The Lancet: Globally the health of adolescents is at a tipping point; action needed to tackle rising threats to young people’s health and wellbeing
The Lancet
- New analysis indicates that without targeted action by 2030 at least half of the world’s adolescents (over 1 billion) will still live in countries where they are at risk of experiencing poor health across many indicators, including mental health and overweight.
- Over the past decade, progress in adolescent health and wellbeing has been mixed and uneven. While global rates of smoking and alcohol use have declined and educational participation - especially among young women - has increased, obesity-related diseases and mental health disorders are rising in all regions.
- The second Lancet Commission on adolescent health and wellbeing highlights that today's adolescents, the first generation to grow up under harsher climate conditions and the pervasive presence of digital technologies, disproportionately face emerging global health threats.
- Adolescents in low- and middle-income countries represent over a quarter of the population and bear a disproportionate share of the global disease burden (9.1%) - yet receive just 2.4% of global development aid.
- Adolescents and youth from over 36 countries were central to the Commission. They call for young people to claim their right to be involved in shaping policies, in research, and in advancing solutions that directly affect their lives.
By 2030, there will still be over 1 billion of the world’s adolescents (aged 10-24 years) living in countries where preventable and treatable health problems like HIV/AIDS, early pregnancy, unsafe sex, depression, poor nutrition and injury collectively threaten the health and wellbeing of adolescents, suggests a new analysis from the second Lancet Commission on adolescent health and wellbeing.
Commission co-chair, Professor Sarah Baird, George Washington University (USA) says, “The health and wellbeing of adolescents worldwide is at a tipping point, with mixed progress observed over the past three decades. Whilst tobacco and alcohol use has declined and participation in secondary and tertiary education has increased, overweight and obesity have risen by up to eight-fold in some countries in Africa and Asia over the past three decades, and there is a growing burden of poor adolescent mental health globally. Additionally, the challenges faced by the world’s adolescents are at risk of being exacerbated by emerging global issues including climate change, world conflicts and a rapid transition to a more digital world.
“Investing in the health and wellbeing of young people is crucial for safeguarding our collective future. We must prioritise investment in adolescent health and wellbeing through initiatives including those that strengthen schools to promote health and wellbeing and to ensure universal access to healthcare for adolescents. Furthermore, adolescent engagement and activism must be central to creating the social and community changes we need to foster a more just society and create a healthier planet with more opportunities for everyone.”
Insufficient and uneven progress
A decade since the first Lancet Commission on adolescent health and wellbeing published in 2016 [1], there have been global improvements in education, and in reducing global rates of smoking and alcohol use. However, across many areas of adolescent health, progress has been undermined by the COVID-19 pandemic and a chronic lack of funding.
In a novel analysis using data from the 2021 Global Burden of Disease study [2], the Commission estimates that there were nearly 1.1 billion adolescents living in countries where preventable and treatable health problems like HIV/AIDS, early pregnancy, unsafe sex, depression, poor nutrition and injury remain a daily threat to their health, wellbeing, and life chances (which the Commission terms multi-burden countries). [3]
This compares to just under 1 billion adolescents living in multi-burden countries in 2016 indicating, alongside population growth, a lack of progress in addressing adolescent health. New projections suggest that, without political will, policy initiatives and financial investments, there will still be more than 1 billion adolescents living in multi-burden countries in 2030.
Limited progress is evident in several critical areas impacting adolescents. The Commission estimates that nearly one-third of adolescent girls will be anaemic globally by 2030, highlighting inadequate efforts to tackle this issue. Anaemia can cause fatigue,hinder growth and cognitive development and, in extreme cases, lead to organ damage, making it crucial to address for the wellbeing of girls.
Similarly, adolescent mental health has seen a significant decline over the past three decades in countries with available data, a trend exacerbated by the COVID-19 pandemic. In 2030, the Commission projects 42 million years of healthy life will be lost to mental disorders or suicide (2 million more than in 2015).
Additional projections indicate that one-third of adolescents in high-income countries, Latin America, and the Middle East will be overweight by 2030, underscoring the shortcomings in combating adolescent obesity. In 2030, the Commission projects 464 million adolescents globally will be overweight or obese (143 million more than in 2015).
Commission co-chair, Professor Alex Ezeh, Drexel University (USA) says, “Demographic shifts will continue to drive global progress or lack thereof in adolescent health and wellbeing. Africa’s share of global adolescents will increase from under 25% currently to more than 46% by 2100. Consequently, progress in improving the health and wellbeing of adolescents in Africa will increasingly determine progress in improving the health and wellbeing of adolescents globally. This calls for targeted attention to the needs of adolescents in Africa.”
New threats to adolescent health
The Commission identifies several significant new threats to adolescent health, emphasising that young people are navigating a rapidly changing world. Emerging challenges, such as climate change and the shift towards a more digital world, are expected to have a profound impact on young people’s future health and wellbeing.
Today’s adolescents are the first generation who will live their entire life with the average annual global temperature that has consistently been 0·5oC higher than pre-industrial levels. And by 2100, 1.9 billion adolescents will live in a world that is expected to warm around 2.8oC above pre-industrial times, bringing catastrophic risks for their health such as heat-related illnesses, reduction in food and water quality and availability, and a rise in mental health conditions related to climate events.
The Commission undertook a new systematic review to identify how climate change affects adolescent mental health. The review found that both quick acting climate disasters such as hurricanes and slower acting effects such as chronic food insecurity contribute to mental health conditions in adolescents such as post-traumatic stress disorder, anxiety and depression. [4]
Commissioner Dr Aaron Jenkins, University of Sydney (Australia), says, “I am profoundly encouraged by our Second Lancet Commission on adolescent health and wellbeing, which embraces the ecological foundations of human wellbeing—highlighting biodiversity, environmental integrity, and climate as pivotal determinants of adolescent health. This holistic approach underscores that safeguarding our planet’s health is inseparable from nurturing the potential and resilience of young people. For the first time, we are identifying and encouraging interventions that simultaneously advance adolescent health, ecological integrity, biodiversity conservation, climate change mitigation, and social justice. This integrative co-benefit strategy not only addresses the multifaceted challenges faced by today’s youth but also paves the way for a sustainable and equitable future.”
Additionally, the Commission highlights how the digital transition offers adolescents new opportunities for social interaction, education, employment, and health promotion. However, many key social and emotional experiences now occur online, raising concerns about potential harm to their development and wellbeing. While the impact of the digital world, especially social media, on adolescent mental health remains highly debated with limited causal evidence, there is a need to balance early protective actions with avoiding unintended harm by overly restricting digital access.
Actions to address adolescent health and wellbeing
The Commission highlights that current funding for adolescent health and wellbeing is not proportionate with the magnitude of the challenge nor targeted to areas of greatest need.
An analysis of funding undertaken by the Commission finds adolescent health and wellbeing makes up only 2.4% of global aid, despite adolescents being 25% of the world population and making up 9% of the total burden of disease. [5]
The Commission’s analyses of the returns on investments in adolescence show they are on par with investments in children aged 0–9 years, and that investments in children and adolescents are associated with better returns than investments in adults. The Commission’s exploration of the challenges facing the field of adolescent health suggest that investment is hampered by the absence of global and national leadership, governance and accountability for adolescent health and wellbeing, among many other factors.
This is the first global Commission to prioritise and embed meaningful adolescent and youth engagement at every stage, co-led by ten diverse Youth Commissioners - aged 23 to 35 - spanning academia, civil society, and multilateral organisations. Their lived experiences, research expertise and leadership shaped the Commission, while Youth Solution Labs run by the Commission engaged over 200 adolescents across 36 countries to identify key priorities and develop actionable recommendations.
Youth Commissioner Dr Shakira Choonara, says, "Young people are navigating a rapidly changing world, and through this Commission we’ve heard the diverse and alarming concerns adolescents have about their health and wellbeing. However, there are also opportunities—and we've seen firsthand and through the Commission findings how adolescents are already stepping up as active citizens and powerful agents of change, from leading advocacy and activism to co-designing policies that shape the future of human health and planetary health. I am deeply inspired by the change youth leaders are bringing to their communities and to the global landscape. Investing in and engaging with our generation will build a healthier, more empowered, and better-equipped generation of future leaders."
Quotes from authors cannot be found in the text of the Commission but have been supplied for the press release.
References:
[1] https://www.thelancet.com/commissions/adolescent-health-and-wellbeing
[2] https://ghdx.healthdata.org/gbd-2021
[3] Multi-burden countries are defined by the Commission as countries where there are more than 2,500 Disability Adjusted Life Years in adolescents per 100,000 due to communicable, maternal or nutritional diseases.
[4] See appendix 12 for the systematic review on climate change and adolescent wellbeing
[5] See appendix 7 for the analysis of development assistance for health
The labels have been added to this press release as part of a project run by the Academy of Medical Sciences seeking to improve the communication of evidence. For more information, please see: http://www.sciencemediacentre.org/wp-content/uploads/2018/01/AMS-press-release-labelling-system-GUIDANCE.pd
IF YOU WISH TO PROVIDE A LINK FOR YOUR READERS, PLEASE USE THE FOLLOWING, WHICH WILL HAVE THE NEW COMMISSION ADDED AT THE TIME THE EMBARGO LIFTS: https://www.thelancet.com/commissions-do/adolescent-health-wellbeing
Funding: The Commission received funding from the Gates Foundation, Human Sciences Research Council, FIA Foundation, and Exemplars in Global Health.
Journal
The Lancet
Method of Research
Literature review
Subject of Research
People
Article Title
A call to action: a second Lancet commission on adolescent health and wellbeing
Article Publication Date
20-May-2025
COI Statement
All authors declare support from the Gates Foundation (INV-056091, INV-048897) for the Commission on Adolescent Health and Wellbeing. DI-J, LTG, SC, LL, SD, RT, AM-K, JMN, YD, and OB report honoraria for their contributions as Youth Commissioners. SS reports royalties from Oxford University Press. AOO reports consulting payments from IPAS, the Society for Family Health, and Plan International Nigeria; royalties from Oxford University Press; a volunteer position on an independent scientific advisory board for a Wellcome Trust-funded study; and nonpaid membership in various organisations, including the Society for Adolescent and Young People’s Health in Nigeria and WHO GAMA. SAM reports honoraria payments from Yale University, Vanderbilt University, Harvard University, New York University, American University, Columbia University, Carleton University, and Northwestern University. DI-J reports payment as a member of the PMNCH Board, is a Youth Advisory Group member of the UGood Project and a board member of IPAS, and holds stock in Pfizer. SAM declares travel support for attending meetings from Wissenschaftskolleg zu Berlin. AOO is a non-paid member of the Society for Adolescent and Young People’s Health in Nigeria and WHO’s Global Action for Measurement of Adolescent Health. AC received travel support to attend meetings afrom the Wellcome Trust, the Australian National Health and Medical Research Council, the Australian Research Council, the European Climate Foundation, the Australian Department of Health and Aged care; the Royal Australasian College of Physicians, and the Victorian Department of Heath. SS declares travel support for meetings from the Human Sciences Research Council and Mastercard Foundation. Commissioners received travel and accommodation support to attend Commission meetings in Kenya (2023) and South Africa (2023), with no payments made to them or their institutions unless otherwise stated. SMS reports an unpaid role as past president of the International Association for Adolescent Health. AE reports financial support through flexible startup funds from Drexel University (made possible by support from Dana and David Dornsife to the Dornsife School of Public Health at Drexel University) for research time and travel. MO’S received subcontract payments through her institutions for her coordination roles for the Commission. JMN, AOO, CL, AKG, CWK, and AM-K received subcontract payments through their institutions for analysis work done for the Commission. All other authors declare no competing interests.
Landmark report reveals key challenges facing adolescents
Murdoch Childrens Research Institute
Poor mental health, rising obesity rates, exposure to violence and climate change are among the key challenges facing our adolescents today, according to a global report.
The landmark report, by experts in adolescent health including from Murdoch Children’s Research Institute (MCRI), has revealed how supporting young people’s health and wellbeing could improve economic, social and public health for generations to come.
The 2025 Lancet Commission on Adolescent Health and Wellbeing found investment in adolescents’ health and wellbeing doesn’t match the scale of the problems faced by young people. Bringing together 44 Commissioners and 10 Youth Commissioners, the Commission stated while adolescents make up 24 per cent of the population (about two billion people), they receive just 2.4 per cent of global development and health funding.
By 2030, more than half of adolescents will be living in countries where their demographic experiences an excess burden of complex disease.
The report found the ongoing challenges faced by this age group included:
- High cases of poor mental health and limited support services
- Increasing rates of obesity due to complex environmental and commercial factors
- Lack of digital safety and exposure to cyberbullying and misinformation
- Experiencing violence in conflict-affected areas and within the home
- Ongoing fallout from the COVID-19 pandemic and related public health measures
- Widening gaps in reproductive rights, particularly for young women
- Environmental challenges and climate change impacts
Published in The Lancet, the report predicted that by 2050, 70 per cent of the world’s adolescents will be living in urban areas. While this potentially brings benefits, rapid unplanned urbanisation may also accelerate poverty, isolation and insecure housing, it found.
The report stated that urban, public spaces should be more amenable and tailored to young people, such as safe and engaging spaces to congregate, which would have a powerful effect on health outcomes.
It also found urgent action was required to better protect young people from violence and ensure equitable access to education and reproductive rights. Almost half of adolescents have experienced violence, profoundly impacting their social and emotional development and wellbeing. Whilst global efforts have largely closed the gender gap in high school education, by 2030, almost a third of young women will not be in post-secondary education, employment or training.
MCRI Professor Peter Azzopardi said there was a great need for targeted actions that focused on early intervention.
“Meaningful, evidence-based, multi-sector partnerships with young people will be the key to improving health and wellbeing,” he said. But we must remain accountable by ensuring that any progress is monitored closely and reported on regularly. As our population ages and fertility rates decline, the health of our adolescents becomes even more crucuial.”
Potential solutions and actions outlined included:
- Advocating for change and amplifying the needs and voices of young people
- Developing goal-centred approaches through the Office of the UN Secretary with a focus on measuring and improving adolescent health and wellbeing
- Involving young people in community-based environmental programs
- Scaling up public health programs that improve sexual and reproductive health outcomes and reduce gender-based violence
- Strengthening actions within health and education sectors while reinforcing collaborations
- Limiting the exposure of advertising targeting adolescents
- Promoting and encouraging the healthy use of social media and online spaces
MCRI Professor Susan Sawyer said partnerships with young people were a cornerstone of the report, which aimed to draw on their capability and leadership to help shape the world they wanted to live in.
“This report represents a wealth of current information about the state of our young people’s health,” she said. The findings are alarming and they demand urgent action and accountability, in collaboration with adolescents, to create safer spaces and meaningful change.”
But Professor Sawyer said lack of national leadership around adolescent health remained a major barrier to overcoming the challenges.
“A common myth is that adolescents are healthy and therefore don’t need health services,” she said. Yet our findings show that in every country, adolescents need access to responsive health services that can confidentially identify and respond to their emerging health needs.”
The report will be launched at the World Health Organization’s 78th Health Assembly in Geneva.
Publication: Sarah Baird, Shakira Choonara, Peter S Azzopardi, Prerna Banati, Judith Bessant, Olivia Biermann, Anthony Capon, Mariam Claeson, Pamela Y Collins, Nicole De Wet-Billings, Surabhi Dogra, Yanhui Dong, Kate L Francis, Luwam T Gebrekristos, Allison K Groves, Simon I Hay, David Imbago-Jacome, Aaron P Jenkins, Caroline W Kabiru, Elissa C Kennedy, Luo Li, Chunling Lu, Jun Ma, Terry McGovern, Augustina Mensa-Kwao, Sanyu A Mojola, Jason M Nagata, Adesola O Olumide, Olayinka Omigbodun, Molly O’Sullivan, Audrey Prost, Jennifer H Requejo, Yusra R Shawar, Jeremy Shiffman, Avi Silverman, Yi Song, Sharlene Swartz, Rita Tamambang, Henrik Urdal, Joseph L Ward, George C Patton, Susan M Sawyer, Alex Ezeh and Russell M Viner. ‘A call to action: the second Lancet Commission on adolescent health and wellbeing,’ The Lancet. DOI: 10.1016/S0140-6736(25)00503-3
Available for interview:
Professor Peter Azzopardi, MCRI Group Leader, Global Adolescent Heath
Professor Susan Sawyer, MCRI Group Leader, Adolescent Heath
Journal
The Lancet
Standardising disposable vape devices may curb young people’s desire to try them
But there is a risk it may lead to fewer people switching from smoking to vaping
Standardising the colour and branding of disposable vaping devices may deter young people who have never smoked or vaped from trying them in the first place, suggests a comparative study, published online in the journal Tobacco Control.
But a potential trade-off is that there is a risk it may lead to fewer people switching from smoking to vaping, say the researchers.
Vaping has surged in popularity among young people in many countries over the past decade in tandem with the introduction of cheap disposable devices, point out the researchers.
Previously published research suggests that colourful branded packaging can increase the appeal of cigarettes and vapes to young people. But there’s no current evidence on whether standardising the appearance of disposable vape devices themselves would affect their appeal and perceptions of harm, they add.
To find out, the researchers drew on 15,259 respondents to the 2023 online International Tobacco Control Youth and Youth Adult Tobacco & Vaping Survey. All the respondents were aged between 16 and 29 and living in England, Canada, or the US.
They were randomly assigned to view images of either 4 branded disposable vapes (7638 participants) or 4 standardised white disposable vapes (7621) and asked which vape products they would be interested in trying, and how harmful they thought they were.
Analysis of the responses showed that standardisation increased the percentage of those reporting no interest in trying at least one of the vapes displayed. Just over 67% of those in the standardised group said they weren’t interested in trying any of the devices shown, compared with just under 63% of those in the branded group.
The smallest effect of standardisation was observed among those who had never vaped or smoked: 93% of those in the standardised group reported no interest compared with just over 91% of those in the branded group.
The greatest impact was observed among those who had smoked, but not vaped, within the past month–47.5% in the standardised group vs 37.5% in the branded group–and these are people who would stand to gain from switching entirely from smoking to vaping, say the researchers.
Among those who had vaped, but not smoked, 20% of those shown standardised packaging reported no interest in trying them compared with 16.5% shown branded devices.
Similar effects were observed among people who both smoked and vaped (13.5% vs 9.5%) and among those who formerly smoked or vaped (just over 72.5% vs 65%).
The effects of standardisation on participants’ harm perceptions of the vaping product displayed were minimal, however.
Just over 31% of those in the standardised group viewed the vape product as less harmful than smoking compared with just under 33% in the branded group. There was no clear difference in how standardisation affected harm perceptions across smoking and vaping groups.
Product and packaging regulations have been used by several countries to reduce the appeal of cigarettes. And in January 2024, the UK government announced plans to introduce new measures to ensure that vape manufacturers implement standardised packaging for their products, but it’s not clear what this would look like, say the researchers.
“Our findings suggest that the integration of regulation on device design into new policy further reduces the appeal of vapes to young people. However, compared with people who have never smoked or vaped, the reduction in interest was more pronounced among smokers, who might benefit from using vapes to quit smoking.
There is a risk that the public health benefits of preventing youth uptake of vaping could be offset by a decline in the number of young people transitioning from smoking to exclusive vaping, or an increase in relapse from exclusive vaping to smoking, including dual use,” they add.
They conclude: “For countries interested in discouraging vaping among young people, standardising the colour of vaping devices could be considered alongside standardised packaging as a potential policy option.
“However, there may be unintended consequences in terms of discouraging those who smoke from switching to vaping, which should be further investigated and possibly balanced with other targeted policies to encourage smoking cessation.”
Journal
Tobacco Control
Method of Research
Observational study
Subject of Research
People
Article Title
Impact of standardising the colour and branding of vape devices on product appeal among young people: a randomised experiment in England, Canada and the United States
Article Publication Date
20-May-2025
COI Statement
Competing interests The authors have never had any financial links to the tobacco or e- cigarette industries or their representatives. JB has received unrestricted research funding from Pfizer and J&J, who manufacture medically licensed smoking cessation medications. DH has served as a paid expert witness on behalf of public health authorities in response to legal challenges from tobacco, vaping, and cannabis companies.
