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Sexually transmitted infections in adolescents in countries of all incomes remain a great concern, as does urbanization in low-income and middle-income countries

Lancet

In a Comment linked to The Lancet Series on Adolescent Health, Professor Robert W Blum (Chair of the Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA) and colleagues highlight some of the major challenges facing adolescents today.

They say that improvements in child survival across countries of all incomes mean that that healthier young people are coming of age and entering the workforce, adding to a nation's wealth. But they add: "However, in many low-income and middle-income countries this dividend has yet to be realised. Impeding this realisation are factors that include disparities in access to resources and services by ethnic origin, region of residence, socioeconomic status, and sex. Furthermore, as young people migrate to urban centres seeking often unavailable education and work, there is a growing population of disenfranchised young people adding to, rather than alleviating, the economic and social burdens."

They also acknowledge the shift from infectious to chronic diseases among adolescents over the past 40 years, but note that major challenges remain regarding certain infectious diseases. They say: "Of great concern are sexually transmitted infections with a protracted or indefinite course (eg, infections with HIV, herpesvirus, or human papillomavirus), which in countries of all incomes are exacerbated by poverty and social inequalities."

They add: "Furthermore, many of the chronic disorders thought [decades ago] uniquely to characterise high-income countries are being identified with greater prevalence in low-income and middle-income countries. For example, there are increases in mental disorders, suicide, homicide, obesity, malnutrition, and precancerous cervical lesions in young people worldwide. Unhealthy behaviours combine with unhealthy environments to offset the improved health status achieved by controlling previously fatal infectious diseases."

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Professor Robert W Blum, Chair of the Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. E) rblum@jhsph.edu

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