More young people are struggling with life in our times; there is no quick fix.
A recent international study measured the health impacts of the COVID pandemic, based on a survey of over 15,000 people in 13 countries. It found that the pandemic resulted in worse health for more than a third of respondents. Measured in QALYs, or quality-adjusted life years, the health impacts of the COVID pandemic and lockdowns were between five and eleven times larger than the COVID-related deaths alone. Anxiety and depression exacted the biggest cost, especially among young people aged under 35.
The authors say that only focusing on COVID cases and deaths overlooks this larger burden of the pandemic and the impacts of policies to control it. Understanding the bigger picture can help us to be better prepared for potential future health shocks, they say.
However, the lessons extend beyond better preparation for such shocks. They include a more general mistake of prioritizing physical health over mental health – in this case COVID cases and deaths over mental disorders and social isolation. This prejudice highlights a widespread neglect or underestimation of the situation of young people, who are bearing the brunt of the mental ill-health arising from sweeping societal changes- social, cultural, economic, environmental. This is the topic of this article, adapted from a longer essay published this month in the US magazine Salon.
Young people’s declining wellbeing
A 2021 advisory by the US Surgeon General on young people’s mental health states that, ‘the challenges today’s generation of young people face are unprecedented and uniquely hard to navigate. And the effect these challenges have had on their mental health is devastating.’ The advisory says recent national surveys of young people have shown alarming increases in the prevalence of certain mental health challenges. ‘In 2019, one in three high school students and half of female students reported persistent feelings of sadness or hopelessness, an overall increase of 40% from 2009.’ Since the pandemic began, rates of psychological distress among young people have further increased, the advisory notes.
Gallup reported in May that the percentage of U.S. adults who report having been diagnosed with depression at some point in their lifetime has reached 29%, nearly 10 percentage points higher than in 2015. The percentage of Americans who currently have or are being treated for depression has also increased, to 18%, up about seven points over the same period. Both rates are the highest recorded by Gallup since it began measuring depression using the current form of data collection in 2015.
Again younger people are the worst affected. Those aged 18 to 29 (34%) and 30 to 44 (35%) have significantly greater depression diagnosis rates in their lifetime than those older than 44. Those aged 18 to 29 (25%) also have the highest rates of current depression or treatment for depression.
Many academic studies of young people’s wellbeing report similar findings. More American adolescents and young adults in the late 2010s, compared to the mid-2000s, experienced serious psychological distress, major depression, and suicidal thoughts, and more attempted suicide and took their own lives, one study found.
The US Surgeon General’s advisory (which cites my research) states that mental health is
‘shaped by many factors, from our genes and brain chemistry to our relationships with family and friends, neighborhood conditions, and larger social forces and policies. We also know that, too often, young people are bombarded with messages through the media and popular culture that erode their sense of self-worth—telling them they are not good looking enough, popular enough, smart enough, or rich enough. That comes as progress on legitimate, and distressing, issues like climate change, income inequality, racial injustice, the opioid epidemic, and gun violence feels too slow.’
The complexity of causation
Young people best reflect the characteristics of our times because they are growing up in them. Their health is an important predictor of future population health because many of the attitudes and behaviors – and even the illnesses – that determine adult health have their origins in early life. About 75% of mental-health problems begin before age 25. While some of these mental disorders are minor and transient, other problems can be severe and recur throughout life. New US research shows increases in poor mental health in younger age groups such as adolescents and college students are now extending up the age scale to adults in their prime (aged 26-49).
I began researching young people’s changing world for the Australian Commission for the Future in the 1980s, suggesting in a report that rising rates of youth suicide, crime, and drug use, were linked to increasing family conflict and breakdown, youth unemployment, child poverty, education pressure, and – a novel dimension – concerns about the world’s future. At the time nuclear war was a prominent fear, as it is again now, with the heightened tensions between the West and Russia and China. There is also, now, more awareness of the spectre of catastrophic climate change, which is not only a future threat but our lived reality.
As evidence emerged, and grew, about young people’s declining health and wellbeing I deepened my study to explore the existential aspects of their lives and how progress and modernity are undermining g these. The impacts are not limited to mental health; physical health is also a concern. Lack of physical activity, poor diet, and increasing obesity (all also linked to mental health) are fueling a rise in chronic problems such as type 2 diabetes at ever-younger ages.
My own focus has been on the effects of cultural change. Rising materialism and individualism are defining characteristics of modern Western culture. Both have conferred benefits to people, including to their health and wellbeing. However, there is growing evidence of diminishing benefits and rising costs. The costs include a heightened sense of risk, uncertainty and insecurity; a lack of clear frames of reference; a rise in personal expectations, coupled with a perception that the onus of success lies with the individual, despite the continuing importance of social disadvantage and privilege; a surfeit or excess of freedom and choice, which is experienced as a threat or tyranny; the confusion of autonomy with independence; and a shift from intrinsic to extrinsic values and goals.
An intrinsic orientation means doing things for their own sake. Intrinsic goals tend to meet basic human needs for competence, affiliation and autonomy. They are ‘self –transcending’ and good for wellbeing. An extrinsic orientation means doing things in the hope or expectation of other rewards, such as status, money and recognition. It is ‘self-enhancing’ in the sense of being concerned with self-image. It is not good for wellbeing. A focus on the external trappings of success and ‘the good life’ increases the pressures to meet high, even unrealistic, expectations, and so the risks of failure and goal conflict.
The change is not just a matter of greater vanity, selfishness and greed (although many people today express concerns about these traits). It is something deeply existential and relational, about how people think of life and how they see themselves in relation to others and the world, and this profoundly affects their wellbeing.
An island of misery, or the tip of an iceberg?
About 10 to15 years ago, I proposed we needed a new narrative of young people’s health. The long-established story is – or was at the time – that young people’s health is continuing to improve in line with historic trends. Death rates are low and falling, and most young people say they are healthy, happy and enjoying life. For most, social conditions and opportunities have generally got better. Health efforts need to focus on the minorities whose wellbeing is lagging behind, especially the disadvantaged and marginalized.
But there was another, very different story. It suggests young people’s health may be declining – in contrast to historic trends. Mortality rates understate the importance of non-fatal, chronic ill-health, and self-reported health and happiness do not give an accurate picture of wellbeing. Mental illness and obesity-related health problems and risks have increased. The trends are not confined to the disadvantaged. The causes stem from fundamental social and cultural changes of the past several decades.
I have used a maritime metaphor to illustrate the difference between the two perspectives: Are troubled youth an island of misery in an ocean of happiness? Or are they the tip of an iceberg of suffering? Which story is the more accurate matters. The old narrative says interventions should target the minorities at risk. The new narrative argues that broader efforts to improve social conditions are also needed.
I posed two questions to highlight the implications of the two stories: What would we do differently if young people’s health, overall, was not improving, but declining? What would we do differently if the social factors behind young people’s health problems were not primarily those of ‘marginalized minorities’, but the characteristics of ‘mainstream majorities’?
The obvious answer to both questions is that we would do things very differently. Yet, by and large, we are not (although the Surgeon General’s advisory on youth mental health implicitly acknowledges the new narrative).
How societies address social problems and challenges depends on how these are represented or framed. Changing the representation, or story, of young people’s health would have the immediate effect of underscoring the need to expand and improve healthcare services, which dominate current policy considerations. However, the new narrative has more profound implications, not just for young people (on which, obviously, youth research focuses), but also for society as a whole and national goals and priorities.
Staying with the old story of young people’s health – health problems in youth are ‘the price of progress’, which is making life better for most people but at a cost to a few – means that health interventions will continue to focus on a minority of people at risk, especially the disadvantaged. Adopting a new story – recent ‘progress’ has harmed a substantial and growing proportion of young people to varying degrees – suggests that, in addition to specific, targeted interventions, a much broader effort is needed to change social conditions.
To give effect to the new story of young people’s health, more emphasis is needed on: the ‘big picture’ of their changing world; total health and wellbeing, and ‘living well’, not a narrow focus on ill-health; the mainstream of society, not just the marginalized and disadvantaged; and developing the social and cultural, as well as economic and material, resources available to young people.
Health and progress
The contrast between the old and new stories of young people’s health and wellbeing is part of a larger contest between the dominant narrative of material progress and a new narrative, sustainable development. Material progress represents an outdated, industrial model of progress: pump more wealth into one end of the pipeline of progress and greater wellbeing flows out the other. Sustainable development reflects (appropriately) an ecological model, where the components of human society interact in more complex ways. Not only does sustainable development better fit the new story of youth health, it is likely to achieve better outcomes in relation to the old story’s focus on socio-economic disadvantage and inequality because it is less intent than material progress on economic growth and efficiency.
Related to this contest, the new story of youth health also challenges the orthodox story of human development, which places Western nations at its leading edge. It shows that the dominant measures of development – not just income, life expectancy or happiness, but also education, governance, freedom and human rights – are not enough. However desirable these qualities may be, they do not capture the more intangible cultural, moral and spiritual qualities that are so important to wellbeing. And it is in these respects – together with the environmental impacts – that Western societies do not do so well.
As discussed above, the most important application of my perspective on young people’s health and wellbeing may be in the contribution it can make to a much broader political and public debate about the lives we want to lead, the societies we want to live in, and the futures we want to create. This debate is intensifying, but health research plays only a limited part in it.
A wider, more comprehensive, view of health would contribute to a better understanding of human development, and of health as a social dynamic: a cause of social changes and developments, not only a consequence, through effects on population resilience, morale and vitality. This effect may well influence how well humanity responds to global threats such as climate change; it is probably impacting on our societies today, including on our politics.
The health of young people should be a focal point in the larger contest of social narratives. They should, by definition, be the main beneficiaries of progress; conversely, they will pay the greatest price of any long-term economic, social, cultural or environmental decline and degradation. If young people’s health and wellbeing are not improving, it is hard to argue that overall life is getting better.