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Adolescent killers

WHO reports lists interpersonal violence, traffic injuries, suicide as main causes of death among youth

Friday, May 16, 2014    

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A new report from the World Health Organisation (WHO) shows that interpersonal violence, traffic injuries and suicide are the three leading causes of death among youths ages 10 to 19 in the Americas while depression is one of the three top causes of illness and disability among youths in the hemisphere.

The report, titled Health for the World's Adolescents, notes that while adolescents are healthy most of the time, many have health problems that require serious attention from the health sector. Greater attention to these problems would not just prevent deaths and illness, but also improve health across the life course, by addressing conditions and behaviors that start or are reinforced during adolescence.

"The world has not paid enough attention to the health of adolescents," says Flavia Bustreo, WHO sssistant director general for family, women and children's health. "We hope this report will focus high-level attention on the health needs of 10 to 19-year-olds and serve as a springboard for accelerated action on adolescent health."

Drawing on a wealth of published evidence and consultations with 10- to 19-year-olds around the world, the report also brings together — for the first time — all WHO guidance on the full spectrum of health issues affecting adolescents. These include tobacco, alcohol and drug use, HIV, injuries, mental health, nutrition, sexual and reproductive health, and violence. The report recommends key actions to strengthen the ways countries respond to adolescents' physical and mental health needs.

The Pan American Health Organisation (PAHO), WHO's Regional Office for the Americas, contributed to the world report with data from countries in the Western Hemisphere.

Situation in the Americas

The region of the Americas ranks fourth among WHO's six regions in levels of adolescent mortality, with 77.5 deaths per 100,000 youths ages 10-19 in 2012. This is below the global average of 110.7 deaths per 100,000 and below levels in Africa (282.5), the Eastern Mediterranean (118.3) and South East Asia (102.3). Only Europe (57.4) and the Western Pacific (43.6) have lower adolescent mortality than the Americas.

The main causes of adolescent deaths in the Americas have changed very little since 2000. In both 2000 and 2012, the five leading causes of death among the Region's youths were interpersonal violence, traffic injuries, suicide, drowning and respiratory infections. In every WHO region, interpersonal violence is one of the five top causes of death among older adolescents.

Sex differences in adolescent mortality are notable. Mortality among boys is considerably higher than among girls, and the leading causes of death are different: interpersonal violence is the leading cause of death among boys (37.21 per 100,000), whereas traffic injuries are the leading cause of death among girls (5.84 per 100,000). Complications of pregnancy and childbirth are the fifth-leading cause of death among girls in the Americas.

Matilde Maddaleno, PAHO regional advisor on adolescent health, notes that sexual and reproductive health, and especially family planning, is a key factor in adolescent health in the Americas.

Depression is among the top three causes of illness and disability in youths in all WHO regions except Africa. Interpersonal violence is leading cause of lost years of healthy life (disability-adjusted life years, or DALYs) among youths 15-19 in the Western Hemisphere.

Global situation

Globally, the top three causes of adolescent deaths are road traffic injuries, HIV/AIDS and suicide. An estimated 1.3 million adolescents died in 2012 worldwide, according to the report.

Road traffic injuries

Road traffic injuries are the number-one cause of adolescent deaths globally, and the number-two cause of illness and disability. Boys are disproportionately affected, with more than three times the rate of deaths than that of girls. Increasing access to reliable and safe public transport can reduce road traffic injuries among adolescents. Road safety regulations (eg, alcohol and speed limits), establishing safe pedestrian areas around schools, and graduated licensing schemes where drivers privileges are phased in over time can all reduce risks.

Mental health problems take a big toll

Globally, depression is the number-one cause of illness and disability in this age group, and suicide ranks number three among causes of death. Some studies show that half of all people who develop mental disorders have their first symptoms by the age of 14. If adolescents with mental health problems get the care they need, this can prevent deaths and avoid suffering throughout life.

Pregnancy and childbirth-related deaths have fallen

Deaths due to complications of pregnancy and childbirth among adolescents have dropped significantly since 2000, particularly in regions where maternal mortality rates are highest. WHO's South-East Asia, Eastern Mediterranean and African Regions have seen estimated declines of 57 per cent, 50 per cent and 37 per cent, respectively. Despite these improvements, maternal mortality still ranks second among causes of death among 15- to 19-year-old girls globally, exceeded only by suicide.

Deaths due to HIV rising

Estimates suggest that the number of HIV-related deaths among adolescents is rising. The increase is predominantly in the African Region, at a time when HIV-related deaths are decreasing in all other population groups. HIV now ranks as the second cause of deaths in adolescents globally.

Some other infectious diseases still major causes of death

Thanks to childhood vaccination, adolescent deaths and disability from measles have fallen markedly — by 90 per cent in the African Region between 2000 and 2012. However, common infectious diseases that have been a focus for action in young children are still killing adolescents. For example, diarrhea and lower respiratory tract infections now rank second and fourth among causes of death in 10- to 14-year-olds. Combined with meningitis, these conditions account for 18 per cent of all deaths in this age group, little changed from 19 per cent in 2000.

New data on adolescent health behaviors

New data from countries where surveys have been done show that fewer than one in four adolescents does enough exercise (WHO recommends at least one hour of moderate to vigorous exercise per day), and in some countries as many as one in three is obese.

But some trends in adolescent health-related behaviors are improving. For example, rates of cigarette smoking are decreasing among younger adolescents in most high-income countries and in some middle- and low-income countries as well.

Critical period for preventing chronic disease

Adolescence is an important time for laying the foundations of good health in adulthood. Many health-related behaviours and conditions that underlie the major noncommunicable diseases start or are reinforced during this period of life.

"If left unchecked, health problems and behaviors that arise during adolescence—such as tobacco and alcohol use, diet and exercise patterns, overweight and obesity—have a serious impact on the health and development of adolescents today, and potentially devastating effects on their health as adults tomorrow," says Jane Ferguson, scientist in WHO's Department of Maternal, Newborn, Child and Adolescent Health and lead author of the report. "At the same time, we must not let up on efforts to promote and safeguard the sexual and reproductive health of adolescents, including HIV."

Health policies from 109 countries were reviewed for this report. Among them, 84 per cent give some attention to adolescents. In three-quarters, the focus is on sexual and reproductive health (including HIV/AIDS); approximately one-third address tobacco and alcohol use among adolescents, and one-quarter address mental health. The report highlights the need for more countries to follow the example of countries like India, whose new adolescent health strategy addresses a broader spectrum of health issues affecting adolescents, including mental health, nutrition, substance use, violence, and noncommunicable diseases, in addition to sexual and reproductive health.

The report also emphasises the need for improved data and information about adolescents' health and the programs that address it.

PAHO, founded in 1902, is the oldest international public health organisation in the world. It works with its member countries to improve the health and the quality of life of the people of the Americas. It also serves as the Regional Office for the Americas of WHO.

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