Our future: a Lancet commission on adolescent health and wellbeing

doi:10.1016/S0140-6736(16)00579-1

Review

. 2016 Jun 11;387(10036):2423-78.

doi: 10.1016/S0140-6736(16)00579-1. Epub 2016 May 9.

Our future: a Lancet commission on adolescent health and wellbeing

George C Patton¹, Susan M Sawyer², John S Santelli³, David A Ross⁴, Rima Afifi⁵, Nicholas B Allen⁶, Monika Arora⁷, Peter Azzopardi⁸, Wendy Baldwin⁹, Christopher Bonell¹⁰, Ritsuko Kakuma¹¹, Elissa Kennedy¹², Jaqueline Mahon¹³, Terry McGovern³, Ali H Mokdad¹⁴, Vikram Patel¹⁵, Suzanne Petroni¹⁶, Nicola Reavley¹¹, Kikelomo Taiwo¹⁷, Jane Waldfogel¹⁸, Dakshitha Wickremarathne¹⁹, Carmen Barroso²⁰, Zulfiqar Bhutta²¹, Adesegun O Fatusi²², Amitabh Mattoo²³, Judith Diers²⁴, Jing Fang²⁵, Jane Ferguson²⁶, Frederick Ssewamala¹⁸, Russell M Viner²⁷

Affiliations

¹ Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Parkville, Melbourne, VIC, Australia. Electronic address: george.patton@rch.org.au.
² Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Parkville, Melbourne, VIC, Australia; Murdoch Childrens Research Institute, Columbia University, New York, NY, USA.
³ Mailman School of Public Health, Columbia University, New York, NY, USA.
⁴ World Health Organization, Geneva, Switzerland; London School of Hygiene & Tropical Medicine, London, UK.
⁵ Department of Health Promotion and Community Health, American University of Beirut, Beirut, Lebanon.
⁶ Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia; University of Oregon, Eugene, OR, USA.
⁷ Public Health Foundation of India, New Delhi, India.
⁸ Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Parkville, Melbourne, VIC, Australia.
⁹ Retired.
¹⁰ Institute of Education, University College London, London, UK.
¹¹ School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
¹² Burnet Institute, Melbourne, VIC, Australia.
¹³ United Nations Population Fund, New York, NY, USA.
¹⁴ Institute of Health Metrics and Evaluation, University of Washinton, Seattle, WA, USA.
¹⁵ London School of Hygiene & Tropical Medicine, London, UK; Public Health Foundation of India, New Delhi, India.
¹⁶ International Centre for Research on Women, Washington, DC, USA.
¹⁷ Girls Educational Mentoring Services, New York, NY, USA.
¹⁸ School of Social Work, Columbia University, New York, NY, USA.
¹⁹ CARE International, London, UK.
²⁰ International Planned Parenthood Foundation, London, UK.
²¹ University of Toronto, Toronto, ON, Canada; Aga Khan University, Karachi, Pakistan.
²² Obafemi Awolowo University, Ile Ife, Nigeria.
²³ Australia India Centre, University of Melbourne, Melbourne, VIC, Australia; Jawaharlal Nehru University, New Delhi, India.
²⁴ UNICEF, New York, NY, USA.
²⁵ Kunming Medical University, Kunming, China.
²⁶ London School of Hygiene & Tropical Medicine, London, UK.
²⁷ Institute of Child Health, University College London, London, UK.

PMID: 27174304
PMCID: PMC5832967
DOI: 10.1016/S0140-6736(16)00579-1

Review

Our future: a Lancet commission on adolescent health and wellbeing

George C Patton et al. Lancet. 2016.

. 2016 Jun 11;387(10036):2423-78.

doi: 10.1016/S0140-6736(16)00579-1. Epub 2016 May 9.

Authors

Affiliations

¹ Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Parkville, Melbourne, VIC, Australia. Electronic address: george.patton@rch.org.au.
² Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Parkville, Melbourne, VIC, Australia; Murdoch Childrens Research Institute, Columbia University, New York, NY, USA.
³ Mailman School of Public Health, Columbia University, New York, NY, USA.
⁴ World Health Organization, Geneva, Switzerland; London School of Hygiene & Tropical Medicine, London, UK.
⁵ Department of Health Promotion and Community Health, American University of Beirut, Beirut, Lebanon.
⁶ Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia; University of Oregon, Eugene, OR, USA.
⁷ Public Health Foundation of India, New Delhi, India.
⁸ Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Parkville, Melbourne, VIC, Australia.
⁹ Retired.
¹⁰ Institute of Education, University College London, London, UK.
¹¹ School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
¹² Burnet Institute, Melbourne, VIC, Australia.
¹³ United Nations Population Fund, New York, NY, USA.
¹⁴ Institute of Health Metrics and Evaluation, University of Washinton, Seattle, WA, USA.
¹⁵ London School of Hygiene & Tropical Medicine, London, UK; Public Health Foundation of India, New Delhi, India.
¹⁶ International Centre for Research on Women, Washington, DC, USA.
¹⁷ Girls Educational Mentoring Services, New York, NY, USA.
¹⁸ School of Social Work, Columbia University, New York, NY, USA.
¹⁹ CARE International, London, UK.
²⁰ International Planned Parenthood Foundation, London, UK.
²¹ University of Toronto, Toronto, ON, Canada; Aga Khan University, Karachi, Pakistan.
²² Obafemi Awolowo University, Ile Ife, Nigeria.
²³ Australia India Centre, University of Melbourne, Melbourne, VIC, Australia; Jawaharlal Nehru University, New Delhi, India.
²⁴ UNICEF, New York, NY, USA.
²⁵ Kunming Medical University, Kunming, China.
²⁶ London School of Hygiene & Tropical Medicine, London, UK.
²⁷ Institute of Child Health, University College London, London, UK.

PMID: 27174304
PMCID: PMC5832967
DOI: 10.1016/S0140-6736(16)00579-1

No abstract available

PubMed Disclaimer

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. 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. 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. 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. 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. 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**
Conceptual framework for defining health needs and actions in adolescents and young adults

**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. 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. 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. 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. 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. 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. 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. 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. 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. 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**
Conceptual framework of the essential elements in meaningful youth engagement

**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**
Four-step accountability framework for adolescent health and wellbeing

See this image and copyright information in PMC

Comment in

From Advocacy to Action in Global Adolescent Health.
Patton GC, Sawyer SM, Ross DA, Viner RM, Santelli JS. Patton GC, et al. J Adolesc Health. 2016 Oct;59(4):375-7. doi: 10.1016/j.jadohealth.2016.08.002. J Adolesc Health. 2016. PMID: 27664465
Involving adolescents in the discussion about SDGs.
Bandara AN. Bandara AN. Lancet. 2017 May 20;389(10083):1979. doi: 10.1016/S0140-6736(17)31318-1. Lancet. 2017. PMID: 28534748 No abstract available.
Adolescent health and wellbeing: advocating a role for urban design.
Roe J, Knöll M. Roe J, et al. Lancet Child Adolesc Health. 2018 Oct;2(10):697-699. doi: 10.1016/S2352-4642(18)30253-0. Lancet Child Adolesc Health. 2018. PMID: 30236374 No abstract available.

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References

1. Lamy P, Bachelet M, Barber L, et al. Now for the long term: the report of the Oxford Martin commission for future generations. Oxford: Oxford Martin School; 2013.
1. Whitmee S, Haines A, Beyrer C, et al. The Rockefeller Foundation–Lancet Commission on planetary health. Safeguarding human health in the Anthropocene epoch: report of The Rockefeller Foundation–Lancet Commission on planetary health. Lancet. 2015;386:1973–2028. - PubMed
1. Blakemore SJ, Mills KL. Is adolescence a sensitive period for sociocultural processing? Annu Rev Psychol. 2014;65:187–207. - PubMed
1. United Nations Secretary-General. The global strategy for women’s, children’s and adolescentss health (2016–2030): survive thrive transform. 2015 http://www.who.int/life-course/partners/global-strategy/globalstrategyre... (accessed April 3, 2016)
1. UN. Transforming our world: the 2030 agenda for sustainable development. New York: United Nations; 2015.

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[1] Lamy P, Bachelet M, Barber L, et al. Now for the long term: the report of the Oxford Martin commission for future generations. Oxford: Oxford Martin School; 2013.

[2] Lamy P, Bachelet M, Barber L, et al. Now for the long term: the report of the Oxford Martin commission for future generations. Oxford: Oxford Martin School; 2013.

[3] Whitmee S, Haines A, Beyrer C, et al. The Rockefeller Foundation–Lancet Commission on planetary health. Safeguarding human health in the Anthropocene epoch: report of The Rockefeller Foundation–Lancet Commission on planetary health. Lancet. 2015;386:1973–2028. - PubMed

[4] Whitmee S, Haines A, Beyrer C, et al. The Rockefeller Foundation–Lancet Commission on planetary health. Safeguarding human health in the Anthropocene epoch: report of The Rockefeller Foundation–Lancet Commission on planetary health. Lancet. 2015;386:1973–2028. - PubMed

[5] Blakemore SJ, Mills KL. Is adolescence a sensitive period for sociocultural processing? Annu Rev Psychol. 2014;65:187–207. - PubMed

[6] Blakemore SJ, Mills KL. Is adolescence a sensitive period for sociocultural processing? Annu Rev Psychol. 2014;65:187–207. - PubMed

[7] United Nations Secretary-General. The global strategy for women’s, children’s and adolescentss health (2016–2030): survive thrive transform. 2015 http://www.who.int/life-course/partners/global-strategy/globalstrategyre... (accessed April 3, 2016)

[8] United Nations Secretary-General. The global strategy for women’s, children’s and adolescentss health (2016–2030): survive thrive transform. 2015 http://www.who.int/life-course/partners/global-strategy/globalstrategyre... (accessed April 3, 2016)

[9] UN. Transforming our world: the 2030 agenda for sustainable development. New York: United Nations; 2015.

[10] UN. Transforming our world: the 2030 agenda for sustainable development. New York: United Nations; 2015.

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Our future: a Lancet commission on adolescent health and wellbeing

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Our future: a Lancet commission on adolescent health and wellbeing

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