Introduction

Investing in the health of young people generates a triple benefit: 1) healthy young people now; 2) healthy adults in the future; and 3) healthy future generations. The Sustainable Development Goals (SDGs) (1) and the Global Strategy for Women’s, Children’s and Adolescents’ Health (2016-2030) (2) highlight the strategic importance of young persons for the success of the 2030 Agenda for Sustainable Development. In addition, a recent report from the Lancet Commission on Adolescent Health and Wellbeing stated that this generation of adolescents and young adults can transform all of our futures if we ensure they have the resources to do so (3).

In 2008, PAHO Member States adopted the Regional Strategy for Improving Adolescent and Youth Health and, in 2009, the Plan of Action on Adolescent and Youth Health, which provided a comprehensive focus for collective regional efforts aimed at protecting and improving the health of adolescents and youth in the Region of the Americas for the 2010–2018 period (4). The Regional Strategy and the Plan of Action proposed regional goals and objectives for the health of adolescents and youth, as well as strategic action to be taken on the regional and country level to achieve these goals.

Since adoption of the Regional Strategy and Plan of Action on Adolescent and Youth Health, there have been important developments related to adolescent and youth health, most importantly, the SDGs and the Global Strategy for Women’s, Children’s and Adolescents’ Health, outlining a more ambitious, integrated, multisector, and pro-equity health and development agenda. As the implementation period for the regional plan of action is drawing to an end, it is appropriate to take stock of the current status of the health of young people in the Region, and of the regional response, to inform the development of a new regional adolescent and youth health agenda that is aligned with the SDGs and Global Strategy and builds on achievements and lessons learned.

This regional adolescent and youth health report aims to: 1) analyze the current status of the health of adolescents and youth in the Region; 2) summarize the current status of the implementation of the Regional Strategy and the Plan of Action; and 3) provide a forward-looking perspective on how regional and country-level stakeholders can update and galvanize actions to improve the health and well-being of young persons in the Americas, taking into account recent regional and global commitments, strategies, and targets. These include the Strategy for Universal Access to Health and Universal Health Coverage (Resolution CD53.R14) adopted by PAHO Member States in 2014 (5), the SDGs (1), the Global Strategy for Women’s, Children’s and Adolescents’ Health (2), and the Global Accelerated Action for the Health of Adolescents (AA-HA!) (6).

This report has drawn from a number of sources, including an assessment of the implementation of the Regional Strategy and the Plan of Action for adolescent and youth health, mortality statistics and other data reported to PAHO by Member States, global databases, and a review of the scientific literature. Also included in this report is an analysis for this age group and the Region based on the 2015 Global Burden of Disease data prepared for PAHO by the Institute for Health Metrics and Evaluation (IHME).

The report is divided into five parts:

• Part I provides a profile of adolescents and youth in the Americas, with a focus on demographic and socioeconomic characteristics.
• Part II analyzes the health status of adolescents and youth in the Americas. The analysis is guided by the health-related targets and indicators from the regional Plan of Action.
• Part III reviews key actions taken on the regional and country level in the seven strategic areas proposed by the Plan of Action, highlighting progress and challenges.
• Part IV describes the evolving global and regional context of the health and development of young people and the implications that has for the regional response. Part IV also considers how the Region can transform the legal, policy, and societal environments to ensure that all young people can survive and thrive and can have the opportunity to realize their right to health, especially those who are living in situations of vulnerability.
• Country profiles: Part V presents adolescent and youth health profiles. Each profile presents the latest available data on a range of adolescent and youth health indicators drawn from the Plan of Action on Adolescent and Youth Health (4). The country profiles are based on international estimates, data reported to PAHO, and published survey data, in some instances adapted to incorporate new national data reported by countries.

Age group terminology

In line with the Regional Strategy and the Plan of Action, this report covers the health of young persons in the age group 10-24 years. This age range includes overlapping groups, who are referred to as “adolescents,” “youth,” and “young persons” (WHO) (Table 1) (7).

A more detailed classification proposed by PAHO in 2005 (8,9), identifies the stages of pre-adolescence, early adolescence, middle adolescence, late adolescence, youth, and young adulthood, specifying that in general adolescence starts earlier in girls (Annex A).

The age group terminology used in this report is aligned with that of the World Health Organization as presented in Table 1. In addition, the report will apply the following simplified subgroups and age ranges:

Early adolescence: 10-14 years
Late adolescence: 15-19 years
Young adulthood: 20-24 years

In some exceptional cases, data will be presented for other age groups outside of those mentioned, depending on the age groups used to calculate certain international indicators.