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The second Lancet Commission on Adolescent Health and Wellbeing aims to understand and advance adolescent health and wellbeing at a global, regional, country and local level.
The Second Lancet Commission on Adolescent Health and Wellbeing brought together 44 experts from across the world, including from Murdoch Children’s Research Institute (MCRI), to understand the state of adolescent health and wellbeing in today’s rapidly changing world.
A strong commitment to engaging young people lay at its core — not just as participants but as full contributors. Beyond the 10 youth commissioners who worked alongside senior leaders and acted as co-leaders, we connected with a wider group of adolescents worldwide, including six adolescent and youth peer reviewers. They provided valuable perspectives across the entire process.
Building on the 2016 Lancet Commission on Adolescent Health and Wellbeing, this Commission proposes a multisector approach and represents an expanded conceptual framework that defines key ways we can ensure accountable action. It also presents substantial research that supports specific, cross-sectoral actions to advance adolescent health and wellbeing at a global, regional, country and local level.
Progress in adolescent health: some, but not enough
The Commission revealed a mixed picture from the past decade — with communicable diseases, non-communicable conditions and mental health issues on the rise. By 2030, 464 million adolescents are projected to be overweight or obese, an increase of 143 million since 2015. It also revealed an astonishing 42 million years of healthy life lost to mental illness and suicide. A primary finding was that investment in adolescent health was not keeping pace with growing needs and new challenges — such as the triple planetary crisis (climate change, biodiversity loss, and pollution), increasing commercial influences and conflict-driven violence. Our forecasting suggests that by 2030, over a billion young people will be living in countries with the worst adolescent health profile.
Why is adolescent health not getting the attention it deserves?
Insufficient investment in what we know works
While many solutions exist for these health burdens, limited funding prevents proven cost-effective solutions from being realised. Although adolescents make up over 25% of the global population, only 2.4% of development assistance for health between 2016 and 2021 was specifically dedicated to them. Previous modelling suggests that investing in adolescent health yields a return of $5.40 to $9.60 for every dollar spent. This is similar for education and learning, which shows a return of $15.90–$28.60 per dollar. Investing in mental health support in this age group offers a 23.6% return on investment, while also saving global health care systems substantial money. Failing to secure funding could hinder the potential of adolescents now and when they are adults and the children they will parent.
The current generation of adolescents faces new threats to health
Today’s adolescents are the first generation to live their entire lives under the ongoing threat of climate change. By 2100, a projected 1.8 billion adolescents will live in a world that is expected to be 2.8°C hotter than pre-industrial times, with major health impacts. We also found that commercial food companies are deliberately targeting adolescents, contributing to over half of young people drinking sugary beverages daily. Similarly, the rise in e-cigarette use among teens — ranging from 1% to 35% depending on the country — can largely be blamed on weak regulations that let these products be heavily advertised and easily sold to youth.
Moving forwards: working with young people
In this Commission, we demonstrated diverse ways in which adolescents can be meaningfully engaged in changing their communities. The Youth Solutions Lab was initiated to ensure young people’s voices shape the adolescent health and wellbeing agenda. Our Youth Commissioners mapped the most pressing issues encountered by today’s adolescents. We then engaged a global group of 16–20-year-old adolescents to prioritise these key issues, co-create solutions, and propose actionable recommendations. Reflecting young peoples’ capacities for high-level engagement, this approach supported young changemakers to leverage their lived experience and produce five priority youth-led, youth-centred, practical solutions around mental and emotional health care, education and employment gaps, sexual and reproductive health education, civic engagement on the climate crisis, and healthy lifestyles and nutrition.
Moving forwards: prioritising adolescent health – multisectoral actions
Given our projected adolescent health burdens, maintaining the status quo is no longer an option. To tackle public health challenges, beyond funding constraints and a focus on the health sector, we need to understand what’s limiting progress and consider a wider set of multisectoral actions. Key barriers include stigma, limited data (including mental health data coverage), disagreements over terminology and a fragmented group of stakeholders. Promisingly, schools offer a cost-effective setting for meaningful change. Creating safe, inclusive and respectful environments in schools can help reduce stigma around mental health and provide meaningful support through peers and teachers. Although school health services exist in over 100 countries worldwide, mental health remains insufficiently prioritised and inadequately addressed through responsive services or preventive efforts.
The interactions between young people and their living environments, especially in urban settings, should also not be underestimated. By 2050, the world’s cities will be home to 70% of people younger than 18 years, presenting significant opportunities for empowerment, health and wellbeing. Cities are engaging youth in the co-design of smart, sustainable urban environments, particularly in response to the urgent challenges posed by the global climate crisis. For example in Australia, the Plan Your Brisbane initiative fostered a sense of ownership and responsibility among young residents, enabling them to contribute to the development of equitable and sustainable local communities.
As noted in the Commission, protecting the health of adolescents is “one of the strongest mechanisms we have to safeguard our collective future, ensure a more just society, and create a healthier and more productive planet.”
Luo Li served as a youth commissioner for the second Lancet Commission on Adolescent Health and Wellbeing and is part of the CREYATE group at the Centre for Research Excellence. Ms Li is also a PhD student with Murdoch Children’s Research Institute’s (MCRI) Global Adolescent Health group and graduate researcher at the University of Melbourne. She focuses on quantifying and boosting adolescent wellbeing.
Professor Pete Azzopardi leads the Global Adolescent Health group at Murdoch Children’s Research Institute where he focuses on collaborative international research alongside young people. Professor Azzopardi uses data to describe the health needs of youth around the world and explores how adolescents can help create and implement responsive programs that directly benefit their health and wellbeing.
Molly O’Sullivan is an experienced research coordinator, health communicator and program manager with an extensive and varied background in public health and clinical trials within paediatric and adolescent research. Ms O’Sullivan has expertise in youth engagement, health and research communications, with a focus on research impact. Her work looks at how research can be accessible and useful to the community and inform global policy and practice.
Professor Susan Sawyer is Director of the Centre for Adolescent Health at Murdoch Children’s Research Institute (MCRI) and The Royal Children’s Hospital, a World Health Organisation collaborating centre for adolescent health. She holds the Geoff and Helen Handbury Chair of Adolescent Health at The University of Melbourne.
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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