith, Vineeta Gupta, Susannah Hurd, Dan Irvine, Mande Limbu, Jaideep Malhotra, Harriet Nayiga, Oyeyemi Pitan, Miriam Sangiorgio, Petrus Steyn, Goknur Topcu. Leadership and Management of the group: Jennifer Requejo (co-chair), Jonathan D. Klein (vice chair), Sophie Arseneault (vice chair, under 30 years of age), Ilze Kalnina (PMNCH Secretariat)