Young people are commonly regarded as healthy and for that reason few attempts have been made to systematically measure their health. Yet adolescence and young adulthood coincide with major changes in health problems and determinants of health in later life.1, 2, 3, 4 Mortality rises due to preventable causes that include injury, HIV, tuberculosis, and maternal death.5 Mental disorders also rise sharply during the adolescent years.6 Many risk processes that lead to chronic non-communicable diseases in later life, including tobacco, alcohol, and illicit substance misuse, unsafe sex, obesity, and lack of physical activity, typically emerge around this time.6, 7
Key messages
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There is wide variation between and within regions in country profiles of adolescent health
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Sub-Saharan Africa has the worst regional adolescent health profile; risks for later life non-communicable diseases (NCDs) are spreading rapidly, with the highest rates of tobacco use and overweight and lowest rates of physical activity in low-income and middle-income countries
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Few indicators are well measured even in sexual and reproductive health, which has had the greatest policy focus
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Simple measures such as better coordination and integration of present data collections, harmonisation of measures across surveys, and development of indicators in neglected areas such as mental health would greatly improve worldwide coverage of adolescent health
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Future initiatives in tacking NCDs, mental health, sexual and reproductive health, and injuries should have explicit measurement strategies for adolescents
Standardised frameworks for health indicators in young people are available for some high-income countries.8, 9, 10, 11 A few also produce regular reports on the health status of their young people.12, 13, 14, 15, 16, 17 These reports have generally evolved from an earlier focus on age disaggregation of routinely collected statistics to the more recent inclusion of health-risk behaviours and states, as well as contextual as well as social determinants of health.13 The Millennium Development Goals (MDGs) have adopted some indicators of the development of young people in low-income and middle-income countries, but with a health focus predominantly on sexual and reproductive health.18
Indicators of health and its determinants are important for good policy responses both nationally and worldwide.19, 20, 21, 22 For this reason there has been a rapid increase in indicators across many aspects of health,23, 24 but few seem well measured.25, 26 One consequence has been a call to define a smaller number of core health indicators.27 For adolescents there is also a need for indicators beyond sexual and reproductive health, the major focus so far. These indicators need to account for the rapid health transitions happening in many countries.23 More comprehensive approaches would include relevant social determinants of health as well as the contribution of adolescent-onset risk states and behaviours to future disease burden.3, 28 We outline a set of indicators drawn from the conceptual framework of this Series (figure 1), present data on the extent to which data systems have comparable measures of these indicators, and propose strategies for improving global health surveillance in young people.