Young people’s health and well-being in the Middle East and North Africa
The Middle East and North Africa (MENA) is home to almost 140 million young people aged 10-24 years, a quarter of this region’s population. This young population represents a powerful opportunity to influence health and well-being into adulthood and for the next generation, and to advance equitable and sustainable development for communities and societies.
Much of the disease burden, and 90,000 deaths, among young people in the region are preventable. There is also a high prevalence of risk factors for poor health both in adolescence and into adulthood that are amenable to intervention – representing a crucial opportunity for both individual and population-level gains in health and other socioeconomic outcomes. Young people also face multiple threats to their well-being, including exposure to violence, conflict and harmful practices, and missed opportunities to engage in education, employment and civil society that limit the capacity of young people to reach their potential.
One in two deaths of young people in the region (45,000 deaths) are due to injury (transport, other unintended injury and violence). Injuries also cause substantial morbidity, accounting for a quarter of the total disease burden (measured in Disability-Adjusted Life Years (DALYs) among 10-24 year-olds. Non-communicable diseases, including cardiovascular disease, cancers, headache, musculoskeletal disorders and skin diseases, account for 41 per cent of the total disease burden of young people, and led to over 27,000 deaths in 2019. Almost a quarter of the total disease burden is due to mental disorders and intentional self-harm, with over 4,000 deaths of young people in the region due to suicide.
Communicable diseases account for less than 10 per cent of the disease burden among young people in the region. However, in some countries, Djibouti, Sudan and Yemen, communicable diseases, maternal disorders and nutritional deficiencies are leading contributors to poor health – accounting for 20 per cent of the total disease burden. Sudan and Yemen accounted for over half of the 11,000 deaths due to these causes in 2019.
Young people also experience high rates of risk factors for poor health in adulthood (including tobacco smoking, physical inactivity, overweight and obesity) and limited opportunities to complete quality education, transition to meaningful employment, and participate in decisions that impact their lives.
Boys in the region experience a higher burden of poor health and around twice the mortality rate compared with girls, largely driven by injury. While transport and other unintentional injuries are a leading cause of mortality and morbidity, boys also experience substantially higher rates of violence, including peer victimization, homicide and interpersonal violence, and mortality as a result of conflict and collective violence. While the prevalence of suicidal behaviour is similar between boys and girls, two thirds of all suicide deaths are among boys. Boys in the region also experience higher rates of use of tobacco, alcohol and other drugs compared with girls, and in 11 countries, a third or more of adolescent boys are overweight or obese.
Girls also experience a high burden of poor health due to injury, and transport injuries are the leading cause of death of girls in half of MENA countries. Non-communicable diseases are the leading cause of poor health for girls, accounting for around half the disease burden (compared to 36 per cent for boys). Girls also experience a higher burden of mental disorder compared with boys, due to increased depression and anxiety. While boys have higher suicide mortality, girls in the region experience a similar prevalence of suicidal behaviour: between 10 and 23 per cent of female students report attempting suicide in the previous 12 months. Girls also face substantial threats to their health, well-being and full participation: around a third of girls are married by age 18 years in Iraq, Yemen and Sudan; female genital mutilation remains prevalent in some settings; and the rate of girls not in education, employment or training is more than double that of boys. Poor reproductive health, including high unmet need for contraception, adolescent childbearing and maternal disorders are also important contributors to morbidity and mortality in many settings, and contributed to almost 1,700 maternal deaths among 10–24-year-old girls in 2019. However, data for many indicators of sexual and reproductive health are lacking in the region.
This analysis has also identified some important data gaps in the region. For many countries, there are very few national-level estimates of sexual and reproductive health knowledge, behaviours and risks that are age-disaggregated and/or provided for unmarried adolescents. Similarly, national-level data describing the prevalence of intimate partner and sexual violence, mental health outcomes, menstrual health, education completion, access to information and technology, and experiences of discrimination are also very limited. Additionally, internationally agreed indicators of some areas of health and well-being (psychosocial well-being, youth participation, safety and health care access) are very limited. There is also a need for further sub-national analyses and qualitative research to identify and describe inequities (including for refugee and displaced young people), and to understand the context and drivers of poor health outcomes and risks in the region.