One out of every six people in the world is an adolescent. Put another way, there are more than one billion teenagers on Earth. Yet we pay very little attention to the health of 10- to 19-year-olds, individually and collectively.
A new report from the World Health Organization, entitled Health of the World's Adolescents: A Second Chance in the Second Decade, hopes to change that situation.
As the report notes, we tend to assume – and not entirely without reason – that youth is the healthiest time of life.
But the teen years are not all about hormones, acne and heartbreak. Teenagers face a host of health challenges, and these issues will affect them for the rest of their lives.
About 1.3 million adolescents die annually and what's truly tragic is almost every one of those deaths is preventable.
The WHO report includes a list of the top-10 causes of death in adolescence.
It reads like an action plan for where the world should be investing its public-health and health-promotion dollars: road-traffic injuries, HIV/AIDS, suicide, respiratory infections, violence, diarrhea, drowning, meningitis, epilepsy and, finally, endocrine, blood and immune disorders.
In developed countries such as Canada, adolescent deaths are uncommon – even more rare than childhood mortality. In 2011, only 1,022 of 242,074 deaths in this country were in the 10 to 19 age group; motor-vehicle crashes and suicide account for the vast majority.
Of course, mortality is not the only way of measuring the health of a population, particularly a typically healthy demographic such as teenagers.
Teens are risk-takers – thanks to their developing brains – and the decisions they make about smoking, drinking, driving and sex (among others) will have a profound, life-long impact on their physical, mental and economic health. So too will the conditions they may develop in adolescence, such as obesity or depression.
In fact, the report makes the point well that mental-health issues are the overwhelming health challenge for young people, regardless of where they live in the world.
Of the 10 leading causes of illness and disability among teens – depression, road-traffic injuries, anemia, HIV/AIDS, self-harm, back and neck pain, diarrhea, anxiety disorders, asthma and lower respiratory infections – three are directly related to mental health.
"Mental-health problems take a particularly big toll in the second decade," said Dr. Flavia Bustreo, assistant director-general for family, women and children's health at the WHO.
While the lists make for thought-provoking reading, they do not fully capture the health challenges faced by adolescents.
For teen girls, the biggest issue by far is lack of reproductive rights – the lack of access to contraception and the complications that follow from unprotected (and often non-consensual) sex, including sexually transmitted infections such as HIV and complications from pregnancy and childbirth.
One of the overriding priorities of public-health advocates in recent years has been to improve maternal and child health.
Each year, about 287,000 mothers die due to the complications of pregnancy or childbirth, and the majority of them are young mothers in their teens. And more than 6.6 million children under the age of five die annually, most of preventable or treatable causes; again, those with young mothers (who are more likely to be poor) are at higher risk.
Despite those sobering numbers, there have actually been tremendous gains – drops of 40 to 60 per cent in childbirth-related deaths in large parts of Asia and Africa. How to build on those successes will be the focus of the Global Summit on maternal, newborn and child health being held in Toronto from May 28 to 30.
But girls should not have to become mothers much too young and boys should not have to become infected with HIV/AIDS in their teens to have access to health programs.
The next big challenge for proponents of public health is to extend the improvements in maternal and child health to adolescents.
There are no simple wave-the-magic-wand solutions for preventing death, disability and illness in teenagers, not any more so than in other age groups.
But teenagers need and deserve something they have never had in public policy: adequate consideration and a voice.
Only when health initiatives include adolescents – the jumping-off point for creating a critical mass of healthy, productive adults – will there truly be a good return on investment.