Adolescents in a changing world - The case for urgent investment

Table of Contents

• Appendix__Chapter_2_Tables 134
• Table_A2.2_Interventions_modelled_using_ 135
• Table_A2.3_Fertility_rates_females_151 138
• Table_A2.4_Reduction_in_births_to_adoles 138
• Table_A2.5_Maternal_neonatal_child_dea 138
• Table_A2.6_Adolescent_deaths_from_NCDs_a 138
• Table_A2.7_Reduction_in_anemia_through_O 138
• Table_A2.9_Reduction_in_prevalence_of_me 139
• Table_A2.10_Reduction_in_prevalence_of_m 139
• Table_A2.11_Economic_and_social_benefits 139
• _Hlk165553803 139
• Table_A2.12_Return_on_investment_from_sc 139
• Table_A2.13_Upper_middleincome_countrie 140
• Table_A2.14_TB_deaths_per_100000_popu 140
• Table_A2.16_TB_number_of_deaths_averted 141
• Table_A2.18_TB_cost_per_death_averted_ 141
• Table_A2.19_Adolescent_TB_deaths_averted 142
• Table_A2.20_TB_economic_and_social_bene 142
• Table_A2.21_Myopia_number_of_adolescent 142
• Table_A2.22_Myopia_in_adolescents_benef 142
• Key_points 14
• _Hlk161917047 14
• _Hlk160011273 14
• Emerging_conditions_shaping_adolesce 17
• Domains_linkages_and_platforms_ 17
• _Hlk158738699 17
• _Hlk158370223 18
• _Hlk165555949 21
• _Hlk160012658 21
• Table_1.2_Origins_and_development_paths_ 21
• Table_1.3_Return_on_investment_from_scal 23
• _Hlk165281343 23
• Table_1.4_Education_and_training_interve 23
• _Hlk161045267 24
• _Hlk158366540 24
• _Hlk157522829 24
• _Hlk160808258 24
• Limitations_of_the_economic_and_soci 25
• _Hlk160809331 25
• Key_investment_priorities 26
• Table_1.7_School_health_and_nutrition_pr 26
• _Hlk161921289 29
• _Hlk157523163 29
• _Hlk157523186 29
• OneHealth_Tool_ 31
• Table_2.1_Economic_and_social_benefits_ 34
• Human_papilloma_virus_HPV 35
• _Hlk157586193 37
• 2.3_Interventions_addressing_tuberculosi 38
• Table_2.2_Return_on_investment_from_scal 38
• _Hlk157586607 39
• Table_2.3_TB_cost_per_death_averted_av 39
• Table_2.4_TB_summary_of_economic_and_so 40
• Myopia_in_adolescents 41
• _Hlk158814968 42
• Connectedness 42
• _Hlk160463110 43
• _Hlk157587375 44
• Agency_and_resilience_ 46
• _Hlk161921658 49
• Case_study_connectedness_in_search 49
• Table_3.1_Results_from_SEHER_lay_counsel 50
• _Hlk160788795 50
• _Hlk160446583 50
• _Hlk161921823 51
• _bookmark22 51
• _Hlk158366231 52
• _bookmark23 52
• _Hlk157589189 53
• _Hlk157589446 53
• Introduction_ 56
• Importance_of_mental_health 57
• _Hlk161045729 57
• _Hlk161057099 58
• Structural_factors_affecting_mental_ 59
• _bookmark30 60
• _bookmark31 61
• _bookmark32 62
• Proximal_determinants 63
• _Hlk161922142 63
• _Hlk157764868 64
• _Hlk157589704 64
• _Hlk161045469 65
• _Hlk157589931 65
• _Hlk157589940 65
• Conclusion 66
• Recent_studies_and_action_both_loca 67
• _Hlk161922220 67
• _bookmark36 68
• The_key_messages_of_Ready_to_learn_ 69
• Some_modelling_results 70
• School_attendance_and_the_quality_of 71
• _bookmark40 72
• _bookmark41 73
• Methodology_education_model 73
• _bookmark43 74
• _Hlk161922439 75
• Results_education_outcomes 76
• _Hlk161922509 79
• _bookmark45 79
• _bookmark47 81
• _Hlk158276571 82
• _bookmark48 82
• Introduction 83
• _Hlk160017768 83
• _Hlk160808846 84
• _Hlk161922755 89
• _Hlk160794302 90
• Adolescent_suicide 91
• _Hlk158715772 91
• Road_safety1 91
• _Hlk158715676 92
• _bookmark54 93
• _bookmark55 93
• _Hlk160614346 95
• Table_7.2_Projected_deaths_and_serious_i 95
• Conclusions 96
• Chapter_8_Financing_the_investment_in_a 98
• _bookmark59 99
• Appendix__Chapter_1_Table 116
• _Hlk157585792 124
• Fig. 1.1 Five domains of adolescent well-being 18
• Fig. 1.2 Platforms, linkages and interventions in the investment case modelling 20
• Fig. 3.1 Structural equation model 52
• Fig. 3.2 Relationship between SEL interventions, school climate and academic performance, direct (purple) and indirect (orange) effects 54
• Fig. 4.1 Adolescent* global burden by cause of disease, proportion of global disease burden, tier 2 classification level, 2019 58
• Fig. 4.2 DALY rates for the global adolescent (10–19 years) burden of disease by sex and selected cause, 2019 58
• Fig. 4.3 Scatter diagram of adolescent mental health DALY rate (2019) versus GNI per capita (Atlas method), 202 countries, 2018 59
• Fig. 4.4 Adolescent* mental disorders by type, DALY rate, 202 countries, 2019 60
• Fig. 4.5 Scatter diagram of adolescent mental health DALY rate versus youth unemployment rate, 26 LICs, 2019 61
• Fig. 4.6 Scatter diagram of adolescent mental health, DALY rate, versus political instability/terrorism, 193 countries, 2019 62
• Fig. 6.1 Educational attainment by country group as defined by Filmer et al. (2018, p59) using data from Lee and Lee (2016) 72
• Fig. 6.2 Primary school learning test scores by region, not including South Asia 72
• Fig. 6.3 Learning poverty, globally and by region 73
• Fig. 7.1 The ecological framework, examples of risk factors at each level 85
• Fig. B7.1 Modelling framework for child marriage estimations 86
• Fig. B7.2 Number of school completions before and after the interventions, 2035 and 2050, 70 selected countries 87
• Fig. B7.3 Total additional cost and economic benefits of child marriage prevention, US$ billion, 2024–2050, 70 selected countries 87
• Fig. 7.2 Road traffic injuries and fatalities, 10–19-year-olds, by income group, 2019 93
• Fig. 7.3 Rates of serious road traffic injuries and fatalities, 10–19-year-olds, by income group, 2019 per 100 000 93
• Fig. 7.4 Modelling framework 94
• Fig. 7.5 Estimated BCRs of investment in road safety interventions for adolescents by gender, 77 countries, 2023–2050 96
• Fig. 7.6 Costs, benefits and intervention type, road traffic fatalities and serious injuries, adolescents, $ million. LHS is left hand axis, RHS is right-hand axis 96
• Fig. 8.1 Developing countries’ increasing external public debt, median values for developing countries, 2010–2021 99
• Table 1.1 The five domains and sub-domains of adolescent well-being 19
• Table 1.2 Origins and development paths for eight benefit-cost models used in this report3 22
• Table 1.3 ROI from scale-up of adolescent health services, HPV vaccination, screening and treatment of cervical cancer, prevention and treatment of TB, and screening and treatment of myopia in adolescents 23
• Table 1.4 ROI from education and training interventions in 64 countries, BCRs 23
• Table 1.5 Summary of BCRs for mental health, parenting, health and behavioural problem prevention, school climate and school feeding interventions 24
• Table 1.6 Summary of BCRs for interventions to reduce violence and injuries in adolescents 25
• Table 1.7 School health and nutrition programmes — a summary of the key messages of the multi-agency report Ready to Learn and Thrive (UNESCO, UNICEF and WFP, 2023) 27
• Table 2.1 Adolescent health, economic and social benefits, costs ($ million), and BCRs 35
• Table 2.2 ROI from scale-up of HPV vaccination, screening and treatment, BCRs at 3% discount rate 38
• Table 2.3 TB in adolescents, cost per death averted, average 2023 to 2030, US$ 39
• Table 2.4 TB in adolescents, summary of economic and social benefits, costs and BCRs, 3% discount rate 40
• Table 2.5 Myopia in adolescents, summary of benefits and costs ($ million), and BCRs, 3% discount rate 42
• Table 3.1 Results from SEHER lay counsellor intervention after 17 months 51
• Table 3.2 Effect size of SEL programmes on academic performance, results summary 53
• Table 4.1 Summary, BCRs for mental health interventions in adolescents 57
• Table 5.1 Selected papers in the emerging literature on malnutrition in adolescents 68
• Table 5.2 School health and nutrition programmes, summary of the key messages of the multi-agency report Ready to Learn and Thrive (UNESCO, UNICEF, WFP, 2023) 69
• Table 6.1 List of modelled education interventions, 64 countries 76
• Table 6.2 Educational outcomes, 64 countries (excluding China) 77
• Table 6.3 Parameter settings used in the education benefits model, 64 countries, 2024–2050 80
• Table 6.4 Impact of the interventions on selected educational and economic outcomes across 64 countries, by 2050 80
• Table 6.5 Total additional cost of schooling and training initiatives, by region and country, 64 countries, 2024–35, $ billions 82
• Table 6.6 BCRs of investment in interventions in education, 64 countries 82
• Table 7.1 Summary, benefit-cost ratios for interventions to reduce violence and injuries in adolescents 84
• Table 7.2 Projected deaths and serious injuries due to road traffic accidents in adolescents, 77 countries, 2023–2050 95
• Table 7.3 Estimated costs and benefits of investment in road safety interventions for adolescents, net present value, 77 countries, 2023–2050, weighted BCRs, $ million 96
• Table A1.1 Origins, development paths and validation status for eight benefit-cost models used in this report 118
• Table A1.2 Countries included in OHT modelling, income status 120
• Table A1.3 Interventions modelled using OHT 121
• Table A1.4 Unit cost of outpatient visits and inpatient days, average of delivery platforms, US dollars 2023 125
• Table A1.5 Health worker unit costs 126
• Table A1.6 United States of America GDP Deflator 126
• Table A1.7 Country/territory coverage of analyses 128
• Table A2.1 Countries included in OHT modelling, income status 134
• Table A2.2 Interventions modelled using OHT 135
• Table A2.2 Interventions modelled using OHT (continued) 136
• Table A2.2 Interventions modelled using OHT (continued) 137
• Table A2.3 Fertility rates, females 15–19, 2023–2035 138
• Table A2.4 Reduction in births to adolescent mothers, 2023–2035 138
• Table A2.5 Maternal, neonatal, child deaths and stillbirths averted by OHT interventions, 2023–2035 138
• Table A2.6 Adolescent deaths from NCDs averted by OHT interventions, 2023–2035 138
• Table A2.7 Reduction in anemia through OHT interventions, adolescents, 2023–2035 138
• Table A2.8 Reduction in number of stunted children through OHT interventions, 2023–2035 138
• Table A2.9 Reduction in prevalence of mental disorders and other NCDs through OHT interventions, female adolescents, 2023–2035 139
• Table A2.10 Reduction in prevalence of mental disorders and other NCDs through OHT interventions, male adolescents, 2023–2035 139
• Table A2.11 Adolescent health, economic and social benefits, and costs ($ million), and BCRs 139
• Table A2.12 Return on investment from scale-up of HPV vaccination, screening and treatment, economic and social benefits, and costs ($ million), and BCRs 139
• Table A2.13 Upper middle-income countries and areas eligible for TB funding from the Global Fund 140
• Table A2.14 TB, number of adolescent deaths per 100 000 population 140
• Table A2.15 Global world population 2023 to 2023 thousands 140
• Table A2.16 TB, number of adolescent deaths averted 2023 to 2023 141
• Table A2.17 TB in adolescents, cost estimates billions 2020 dollars 141
• Table A2.18 TB in adolescents cost per death averted 2023 to 2023 141
• Table A2.19 TB in adolescents deaths averted 2023 to 2035 142
• Table A2.20 TB in adolescents economic and social benefits and costs ($ million) and BCRs (3% discount rate) 142
• Table A2.21 Myopia number of adolescent patients treated 2021 to 2030 142
• Table A2.22 Myopia in adolescents benefits and costs ($ million) and BCRs (3% discount rate) 142
• Box 7.1 Estimating the economic and social benefits of reducing child marriage 86
• Box A1.1 VISES reports and other papers 119
• Foreword 10
• Preface 11
• Acknowledgements 12
• Acronyms 13
• Executive summary 14
• 1. Introduction and review – the urgency of action on adolescent well-being 17
• 1.1 Emerging conditions shaping adolescent well-being 17
• 1.2 Domains, linkages and platforms 18
• 1.3 Costs and benefits of the interventions 21
• 1.4 Limitations of the economic and social modelling 25
• 1.5 Key investment priorities 26
• 1.6 Conclusion 30
• 2. Health investments 31
• 2.1 A broad package of health interventions provided to adolescents 31
• 2.2 HPV 36
• 2.3 TB 38
• 2.4 Myopia 41
• 3. Building connectedness, agency and resilience 43
• 3.1 Connectedness 43
• 3.2 Agency and resilience 46
• 3.3 Case study – connectedness, in search of economic evaluations of its impact 49
• 3.4 Conclusion 55
• 4. Investing in adolescent mental health5 56
• 4.1 Introduction 56
• 4.2 Importance of mental health 57
• 4.3 Structural factors affecting mental health 59
• 4.4 Proximal determinants 63
• 4.5 Conclusion 66
• 5. School feeding – one key response to malnutrition 67
• 5.1 Introduction 67
• 5.2 Recent studies and action, both locally and globally 67
• 5.3 The key messages of Ready to Learn and Thrive 69
• 5.4 Some modelling results 70
• 5.5 Conclusion 70
• 6. Education, skills and employment 71
• 6.1 School attendance and the quality of learning 71
• 6.2 Methodology – education model 73
• 6.3 Results – education outcomes 76
• 6.4 The benefits model – methodology 77
• 6.5 Results 80
• 7. Violence and injuries 83
• 7.1 Introduction 83
• 7.2 IPV 83
• 7.3 Adolescent suicide 91
• 7.4 Road safety8 92
• 7.5 Conclusions 97
• 8. Financing the investment in adolescent well-being 98
• References 101
• Annex 1. Additional methodological details and tables related to Chapter 1 116
• 1. The cost of inaction 116
• 2. Validation of models 118
• 3. Detailed methodology for health services modelling 119
• Tables related to Chapter 1 128
• Annex 1: References 133
• Annex 2. Chapter 2 tables 134
• Annex 2: References 142