Research sheds light on what's killing young people, especially boys and young men
First, the good news: The death rate among young people around the world has been declining, a new study shows.
But boys and young men are not doing as well as girls and young women.
Since 1950, the death rate of young females ages 10 to 24 has gone down by 30%. But for males in this age group, it's only gone down by 15%. And in many countries, the gap in mortality rates between the genders is broadening. In 2019, 61% of all deaths among this age group were among young men.
These numbers come from a major analysis published by The Lancet in late October. About a dozen researchers, aided by several hundred collaborators, wanted to understand where — and why — young people are dying. Their intent was to provide governments and nonprofit groups with data that show where public health efforts are needed.
Using data from the Institute for Health Metrics and Evaluation in Seattle, which maintains a massive database of health statistics from around the world, researchers analyzed the number of deaths, years of life lost and mortality rates by sex and age groups of young people in 204 countries. (The report was funded by the Bill & Melinda Gates Foundation, a funder of NPR and this blog.)
The findings surprised them. "The scale of the difference in mortality burden between males and females is quite striking," says lead author Dr. Joseph Ward with University College London.
The data also showed that the gap in mortality rates for young people in the worst-performing countries and the best-performing countries increased over time. The inequities, the authors write, "reveal a persistent failure by policymakers to adequately address global health risks during adolescence" — an age group that the researchers define as 10- to 24-year-olds.
Overall, about a third of deaths in young people were due to accidents, injuries or conflicts and violence. Another third were from infections, poor nutrition or pregnancy. And the rest were from non-communicable diseases such as cancer or suicide.
The researchers note that many of these premature deaths are preventable.
The following discussion we had with Ward about his team's findings and what they mean for young people globally has been edited for length and clarity.
How did these rates of death vary around the world?
Not unexpectedly, mortality rates were strongly associated with a country's level of development, and were lower in high-income countries as compared to low-income countries. However, we were able to identify some countries with lower mortality than you would expect from their level of development — for example, Ethiopia and China.
The cause of death also varied among regions. Suicide was the leading cause of death in 15 to 24 year old males in central and eastern Europe and central Asia, for example, whereas in most other places it was transportation-related injuries. And violence and conflict were bigger problems in Latin America and the Caribbean.
What's driving those patterns is complex, and definitely warrants further investigation.
How has the situation for young people improved over time?
We were able to look at deaths from specific causes only from 1980. Overall, there has been a reduction in deaths due to communicable diseases like respiratory and gastrointestinal infections, and an increase in non-communicable diseases, such as cancer. For many countries, particularly in sub-Saharan Africa, infectious causes were still leading causes of death in 2019, in part due to the continued large number of deaths due to HIV/AIDS among young people in this region.
We also found slower progress in reducing deaths from violence and injuries in many regions.
What were the major differences in mortality between young men and women?
Overall, far more men ages 10 to 24 die than women in that age group. Also, the rate of improvement in mortality over time has been much greater in women than men. In fact, globally, more men ages 10 to 24 died in 2019 than women [in this age group] in 1950. We found some of the greatest relative reductions in mortality to be in younger female adolescents in high-income countries, and the slowest improvements were in 20- to 24-year-old males, particularly in sub-Saharan Africa.
Why focus on young people?
As was highlighted in the Lancet Commission on Adolescent Health and Wellbeing in 2016, an investment in the health of young people brings a triple dividend. It helps the young people themselves. Really importantly, it helps the adults they're soon to become. And it also helps the children that they are soon to parent.
In your study, you and the authors say that this age group is "neglected." Why is that?
Adolescence is often viewed as a healthy period of life, and has historically received less attention than other age groups. If you look at the relative reductions in mortality in children under the age of 5, compared to 10- to 24-year-olds, the pace of change is far better. These differences by age may in part be due to adolescents not being the focus of interventions — such as within the Millennium Development Goals [an ambitious plan from the U.N. to drastically reduce global poverty by 2015] — which made a large difference to improving outcomes for young children through a wide range of programs.
We need a renewed focus on establishing which interventions for specific health problems work for 10- to 24-year-olds, and investment in those where evidence is available — particularly in low-income settings.
So what do you think needs to be done?
This study doesn't address which interventions work and under what conditions. But it does suggest that policymakers need to focus on a broad range of causes of mortality that vary from country to country and region to region.
They should also make sure that interventions are specific to adolescents, and are separate from those targeted at adults or young children. A good example of the need for adolescent-specific interventions includes HIV/AIDS mortality, where reductions in deaths in 15- to 19-year-olds have been much slower than they have been in younger and older groups.
And interventions need to be specifically tailored for adolescents — like where you might have adults coming to an adult clinic, you might want to set up a separate clinic for adolescents where they might feel more welcome.
The data you analyzed went through 2019, so you didn't see the effects of COVID-19. How do you think the pandemic affected mortality rates in young people?
Direct effects on mortality from the pandemic are likely to be small in this group — the case fatality amongst young people is far lower than it is for older adults.
Much more troubling are the indirect effects of disruption to education. Education has been shown to be beneficial to health. It's associated with increased earnings and employment opportunities later in life, and also increased understanding of health and the impact and importance of adopting certain health behaviors.
So, all in all, how do things look for the next generation of 10- to 24-year olds?
There are many ongoing challenges to improving global adolescent health, not least related to indirect effects of the COVID-19 pandemic. But there are also many reasons to be optimistic, as recognition of the importance of young people to global health and development continues to grow.
If you or someone you know may be considering suicide, contact the National Suicide Prevention Lifeline at 1-800-273-8255 (En Español: 1-888-628-9454; Deaf and Hard of Hearing: 1-800-799-4889) or the Crisis Text Line by texting HOME to 741741.
Joanne Silberner is a freelance journalist and former health policy correspondent for NPR. She has covered global health issues since the outbreak of HIV.
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