Shared learning from the COVID-19 pandemic
The COVID-19 pandemic has exposed social inequalities and highlighted the ecological, political, commercial, digital and social determinants of health and health inequities within and between social groups and nations. Adolescents have experienced lower COVID-19 morbidity and mortality than adults, but they have been disproportionately affected by public health and social measures designed to limit the spread of the pandemic, as described below.
School closures have severely disrupted education, and the digital divide put millions of adolescents at further disadvantage.
Millions of learners are at risk of never catching up on the months of education disrupted or even of not returning to school. For instance, it was estimated that globally, a school shutdown of 5 months could generate learning losses that have a present value of US$ 10 trillion.
Loss of school-related safety nets, benefits and services.
Adolescents have been missing health and well-being activities offered as part of routine education programmes, such as physical activity, school meals, school-based or school-linked health services, deworming, clean water, sanitation and hygiene and other services for children with disabilities or those with specific needs such as learning support, speech therapy, counselling, behavioural support and social skills training.
The risk of violence against children in their homes, communities and online has increased,
exacerbated by the compromised ability of child protection systems to promptly detect and respond to cases of violence during lockdowns.
An increase in mental health problems and addictive behaviours (for example, gaming) among youth was reported during the COVID-19 pandemic.
It has been estimated that, in the first year of the COVID-19 pandemic, the proportion of youth experiencing clinically elevated symptoms of depression and anxiety doubled over pre-pandemic levels.
The risk of poor sexual reproductive health increased.
Driven by an increase in sexual violence during social isolation and loss of livelihoods, adolescent pregnancy and child marriage increased during the pandemic. The further result is young women forced to leave school and experiencing poor pregnancy outcomes, exacerbating the gender divide.
Decreased access to and coverage by essential services.
COVID-19 disproportionately impaired the delivery of health services to adolescents, disrupting essential health care such as routine immunization, childhood TB services, reproductive health services, mental health care and substance use treatment for adolescents.
Decline in physical activity.
Lockdowns and other public health and social measures to control the pandemic changed work patterns and reduced opportunities for general mobility and access to fitness facilities. As a result, adolescents reduced their physical activity and increased sedentary behaviours.
Looking forward, it is important to appreciate that, should a new epidemic or pandemic occur, adolescents may face similar challenges if we do not adjust our response by learning from the COVID-19 pandemic.
Climate change
Evidence is emerging that climate change is associated in multiple ways with adverse health and well-being outcomes in adolescence:
- Rising temperatures increase the risk of heat-related mortality, adverse birth outcomes, infectious diseases and respiratory disorders.
- Excessive rainfall, extreme temperatures and drought are associated with undernutrition, particularly among young children.
- Higher temperatures, rainfall variability and air pollution are linked to poorer cognitive ability, lower school enrolment and leaving school earlier.
- In disaster-affected families, family functioning worsens (that is, hostile and anxious parenting, child neglect and violence, low connectedness, parent–child or family conflict).
- Gender-based violence increases during or after extreme climate events.
- Climate-related disasters disrupt education and training.
Armed conflicts and displacements
Worldwide, at least 415 million children under the age of 18 years were living in conflict-affected areas in 2018. The number is assumed to have increased further following recent escalation of conflicts in Afghanistan, Ethiopia and Ukraine, exposing millions more families and children to enormous additional physical and mental health risks.
As of May 2022, more than 100 million people were forcibly displaced worldwide by persecution, conflict, violence, human rights violations or events seriously disturbing public order. This amounts to more than a doubling compared with 10 years earlier; in 2012 there were 42.7 million forcibly displaced people. At least 40% of displaced people are children (<18 years). Children and adolescents are exposed to family separation, physical violence and other violations of their human rights, including sexual abuse and exploitation, military or other armed attacks, trafficking and limited access to education, health services and food. Many suffer from neglect and violence due to parental substance use while in humanitarian settings. Chapter 2 details the state of health and well-being in humanitarian and fragile settings, and Chapter 5 describes effective national programming responses.
Opportunities
This recent experience opens a window of opportunity to invest long-term in strengthening the resilience to shocks of systems upon which adolescents’ health and well-being depend. Needed steps include these:
- Reinvigorate global commitments to adolescent health, well-being and children’s rights.
- Equitably scale up evidence-based interventions delivered through resilient primary health care to achieve UHC.
- Establish resilient, flexible and easily adaptable systems for delivering adequate nutrition, social protection and education.
- Ensure equitable distribution of the systems and interventions supporting learning, development, health and well-being, addressing the digital divide, the gender divide, disability and the needs of marginalized and hard-to-reach adolescents in diverse settings.
