We must harness the power of youth to reset health inequalities

Worldwide there are 1.2 billion people aged between 10 and 19, almost 90% of whom live in low- and middle-income countries. They deserve education and access to healthcare to remain able, productive and empowered.

As we explore the elements of holistic wellbeing, mental health has also emerged as a growing concern. UNICEF estimates that one in five adolescents worldwide will suffer a mental disorder each year. Depression accounts for the greatest fragment of disease burden amongst those aged 15 to 19, and suicide is one of the three most prominent causes of death among people aged between 15 and 35. The arrival of COVID-19 may have driven these numbers even higher. We must reflect on the elements that contribute to this disease burden if we are to properly address this burgeoning need.

We currently see health primarily in relation to disease. One falls ill and must be cured in order to be brought back to health. Most of our current healthcare systems are focused on this process of providing a cure. Importantly, however, we must consider that the other aspect of healthcare is care, which includes the prevention and maintenance of health – both on an individual and a collective basis. According to the WHO, "Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity" – and as such it is dependent on a plethora of biological and socio-environmental factors. When one considers individual health, the social determinants of health (SDH) must be acknowledged - ultimately referring to the conditions in which people are born, grow, work, live and age, and the wider set of forces shaping the conditions of daily life.

There is increasing evidence that social factors have an outsized influence on health. Children are especially sensitive to their social circumstances and, for older youth, it can be particularly decisive. Arguably, however, the most significant impact of SDH on health is noted in the most vulnerable populations – particularly surrounding education and level of income. When the social determinants of health are not acknowledged, discrimination, disparities and despair may ensue and we must use our current circumstances to remind ourselves of the extent to which our health is determined by our livelihoods.

Several studies have interrogated the effect of social variables on health, with some attributing up to 50% of deaths in the USA to a diverse mix of behavioural and social factors. It is not inconceivable to imagine that one’s income, education and employment status necessarily affects one's health-related behaviours. With such a potent relationship between health and social circumstances, it is no surprise that COVID-19 has flourished in underserved populations, spreading rapidly through the social cracks of systemic and structural inequities.

The effects of SDH is perceptible in most countries around the globe, with the profile of health outcomes being distinctly different amongst social classes. Social protection and employment, education and housing have all been shown to significantly contribute significantly to health inequality in South Africa and Italy alike. The simplest lens through which we can observe the effect of COVID-19 on social equity, however, is race in the USA, where COVID-related morbidity and mortality are disproportionately higher in the Black population. A review of COVID-19 cases in the epicentre of the pandemic in the US, New York, showed age-adjusted mortality rates in Black and Hispanic patients twice as high as comparable white and Asian patients. This pattern is reflected in many of the Southern States. Similar changes have been reflected amongst several other regions in Europe and Africa, and the relationship between health outcomes and socioeconomic status persists with countries as the unit of analysis.

Such disparities have been attributed to a higher concentration of such individuals living and working in crowded conditions, being reliant on public transportation, and lacking access to protective gear. Unsurprisingly, such communities have the highest incidences of COVID-19 infection. Furthermore, such communities are likely to demonstrate greater incidences of preexisting disease – such as hypertension, diabetes and obesity – often due to structural and environmental factors such as poor access to healthcare and education.

COVID-19 has forced us to innovate rapidly, as seen in the transformation of healthcare to a technology-enabled sector overnight. The onus rests upon us to address social disparities in health outcomes with the same level of urgency.

As we seek to solve for health through solving for social determinants, we must harness the collective power, energy and purpose of the young people who are instrumental in designing and shaping the future. The United Nations Major Group for Children and Youth states that healthy and empowered young people can be a significant driving force towards equitable societies and prosperous economies.

Sir Michael Marmot, a leader in the field of health inequalities and chair of the WHO's Commission on Social Determinants of Health (CSDH) in 2005 has said: “For people aged 30 and above, if everyone without a degree had their death rate reduced to that of people with degrees, there would be 202,000 fewer premature deaths each year. Surely this is a goal worth striving for.” Now is the right time to take action. We must engage legacy healthcare stakeholders in co-creating the health of the future by designing clear health outcomes that are surmountable through crafting social structures that enable the health of all. The Global Shapers Community has committed to this calling by designing the Youth Health Goals, a compass that points the collective youth towards a more health-equitable society. As we seek to navigate the Great Reset of modern times, let us harness the power of the youth to restart health on an inspired, inventive and inclusive note. This may be our only chance.