Review article
The health of young people in a global context

https://doi.org/10.1016/j.jadohealth.2003.10.007Get rights and content

Abstract

Purpose

To examine the chief causes and influences of morbidity and mortality among young people throughout the world.

Methods

A comprehensive literature search was conducted that included WHO's Global Burden of Disease, UNFPA's State of the Worlds' Population, Medline, Popline, Sociological Abstracts, as well as data collected from UNICEF, UNAIDS, Population Reference Bureau, and the United Nations Headquarters. Experts in the fields of substance use, suicide, and infectious diseases were also contacted for unpublished and published sources. Studies were restricted to those completed after 1985, had a sample size of at least 100, focused primarily on the age group of 10–24 years, and examined trends related to unintentional injuries, HIV/AIDS, suicide, homicide, war, maternal mortality, pregnancy, abortion, sexually transmitted diseases, substance abuse, and infectious diseases.

Results

Trends in adolescent morbidity and mortality have shifted over the past decade from predominately infectious to social etiologies. Currently, unintentional injury is the leading killer of young people in nearly every region of the world, with homicide, war, and interpersonal violence following closely behind.

Conclusions

The changes in population, migration, age of marriage, and education have had profound impact on the mortality and morbidity among adolescents. As we come to learn about the factors that influence adolescent morbidity and mortality, we begin to have a better understanding of how to improve the health of youth throughout the world.

Section snippets

Methods

To gather the information for this paper, a comprehensive literature search was conducted using a variety of different data sources. First, the World Health Organization's (WHO) Global Burden of Disease's mortality tables were collected, which estimate the causes of death by age and gender using vital registration data, verbal autopsy reports, demographic and health surveys, UN population estimates, and published and unpublished reports on mortality. In addition, databases such as the United

Growing youth population

Today adolescents comprise 20% of the world's population, with more than 85% residing in developing countries. Over the 50-year period between 1970 and 2025, it is estimated that the number of urban youth will increase 600% [2]. Table 2 presents the current and projected populations of young people ages 10 to 24 years, by region.

Child survival

Of all the social changes that have had a major impact on adolescent health in the world, none has been as profound as that resulting from improved child survival.

Causes of mortality

Table 1depicts the five leading causes of death for young adults aged 15 to 29 years, both globally and by region. In it we see that unintentional injury is the leading killer of young people in nearly every region of the world, with HIV/AIDS and other infectious diseases still the second leading cause of death in much of the developing world (in most industrialized nations, it is suicide). Homicide, war, and interpersonal violence follow.

Pregnancy and early childbearing

A substantial number of sexually active unmarried young women experience pregnancy, which is typically both unplanned and unwanted. In Jamaica, approximately 40% of women experienced an unwanted pregnancy at least once before they reached the age of 20 years [49]. In general, it appears that in-school youth are less likely to experience an unwanted pregnancy than those from the general population. For example, among students in the final three years of secondary school in Buenos Aires,

Sexual coercion and abuse

Given the sensitive nature of the topic, nonconsensual sexual activity is difficult to study. The topic is particularly sensitive among youth, the age group in which coercion and abuse is most likely to occur. Accurately estimating the prevalence of sexual coercion and abuse in the world, especially in developing countries, is complicated primarily because there have been relatively few studies to address this, and cultural mores against reporting abuse make it difficult to collect from

Mental health

Until recently, the magnitude of the burden of disease related to adolescent mental disorders has been difficult to quantify. Now, with the global crisis involving adolescents affected by war, orphaned by AIDS, and forced to migrate for economic and political reasons, the dimensions of the burden of compromised mental health are increasingly evident and alarming. Worldwide, up to 20% of children and adolescents suffer from a disabling mental illness. The World Health Organization indicates that

Tobacco use

Currently, smoking remains one of the most important preventable causes of death in the world. According to the World Health Organization, approximately 4 million people a year die from tobacco-related illnesses, a figure that is expected to rise to 10 million by the year 2030 [91]. By that time, approximately 70% of these deaths will be occurring in developing countries.

Studies conducted in industrialized countries indicate that most people begin using tobacco before the age of 18 years 92, 93

Conclusions

When we look across the world, a number of conclusions can be drawn with significant consequences for the future of young people. First, in both relative terms and absolute numbers, more young people are living now than ever before. These numbers will continue to increase over the next 50 years, especially in developing countries, whereas the relative proportion of youth in industrialized countries will decline. In addition, transnational migration means that what were viewed as distant

Limitations

There are several limitations to this literature review that need to be mentioned. First, comparing international rates of suicide, abortion, STIs, and homicide is inherently problematic given that different methods are used to classify each of these outcomes. The classification of suicide, for example, is to some degree culturally determined. The same applies to abortion and homicide. Classifying STIs is also problematic, given that many of these infections have wide variation in symptoms and

Acknowledgements

This work is based upon a background paper for the National Academy of Sciences Panel on Transitions to Adulthood in Developing Countries.

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