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This includes social and emotional learning (SEL), improved nutrition, deworming and the prevention of anaemia and malaria.
Rather than distracting schools from their central educative role, there are good reasons for thinking that such programmes can assist schools in achieving their primary goals of student retentio... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
This approach, and the need for enhanced schools in this sense and for increased investment in them, was strongly endorsed by the 2022 Transforming Education Summit report produced by the UN (2022a).
This report also stresses the depth of inequality and disadvantage inherent in current schooling arrangements; globally... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
By sharp contrast, the 25% of the world’s children aged 0–14 years living in upper-middle and high-income countries (UMHICs) have access to 91% of global investment.
In addressing the severe challenges facing adolescents noted above, the reshaping of schools into powerful, shared platforms to deliver high-quality educ... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
1.2).
1.2.4 The community platform The other vital platform is the community development network at the local level, which can be critical to the effective implementation of interventions.
Interventions employing these networks often focus on improved parenting and address adolescent delinquency, IPV and harmful subs... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
This is illustrated briefly in section 1.6.4 in relation to the position of women.
Fig.
1.2 Platforms, linkages and interventions in the investment case modelling 5 1.
Introduction and review – the urgency of action on adolescent well-being 2.
It follows that the research conducted for this study was based on exist... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
1.3 Costs and benefits of the interventions In this section, we summarize some of the quantitative results of the study.
First, in section 1.3.1, we report our estimates of the costs of inaction to the countries concerned, which are the costs of doing nothing further to address the challenges facing adolescents.
Seco... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The cost-benefit results are derived by updating, or re-estimating, models developed by reserachers within the VISES for earlier studies (see Tables 1.2–1.4) and by a review of the academic literature to identify benefit-cost models relevant to this project (see Tables 1.5–1.6).2 1.3.1 The costs of inaction The cost of... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
There are several possible approaches to measuring the cost of inaction, but in this report we take a social opportunity cost approach.
In each of the intervention areas noted below, we construct a base case (broadly the consequences of persisting with existing policies and programmes) and an intervention case (broadl... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Using epidemiological or other subject-specific models to estimate the human impact of the interventions and an economic model to value those impacts, we derive an estimate of the economic and social benefits of the intervention outcomes relative to those of the base case.
The full report describes the process of cons... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
That is, the costs of inaction are equal to the value of the benefits achieved through the interventions and foregone by inaction.
We have applied this approach to the following areas: health (adolescent health services, HPV vaccination, tuberculosis (TB) prevention and treatment and treatment of myopia); educatio... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The cost of inaction (the benefits foregone) pertains to failing to implement the interventions over the period 2024–2050.
They are expressed as net present values (NPVs) at a 3% discount rate (further details are provided in Annex 1).
The period of the cost of inaction is defined by the period for which the interven... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
We estimate that the average annual cost of inaction over the period 2024–2050 for these areas and for the countries we study, which vary for different interventions, to be US$ 4.1 trillion per annum.
This amounts to 7.7% of the projected total GDP of these countries over this 27-year period.
That is, on average, the... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
We use the projected GDP of countries in the World Bank’s emerging market and developing economies as a proxy for the GDP of modelled countries.
These estimates relate to the number of countries for which the modelling has been undertaken as listed in the tables below and detailed in Annex 1, Table A1.7.
For most cas... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
1.3.2 Models and sources for BCR results In terms of BCRs, we report two types of modelling results in the tables below and in the individual chapters that follow.
The first type consists of results arising from eight models developed by the reserachers of the current report (see Annex 1 for further details).
In many... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
6 Adolescents in a changing world.
The case for urgent investment We wish to acknowledge the contributions made by these various co-authors of earlier papers and the role of the agencies, especially UNFPA, which commissioned and, in part, funded these studies.
Table 1.2 provides a summary of the development history o... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
First, they adopt, in several different forms, a broadly human capital approach to valuing the benefits.
A central aspect is the potential GDP lost from death, illness or injury and/or the potential GDP gained from improved human capital, with, where relevant, the additional social value lost through death, illness or... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Secondly, for multi-country studies, two methods are available for reporting the average ratio of benefits to costs and hence the average BCR.
The first is simply to add up the BCRs for each country and divide by the number of countries.
The second is to sum up all the estimated benefits separately and then compile t... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
This gives a much bigger weighting to countries generating larger estimated benefits and costs (for example, those with larger populations such as China and India).
We call the BCRs produced by the first method the unweighted average (of the country results) and the second the weighted average, where the weighting of ... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Both of these are reported here.
Table 1.2 Origins and development paths for eight benefit-cost models used in this report3 Model Origin and development Development work for this report 1.
Adolescent health services Built for Sheehan et al.
(2017) based on prior work for Stenberg et al.
(2014) and reported in Sween... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
See Chapter 2, section 2.1.
2.
HPV While an earlier model was used for Sheehan et al.
(2017), a new model is used here.
The new model was built jointly with the Daffodil Centre, University of Sydney and Sweeny, Nguyen et al.
(2023).
See Chapter 2, section 2.2.
3.
TB prevention and treatment Not previously inclu... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
See Chapter 2, section 2.3.
4.
Myopia screening and treatment Not previously included in published VISES modelling.
This new model, developed with the support of the Fred Hollows Foundation (FHF), uses inter alia evidence from the Lancet Global Health Commission on Global Eye Health (Burton et al., 2021).
See Chapt... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
(2019).
The re-developed model retains the basic structure of transition through grades.
Upgrades include a new meta- analysis for effect sizes and the grouping of related interventions.
See Chapter 6, section 6.2.
6.
Improved productivity and employment Built for Sheehan et al.
(2017); reported in Sheehan and Sh... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
See Chapter 6, section 6.4 and Table 6.3.
7.
Prevention of child marriage Initial modelling reported in Sheehan et al.
(2017) and Rasmussen, Maharaj et al.
(2019) with further development in UNFPA (2022).
The model used here now includes 70 countries with updated data inputs and effect size estimates.
An optimiza... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
See Chapter 7, section 7.2.2.
8.
Road traffic injury prevention Initially developed for Sheehan et al.
(2017); see also Symons et al.
(2019).
Further enhanced since then with support from the FIA Foundation (Symons et al., 2022).
For this project, the model has been substantially upgraded from the latest publishe... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
See Chapter 7, section 7.4.
3.
Details of the interventions modelled are provided in the individual chapters of this report, and for health services in the table in the online Annex.
7 1.
Introduction and review – the urgency of action on adolescent well-being 1.3.3 The interventions – costs and benefits As describ... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Annex 2 to this report provides more details on the methods used and, in Table A2.2, a full listing of interventions analysed.
The modelling is undertaken using the OHT together with an economic model to calculate the economic and social benefits.
Chapter 2 also provides details of modelling undertaken with other par... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Table 1.3 shows that the BCR for a broad range of adolescent health services on an unweighted basis and covering both economic and social benefits is 9.6 and 5.4 on a weighted average basis.
This latter result reflects lower BCRs than the unweighted average for several large countries.
The BCRs for the smaller three ... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
These analyses are discussed in Chapter 2.
These results suggest that there are high returns to implementing proven, simple and low-cost interventions in well-defined populations. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
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 Status BCR economic BCR economic plus social BCR economic BCR economic plus social Unweighted average Unweighted av... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
In cost terms, and probably also in terms of linkage to a range of other domains of adolescent well-being, the initiatives for schooling, learning and training are a dominant part of the necessary investments.
The analysis of these issues is reported in Chapter 6, including the details of the models used, the specific... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The BCRs for these education and training investments, covering both economic and social benefits, are high, at 28.6 unweighted and 15.9 weighted (Table 1.4).
Table 1.4 shows that these are genuinely transformative investments. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Table 1.4 ROI from education and training interventions in 64 countries, BCRs Low-income Lower middle-income Upper middle-income Total Unweighted average Total 33.0 17.5 34.6 28.6 Weighted average Both 27.6 16.4 33.8 15.9 Note: See the description of weighted and unweighted averages in section 1.3.2.
8 Adolescents in ... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
8 Adolescents in a changing world.
The case for urgent investment Table 1.5 provides a summary of studies from the recent literature and from our own new modelling for this project, covering a wide range of areas discussed in Chapters 3, 4 and 5, namely aspects of connectedness, agency and resilience; mental health; a... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
As discussed in these chapters, modelling of many of these issues is difficult and highly complex with few multi-programme analyses published in the literature.
Within the available studies, we highlight the paper by Stelmach et al.
(2022), which finds a BCR of 23.6 for a wide range of interventions to improve mental... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Table 1.5 Summary of BCRs for mental health, parenting, health and behavioural problem prevention, school climate and school feeding interventions Author Location Interventions Benefits BCR Multi-programme studies Stelmach et al.
(2022) 36 countries across all income groupings Wide-ranging mental health interventions ... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
(2020) 14 countries in Latin America, South Asia and Sub-Saharan Africa School meals with treatment for worms and supplements to prevent anaemia Reduced STH and anaemia cases; improved learning outcomes and wages 17.0 (range 7–35) Single programme studies Belfield et al.
(2015) United States of America SEL (life skill... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
(2020) Sweden Positive parenting and parenting competence Improved adolescent behaviours 10.6 Spoth et al.
(2002) Mid-west United States of America Parenting programme Reduced harmful substance use 9.6, 5.9 Kuklinski et al.
(2015) United States of America CTC programme Reduced harmful substance use, delinquency and v... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
(2021) 24 communities in various states in the United States of America CTC provides resources to activate communities Reduced adolescent substance use, delinquency, and related problems (long-term) 12.9 This report Bihar, India School climate and connectedness Reduced depression and bullying and improved education out... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Table 1.6 provides a summary of BCRs for interventions to protect adolescents from various types of violence and injury, such as child marriage, aggression, suicide and road traffic injuries.
Here we highlight two studies completed by the VISES team specifically for this study, both elaborated on in Chapter 7.
One is... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The other is detailed modelling of interventions to reduce road accident fatalities and serious injuries in 77 countries, which produces a weighted BCR of 9.1.
9 1. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
9 1.
Introduction and review – the urgency of action on adolescent well-being Table 1.6 Summary of BCRs for interventions to reduce violence and injuries in adolescents Author Location Interventions Benefits BCR Chapter 7 of this report 70 countries Education and community programmes Reduce child marriage 25.9 WSIPP (... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
(2022) 36 countries Hospital and school-based suicide prevention programme Reduce suicide 62 (hospital) 3.5 (school) Chapter 7 of this report 77 countries Broad-based programmes: infrastructure, alcohol, speed and helmets Reducing road fatalities and serious injuries 9.1 1.4 Limitations of the economic and social model... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Some of the domains lend themselves to the type of investment case evaluations employed in this report, some less so.
Domains 1 and 4 encompass health and education, which are the major focus areas of public investment and, for that matter, a good deal of private investment in adolescent well-being. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Accordingly, the important features of the health and education systems have received significant academic and other research attention, facilitating the development of evaluation models designed to test the ROI in these domains, such as those described in this report (Sheehan et al., 2017; Stenberg et al., 2017; Damon... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
This is not to say that there are no gaps in the evidence base, but it is generally more comprehensive than the other domains.
Domain 3 on safety and a supportive environment contains elements that have been studied in some detail and these studies support the development of models for investment returns analysis.
He... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
These are child marriage, female genital mutilation (FGM) and road traffic injuries (Rasmussen, Maharaj et al., 2019; Katz et al., 2021; Symons et al., 2019).
We are conscious, however, of the many other equally important areas of adolescent safety for which quantitative studies are not available.
One that is receivi... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Considerations of inequality and human rights remain, of course, powerful reasons for investment in such areas.
Outside these specific domains, the broader issue of IPV among adolescent males, including in war and terrorist activity, is one of the more prominent causes of male adolescent death and injury, but interven... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
These are Domain 2 on connectedness, positive values and contribution to society and Domain 5 on agency and resilience.
Those individuals who have high levels of these attributes are more likely to thrive and be able to survive the emotional and physical challenges of adolescence.
The fact that data limitations restr... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The case study presented in Chapter 3 was developed based on the results of the Strengthening the Evidence base on scHool-based intErventions for pRomoting adolescent health (SEHER) study in Bihar (Shinde et al., 2018), which links school connectedness to mental health and education impacts. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
This is a rare attempt to demonstrate that interventions to improve connectedness (in this case, to school and schoolmates) can have measurable outcomes, resulting in a cost-benefit analysis with a significant BCR of 25.6.
10 Adolescents in a changing world.
The case for urgent investment 1.4.2 Multi-country models a... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Thus, the models have a limited ability to tailor the intervention parameters to the situation of a specific country or indeed to model those interventions that will be most effective in that specific country.
Each country should invest in the set of interventions likely to be most effective in the country’s specific ... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
One modelling approach that may assist with this selection process is that of optimization across interventions to determine a suite of interventions that will achieve a given level of the target outcome (for example, reduction in child marriage) most effectively.
Some results of this approach are discussed in Chapter... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
1.4.3 Uncertainty in BCR estimates The BCR results reported in Tables 1.3 to 1.6 emerge from complex analyses in which many decisions need to be taken on modelling methodologies, parameter values and other factors.
In many cases, these decisions must be taken on the basis of the best information available, although th... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
It should be recognized that the uncertainty ranges around the point estimates provided are likely to be substantial, but also that the point estimate BCR results are high.
1.5 Key investment priorities On the basis of discussions with the Expert Consultative Group and our own analyses, we have identified the followin... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
1.5.1 Malnutrition Malnutrition, which covers undernutrition, overweight and obesity, remains a critical challenge for current and emerging adolescent cohorts.
Indeed, the DBM affects most LICs and MICs (Popkin et al., 2020).
DBM increased in many LICs and MICs between 1990 and 2010, with Indonesia having seen the bi... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Sustained action to address these issues has been widely discussed in the literature and some modelling has been done. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The impact of malnutrition comes through three channels: inadequate intake of micronutrients, such as various vitamins, iron, iodine, zinc and folic acid, which can predispose adolescents to various adverse effects, such as cognitive defects, maternal haemorrhage, birth defects and diseases; hunger and macronutrien... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The key interventions to address undernutrition in adolescents are micronutrient supplements of various types and the expansion of school feeding programmes integrated with programmes to provide micronutrient-fortified foods.
There is increasing empirical evidence on such school feeding programmes, suggesting that the... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
These programmes are explored in Chapter 5.
The key messages of the important 2023 multi-agency review led by UNESCO, summarized in Table 1.7, highlight the importance of both school health and nutrition programmes as part of a broad enhanced schools programme.
11 1.
Introduction and review – the urgency of action o... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The health, nutrition and well-being of learners are key determinants of education outcomes; 2.
Almost every country in the world implements school health and nutrition programmes; 3.
Such programmes are cost-effective and feasible in all settings and deliver significant gains; 4.
School health and nutrition program... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
More comprehensive and sustained school health/nutrition programmes are required.
1.5.2 Mental health prevention and treatment Mental health conditions are among the leading causes of illness and disability among adolescents.
Such disorders represent 13% of the global burden of disease for adolescents, as measured by... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The burden of mental disorders is greater for girls than for boys in both adolescent age-groups, with anxiety disorders predominant for 10–14-year-olds but depressive and anxiety disorders both highly prevalent for 15–19-year-olds (WHO, 2023a).
There are wide disparities in the burden of mental disorders between count... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Inequality and the level of youth unemployment also potentially play a role (Viner et al., 2012).
For adolescents in many countries, these structural determinants of mental health may have a very large impact on mental health outcomes.
However, in formulating preventive interventions to address adolescent issues, it ... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
As explored in Chapter 3, connectedness to school is a powerful protective factor against mental health risks such as bullying, and mental disorders including depression and anxiety (Patton, 2000; Bond et al., 2004; Shinde et al., 2018). | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
School-based SEL programmes conducted by teachers or other trained staff are effective interventions to reduce depression and anxiety (Durlak et al., 2011; Taylor et al., 2017; Corcoran et al., 2018), and have been included in recent WHO guidelines on mental health promotive and preventive interventions for adolescents... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
In evaluating SEL programmes, attempts are being made to capture mental health benefits, such as reductions in delinquency, conduct disorder, depression and anxiety; education benefits such as improved academic performance and enrolment retention; and direct earnings benefits through higher self-esteem and what are ref... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
For a detailed analysis of the quantitative assessment of programmes for the prevention and treatment of adolescent mental health see Chapter 4.
However, the actual implementation of known successful intervention programmes with demonstrably high BCRs is limited in all countries, spanning the range from low- to high-i... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
1.5.3 Learning, skills and employment This is a critical area given that the issue of learning quality has become so central to the global debate, together with the importance of the link between schooling and mental health, bullying, nutrition and school climate (Gray et al., 2022).
Many of these matters have been in... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
(2019) has been completed, as has the revision of the employment model (Sheehan and Shi, 2019).
12 Adolescents in a changing world.
The case for urgent investment The interventions analysed through these models are listed in Chapter 6.
They focus, in particular, on increasing secondary school retention and improving... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
In the longer term, they improve the productivity of cohorts post-school and improve their ability to secure formal rather than informal jobs.
The improved human capital of the workforce also enhances the innovation capacity of the economy as a whole.
The BCRs derived from the analysis of these interventions are summ... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
1.5.4 Interventions to improve the position of women The disadvantage experienced by adolescent girls ranges from implicit discrimination to violent injury and premature mortality.
Intervention programmes to address this disadvantage include developing and affirming human and civil rights, working in communities to ch... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
More than 200 million women and girls have undergone FGM, which in turn costs health systems US$ 1.4 billion per year to treat the complications from FGM (WHO, 2024).
Over 12 million girls are married each year before the age of 18 (UNICEF, 2023a).
According to UNESCO, 129 million girls are out of school, including 3... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Katz et al.
(2021) estimate that employing high coverage targets for 31 countries by 2030, requiring an investment of US$ 3.3 billion, would avert more than 24 million cases of FGM at a relatively modest cost of US$ 134 per girl, although not all would be adolescents.
Unplanned pregnancies also often come at a high c... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
A cost-benefit study conducted by the Burnett Institute (UNFPA, 2022) on a programme of interventions to end an unmet need for family planning and the prevention of maternal deaths estimated the returns to have a BCR of 8.4.
It was not, however, limited to adolescents.
Of the total estimated benefits of US$ 660 billi... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
In developing an investment case for adolescent well-being, we have assembled existing evidence on the success of intervention programmes across many of these dimensions and developed some of our own.
These interventions address many, but not all, of the fundamental issues that confront adolescents.
There are three i... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
These are: enhanced school-based intervention programmes incorporating more than basic teaching and learning; adolescent health services provided by accessible clinics and hospitals; and broad-based community platforms conducted by civil society and government agencies.
Enhanced schools can contribute greatly to... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Schools need to be within walking distance and once there, they need to be girl-friendly.
At the most basic level, this may be by the provision of girls-only latrines.
These interventions typically have high effectiveness.
Programmes to reduce child marriage are effective in increasing enrolments of girls and enabli... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Intervention programmes generally address three aspects of deterring early marriage: economic and other incentives to remain in school; empowerment through specific group education programmes, which include life skills, financial literacy, sexual and reproductive health (SRH) and negotiating strategies; and commu... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
13 1.
Introduction and review – the urgency of action on adolescent well-being Much of the focus of interventions for female adolescents delivered through a health platform is on SRH.
Firstly, adolescent girls are entitled to professional advice and information about SRH.
Secondly, it is essential that interventions... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Thirdly, it is important that quality antenatal and postnatal care and safe delivery attended by skilled personnel are available for adolescents.
Fourthly, screening and treatment for sexually transmitted infections (STIs) should be available and programmes should be implemented to eliminate harmful gender-based pract... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
As already mentioned, a number of intervention programmes for female adolescents have a community component directed towards persuading influential community leaders to support changed attitudes to longstanding practices.
Both child marriage and FGM programmes have benefited from the mobilization of changed community ... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The outcome of a recent systematic review and assessment by Malhotra and Elnakib (2021) of 20 years of evaluations of interventions to reduce child marriage emphasized the importance of education interventions.
This included conditional cash or in-kind transfers for schooling support and enhancing the girl’s own human... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Other successful interventions have included conditional asset transfers for delayed marriage, life skills training (LST) (including gender rights) and, to a lesser extent, community mobilization.
Interventions that have had little success include unconditional cash transfers.
These have been directed largely at addr... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The Girls Not Brides (2023) evidence review, discussed in Chapter 7, confirmed how effective cash transfers can be in keeping girls at school and that the supply side of girls’ education can be as important as the demand side; often girls are unable to stay at school due to poor availability and quality of schools, par... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Favourable job markets can have a positive impact on keeping girls in school (Rose, 2021), as well as vocational training in areas including tailoring, hairdressing, catering or carpentry, with a view to improving adolescent girls’ financial independence (Freccero and Taylor, 2021).
There is much still to be achieved ... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Our analysis suggests that interventions addressing health and education issues that have the most reliable evidence base are likely to be highly effective and cost-effective.
However, the scarcity of empirical data on costs and benefits has, so far, hampered the possibility of calculating formal BCRs.
1.5.5 The prev... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
These include child marriage, IPV, transport injuries, suicide and other self-harm and violence related to war and terrorism.
These diverse elements of violence and injury have a major impact on adolescent well-being and addressing them must be a key priority.
Globally, it has been estimated that over half of childre... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
There are many different types of violence perpetrated on adolescents.
These include homicide, maltreatment, bullying and intimate partner violence.
In humanitarian situations in particular, adolescents are subject to increased forms of violence that include recruitment into conflict, increased trafficking of girls a... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
A range of countries have estimated that violence against children has economic costs of up to 5% of GDP (UNICEF, 2022), and the global cost of violence against children is estimated at 8% of GDP (Pereznieto et al., 2014).
Violence prevention approaches related to the enforcement of laws that have high BCRs include la... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Ferrari et al.
(2022) provided costs for implementing programmes for secondary school girls aimed at changing norms, some of which are effective in terms of DALYs averted.
One such initiative, although not exclusively for adolescents, is the Cardiff Violence Prevention Programme (CVPP), a violent crime and injury dat... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
14 Adolescents in a changing world.
The case for urgent investment Response and support services are usually provided in health care facilities.
Educational interventions have the most marked effect on preventing violence.
Schools offer an important platform for delivering preventive interventions and have positive ... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
These result in reductions in child marriages, reductions in sexual and intimate partner violence, reductions in bullying behaviour and empowering adolescents to protect themselves from violence.
1.5.6 Engaging adolescents in coping with emerging realities There is now a powerful body of evidence that the emerging rea... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Many others share a sense of foreboding about the state of the world that they will inherit (van Nieuwenhuizen et al., 2021; Hickman et al., 2021).
This is also true of other ongoing trends, such as the increasing number of zoonotic diseases (diseases in animals that can affect humans) and the ongoing likelihood of fu... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Consistent with the themes of connectedness, agency and resilience, some studies have shown that engaging young people in the response to climate change is an effective way for them to cope with the change.
Systematic programmes to engage adolescents in addressing such global and national challenges are likely to be a... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
1.6 Conclusion Large-scale and immediate investment to increase the capabilities and well-being of adolescents is now of critical importance.
This investment will empower young people to meet these challenges before them and to thrive during adolescence and in the decades ahead.
The cost of inaction will be very high... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The cost of inaction will be very high.
However, we show in this report that the returns to these investments – the returns on action – are also high, both in terms of BCRs and in terms of fulfilling human rights and reducing inequalities around the world.
The time for action is now.
15 2.
Health investments 2.
He... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Separate epidemiological models were used to estimate the impact of interventions for: (i) selected aspects of reproductive and sexual health, maternal and child health, communicable and NCDs and mental health; (ii) HPV; (iii) TB; and (iv) myopia.
Economic models use the output from these models to calculate the ROI f... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
2.1 A broad package of health interventions provided to adolescents 2.1.1 Introduction This section reports on the modelling of 95 adolescent health interventions using the OHT in 40 LICs and MICs.
The countries included in the modelling, which account for more than 80% of the global adolescent burden of disease, are ... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The results from the OHT modelling are then used in an economic model to undertake an ROI analysis.
This analysis is a quantitative undertaking with both strengths and weaknesses.
A key limitation is that, in some important areas of adolescent health and well-being, evidence on the effectiveness of interventions is s... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Examples include intimate partner and other violence, injuries such as drowning and falls, self-harm and suicide, harmful substance use, some neurological conditions, musculoskeletal conditions and some communicable diseases such as typhoid, headaches and lower back pain.
2.1.2 Methods The approach for this study is s... | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
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