Adolescent Health and Road Safety

Young people under 25 comprise over 40% of the global population with adolescents aged 10 to 19 years old. This accounts for an estimated 1.2 billion in the overall population.^[1] Despite the size of the adolescent population and the short and long-term benefits of investment in this age group, there is a struggle in efforts to leverage attention, funding, and political will toward adolescent health and well-being.

Adolescents have often been considered healthy but persistent and complex factors act as barriers to the health and well-being of many young people who contend with challenging contexts.^[2]  The second decade of life is a period of rapid development and growing independence with internal and external factors influencing adolescents’ present and future health and well-being.^[3]  Because of this, adolescents face complex challenges compounded by gender stereotyping, economic factors, and other social determinants of health that require a unique approach to the diverse range of needs within this demographic.^[4]

Importantly, adolescent health trends in recent decades have not seen improvements in health outcomes observed in the first decade of life. This is despite the fact that the majority of fatalities are related to preventable causes.^[5]  In fact, an estimated 1.1 million adolescents die each year from preventable causes^[6] such as interpersonal violence, HIV/AIDS, suicide, maternal health, and road traffic injury. ^[7]

Road traffic injury is a major public health burden globally, especially for children and youth. It is the leading cause of death for those aged 5 to 29.^[8] It is the third leading cause of death for adolescents aged 10 to 14 and the leading cause for those aged 15 to 19.^[9] Beyond fatalities, an estimated 10.5 million children and adolescents under 20 are injured or disabled by road traffic injury.^[10] Environments that are dominated by motorized traffic greatly impact adolescent health beyond injuries; outdoor air pollution, and lack of safe infrastructure for active transport contribute to other non-communicable diseases.^[11]

Despite the wide-ranging impacts of road traffic injury on adolescent health and the car-dominated environments that enable it, funding and political will are nowhere near commensurate with the scale of the issue. There is already a major funding disparity between the total global health assistance and investment in targeted interventions for adolescent health; only 2.2% is directed toward adolescents.^[12] Within this spending, only an estimated 0.3% of financing is invested in road safety interventions for this age group despite road traffic injuries being the leading cause of death for adolescents.^[13]

The pervasive overrepresentation of adolescents in road crashes, despite the multitude of road safety interventions in the past decade, suggests that innovative approaches are required to understand and address adolescents’ road crash risks. The focused attention required is often undermined by research. 

This results in missed opportunities to address specific challenges experienced by adolescents at risk of road injury.^[14]  We need more systematic and targeted practices to identify, assess, and address adolescent needs.  

Understanding the heterogeneous experiences of young people informs policy and programmatic interventions so that they can be more responsive to adolescents’ realities requires extending traditional research methods to embed multiple methods that prioritize youth participation as a key principle. The Gender and Adolescence Global Evidence (GAGI)^[15] is an example of what such an initiative could look like.

The collaborative and co-creation approaches that foster meaningful participation where researchers are engaging with adolescents and their stories provide opportunities to understand the highly diverse contexts, experiences, and strengths of adolescents across the globe. This particularly would pave the way to affirming the skills and agency of young people to achieve their aspirations for transport access and safety rather than be seen merely as abstract subjects for whom generic interventions are designed.^[16]

Additionally, while we recognize that there are methodological challenges to overcome reflecting decades of inaction in this respect, greater effort must be invested to enable the enthusiasm of young people so that they can translate these challenges into opportunities where they become active agents in evaluating interventions designed to serve them.

This requires prioritizing initiatives that meaningfully and practically engage young people in the design and implementation of project evaluations that consider and reflects their diverse values, identities, and culture. Incorporating adolescents in the evaluation process in turn increases the validity of findings. For example, when conducting interviews or presenting findings, youth partners are highly effective and authentic communicators, particularly when engaging with their peers as well as underserved or underrepresented populations. 

In summary, to generate policy-relevant data and foster road safety interventions that can address the distressingly persistent impacts of road injury experienced by adolescents, we must meaningfully engage diverse communities and thoughtfully create spaces where young people have a voice and the tools to be integral agents in the solution.