Urgency for transformation: youth engagement in global health

Global leaders at the 2018 UN Climate Change Conference were powerfully reminded by Greta Thunberg that, “You say you love your children above all else. And yet you are stealing their future.”1Thunberg G High-level segment statement COP 24.https://unfccc.int/documents/187780Date accessed: May 10, 2019Google Scholar In less than 7 months, the 16-year-old environmental activist mobilised a global movement of young people in over 120 countries calling for urgent action to address climate change.2Hougaard R The true meaning of leadership—taught by our children.https://www.forbes.com/sites/rasmushougaard/2019/03/15/the-true-meaning-of-leadership-taught-by-our-children/#3cbb028e4c9cDate accessed: May 10, 2019Google Scholar Young people elsewhere are catalysing important conversations on crucial issues, such as Malala Yousafzai on global education and March for Our Lives on reforming gun control in the USA. The potential of youth engagement is striking, but how can their power be effectively amplified to address the most pressing and interconnected challenges in global health? Achieving the ambitions of the 2030 Agenda for Sustainable Development will not be possible without the meaningful engagement of young people.3WHOGlobal accelerated action for the health of adolescents (AA-HA!): guidance to support country implementation. World Health Organization, Geneva2017https://apps.who.int/iris/bitstream/handle/10665/255415/9789241512343eng.pdf;jsessionid=2191E184BC0EDC56D4BB1C42C15A0FF7?sequence=1Date accessed: May 10, 2019Google Scholar, 4Patton GC Sawyer SM Santelli JS et al.Our future: a Lancet commission on adolescent health and wellbeing.Lancet. 2016; 387: 2423-2478Summary Full Text Full Text PDF PubMed Scopus (1511) Google Scholar, 5UN Population FundThe power of 1·8 billion: adolescents, youth and the transformation of the future. United Nations Population Fund, New York, NY2014https://www.unfpa.org/sites/default/files/pub-pdf/EN-SWOP14-Report_FINAL-web.pdfDate accessed: May 10, 2019Google Scholar, 6WHO Joint UN Programme on HIV/AIDSUN Population FundUN Children's FundUN WomenThe World Bank GroupSurvive, thrive, transform. Global strategy for women's, children's and adolescents' health: 2018 report on progress towards 2030 targets. World Health Organization, Geneva2018http://www.unaids.org/sites/default/files/media_asset/EWECGSMonitoringReport2018_en.pdfDate accessed: May 10, 2019Google Scholar The world currently has the largest generation of youth in its history, with more than half the global population younger than 30 years.5UN Population FundThe power of 1·8 billion: adolescents, youth and the transformation of the future. United Nations Population Fund, New York, NY2014https://www.unfpa.org/sites/default/files/pub-pdf/EN-SWOP14-Report_FINAL-web.pdfDate accessed: May 10, 2019Google Scholar Perhaps just as noteworthy, among the 1·8 billion young people aged between 10 and 24 years, close to 90% live in low-income and middle-income countries, where health and social systems are often the most vulnerable.5UN Population FundThe power of 1·8 billion: adolescents, youth and the transformation of the future. United Nations Population Fund, New York, NY2014https://www.unfpa.org/sites/default/files/pub-pdf/EN-SWOP14-Report_FINAL-web.pdfDate accessed: May 10, 2019Google Scholar This cohort represents a magnitude of human potential, with massive unrealised benefits for both socioeconomic growth and health. In fact, the 2016 Lancet Commission on Adolescent Health and Wellbeing4Patton GC Sawyer SM Santelli JS et al.Our future: a Lancet commission on adolescent health and wellbeing.Lancet. 2016; 387: 2423-2478Summary Full Text Full Text PDF PubMed Scopus (1511) Google Scholar concluded that investing in adolescents will yield a triple dividend—in the present day, into their adulthood, and through to the next generation of children. Finally, with young people's unique ability to cut through the status quo and hold leaders accountable, they are today emerging as the most vocal advocates on complex issues in global health, such as gender inequality or sexual and reproductive health and rights. Their unparalleled fluency in social media and digital technology makes this generation the most likely to make solutions a reality. Awareness and efforts by many organisations to engage and enable young people to participate in decision making and policy dialogues in global health are increasing. Examples include the launch of the Global Health Workforce Network Youth Hub, the crowd-sourcing of obesity policy solutions from adolescents through CO-CREATE, the crowd-sourced NCDFREE social movement, or the inaugural African Union Youth Advisory Council. However, governance structures and a silo mentality prevent the creation of opportunities that are effective or fast enough to meaningfully tap into their potential. Quite simply, by failing to include the next generation of young leaders as equal partners in policy and practice, the Sustainable Development Goals will remain just that—important, yet ultimately unrealised, goals. The transformative potential of young people can only be achieved through participatory leadership; development of the necessary partnerships and resources to enable young people to fully engage as leaders are urgently needed.7Marcus R Cunningham A Young people as agents and advocates of development evidence gap map report. Overseas Development Institute, London2016https://www.odi.org/sites/odi.org.uk/files/resource-documents/11187.pdfDate accessed: May 10, 2019Google Scholar Recognising the need to ensure its work reflects the lived reality of young people's experiences and solutions, WHO commissioned the report Engaging Young People for Health and Sustainable Development.8WHOEngaging young people for health and sustainable development. Strategic opportunities for the World Health Organization and partners. World Health Organization, Geneva2018https://apps.who.int/iris/bitstream/handle/10665/274368/9789241514576-eng.pdf?ua=1Date accessed: May 10, 2019Google Scholar Launched in September, 2018, in conjunction with the UN Youth Strategy,9UNYouth2030: the United Nations strategy on youth.https://www.un.org/youthenvoy/youth-un/Date accessed: May 10, 2019Google Scholar the WHO report provides areas of strategic opportunity for WHO and its partners to transform the way it engages with young people in achieving its “triple billion” targets.4Patton GC Sawyer SM Santelli JS et al.Our future: a Lancet commission on adolescent health and wellbeing.Lancet. 2016; 387: 2423-2478Summary Full Text Full Text PDF PubMed Scopus (1511) Google Scholar Furthermore, the WHO Knowledge Action Portal offers an innovative opportunity to bring communities together, including young people, on the prevention and control of non-communicable diseases. In addition, the Partnership for Maternal, Newborn and Child Health, in collaboration with The International Youth Alliance for Family Planning and Family Planning 2020, created the Global Consensus Statement on Meaningful Adolescent and Youth Engagement,10Partnership for MaternalNewborn and Child HealthInternational Youth Alliance for Family Planning, and Family Planning 2020Global consensus statement on meaningful adolescent and youth engagement.https://www.who.int/pmnch/mye-statement.pdf?ua=1Date accessed: May 10, 2019Google Scholar defining it as an inclusive, intentional partnership between youth and adults. Importantly, the consensus notes that power must be shared, respective contributions must be valued, and young people's perspectives and skills must be integrated into both the strategic design and delivery of health and related programmes and policies, particularly when they affect young people's lives and communities. While we applaud this progress, much more must be done to position young people as equal stakeholders in the realisation of global, regional, and national goals in health. Notably, there remains substantial underinvestment of both intellectual and financial resources for the development and implementation of tangible and meaningful youth engagement strategies. The key to achieving meaningful youth engagement is the active investment in youth, particularly by governments, foundations, and the private sector. Furthermore, global institutions, such as WHO (panel), must act as leaders in engaging young people if they are to achieve health for all. To do this, such institutions must first critically reflect on themselves and commit to transforming their own ethos and organisational cultures by placing young people at the core of their strategy.PanelRecommendations for strategic opportunities to transform youth engagement with WHO and partners8WHOEngaging young people for health and sustainable development. Strategic opportunities for the World Health Organization and partners. World Health Organization, Geneva2018https://apps.who.int/iris/bitstream/handle/10665/274368/9789241514576-eng.pdf?ua=1Date accessed: May 10, 2019Google Scholar *Report commissioned by the WHO and led by two of the authors of this Comment (BB and RR). *Report commissioned by the WHO and led by two of the authors of this Comment (BB and RR).Leadership:•Create a fully resourced WHO strategy for engaging with young people•Modernise WHO culture to orient the organisation towards young people, ensuring that none are left behind in the Sustainable Development Goals eraCountry impact:•Engage all young people, taking into account their diverse backgrounds and characteristics, in health and sustainable development planning and implementation•Strengthen the capacity of organisations to engage safely, effectively, and meaningfully to enable young people to augment their knowledge and lead on health and rightsFocusing global public goods on impact:•Engage young people throughout the design and delivery of global public goods, particularly on issues that affect their health and rights•Establish an innovative partnership and technology-driven platform so that young people can share their experiences and ideas to monitor and drive change on health and the Sustainable Development GoalsPartnerships:•Forge innovative partnerships with diverse organisations that engage with young people•Mobilise resources for a comprehensive, coherent global movement that engages the power of young people for health and sustainable development Leadership: •Create a fully resourced WHO strategy for engaging with young people•Modernise WHO culture to orient the organisation towards young people, ensuring that none are left behind in the Sustainable Development Goals era Country impact: •Engage all young people, taking into account their diverse backgrounds and characteristics, in health and sustainable development planning and implementation•Strengthen the capacity of organisations to engage safely, effectively, and meaningfully to enable young people to augment their knowledge and lead on health and rights Focusing global public goods on impact: •Engage young people throughout the design and delivery of global public goods, particularly on issues that affect their health and rights•Establish an innovative partnership and technology-driven platform so that young people can share their experiences and ideas to monitor and drive change on health and the Sustainable Development Goals Partnerships: •Forge innovative partnerships with diverse organisations that engage with young people•Mobilise resources for a comprehensive, coherent global movement that engages the power of young people for health and sustainable development Young people not only want to be involved in actively achieving the Sustainable Development Goals, as evidenced through youth initiatives globally, but they are necessary partners in shaping and implementing effective policies and programmes in their own communities. The exclusion of young people at all levels of health and social systems delays progress at best and costs lives at worst. We are calling on all leaders in global health to actively dedicate resources to youth engagement and to urgently rethink approaches to enable young people to have the space, voice, audience, and influence that they need to shape and implement agendas, particularly on issues that affect their own health and wellbeing. Such a shift in framework and in mindset is necessary and will lead to new forms of powerful partnerships that will profoundly change the direction of health and sustainable development for a shared future. We declare no competing interests. We thank Rachael Hinton, Korane Idarousse, and Sabrina Sarli for their contribution to this manuscript.

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