World health report

Executive summary

Health of school-age children and adolescents

Across the world some 2.3 billion people, about 40% of the total population, are aged under 20. Although teenagers and young adults are generally healthy, they are among the most vulnerable in terms of the diseases of society - poverty, exploitation, ignorance and risky behaviour. In squandering the health of its young, the world squanders its tomorrows. The behaviour patterns established in adolescence, highly influenced by the adult world, are of immense importance to an individual's life span and to public health as a whole.

In many countries health services are not meeting adolescent needs, and there are concerns that education, training and jobs for the young are inadequate. Education is a vital, although often unrecognized, contributor to the well-being and sensible fertility practices of young people, because schooling is closely linked with health status and pregnancy rates. A blackboard and piece of chalk can be as influential as antibiotics and contraceptives in protecting health. Improving the education of adolescents in general, and girls in particular, is one of the most effective ways to promote equity, enhance development and protect health for all.

The desire for sex and a fulfilling relationship are powerful driving forces for most young people, who at the same time are under pressure to engage in sexual relationships too early. Yet many young people are denied even basic knowledge about their own bodies or the means to protect themselves from unwanted pregnancy and sexually transmitted diseases (STDs). These diseases are most frequent in younger sexually active people, and appear to be increasing worldwide. The highest rates for notifiable STDs are generally seen in the 20-24 age group, followed by those aged 15-19 and 25-29. In nearly all parts of the world the peak age of infection is lower in girls than in boys.

At the same time HIV and AIDS are having a devastating effect on young people. In many countries in the developing world, up to two-thirds of all new HIV infections are among people aged 15-24. Overall it is estimated that half the global HIV infections have been in people under 25 years - with 60% of infections of females occurring by the age of 20. Thus the hopes and lives of a generation, the breadwinners, providers and parents of the future, are in jeopardy. Many of the most talented and industrious citizens, who could build a better world and shape the destinies of the countries they live in, face tragically early death as a result of HIV infection.

Other health dangers facing adolescents include tobacco, alcohol and other drug misuse, their exploitation as cheap and often illegal labour, and the worrying growth in the numbers of street children. Recent estimates suggest there may be as many as 100 million street children, at high risk of malnutrition, infectious diseases, STDs including HIV/AIDS, and criminal and sexual exploitation. The rise in accidents, violence and suicides involving young people in many parts of the world is a cause for deep concern.