Why cities matter for adolescent mental health and wellbeing

• Published in: The Lancet (British edition) Vol. 403; no. 10428; pp. 708 - 710
• Main Authors: Hannon, Elliot, Anselimus, Sweetbert M, Bardikoff, Nicole, Bulc, Barbara, Germann, Stefan, Gonsalves, Pattie P, Melendez-Torres, G J, Ospina-Pinillos, Laura, Sinha, Moitreyee, Wanjiru, Maureen
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 24.02.2024; Elsevier Limited
• Subjects: Adolescent; Adolescent Health; Adolescents; Child development; Cities; Environmental factors; Environmental stress; Health problems; Health promotion; Humans; Leadership; Mental disorders; Mental Health; Poverty; Problem solving; Social conditions; Social exclusion; Social factors; Social networks; Social organization; Surveys and Questionnaires; Teenagers; Traffic accidents & safety; Urban environments; Urban populations; Well being; Young adults
• ISSN: 0140-6736; 1474-547X; 1474-547X
• DOI: 10.1016/S0140-6736(23)02238-9

The health and wellbeing of young people during adolescence, the period between ages 10 and 19 years,1,2 constitute major determinants in their future life prospects.3 WHO estimates that 35% of the total global burden of disease can be traced back to adolescence.4,5 Promotion of good mental health among adolescents is crucial to their wellbeing, as mental health problems now account for over a third of the total burden of disease in adolescents.1,4 For the 1·2 billion adolescents that make up the world's population,6 nine out of 10 live in low-income and middle-income countries (LMICs)7 where social and environmental factors such as poverty, armed conflict, violence, and environmental stressors and disasters tend to be endemic and contribute to significant mental health difficulties.8–11 LMICs are also characterised by numerous barriers to both the supply and demand of mental health care.12–14 By 2030, it is estimated that more than half of urban populations will be younger than 18 years, with LMIC settings expected to account for 90% of this growth.15 The state of the world's cities, therefore, has a profound and lasting effect on the state of young people's health and life prospects. Multilevel interventions that align inner or individual skills (eg, emotional regulation or belonging), social network capacities and social structures (eg, stigma reduction and strengthened social networks), and environmental domains (eg, service access) towards inner development, and activate these interventions to create sustained and evolving impacts for adolescents and communities, can transform urban environments into mental health-promoting contexts for all adolescents.29 The challenge is to harness these multiple systems, to align them to promote better mental health and, beyond immediate implementation, to activate the conditions for communities to continue to organise themselves towards mental wellbeing. First and foremost, this approach requires a rethink of existing social and economic systems while supporting existing youth-led and youth-focused initiatives and interventions powered by intergenerational leadership.