Key facts

• In 2020, there were over 1.5 million deaths of adolescents and young people aged 10–24 years, nearly 5000 deaths daily.
• The lowest risk of death among all age groups are children of younger adolescence (10–14 years).
• The leading causes of death among adolescents and young adults are injuries (including those related to road traffic accidents and drowning), physical violence, self-harm and obstetric and gynecological pathologies.
• Half of all mental health disorders in adults begin to develop much earlier - before the age of 14, but at this age in most cases they are not detected and not treated.
• Early initiation of substance use carries an increased risk of addiction and other problems in adulthood; compared to people of more mature age, young people are disproportionately affected by substance use problems.
• Worldwide, 43 out of 1,000 girls between the ages of 15 and 19 become mothers.

Who is most at risk of death?

The chances of survival for teenagers and young adults in the world vary greatly. In 2020, the 10-24 age group was most likely to die in sub-Saharan Africa, Oceania (excluding Australia and New Zealand), North Africa and South Asia (1). On average, a 10-year-old is six times more likely to die before the age of 24 in sub-Saharan Africa than in North America and Europe. 

Major health problems

Traumatism

Unintentional injuries are the leading cause of death and disability among adolescents. In 2019, nearly 1,000,000 adolescents (10–19 years old) died in road traffic accidents (2). Many of the dead were in the category of "vulnerable road users", i.e. pedestrians, cyclists or drivers of two-wheeled motor vehicles. In many countries, laws relating to road safety need to be more comprehensive and enforcement measures need to be strengthened. In addition, young drivers should be provided with instruction in safe driving techniques, and legislative prohibitions on driving under the influence of alcohol and drugs should be strictly observed by representatives of all age groups. The blood alcohol limit for young drivers should be set at a lower level than for adults. It is recommended that novice drivers issue driving licences with a probationary period, during which there is zero tolerance for drunk driving.

Drowning is also one of the leading causes of death among adolescents, with an estimated 30 000 adolescents drowning in 2019, more than three-quarters of them boys. The most important measure to prevent this type of mortality is the training of children and adolescents to swim.

Violence

Interpersonal violence is the fourth leading cause of death for adolescents and young adults worldwide. This varies considerably from region to region. In low- and middle-income countries in the Region of the Americas, interpersonal violence is responsible for approximately one third of all adolescent male deaths. According to the Global School Health Survey, 42 per cent of boys and 37 per cent of adolescent girls have been bullied. Sexual violence also affects a large proportion of young people: one in eight young people report having been sexually abused.

In addition, adolescent violence increases the risk of injury, HIV and other sexually transmitted infections, mental health problems, poor school performance and attendance, premature pregnancy, reproductive health problems, and the risk of communicable and noncommunicable diseases.

Effective approaches to violence prevention and response include activities aimed at educating parents and creating an enabling environment for early childhood development, preventing bullying in schools, developing children's life and social skills, and approaches to limit access to alcohol and firearms based on interaction with local communities. Effective and attentive care and assistance to adolescent survivors and ongoing support help to overcome the physical and psychological consequences.

Mental health

Depression is one of the leading causes of illness and disability among adolescents, and suicide is the third leading cause of death in the 15-19 age group (2). Sixteen per cent of the combined burden of disease and injury in adolescents and young people aged 10–19 years is due to mental health conditions. Half of all mental health disorders in adults begin to develop much earlier - before the age of 14, but at this age in most cases they are not detected and not treated.

The well-being and mental health of adolescents is influenced by many factors. Violence, poverty, stigmatization, marginalization, living in a humanitarian catastrophe or instability can increase the risk of developing mental health problems. The consequences of inaction with regard to mental health disorders in adolescents are felt in adulthood, causing damage to both physical and mental health and limiting the ability of adults to live full lives.

The development of social and emotional skills in children and adolescents and the provision of psychosocial support in schools and other contexts contribute to their mental health. In addition, programmes that strengthen the bonds between adolescents and their families and improve the quality of living conditions are important. When problems arise, they should be identified and addressed in a timely manner with the involvement of competent and attentive health workers.

Use of alcohol and drugs

The use of alcohol by adolescents is a serious concern in many countries. Alcohol leads to a decrease in self-control and increases the risk of dangerous behaviors, such as unsafe sex and dangerous driving. It is also one of the root causes of injuries (including injuries caused by road traffic accidents), violence and premature death. Drinking alcohol can also lead to health problems later in life and has a negative impact on life expectancy. At the moment, alcohol is consumed by more than a quarter of all people aged 15-19 years worldwide, i.e. 155 million adolescents. In 2016, the prevalence of episodic large amounts of alcohol consumption among adolescents aged 15–19 years was 13.6%, and male adolescents were most at risk in this regard.

Marijuana is the most widely used psychoactive substance among young people: in 2018, approximately 4.7% of adolescents aged 15–16 years used marijuana at least once. Alcohol and drug use by children and adolescents causes neurocognitive changes that, in later life, can lead to behavioral, emotional, social, and learning disabilities.

Prevention of alcohol and drug use is an important area of public health action and can include strategies and interventions at both the population level and at the level of activities at the school, community, family, and individual levels. Setting a minimum age for the purchase and consumption of alcohol, banning child-oriented marketing and advertising of alcoholic beverages are among the key strategies to reduce the use of alcohol by adolescents.

Tobacco use

The vast majority of people who use tobacco today began doing so as young as teenagers. Measures such as banning the sale of tobacco products to minors (under 18 years of age) and raising the price of tobacco products through higher taxes, banning tobacco advertising and creating a smoke-free environment are crucial. Globally, at least one in ten adolescents between the ages of 13 and 15 use tobacco, although the rate is significantly higher in some regions.

HIV/AIDS

In 2019, the number of adolescents (aged 10–19 years) living with HIV was estimated at 1.7 million, approximately 90% of whom lived in the WHO African Region (3). Despite a significant decline in the number of new HIV infections among adolescents from the peak in 1994, approximately 10% of new HIV infections among adults still occur among adolescents, with three-quarters of them girls (3). In addition, while the number of new infections appears to have declined in many of the most affected countries, testing coverage has recently remained low, suggesting that many adolescents and young people living with HIV are unaware of their HIV status (5).

Adolescents living with HIV have less access to antiretroviral therapy, poorer adherence to treatment, harder to keep in follow-up and more difficult to achieve viral suppression. One of the key factors exacerbating this state of affairs is the low level of adolescent-friendly services, including psychosocial interventions and support.

Adolescents and young adults need to be provided with information on HIV prevention and access to appropriate tools. This includes access to HIV prevention interventions, including voluntary male circumcision services, condoms and pre-exposure prophylaxis, increased access to HIV testing and counselling, and closer contact with HIV treatment services for HIV-positive adolescents.

Other infectious diseases

The number of adolescent deaths and disabilities caused by measles has been significantly reduced by increased vaccination of children: in the African Region, for example, adolescent mortality fell by 90% between 2000 and 2012.

Diarrhoea and lower respiratory tract infections (e.g. pneumonia) are estimated to be among the top 10 causes of death in adolescents aged 10–14 years. These two groups of diseases, along with meningitis, are among the top five causes of death for adolescents in low- and middle-income countries in Africa.

An infection such as the human papillomavirus usually occurs after the onset of sexual activity and can lead not only to short-term consequences (genital warts) in adolescence, but also, more dangerously, to cervical cancer and other oncological diseases that appear after several decades. Younger adolescence (9–14 years) is optimal for HPV vaccination, and it is estimated that if 90% of the world's girls received the HPV vaccine, more than 40 million lives would be saved in the next hundred years. However, it is estimated that in 2019, only 15% of girls worldwide received such a vaccine.

Premature pregnancy and childbirth

In developing countries, some 12 million girls aged 15–19 years and at least 777 000 girls under the age of 15 are reported to have births each year. Complications during pregnancy and childbirth are one of the leading causes of death among girls aged 15–19 years worldwide.

According to the UN Population Division, the fertility rate among adolescents worldwide in 2020 was 41 births per 1,000 adolescent girls, with country rates ranging from 1 to 200 births per 1,000 girls (5). This indicates a significant decline in the number of births to adolescents since 1990, and in parallel with this decline, the maternal mortality rate among girls aged 15 to 19 has also decreased.

One of the targets of the Sustainable Development Goal on health (SDG 3) is to achieve global universal access to sexual and reproductive health services by 2030, including family planning services, information and education, and the integration of reproductive health into national policies and programmes.

Adolescents have the right to the comprehensive sexuality education they need, which is a formalized learning process of learning and learning about the cognitive, emotional, physical and social aspects of sexual life. Improving access to contraceptive information and services can reduce premature pregnancies and births at too young age among girls. The introduction and enforcement of legislation setting the minimum age for marriage at 18 years could help.

In the event of pregnancy, adolescent girls should be provided with quality antenatal care. Where permitted by applicable law, adolescents who choose to terminate a pregnancy should have access to safe abortion services.

Nutrition and micronutrient deficiencies

In 2016, iron deficiency anaemia was the second leading cause of lost years of life among adolescents due to death and disability. In addition, iron and folic acid supplements contribute to the health of adolescents, who will become parents in the future. In areas where intestinal helminths, such as hookworms, are common, regular deworming is recommended to prevent micronutrient deficiencies (including iron).

The formation of healthy eating behavior in adolescents is the basis of good health in adulthood. Tackling advertising for foods high in saturated fat, trans fatty acids, free sugars and salt, as well as increasing access to healthier foods and creating opportunities for physical activity, are important for all age groups, but especially for children and adolescents.

Malnutrition and obesity

Many boys and girls in developing countries enter adolescence in a state of chronic malnutrition, making them more vulnerable to disease and the risk of premature death. In parallel, in both low- and middle-income and high-income countries, the number of adolescents who are overweight or obese is increasing.

In 2016, about one in six adolescents aged 10–19 years were overweight worldwide. The prevalence of overweight varies from less than 10% in the South-East Asia Region to more than 30% in the Region of the Americas.

Physical activity

Physical activity brings fundamental benefits to adolescent health, in particular by improving the condition of the respiratory, cardiovascular, muscular and skeletal systems, ensuring the maintenance of a healthy body weight, as well as strengthening psychosocial well-being. 

Globally, it is estimated that only one adolescent out of five can meet these recommendations. The prevalence of insufficient physical activity is high in all WHO regions, with adolescent girls being higher than boys.

In order to increase the level of physical activity of the country, society as a whole and local communities should create a safe and supportive environment and opportunities for all adolescents to engage in physical activity.

Rights of adolescents

International legal instruments enshrine the rights of children (under 18) to survival, growth and development. In 2013, the Committee on the Rights of the Child (CRC), which monitors compliance with the Convention on the Rights of the Child, published guidelines on the right of children and adolescents to the enjoyment of the highest attainable standard of health, and in 2016 a general comment on the implementation of the rights of children during adolescence was published. It emphasizes the duty of States to recognize the special needs and rights of adolescents and young people with regard to health and development.

The Convention on the Elimination of Discrimination against Women also establishes the rights of women and girls to health and appropriate medical care.

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