Author Archives: Molly O'Sullivan

The Coalition

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The Coalition of Centres in Global Child Health (The Coalition) is a global network of expert individuals and academic centres and institutions that have explicitly expressed commitment to a collectively-developed set of principles and plans of advancing global child health. Members of The Coalition will have the opportunity to collaborate and communicate with their peers from around the world via symposia, workshops, and other forums. Two of our very own Commissioners are involved, Dr Zulfiqar Bhutta (Chair, The Coalition of Centres in Global Child Health) and Prof Susan Sawyer.

Their vision, collaborating to inform and advance global child health through providing a platform for academic centres to collaborate. The Coalition website is now live. The website is designed to serve as a place where Coalition partners can exchange knowledge and easily access the latest resources in global child health, curated by expert members of The Coalition Steering Committee.  These materials are broken into focus areas for ease of reference.

Youth! IAAH needs you

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IAAH World Congress on Adolescent Health

“Looking for youth and young professionals”

The International Association for Adolescent Health (IAAH) 11th World Congress on Adolescent Health will be organised from October 26-28, 2017 in New Delhi, India. The Congress is hosted by the Public Health Foundation of India (PHFI) and MAMTA Health Institute for Mother and Child with the support of the Ministry of Health and Family Welfare, Government of India (MoHFW). The theme of the 2017 Congress is “Investing in Adolescent Health-the Future is Now”.

Young people are a global force to reckon with and this will be reflected in the Congress by ensuring that youth and young professionals are central to the Congress planning and programme. Young participants in the broad age ranges of 15-18 years (adolescents); 19-24 years (youth) and 25-30 (young professionals) from schools, colleges and professional universities from across the world are encouraged to participate in the Congress with the following objectives:
(a) build their capacities in essential research and advocacy skills through mentorship opportunities and
(b) provide a platform to young stakeholders to voice their health priorities and engage in scientific and policy-oriented discussions on adolescent health.

Youth applications for the IAAH Adolescent Health Congress are now open and the deadline for submission is May 31, 2017. Limited scholarships are available for youth from LMICs.

Youth: Register here

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The Lancet’s New Journal

The Lancet Child & Adolescent Health: a call for papers for a new journal

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Building on the foundations of The Lancet‘s sustained commitment to publishing the best in research around the world, including clinical paediatric research and global child health, it is exciting to see The Lancet announce the launch of a new journal — The Lancet Child & Adolescent Health.

The Lancet Child & Adolescent Health will publish research Articles, Comments, Correspondence, Clinical Pictures, Editorials, Reviews, and Viewpoints. They are inviting submissions that effect clinical practice or public health across the life course from the fetal period through to young adulthood at 24 years.

The new editor of The Lancet Child & Adolescent Health is Ms Jane Godsland. We are delighted that three of the Lancet Commissioners, Professors Susan Sawyer, Rima Afifi and Zulfikar Bhutta have been invited to join the international advisory board. It is also pleasing that a US trainee in adolescent health and medicine, Dr Jason Nagata, is also on the board.

The journal offers a fast-track publication process by which original research can be published online within 4–8 weeks from submission. Randomised trials that strengthen the evidence base for disease treatment will be given priority, but we also welcome any studies that have the potential to change or challenge clinical or public health practices.

For The Lancet Child & Adolescent Health see

Poor kids hit puberty sooner

Poor kids hit puberty sooner and risk a lifetime of health problems

Shape-shifting bodies. Cracking voices. Hairs sprouting in new places. Puberty marks a dramatic period of change for young people. New research shows children who grow up in poor homes enter puberty early.

Not only do they experience more emotional, behavioural and social problems compared to their peers, early puberty puts them at risk of a range of health issues for the rest of their lives.

The research, published yesterday in the journal Pediatrics, adds to a body of work showing the cumulative effect of adversity in childhood can have lifelong physical, mental and behavioural repercussions. However, the reason why these disadvantaged children enter puberty early remains unclear. And work is continuing to pinpoint factors that trigger the cascade of hormones that mark this critical period of development.

What is puberty?

Puberty is an inherently awkward transition in which a child’s body matures to allow reproduction. In girls, it typically begins with breast development between the ages of eight and 13 and ends with menarche, or the first period. In boys, puberty begins between ages nine and 14, on average, starting with growth of the sexual organs and wrapping up with facial hair and a deepened voice.

But changes at puberty are not all physical. Puberty also triggers rapid biological and social change, and increasing risk for psychological health problems, like depression and anxiety, substance use and abuse, self-harm and eating disorders.

We still don’t know exactly what triggers the cascade of hormone secretions that, over time, produces these tell-tale changes. And “What triggers puberty?” was one of the 125 questions posed in Science magazine’s 125th anniversary edition in 2005 that still remains unanswered today.

In particular, we still don’t know exactly what causes some children to enter puberty earlier than others, although there have been many factors linked to early puberty. These include childhood obesity, being born small for gestational age and exposure to environmental chemicals. Other researchers have linked early puberty with living with a stepfather or having experienced stressful life events, such as childhood maltreatment and abuse.

What we did

Previous studies looking into social impacts on the timing of puberty have had mixed results. While one Indian study found poor girls started their periods later than normal, a UK study found girls who grew up the poorest were twice as likely to have started their periods earlier than the richest.

So, we carried out the first study of its kind in Australia to see how cumulative exposure to social disadvantage affected the age children entered puberty. We asked parents of 3,700 children in the Growing Up in Australia Study to report signs of their children’s puberty at age eight to nine, and then again at ten to 11. Signs included: a growth spurt, pubic hair and skin changes; breast growth and menstruation in girls; and voice deepening and facial hair in boys.

We then compared the family’s socioeconomic position – as measured by their parent’s annual income, education and employment – of those who started puberty early with others who started on time.

At ten to 11 years old, about 19% of boys and 21% of girls were classified in the early puberty group. In other words, they had entered puberty earlier compared to their counterparts.

Boys from very disadvantaged homes had a four-fold increase in the rate of early puberty, while girls’ risk increased nearly two-fold compared with kids that came from the richest families.

How could this happen?

Research on the biology of stress shows how major adversity, like extreme poverty, can permanently set the body’s stress response to high alert, affecting the brain’s circuits. This might, in turn, influence how reproductive hormones are regulated, so affecting the timing and trajectory of puberty.

Another body of research suggests the social environment can influence so-called epigenetic changes in our genes. These changes might affect the regulation of genes involved in reproductive development, switching some on or off sooner than usual.

Another theory is that in the face of hardship – for instance, economic disadvantage, harsh physical environment, the absence of a father – children may be programmed to start the reproductive process earlier to ensure their genes are passed on to the next generation.

Yet, we still don’t know exactly how poverty or disadvantage triggers early puberty.

Why this matters

What we do know, however, is early puberty is linked with a range of health issues. For instance, in girls, it’s linked with emotional, behavioural and social problems during adolescence including: depressive disorders, substance disorders, eating disorders and earlier-than-usual displays of sexuality.

Early puberty also affects people’s health far beyond their teenage years. It places them at a greater risk of developing obesity, reproductive cancers and cardiometabolic diseases (diabetes, heart disease or stroke) in later life.

Written by Associate Professor Ying Sun

This article was originally posted on The Conversation.

The lead author on the study is Associate Professor Ying Sun, a visiting researcher at The Centre for Adolescent Health, Murdoch Children’s Research Institute (MCRI) based at Anhui Medical University, China. The other co-authors are Commissioners Prof George Patton, Dr Peter Azzopardi, as well as Professor Melissa Wake, and Dr Fiona Mensah.

What is the Global AA-HA! Guidance?

On Tuesday 16 May, we were thrilled to see the launch of the Global Accelerated Action for the Health of Adolescents (AA-HA!). The launch event took place at the Global Adolescent Health Conference, Ottawa, Canada and was hosted by the Canadian Partnership for Women and Children’s Health (CanWaCH), along with Every Woman Every Child (EWEC), the Partnership for Maternal, Newborn and Child Health (PMNCH) and WHO.

Screenshot 2017-05-18 11.12.31What is the Global AA-HA! Guidance?

Simply put, the Global AA-HA! Guidance aims to assist governments in deciding what they plan to do – and how they plan to do it – as they respond to the health needs of adolescents in their countries.

It is intended as a reference document for national-level policy-makers and programme managers to assist them in planning, implementing, monitoring and evaluation of adolescent health programmes.

The Guidance summarises the main arguments for investing in adolescent health, and details the key steps from understanding the country’s epidemiological profile, undertaking a landscape analysis to clarify what is already been done and by whom, conducting a consultative process for setting priorities, to planning, implementing, monitoring and evaluating national adolescent health programmes. It also includes key research priorities and case studies to illustrate that what is being recommended can be done, and in some cases has already been done.

Global AA-HA! Guidance has 6 overarching messages

1. Approach

The AA-HA! guidance provides a systematic approach for understanding adolescent health needs, prioritising these in the country context and planning, monitoring and evaluating adolescent health programmes.

2. Prevention

More than 3000 adolescents die every day from largely preventable causes such as unintentional injuries; violence; sexual and reproductive health problems, including HIV; communicable diseases such as acute respiratory infections and diarrhoea; noncommunicable diseases, poor nutrition and lack of physical activity; and mental health, substance use and suicide. Even more suffer from ill health due to these causes. Although much research is still needed, effective interventions are available for countries to ACT NOW.

3. Priority setting

The nature, scale and impact of adolescent health needs vary between countries, between age groups and between the two sexes. Funds are limited, and governments should prioritise their actions according to the disease and injury risk factor profiles of their adolescent population, as well as the cost-effectiveness of the interventions. Adolescent health needs intensify in humanitarian and fragile settings.

4. Leadership

Strong leadership at the highest level of government should foster implementation of adolescent-responsive policies and programmes. To accelerate progress for adolescent health, countries should consider institutionalizing national adolescent health programmes. Through the Sustainable Development Goals and the Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030), globally agreed targets related to adolescent health exist, along with indicators to monitor progress towards these. Age and sex disaggregation of data will be essential.

5. Yields from investing in adolescent health span across generations

There is a pressing need for increased investment in adolescent health programmes, to improve adolescent health and survival in the short term, for their future health as adults, and for the next generation. This is a matter of urgency if we want to curb the epidemic of noncommunicable diseases, to sustain and reap the health and social benefits from the recent impressive gains in child health, and ultimately to have THRIVING and peaceful societies.

6. Together

WITH adolescents, FOR adolescents. Adolescents have particular health needs related to their rapid physical, sexual, social and emotional development and to the specific roles that they play in societies. Treating them as old children or young adults does not work. National development policies, programmes and plans should be informed by adolescents’ particular health related needs, and the best way to achieve this is to develop and implement these programmes with adolescents.

Whole-of-government. To achieve the Sustainable Development Goal targets, the health and other sectors need to normalise attention to adolescents’ needs in all aspects of their work. An Adolescent Health in All Policies* (AHiAP) approach should be practised in policy formulation, implementation, monitoring and evaluation.

*AHiAP is an approach to public policies across sectors that systematically takes into account the implications of decisions for adolescent health, avoids harmful effects and seeks synergies – in order to improve adolescent health and health equity. It is a strategy that facilitates the formulation of adolescent-responsive public policies in all sectors, and not just within the health sector.Screenshot 2017-05-18 13.25.45

Adolescent participation

Countries should ensure that adolescents’ expectations and perspectives are included in national programming processes. Adolescent leadership and participation should be institutionalized and actively supported during the design, implementation, monitoring and evaluation of adolescent health programmes. Furthermore, respecting adolescents’ views regarding their health care ensures that more adolescents will seek services and remain engaged in accessing them.

From a developmental perspective, the engagement of adolescents enhances adolescent-adult relationships, develops adolescent leadership skills, motivation and self-esteem, and enables them to develop the competencies and the confidence they need to play an active, positive and pro-social role in society.



Launch of the AA-HA!


Global Accelerated Action for the Health of Adolescents (AA-HA!)

The Lancet Commission on Adolescent Health and Wellbeing is excited to support the launch of the Global AA-HA! Guidance. Commission Chair Professor Patton and Commission lead Prof Ross will be at WHO launch at the Global Adolescent Health Conference, Ottawa, Canada on 16-17 May 2017. The event is hosted by the Canadian Partnership for Women and Children’s Health (CanWaCH), along with Every Woman Every Child (EWEC), the Partnership for Maternal, Newborn and Child Health (PMNCH) and WHO.

More than 3000 adolescents die every day, totalling 1.2 million deaths a year, from largely preventable causes, according to a new report from the World Health Organization (WHO) and partners. In 2015, nearly two thirds, some 855,000 10 to 19-year-olds died in low- and middle-income countries of the African and South-East Asia Regions. Road traffic injuries, lower respiratory infections and suicide are the biggest causes of death among adolescents.

Most of these deaths can be prevented with good health services, education and social support. But in many cases, adolescents who suffer from mental health disorders, substance use or poor nutrition cannot obtain critical prevention and care services – either because the services do not exist, or because they do not know about them.

In addition, many behaviours that impact health later in life, such as physical inactivity, poor diet, and risky sexual health behaviours, begin in adolescence.

“Adolescents have been entirely absent from national health plans for decades,” says Dr Flavia Bustreo, Assistant Director-General, WHO. “Relatively small investments focused on adolescents now will not only result in healthy and empowered adults who thrive and contribute positively to their communities, but it will also result in healthier future generations, yielding enourmous returns.”

Data in the report, Global Accelerated Action for the Health of Adolescents (AA-HA!): Guidance to Support Country Implementation, reveal stark differences in causes of death when separating the adolescent group by age (younger adolescents aged 10-14 years and older ones aged 15-19) and by sex. The report also includes the range of interventions – from seat-belt laws to comprehensive sexuality education – that countries can take to improve their health and well-being and dramatically cut unnecessary deaths.

Top 5 causes of death for adolescents 10-19 years 

Total #deaths
1. Road injury 115,302
2. Lower respiratory infections  72,655
3. Self-harm  67,149
4. Diarrhoeal diseases  63,575
5. Drowning  57,125

Road injuries top cause of death of adolescents, disproportionately affecting boys
In 2015, road injuries were the leading cause of adolescent death among 10 to 19-year-olds, resulting in approximately 115,000 adolescent deaths. Older adolescent boys aged 15 to 19 years experienced the greatest burden. Most young people killed in road crashes are vulnerable road users such as pedestrians, cyclists and motorcyclists.

However, differences between regions are stark. Looking only at low- and middle-income countries in Africa, communicable diseases such as HIV/AIDS, lower respiratory infections, meningitis and diarrhoeal diseases are bigger causes of death among adolescents than road injuries.

Lower respiratory infections and pregnancy complications take toll on girls’ health
The picture for girls differs greatly. The leading cause of death for younger adolescent girls aged 10-14 years are lower respiratory infections, such as pneumonia, often a result of indoor air pollution from cooking with dirty fuels. Pregnancy complications, such as haemorrhage, sepsis, obstructed labour and complications from unsafe abortions, are the top cause of death among 15 to 19-year-old girls.

Adolescents are at very high risk of self-harm and suicide
Suicide and accidental death from self-harm were the third cause of adolescent mortality in 2015, resulting in an estimated 67 000 deaths. Self-harm largely occurs among older adolescents, and globally it is the second leading cause of death for older adolescent girls. It is the leading or second cause of adolescent death in Europe and South-East Asia.

Top 5 causes of death for adolescent males and female, 10-19 years

Males #deaths Females #deaths
1. Road traffic injury 88,590 1. Lower respiratory infections 36,637
2. Interpersonal violence 42,277 2. Self-harm 32,499
3. Drowning 40,847 3. Diarrhoeal diseases 32,194
4. Lower respiratory infections 36,018 4. Maternal conditions 28,886
5. Self-harm 34,650 5. Road traffic injury 26,712

A vulnerable population in humanitarian and fragile settings
Adolescent health needs intensify in humanitarian and fragile settings. Young people often take on adult responsibilities, including caring for siblings or working, and may be compelled to drop out of school, marry early or engage in transactional sex to meet their basic survival needs. As a result, they suffer malnutrition, unintentional injuries, pregnancies, diarrhoeal diseases, sexual violence, sexually-transmitted diseases and mental health issues.

Interventions to improve adolescent health
“Improving the way health systems serve adolescents is just one part of improving their health,” says Dr Anthony Costello, Director, Maternal, Newborn, Child and Adolescent Health, WHO. “Parents, families and communities are extremely important, as they have the greatest potential to positively influence adolescent behaviour and health.”

The AA-HA! Guidance recommends interventions across sectors, including comprehensive sexuality education in schools; higher age limits for alcohol consumption; mandating seat-belts and helmets through laws; reducing access to and misuse of firearms; reducing indoor air pollution through cleaner cooking fuels; and increasing access to safe water, sanitation and hygiene. It also provides detailed explanations of how countries can deliver these interventions with adolescent health programmes.


The AA-HA! Guidance was produced by WHO in collaboration with UNAIDS, UNESCO, UNFPA, UNICEF, UN Women, World Bank, the Every Woman, Every Child initiative and The Partnership for Maternal, Newborn , Child & Adolescent Health.

The document will be launched at the Global Adolescent Health Conference: Unleashing the Power of a Generation on 16 May in Ottawa, Canada.

The report helps countries implement the Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030) by providing comprehensive information needed to decide what to do for adolescent health, and how to do it. The Global Strategy, which was launched in 2015 to support the Sustainable Development Goals (SDGs), provides an opportunity to improve adolescent health and to respond more effectively to adolescents’ needs.

Systematic review

Systematic Review of Positive Youth Development in Low- and Middle-Income Countries

YouthPower Learning is pleased to announce the publication of Systematic Review of Positive Youth Development (PYD) Programs in Low- and Middle-Income Countries (LMICs)! The Systematic Review presents the results of a rigorous analysis of existing evidence of PYD in LMICs. It expands the knowledge base on the impacts and measurement of PYD programs and provides valuable insights for international implementing organizations, researchers, and donors.

What is the purpose of the Systematic Review?

The Systematic Review documents how PYD approaches have been applied in LMICs, and what the evidence shows about the effectiveness of such approaches.

What does the Systematic Review provide?

  • A comprehensive framework to understanding PYD in LMICs
  • Findings of how PYD has been implemented and areas in need of further investigation
  • The latest evidence of what works in achieving positive youth-focused outcomes in LMICs
  • Lessons learned that international implementing organizations can integrate into practice
  • Recommendations to inform future program design, implementation, and evaluation efforts

How can I access the Systematic Review?

Download the Systematic Review here.
Download the Systematic Review Brief here.

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Global investment in Adolescents

Building the foundations for sustainable development: a case for global investment in the capabilities of adolescents

As the World Bank meetings begin, a new study, Building the foundations for sustainable development: a case for global investment in the capabilities of adolescents, published yesterday in The Lancet, builds upon our Lancet Commission on Adolescent Health and Wellbeing which highlighted the importance of investing in adolescents, and shows that investments in adolescent health and wellbeing are some of the best that can be made towards achieving the SDGs.

Improving the physical, mental and sexual health of adolescents aged 10-19 years, at the cost of US$4.6 per person per year, could bring a 10-fold economic benefit by averting 12 million adolescent deaths and preventing more than 30 million unplanned pregnancies in adolescents.

Investment1Similarly, investing to increase the extent and quality of secondary education, at a cost of US$22.6 per person per year, would generate economic benefits about 12 times higher and result in an additional 12 million formal jobs for people aged 20–24 years.

The findings are published in The Lancet on the eve of the World Bank Spring Meetings in Washington D.C. [1] where finance and development leaders from 188 countries will discuss the critical need for investment in adolescents.

The Lancet: Investing in adolescent health and education could bring 10-fold economic benefit

In addition to health and education, the study shows that investing in improving road safety, at US$ 0.60 per person per year, would give economic benefits about 6 times higher and prevent nearly 500,000 adolescent deaths by 2030. Programmes to reduce child marriage, at US$3.8 per person, had a 5.7-fold return on investment and could cut child marriage by around a third.

“Some of the best investments in adolescent health and wellbeing lie outside the health sector – tackling child marriage, reducing road injuries and improving education. There is little doubt that the actions outlined in our study could be delivered on a large scale in countries, transforming the lives of boys and girls around the world. The economic and social impacts of investments in adolescent health and wellbeing are high by any standards, and are among the best investments that the global community can make to achieve the UN’s Sustainable Development Goals.” says lead author Professor Peter Sheehan, Victoria University. [2]

The study published yesterday was led by authors from Victoria University, the University of Melbourne (Australia) and UNFPA, the United Nations Populations Fund. Four of the Lancet Commissioners (G Patton, S Sawyer, N Reavley, J Mahon) were involved.

Globally, HIV/AIDS, road traffic accidents, drowning, diarrhoeal and intestinal infectious diseases, lower respiratory infections and malaria are responsible for about half of all deaths for 10–14 year olds. Road traffic accidents, self-harm and violence are the leading causes of death for 15–24 year olds, and depression is the leading cause of ill health affecting more than 1 in 10 10-24 year olds [4].

In the analysis, the authors calculate the economic and social impact of health interventions aimed at improving maternal, newborn and reproductive health services, improved access to treatments for HIV/AIDS, malaria, depression, alcohol dependence and epilepsy, and expansion of HPV vaccinations. They also calculate the impact of programmes to reduce child marriage and interpersonal violence. Education programmes analysed in the study include those aimed at reducing drop-out, providing free school uniforms, better teaching methods and computer, radio and TV assisted learning. Finally, they also calculate the impact of interventions to improve road safety such as helmet and seat belt use, speed compliance, alcohol testing as well as safer roads and improved motor vehicle safety.

“Investing in young people is in everyone’s interest,” says UNFPA Executive Director, Professor Babatunde Osotimehin. “A small investment in empowering and protecting the world’s over a billion adolescents can bring a ten-fold return, or sometimes even more. Our pioneering research must now be seen by policy makers, and used to chart the way forward.” [2]

The total cost to 2030 of all the interventions studied, except those for education, is estimated at $524 billion, equivalent to $6.7 per person per year. For education, the overall total is estimated at $1774 billion, or $22.6 per person per year. Overall, the total annual investment across all programmes amounts to 0.20% of the global Gross Domestic Product.

triple-d_mg“There are 1.2 billion 10- to 19-year-olds in the world today. Investments to transform health, education, family and legal systems will help improve their physical, cognitive, social, and emotional capabilities. This will generate a triple dividend reducing death and disability in adolescents today, promote health and productivity across the life-course, and because this is the next generation to parent, provide the best possible start to life for the generation to come. This generation of young people can transform all our futures. There is no more pressing task in global health than ensuring they have the resources to do so,” says Professor George Patton, co-author from the University of Melbourne, and Commission Chair. [2]

The authors note several limitations, mostly related to the quality of evidence available. While the evidence base for the cost and impact of interventions in sexual, reproductive, maternal and child health is strong, there is still a great need for research on many interventions to improve adolescent health. The authors have therefore taken a conservative approach to their analysis.

The paper can be accessed here:   

[1] World Bank spring meeting
[2] Quote direct from author and cannot be found in the text of the Article
[3] Adolescent Health Commission
[4] Global Burden of Disease 2013, Adolescents

Seven briefs for seven adolescent research challenges

Welcome to the Septuplets!

On behalf of The Lancet Commission on Adolescent Health and Wellbeing and the UNICEF Office of Research – Innocenti, I am very pleased to announce the birth of a new series of seven briefs on how to conduct research with adolescents in low- and middle- income countries.

The current cohort of adolescents and young adults is the largest the world has ever seen – 1.8 billion. Investments in adolescent health and wellbeing offer a triple dividend:  to adolescents today, towards health and wellbeing across the lifespan, and to the next generation of the world’s children. While much is understood about adolescence, The Lancet Commission on Adolescent Health and Wellbeing highlights the great need for continuing research with young people, so that we address the tremendous unrealised opportunities, not only for the health and wellbeing of young people themselves, but also for the future of society and future generations.

These seven new briefs focus on research methodologies, and are intended to identify best-practice approaches for conducting research with adolescents. The briefs cover diverse topics including: indicators and data sources; research ethics; research with disadvantaged, vulnerable and/or marginalised populations; participatory research; measuring the social determinants of health, and economic strengthening interventions for improving adolescent wellbeing. Written by leading experts in adolescent health and wellbeing, the briefs are designed to improve how research on adolescent health and wellbeing in low- and middle- income countries is conducted and interpreted.

“The briefs cover: indicators and data sources; research ethics, research with disadvantaged, vulnerable and/or marginalized populations, participatory research, measuring the social determinants of health, and economic strengthening interventions for improving adolescent wellbeing.”

Adolescents are unique human beings—no longer children but not quite fully-formed adults. They have distinctive needs, exceptional capabilities, and matchless potential. As the father of two adolescent men, I understand first-hand the exhilaration, the frustration, and the pride that adolescence draws out of us. As an adolescent medicine physician, I have had the supreme pleasure of working closely with, and learning from, this special group of human spirits. And as a public health policy wonk, I have been amazed to see the recent global explosion of interest in adolescence. A key global force driving this recent interest has been the Lancet Commission and its fearless leader: George Patton from the University of Melbourne. The Lancet Commission provides a blueprint for a new understanding of the importance of adolescence in a lifetime of health and wellbeing.

I was pleased to be able to lead the writing of Brief 3, Inclusion with protection: obtaining informed consent when conducting research with adolescents. This brief addresses ways to work ethically with adolescents in conducting research. Research ethics has been a long standing cause for me. Too often adolescents have been excluded from essential research, based on the false premise of protection from research risk. Brief 3 provides an avenue to inclusion with protection building on the concepts of the Convention on the Rights of the Child, particularly the concept of emerging capacities. Adolescents are often best able to make informed and sensible decisions about their own lives. Inclusion of adolescents in research is essential if adolescents are to reap the full benefits of research. Research can guide the creation of improved policies and programmes for adolescents and appropriately tailored services and infrastructure. Research can also strengthen adolescent resiliency, promote wholesome development, reduce adolescent morbidity and mortality, improve nutritional status, promote educational success and mental health, prevent risk behaviours, and prevent or treat infectious disease.

In my own service on ethics committees, I have too often seen adolescents excluded from specific research projects – even low risk studies. Either the investigators or the ethics committee could not figure out an ethical way to include adolescents in studies which could promote adolescent health and wellbeing. We can and should do better. Brief 3 suggests ethical and practical ways to resolve these dilemmas.

These briefs are part of a broader effort to increase understanding of the social and structural determinants of adolescent wellbeing. Adolescence is marked by multiple physical, psychological, and social role transitions. Social and structural determinants and social role transitions are key drivers of health and wellbeing during the adolescent period. By influencing vital social transitions from adolescence into adulthood, these social and structural determinants have enormous implications for an adolescent’s health and wellbeing during adolescence and across the lifespan. Briefs 1, 6 and 7 address the scope of these social determinants and ways to address them in research.

The UNICEF research briefs are the result of a year’s work by a small army of contributors: authors, reviewers, and advisors, all acknowledged in the briefs, who worked tirelessly to refine the briefs and made special efforts to insure the writing was accessible and its utility, maximised. Special thanks to my collaborator and co-editor Nikola Balvin from the UNICEF Office of Research – Innocenti. I join her in thanking the UNICEF Innocenti, which insightfully recognised the importance of this effort and generously supported the writing and publication of these briefs. The briefs should be useful to a wide range of stakeholders interested in adolescence research, but are primarily designed to assist professionals, including UNICEF staff, who conduct, commission, or interpret research and/or evaluate research findings in international development contexts, in order to make decisions about programming, policy, and advocacy. The seven briefs are available online at:

Serving as an editor is a bit like having a baby. There is always a bit of uncertainty about arrival dates and how the offspring will arrive. The gestation period often seems a bit longer than expected; the labour pains can be sharp. Despite all the travails, the delivery is accompanied with pride and wonder. What a beautiful product we have helped bring into the world!

We hope this effort will make the world a better place for the adults who care about adolescents and – especially – for the adolescents themselves.

Dr. John Santelli is one of Commission leads, as well as a Professor of Population and Family Health and Pediatrics and was the chair of the Department of Population and Family Health at the Mailman School of Public Health, Columbia University.

This initiative was funded by the UK Department for International Development.

This post was originally posted on UNICEF’s website about the series.

World Health Day

World Health Day 2017 poster: Eastern Mediterranean  World Health Day 2017 poster - Depression: Let’s talk

World Health Day 2017

“Depression: let’s talk”

April 7 is #WorldHealthDay, a day that is celebrated every year (on April 7) to mark the anniversary of the founding of the World Health Organisation. The theme of this years World Health Day campaign is Depression.

Depression affects people of all ages, from all walks of life, in all countries. It causes mental anguish and impacts on people’s ability to carry out even the simplest everyday tasks, with sometimes devastating consequences for relationships with family and friends and the ability to earn a living. At worst, depression can lead to suicide, now the biggest killer of teenage girls (15-19 years) worldwide and the second leading cause of death among 15-29-year-olds.

In a blog piece published earlier in the year, Suicide & Adolescent Girls, Commissioner Suzanne Petroni wrote on this surprisingly changing landscape of depression, suicide and adolescents.

Adolescents, no matter where they live, face a host of challenges as they navigate the rocky waters between childhood and adulthood. During adolescence, both boys and girls experience rapid physical growth and changes, accompanied by shifts in cognitive and emotional development. At the same time, environmental factors, including influences from family, peer groups, schools, communities and societal expectations more broadly, can work to either support or hinder young people’s wellbeing.

Yet, depression can be prevented and treated. A better understanding of what depression is, and how it can be prevented and treated, will help reduce the stigma associated with the condition, and lead to more people seeking help.

According to the latest estimates from WHO, more than 300 million people are now living with depression, an increase of more than 18% between 2005 and 2015. Lack of support for people with mental disorders, coupled with a fear of stigma, prevent many from accessing the treatment they need to live healthy, productive lives.

The overall goal of the “Depression – let’s talk” campaign is that more people with depression, everywhere in the world, both seek and get help.

This short video, ‘Let’s talk about depression – focus on adolescents and young adults’ has been produced as part of WHO’s “Depression: let’s talk” campaign and highlights some of the symptoms of depression  and the importance of talking as the first step towards getting help.


WHO have developed a set campaign materials for use in “Depression: let’s talk”  campaign activities and beyond, and include:

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