The burden of disease in adolescents

SPEAKER 1: We’re now going to talk about the burden of disease in adolescents. This is a combination of mortality and morbidity. So, for example, mortality contributes the years of life that you’ve lost if you die from a condition and the disability in which, for example, if you were bedridden from an acute illness for one week and then you recover completely, you’d have lost most of your healthy life for that one week. And the measure is the disability-adjusted life years lost. And this takes into account both life years, healthy life years lost within the age group and into the future.

One of the key things to note is that the burden of non-communicable health conditions has been increasing dramatically globally. And these are due to injuries, mental health disorders, cardiovascular disease, and diabetes as well as obesity. Most of these either have their biggest effects during adolescence, such as injuries, or they present for the first time during adolescence, such as mental health disorders, or the behaviours and risk factors that start during adolescence lead to cardiovascular disease or diabetes and obesity in later life. If we look at the disability-adjusted life years by age and by sex, we can see here that the biggest burden of disease is an under-fives.

And, in fact, this is due to infants where there is a very high mortality rate and also disability rate. The burden of disease is minimum and it’s lowest level in 10- to 14-year-olds. But already, in 15- to 19-year-olds, it’s increased substantially and it continues to go up in 20- to 24-year-olds. So what’s causing this burden of disease in adolescence? This graph shows what is going on and what the major causes are. I’d like to highlight two things in this graph, first of all, the real importance of psychiatric conditions. These are also known as mental health problems, depression, for example. That’s the purple in this graph. And, also, the importance of injuries, especially in males.

That is in red in this graph. When we look at the top five causes of burden of disease in older adolescents, we can see the importance, especially in males, of road injuries and skin and subcutaneous diseases, low back and pain, interpersonal violence, and depressive disorders. In females, the number one cause is depression followed by skin and subcutaneous diseases, low back and neck pain, iron deficiency anaemia, and self-harm. And you can see, if you look at the numbers on the right hand side of this graph, that the huge burden that comes from road injuries in males and from depression in females. When thinking about adolescent burden of disease, we must take a life cycle or a life course perspective.

And that’s illustrated in this diagram here where things that happen to you even, as a foetus in your mother’s womb, have major impacts on you as an adolescent. Similarly, things that happen to you during childhood are very important for what’s going to happen to you in adolescence. Also, the issue of puberty and social role transitions that are happening that we heard about in a previous step is happening to you in adolescence. But that is affected dramatically by things that are happening outside you as an individual.

So the societal determinants of health, such as the norms of the culture you’re living in, the environment that you’re living in, the particular risk and protective factor such as whether you have parental care and concern are important. They can also include factors such as education and employment, marriage and parenthood, marketing and digital media, and the quality of universal health coverage. The health-related behaviours and states such as smoking, alcohol consumption, drug use, all of these can lead to specific adolescent health outcomes but can also have important outcomes later into adulthood.

And all of these factors are affected, both if you like, by the local environment but also the social, educational, and economic policies, environment that you’re in and the particular health policies that you’re living within the country that you’re living in. So what are the really important risk factors? This is in 15- to 19-year-olds for the burden of disease. And here you can see, in males, the really important factor is alcohol consumption. In females, the main risk factors are iron deficiency, unsafe sex, unsafe water, intimate partner violence, and alcohol consumption. So, from this, what are the major health priorities in adolescents? The number one, two, and three are injuries, mental health disorders, and sexual and reproductive health issues.

And we’re going to be going into these in more detail in subsequent steps. Other really important priorities include nutrition and exercise, common endemic communicable diseases such as schistosomiasis, malaria, soil transmitted helminths such as hookworm. Common infectious diseases remain an important problem in this age group, diarrhoea and pneumonia being the most important, and also alcohol consumption and other psychoactive drugs where cannabis is a major drug consumed in this age group and tobacco.