To anyone who shares a home with one, or is responsible for teaching them, it might seem that the demands of adolescents and young people are hard to ignore. But as a group, the needs and especially the future prospects of this section of the population have been substantially overlooked. In the UK we have seen this very clearly in the Brexit outcome: the substantial majority of those adolescents who voted, opted to remain in the EU, the opposite of older members of society. Their younger siblings could not even vote on their future.
Now consider the global picture. What does the future look like for the 1.2billion adolescents in the world today, almost 90% of whom live in developing countries? For adolescent girls in particular, under-age marriage, violence and abuse and teenage pregnancy blight their lives. Their access to education or a minimum wage if employed, and especially to health care, is severely limited.
Because adolescents make few demands on health care systems, we have assumed that their needs are small. We ignore the fact that these systems do not reach out to them even though many adolescents are already on a risky path to disease which will cost them and society dearly. For example, a recent study following a large cohort of adolescents in Israel showed how their level of fatness, across the normal range, translates into risk of death from cardiovascular disease up to 40 years later.
The challenge we all face is that this group has a higher risk of non-communicable disease at a younger age than previous generations, and that mental health, alcohol and other drug-related problems are now becoming prevalent. Additionally in some parts of the world adolescents also face high levels of communicable disease. The inequalities in health are now a human rights issue, especially for disadvantaged groups such as migrants or those of low socioeconomic status or educational attainment.
The good news is that helping today's adolescents will benefit two generations for the price of one: adolescence is a period when many unhealthy behaviours are established, so promoting a healthy lifestyle at this time can confer sustained benefit. In addition, adolescents are future parents, so health in the preconception period in the woman and her partner will benefit their children as well.
A very good example is the epidemic of obesity, about which so much has been written but so little has been achieved by way of reduction. How does taking an adolescent or preconception view alter the picture?
First, the number of women of reproductive age around the world who are overweight or obese is increasing: it is now about 50% in women aged 25-34 in the UK. Not only does this affect the woman's own health, putting her at greater risk of gestational diabetes and type two diabetes and cardiovascular disease in the longer-term, but it also places her offspring at risk of developing childhood obesity and its later consequences. And there we have the issue - the cycle repeats. If we can help today's young people to be healthier, their own future risk of conditions such as obesity will be reduced and so will their children's. The alarming rise in childhood obesity led the Director General of the World Health Organisation (WHO) to establish a Commission on Ending Childhood Obesity, which reported to the World Health Assembly in May of this year. The report stressed the need for concerted and sustained action, not only in childhood but earlier in the life course, in the mother (and father) both before and during pregnancy.
If many adolescents and young people view their health as a low priority, perhaps it is because we have not given them clear information on what they can do to optimize it for themselves and their children. Initiatives such as our LifeLab project are key to enhancing young people's ideas about how they can improve their health. Our recent feasibility study of LifeLab has shown that the intervention increased teenagers' awareness about how the food they eat now affects the health of their future children. But this is not enough. Changing opinions does not automatically lead to a change in behaviour unless we provide the tools and facilities to do so.
Fortunately the story is starting to change, although it seems to have taken the intervention of some very eminent actors to start a new chapter. In The Lancet (of June 11th) the UN Secretary-General Ban Ki-moon refers to the opportunities afforded by the Sustainable Development Goals as those for a Sustainable Development Generation, and Melinda Gates highlights the unprecedented transformation underway as the largest generation of young people ever comes of age.
This is a start but more needs to be done. The future belongs to young people and we owe them the opportunity to make it healthy. We need to make sure they are not the forgotten generation.
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