An article by Melinda Gates, Co-Chair of the Bill & Melinda Gates Foundation
From The Lancet
The world is about to undergo an unprecedented transformation: the largest generation of young people in human history is coming of age. As a mother to teenagers, I have a good idea how this is an important stage of life. Every day, I see how my children’s worlds are expanding beyond our family, exposing them to new experiences and influences. While this inevitably leads to some anxieties, on the whole it is an exciting time as they begin new chapters in their lives. It is a similar story for many young people. But not all. I have also seen from my work for the Bill & Melinda Gates Foundation the problems that come with adolescence for those in the poorest parts of the world.
The Lancet Commission on adolescent health and wellbeing illuminates for the first time the magnitude of challenges faced by young people aged 10–24 years. This is a dynamic period of cognitive and physical development that can bring opportunity, but also angst and upheaval. Mental disorders commonly emerge at this time, self-harm and suicide spike, and it’s the age when substance use typically starts. Instead of being a time filled with possibility, adolescence can be when the world begins to contract for some young people. It is when they stop going to school, are at risk from HIV infection, or start having babies before they are emotionally or physically ready. All this wasted human potential still happens despite the progress the world has made making my children’s generation the healthiest and most educated ever. So the Lancet Commission is a powerful reminder that there is more to do to meet the unique needs of adolescents. And the compelling findings of the Commission must serve as an important wake-up call to individuals, organisations, and governments to support a new approach.
The stakes are high, so we must respond urgently. Failure to address the distinctive challenges that come with adolescence could not only jeopardise all that has been accomplished so far, it could also severely dent our chances of meeting the Sustainable Development Goals (SDGs) related to health, nutrition, education, gender equality, and food security. But as the Commission makes clear, if we do act, then we will see a triple dividend of benefits: for adolescents now, for them later as adults, and later still for their children. The world is already moving in the right direction. The Every Woman Every Child Global Strategy for Women’s, Children’s, and Adolescents’ Health and the SDGs, both explicitly call out the importance of adolescent health. The Lancet Commission gives us the blueprint we need to move this work forward and forces us to think differently.
Existing systems and structures focus almost exclusively on children or on adults, meaning few investments and interventions are directed specifically to young people. This is an issue that we have recognised at the Bill & Melinda Gates Foundation. The foundation’s work on family planning, nutrition, HIV, and maternal health has helped improve adolescent wellbeing—but until recently, only indirectly. As the Commission underlines, investment is needed in an ambitious, comprehensive, and cross-sector agenda focused solely on adolescents, and in line with its key recommendations our foundation is currently exploring three areas where we believe we can help to make a difference.
It starts with filling the knowledge gap around adolescent health. This is especially important for women and girls, where the gaps are pervasive. Youth and adolescence is such a pivotal time of life and yet we know so little about this age group. The Commission rightly identifies indicators that should be collected and monitored. These include early marriage, fertility, nutrition, and non-communicable diseases. Importantly, the information gathered will need to be broken down by sex, age, economic status, and location, to help focus resources where they are most needed. Already, our foundation is learning more by accumulating evidence on the health and wellbeing of people aged 10–14 years. But this step is just the beginning. Gathering data makes the invisible visible, and analysing it helps us discover what works and what doesn’t.
For that, as the Commission points out, it is crucial to involve young people. Too often the global community creates solutions for them rather than with them. This is a generation brimming with energy, ingenuity, leadership potential, and a natural determination to challenge the status quo. By harnessing those qualities and freeing them from social norms that prevent their voices being heard, we can empower young people to drive change. Accordingly, we are beginning to co-invest in initiatives that not only draw on behavioural and cognitive science, use new technologies, and include partnerships with adults, but that also take inspiration and direction from adolescents themselves.
Adolescence and young adulthood is also typically the time that gender roles and stereotypes take hold. With that, come the inequalities that determine the entire trajectory of girls’ lives—for example, in sub-Saharan Africa, young women aged 15–24 years are twice as likely to be living with HIV compared with young men. Addressing such disparities is our foundation’s third area of focus. We are already committed to putting women and girls at the centre of our global health and development agenda, with a specific emphasis on adolescents in family planning and nutrition. Now we are exploring new ways to ensure that women and girls remain a priority as the world gets to work on the SDGs. As part of this, we are looking for big ideas to promote women and girls’ empowerment, and examining policies and laws that make the greatest difference to women’s health and development.
My children’s generation is better equipped to expand the limits of human possibility than any that has gone before. But while responsibility for their health and wellbeing lies with everyone, accountability currently rests with no one. Our foundation strongly supports the Lancet Commission’s call for a global accountability mechanism that can offer independent oversight of a comprehensive adolescent health agenda, with young people at the forefront. For too long adolescents have been the forgotten community of the health and development agenda. We cannot afford to neglect them any longer.