Editorial
Health and wellbeing in adolescence and early adulthood
That young people are less healthy in the UK than in
similar high-income countries is the headline finding
of a major report published last week. International
comparisons of health and wellbeing in adolescence and
early adulthood, published by the Nuffield Trust and
the Association for Young People’s Health, examines
17 indicators of health and wellbeing in young people
aged 10–24 years in 19 similar high-income countries
within and outside Europe.
Young people in the UK are more likely to die
from asthma, be obese or overweight, or have a
poor quality of life from long-term conditions such
as type 1 diabetes than are most young people in
similar countries. The mortality data for asthma are
particularly concerning, given that most asthma
deaths are preventable. Global Burden of Disease
2016 data show that the UK has the highest asthma
mortality rate among European countries included
in the report, and only Australia, New Zealand, and
the USA have higher rates in young people aged
10–24 years. Time trends from 1998 to 2016 show
a decline in asthma mortality rates overall but a
plateauing since 2011 in the UK. Data from Asthma
UK suggest that two-thirds of young people are not
getting the care they need to prevent asthma attacks,
with poor access to general practitioner appointments
and the stigma of using inhalers at school or in public
being important barriers.
One in five children are obese in the UK by the time
they leave primary school (age 10 or 11 years), and
there has been an overall increase in obesity prevalence
among adolescents aged 15–19 years from 5·6% in 1995
to 8·1% in 2015. For all years studied, the UK’s obesity
prevalence was closer to the worst performing country
(the USA) than to the best performing country (Japan).
Data from the UK Office for National Statistics
released on Feb 22, show that a third of deaths of
children and young people aged 0–19 years were classed
as avoidable in 2017, with no substantial improvement
since 2014. The leading cause of avoidable mortality in
children and young people was injuries (intentional and
unintentional), with maternal and infant causes (deaths
from complications of the perinatal period, congenital
malformations of the circulatory system, and spina
bifida) the next largest category.
www.thelancet.com Vol 393 March 2, 2019 847
The Nuffield Trust report follows on from research
on health in young children that also reported poorer
health outcomes in the UK than in similar countries, in
addition to data showing rising or plateauing of infant
mortality rates in various UK regions.
For most health indicators, disparities in outcomes
Tetra Images/Getty Images
are driven by social inequalities, with more deprived
young people having worse health outcomes than their
wealthier peers. With the proportion of children living
in relative poverty predicted to be 37% by 2023–24 by
the Resolution Foundation, the outlook is grim.
Young people aged 10–24 years make up about
a fifth of the UK population and are usually thought
of as relatively healthy and low users of health care
compared with other age groups. Adolescence is a
formative time, when huge biological, psychological,
and social changes occur. It should be a time when
the foundations for adult life are laid, including an
appreciation of the importance of prevention of
disease and the value of a healthy lifestyle. Although
there is some good news in the Nuffield Trust
report, with fewer young people smoking, drinking
alcohol, or taking cannabis compared with the
previous decade, the rise in obesity and the decline in
regular physical exercise do not bode well for healthy
adulthood.
The report’s inclusive remit, looking at young people
up to the age of 24 years is welcome, and encompasses
the three key phases—early adolescence (10–14 years),
late adolescence (15–19 years), and young adulthood
(20–24 years), as defined in the Lancet Commission
on adolescent health and wellbeing. With a focus on
children and young people in the UK National Health
Service Long Term Plan, implementation of the
For the International
Nuffield Trust report’s recommendations would go a comparisons of health and
long way to improving the health of young people. wellbeing in adolescence and
early adulthood report see
Integration of young people’s health in all policies https://www.nuffieldtrust.org.
and research agendas is crucial, including in sectors uk/research/international-
comparisons-of-health-and-
outside health, such as education, employment, and wellbeing-in-adolescence-and-
housing. Management of long-term conditions such early-adulthood
as asthma and diabetes must improve and be targeted For more on Asthma UK see
www.asthma.org.uk
at the needs of young people. Actions to reduce health For the Lancet commission on
inequalities and to ensure equitable access to health adolescent health and
wellbeing see The Lancet
services must be an increasing priority in the UK. The Commissions Lancet 2016;
future of this generation is at stake. n The Lancet 387: 2423–78