Health in the Inaugural Global Youth Wellbeing Index
August 30, 2014
Health is a foundational component to overall wellbeing, with economic development and education outcomes closely linked to health results. Yet the Global Youth Wellbeing Index, released in April, shows that large global disparities remain in both mental and physical health situations among youth. Constraints in access to basic services and information, particularly sexual and reproductive services, have significant repercussions in lower and middle income countries. In higher income countries, which have the necessary resources to ensure stronger systems, youth often make poor health choices and still struggle with emotional and non-communicable health issues.
The inaugural Global Youth Wellbeing Index, released by CSIS in partnership with the International Youth Foundation, assesses and compares state of youth in 30 countries around the world, which hold nearly 70% of the world’s youth population. The Index is comprised of 40 indicators divided into six sub-indices; of these, the health domain is the largest, with nine indicators: improved water source, life expectancy at birth, people living with HIV/AIDS, adolescent fertility, tobacco use, youth mortality, self-harm among youth, perceived levels of stress, and youths’ prioritization of healthy eating and living.
Importantly, of the six domains, countries on average fare best in health, with this domain posting the highest 30-country mean score of the six sub-indices, with the fewest nations falling into the lower-middle and lower performance tiers. In fact, 20 of the 30 countries have a domain score above the mean. Arguably this reflects a payoff from increased investments in health, particularly child health, in recent years. Still, disparities exist and many youth still have relative health insecurity. Young people in nations with stronger systems and public services generally experience higher levels of health. Countries that perform best in health include Spain, Australia, Germany, Saudi Arabia, United Kingdom, Vietnam, Sweden, Japan, South Korea, and Jordan. All but Jordan and Vietnam rank within the top ten countries in overall youth wellbeing, and are high income.
Yet youth in wealthier nations do display some weaknesses when it comes to their health, particularly with regards to tobacco use, stress levels, and self-harm (which are correlated). Poorer performance in each of these indicators sees Sweden rank 7th in this domain (2nd place overall ranking), and the U.S drops six ranks relative to its overall position. Similarly, young people in South Korea and Japan post higher levels of self-harm, perhaps resulting from expressed higher levels of stress and less priority on healthy eating and living.
There are also interesting regional trends. Countries within the Americas region, for example, fare significantly worse in health in comparison to their overall performance. Colombia ranks nine places lower, Brazil and Peru each rank five places lower, and Mexico ranks three places lower in health than in the countries’ overall rankings of youth wellbeing. Some of these countries face challenges in the general environment, such as improved water source, as well as within youth-specific outcomes, such as higher youth fertility rates, tobacco use, and in some instances, youth mortality, self-harm, and levels of stress.
Conversely, MENA region countries fare significantly better in the health domain than they do in overall rankings. Egypt ranks ten places higher, while Jordan and Morocco rank seven places higher, and Saudi Arabia ranks five places higher in health than their overall positions. These countries generally fare better in life expectancy at birth, people living with HIV/AIDS, youth mortality rates, adolescent fertility rates and youth self-harm. However, youth do indicate higher levels of stress in Saudi Arabia and Egypt, and Morocco has more limited access to water.
Of the six Index countries in sub-Saharan Africa, five take the last spots in the health domain rankings, with Ghana faring best at 24th with relatively better scores for youth tobacco use, prioritization of healthy eating and living, and incidence of self-harm. Yet all experience high adolescent fertility rates, lower life expectancy, poor water access, and higher youth mortality. Additionally, Nigeria, Tanzania, Kenya, Uganda, and South Africa have greater numbers of people living with HIV/AIDS. The MENA and sub-Saharan Africa results in particular remind us also that the weaker status of young women and adolescent girls is likely masked by the macro “youth wide” data and scope of the Index. While not part of this inaugural Index analysis, further disaggregation would likely uncover vulnerabilities and different needs by gender.
Outside of regional or income level trends, we find that when it comes to adolescent health, perceptions matter. Data shows that a more positive and healthy outlook among youth can contribute to other health outcomes; it can affect the choices young people make. Mathematically we see a correlation among health subjective and objective indicators – particularly stress, tobacco use, and incidence of self-harm, as well as the impact of positive outlook on overall domain scores. In Australia, Indonesia, Thailand, and Vietnam, strong scores on outlook indicators significantly contribute to stronger health status. Scores in South Korea, Japan, Mexico, and Turkey, on the other hand, reveal the reverse is also true – all these countries move up the health ranks if perception and outlook indicators are taken out of the model. As we have found for other domains, these results point towards the need to pay closer attention to the social and emotional needs of young people. Greater survey data and consultations on the root of youth stress levels or risky choices could help inform effective points of intervention at the local and national level.
Ensuring youth are healthy is essential in achieving greater growth and development objectives. The results from the Index affirm that while progress is being made, gaps remain. Challenges that are shared regionally may benefit from cross-border interventions. Evidence-based and focused investments in adolescent health must continue in order to capitalize on gains in child survival and ensure that policies, systems, and institutions are providing information, prevention, and care that specifically serves the physical, reproductive, emotional, and mental health interests of youth. With greater investment in basic health infrastructure and youth sexual and reproductive health in emerging economies, and greater efforts to promote emotional and mental health and healthful living habits in more developed countries, the world may become better equipped to create a happy, healthy, and prosperous future for us all. You can explore the Index data and download the reports at www.youthindex.org.
Dr. Nicole Goldin is a Senior Associate with the Center for Strategic and International Studies (CSIS) and was director of the Global Youth Wellbeing Index project in partnership with the International Youth Foundation (IYF). Follow her on Twitter @nicolegoldin.