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As discussed in Chapter 3, the AGI-K delivered multisectoral interventions to more than 6000 girls aged 11–15 in two marginalized areas of Kenya, Kibera and Wajir, and comprised a combination of girl, household and community-level interventions.
The interventions consisted of community dialogues, CCT, group meetings covering a range of sexual and reproductive health (SRH) and life skills topics and financial education. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The aim was to prevent violence against girls and to improve their life and educational skills.
The evaluation calculated a monetary benefit of US$ 55 per girl in Kibera and US$ 94 per out-of-school girl in Wajir (Austrian et al., 2020).
These figures representing less than the costs did not take into account the qualitative benefits such as confidence, voice and choice for which assigning a monetary value is difficult. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Also, with a scaled-up version, there would be a total benefit of US$ 27 783 289, and the relative cost of implementation would be significantly reduced.
Program H, also discussed in Chapter 3, was a gender-transformative curriculum developed for Brazilian young men.
It has been adapted in at least 36 countries and was named best practice by the World Bank and WHO. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
When implemented well and culturally adapted, Program H can lead to changes in attitudes and behaviours related to SRH and IPV (Doyle and Kato-Wallace, 2021).
Program H has three interrelated parts: a gender-transformative group education curriculum; community campaigns; and a culturally relevant, validated evaluation model known as the Gender Equitable Men (GEM) Scale that measures the degree to which gender attitudes change as a result of the interventions. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Manhood 2.0 was adapted from Program H. The cost of implementing Manhood 2.0 is US$ 4771 per complete round of programme delivery and US$ 451 per participant.
The marginal cost per additional round is US$ 3682 (Tang et al., 2022). | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
IPV The CTC prevention programme provides manuals, tools, training and technical assistance to activate communities to use advances in prevention science to plan and implement community services to reduce adolescent substance use, delinquency and related health and behaviour problems.
The study also looked 74 Adolescents in a changing world.
The case for urgent investment at antisocial behaviour, such as being violent and suffering from substance use disorder, during the past year (Hawkins et al., 2008). | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The PATHS curriculum promotes emotional and social competencies and reduces aggression and behaviour problems in elementary school-aged children.
It is available in several languages including Chinese and French.
Several studies have shown that the PATHS curriculum, relative to a control group, results in lower levels of aggression, a better ability to resolve conflicts and many other positive traits. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Greenberg and Kusché (1998) and Greenberg, Kusché and Mihalic (1998) estimated that the programme costs for the PATHS curriculum over a three-year period would range from US$ 15 to US$ 45 per student per year, depending on whether the current staff was redeployed or a new on-site coordinator was hired.
WHO, UNICEF and academic partners have developed and tested parenting programmes to prevent violence in low-resource settings, known as Parenting for Lifelong Health (PLH for Teens) (WHO and UNICEF, 2023). | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
After showing positive results in evaluations, the PLH programmes are currently being scaled-up in more than 20 LICs and MICs.
Parents are taught alternative parenting strategies to reduce adolescent problem behaviours and avoid harsh disciplining techniques at home.
Some parenting interventions in LICs and MICs (McCoy et al., 2020) have positive results in preventing violence against children, but there are no benefit-cost evaluation studies. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The effectiveness of Sinovuyo Teen, one of the PLH for Teens programmes, was evaluated with a cluster-RCT in 40 villages and peri-urban townships in South Africa from 2015 to 2016 (Redfern et al., 2019).
The total implementation cost for the programme over the duration of the trial was US$ 135 954, or US$ 504 per family enrolled.
Redfern et al. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Redfern et al.
(2019) found that among the 270 families in the treatment group, an estimated 73 incidents of physical and emotional abuse were averted (95% confidence interval [CI] 29 to 118 incidents averted).
The total cost per incident of physical or emotional abuse averted was US$ 1837, which the study considered was likely to decrease to approximately US$ 972 if implemented at scale, with an estimated lifetime saving of US$ 2724 minimum per case.
Pepin et al. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Pepin et al.
(2018) quoted Scottish and London models that use the interdisciplinary public health approach to reduce violence.
The Scottish model looked at reducing knife crime and the London model looked at youth violence.
Another study in Cardiff, United Kingdom of Great Britain and Northern Ireland (Florence et al., 2014) found that the CVPP was highly effective in reducing public violence. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
This programme involved a violence information-sharing partnership between health services, police and local government.
By identifying injury and victim characteristics such as location, time and weapon, police and local government were able to reduce violence-related injuries through preventative programmes.
The intervention costs were moderate (IT system and related costs) compared with the sizeable reduction in injuries. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The benefits included health and criminal justice system costs avoided and health benefits in terms of QALYs as a result of reduced injuries.
Overall, the programme generated a BCR of 82 while the government services study calculated a BCR of 14.80 for the health service and 19.1 for the criminal justice system. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Bullying Anti-bullying programmes include the Olweus Bullying Prevention Program (OBPP) (Beckman and Svensson, 2015), the bullying prevention programme KiVa (Persson et al., 2018) and the Learning Together intervention (Bonell et al., 2019).
The OBPP had a total discounted cost over a three-year period of 4079 Swedish krona (SEK), and it yielded an incremental cost of 131 250 SEK (€14 470) (Beckman and Svensson, 2015). | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Base-case analysis indicated KiVa leads to an increased cost of €829 for a gain of 0.47 victim-free years per student.
In terms of the cost per QALY gained, the results indicated a base-case estimate of €13 823.
This may be seen as cost-effective given that it is lower than the typically accepted threshold value in Swedish health policy of around €50 000 (Persson et al., 2018). | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The mean (standard deviation) total education sector-related costs of Learning Together were £116 (£47) per pupil in the control arm, compared with £163 (£69) in the intervention arm over the first two facilitated years.
Overall, although the intervention was associated with higher costs, the mean gain in students’ health-related quality of life was slightly higher in the intervention arm. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The incremental cost per quality-adjusted life year was £13 284 (95% confidence interval -£32 175 to £58 743) and £63 (£33) and £74 (£37) per pupil, respectively (Bonell et al., 2019).
75 7.
Violence and injuries 7.3 Adolescent suicide Self-harm including suicide, was the second leading cause of death among adolescents according to a study by IHME (2019).
However, global suicide rates for adolescents aged 10–19 years declined for both sexes between 2010 and 2019. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Overall, during this period, suicide rates for males were higher than for females and declined from 5.27 to 4.42 per 100 000, while for females, they declined from 4.96 to 3.78.
India has the highest suicide rate in the world and over the past two decades has shown a rising trend especially for women (Senapati et al., 2024). | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The increase in suicide rates among female adolescents has been attributed to several factors that include gender-specific issues, such as gender-based violence, discrimination, and social norms that place a higher burden on females (Senapati et al., 2024).
7.3.1 Causes of suicide The analysis by Glenn et al. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
(2020) on worldwide suicide rates found that economic quality or inequality was not related to overall suicide mortality rates, but economic inequality was correlated with a higher ratio of male:female suicides.
Renaud et al.
(2022) indicated that youth in LICs and MICs continue to be highly represented in suicide statistics yet are underrepresented in the research. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The causes of adolescent suicide have been judged to be exposure to corporal punishment (Cramm et al., 2023); mental health problems; substance misuse; family and other non-intimate relationships; and problems at school (Rice et al., 2023).
Rengasamy et al.
(2020) found that cyberbullying for younger adolescents was a contributing factor.
Wasserman et al. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Wasserman et al.
(2021) listed risk factors under different headings, including genetic and neurobiological factors, a family background of psychopathology, personality and cognitive characteristics, stressful life events and poor social relationships.
Renaud et al.
(2022) listed population-based factors, such as attitudes toward suicide, socioeconomic factors, access to lethal means of suicide and access to mental health care, as contributing to adolescent suicides in LMICs. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The individual-based factors for adolescent suicides include psychopathology, negative interpersonal relationships and sexual and gender minorities (Renaud et al., 2022).
7.3.2 Prevention of suicide Wasserman et al.
(2021) categorized suicide prevention strategies according to three different levels, as follows: (1) Universal strategies that target everyone in a defined population, such as a school, a county and a local community, and are aimed at increasing awareness about suicide and mental health. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
These strategies remove barriers to care or promote help-seeking behaviours and protective factors such as social support and coping skills.
These may also include parenting support, improving education or training opportunities or enhancing conditions in schools or in other settings that are conducive to good mental health.
(2) Selective strategies that address specific groups at increased risk for suicidal behaviour, such as adolescents with mental health problems and harmful use of substances. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
(3) Indicated strategies that target high-risk individuals displaying signs of suicidal behaviour.
Universal strategies include those that limit access to lethal means.
Gatekeeper programmes teach gatekeepers, such as schoolteachers, how to recognize signs and symptoms of a suicidal crisis and refer identified at-risk subjects to appropriate help resources. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Interventions that target specific risk factors such as bullying and substance use disorder have been listed in other sections of this report (for bullying sections 3.1.2, 3.3, 4.1 and 4.4; for substance use disorders sections 4.3.3 and 7.2.3).
7.3.3 Cost-effective interventions to reduce suicide As discussed in Chapter 4, Stelmach et al.
(2022) modelled cohorts of adolescents in 36 countries to assess the impact of addressing adolescent mental disorders and suicide on health and non-health outcomes. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
They had difficulty finding appropriate studies with relevant data for suicide interventions in their formal search.
However, they modelled two interventions: a universal school-based suicide prevention intervention and a hospital-based education and follow-up intervention.
Stelmach et al.
(2022) found that the targeted hospital-based suicide prevention intervention for adolescents yielded a BCR of 62.0 while the universal school-based suicide programme had a BCR of only 3.5. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The school-based intervention was based on the 76 Adolescents in a changing world.
The case for urgent investment Saving and Empowering Young Lives in Europe (SEYLE) trial, the effectiveness of which had been reported on by Ahern et al.
(2018) and Wasserman et al.
(2015).
Ahern et al.
(2018) analysed the cost-effectiveness of the Youth Aware of Mental Health (YAM) and other programmes developed for SEYLE. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
YAM consisted of interactive lectures on mental health and role play sessions on lifetime dilemmas, stress and crisis situations combined with educational posters and booklets.
The study found that the YAM programme had the lowest incremental costs per 1% reduction in incidents and per QALY gained versus the control group. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The incremental cost-effectiveness ratios reported for YAM were €34.83 and €45.42 per 1% point reduction in suicide attempts and severe suicidal ideation, respectively, and a cost per QALY gained of €47 017 for suicide attempts and €48 216 for severe suicidal ideation.
However, the likelihood of the intervention being cost-effective was less than 50%.
For suicide attempts, the probability that YAM was cost-effective at a willingness to pay of €47 000 was 39%. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
For severe suicidal ideation, the probability that YAM was cost-effective at a willingness to pay of €48 000 was 43%.
Wasserman et al.
(2015) also studied the three programmes (gatekeeper training [QPR], YAM, and screening at-risk adolescents by professionals [ProfScreen]) that formed part of SEYLE between 1 November 2009 and 14 December 2010. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The study randomly assigned 168 schools (11 110 pupils) to interventions, 40 schools (2692 pupils) to QPR, 45 schools (2721 pupils) to YAM, 43 schools (2764 pupils) to ProfScreen and 40 schools (2933 pupils) to the control group.
No significant differences between the intervention groups and the control group were recorded at the three-month follow-up. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
At the 12-month follow-up, YAM was associated with a significant reduction in suicide attempts (odds ratios [OR] 0.45, 95% CI 0.24-0.85; p=0.014) and severe suicidal ideation (0.50, 0.27-0.92; p=0.025) compared with the control group.
Fourteen pupils (0.70%) reported incident suicide attempts at the 12-month follow-up in the YAM versus 34 (1.51%) in the control group and 15 pupils (0.75%) reported incident severe suicidal ideation in the YAM group versus 31 (1.37%) in the control group.
Schmidt et al. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Schmidt et al.
(2020) undertook a systematic review of health economic evaluations of universal mental health interventions for children and adolescents.
Almost half of the studies evaluated the cost-effectiveness of CBT-based interventions, aimed at preventing depression or anxiety, and had mixed results. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The cost- effectiveness of a parenting programme (All Children in Focus by Ulfsdotter et al., 2015), a school-based social and emotional well-being programme (PATHS by Humphrey et al., 2018) and anti-bullying interventions (KiVa assessed by Persson et al., 2018) were promising.
7.4 Road safety8 Road traffic fatalities and serious injuries for young people are one of the largest causes of death among people aged between 10 and 19 years. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
In 2022, about 71 000 young people were killed on the world’s roads and over 450 000 seriously injured.
Of these, roughly 75% were in the 77 lower middle-income countries (LMICs) studied (Fig.
7.2 and 7.3) and of these approximately 80% of the fatalities and 70% of the serious injuries occurred in males.
Road fatalities and injuries are much higher for males than females by a factor of three for fatalities and two for serious injuries. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
7.4.1 Methodology This section summarizes the analysis and assumptions used to estimate the BCR of investing in road safety interventions.
Two scenarios were compared: Baseline/business-as-usual scenario where existing data for each country were used to estimate trends for deaths and serious injuries out to 2050.
Scale-up of interventions where they increase linearly over the 2024–2035 period to full implementation for all modes.
8.
Compared with Symons et al. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
8.
Compared with Symons et al.
(2019), the BCRs of the more recent modelling reported here are similar but slightly lower than the earlier results with the overall BCR of 9.1 compared with 9.9 in the earlier paper.
This is due to a number of enhancements to the model.
This has included updated intervention data, inclusion in the model of a rural-urban split and methodological changes, including the projection of current trends. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The largest change was to improvements in the granularity of the infrastructure data, including mode specific (pedestrian, bicycle, motorcycle and motor vehicle) infrastructure investment costs for each country.
77 7.
Violence and injuries Fig. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
77 7.
Violence and injuries Fig.
7.2 Road traffic injuries and fatalities, 10–19-year-olds, by income group, 2019 8,041 16,560 43,827 27,087 50,982 71,149 372,535 128,364 Serious injuries Deaths World Bank low-income World Bank lower middle-income World Bank upper middle-income World Bank high-income Source: IHME (2019).
As shown in Fig.
7.2, most of the world’s adolescent traffic injuries and the largest share of fatalities occurred in LMICs. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Of the 623 030 serious injuries, 60% occurred in LMICs and 46% of the total 95 515 deaths for adolescents.
While the size of the population is clearly a large factor.
in the number of road traffic injuries and fatalities, Fig.
7.3 shows that LMICs also had the highest serious injury rate.
However, their death rate (7.0) was slightly lower than the global average of 7.6 per 100 000 population.
Fig. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Fig.
7.3 Rates of serious road traffic injuries and fatalities, 10–19-year-olds, by income group, 2019 per 100 000 Global Fatalities Serious injury World Bank low-income World Bank lower middle-income World Bank upper middle-income World Bank high-income 0 10 20 30 40 50 60 Source: IHME (2019).
7.4.2 Investments The cost of reducing road traffic deaths and serious injuries includes funding two sets of intervention programmes. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
One set includes behavioural measures focused on alcohol and speed compliance, seat belt enforcement, helmet wearing for motorcycle riders, road safety campaigns as well as graduated licensing schemes for motorcycle riders and motor vehicle drivers.
The other set addresses physical changes, including improved infrastructure and policy programmes to encourage safer motor vehicles.
78 Adolescents in a changing world. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
78 Adolescents in a changing world.
The case for urgent investment 7.4.3 Benefits The benefits involve reducing deaths and serious injuries with corresponding economic benefits calculated by following the cohort of people over their lifetimes whose deaths or serious disabilities are averted for each year of the intervention programme.
As the period of the intervention is from 2024 to 2050, there are 27 such cohorts.
7.4.4 Modelling framework The modelling framework (Fig. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
7.4) builds on the studies of Chisholm and Naci (2012) who undertook modelling for LICs and MICs at a regional level.
The framework involves estimating deaths and serious injuries from road accidents by age, gender and mode (pedestrian, cyclist, motorcyclist, motor vehicle occupant) in an unchanged policy base case and compared with one achieved through systematic implementation of the range of interventions identified above.
Fig. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Fig.
7.4 Modelling framework Establishing a base case projection of deaths and serious injuries from road accidents for the 77 countries out to 2050 is a complex task.
Different transport modes have different accident rates (for example, motor cars are safer than motorcycles).
However, the starting point used in the modelling framework for the base case was the matrix of fatality rates (deaths per 100 000 population) from 2010 to 2019 by age, gender and accident type. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
An exponential trend line was then calculated from the years 2010 to 2019 and extrapolated out to 2050 for each of the different fatality rates.
A similar approach was taken for estimating serious injuries, which were assumed to be a subset of injuries, the ones that cause serious and permanent injurie preventing the person from working or attending school.
The population of each country varies over time in line with the ILO population projections. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
However, the matrix of fatality rates remains fixed for each group within each country.
The base case data of fatality rates by age, gender and mode or injury type are from the GBD 2019 data (IHME, 2019).
Two age cohorts (10–14 and 15–19 years) were used for the following types of injured persons or fatalities: pedestrian, cyclist, motorcyclist, motor vehicle occupant and other categories.
This produced 20 baselines (age cohort * gender * transport mode) for each of the 77 countries. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Cost of interventions > Behavioural inventions and enforcement > Infrastructure costs > Capacity-building Unique base case projections for fatalities/serious injuries by country, gender, location and age to 2050 Interventions Affected party Mode-specific infrastructure Alcohol Public awareness Speed Motorcycle helmets Graduated licensing Seatbelts Vehicle safety rating Pedestrians Cyclists Motorcyclists Motorists Impact: reduced fatalities/serious injuries relative to base case (total/urban/rural) Benefit-cost ratio Economic benefits Pedestrians | Cyclists | Motorcyclists | Motorist | Other Deaths/serious injuries by country, gender, location (urban/rural) and age (10–14 and 15–19) 79 7. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Violence and injuries After reviewing the literature, effective interventions to reduce road accidents and estimates of their cost and effectiveness in reducing deaths and serious injuries for young people in the 77 countries were identified.
These estimates were used to calculate the reduction in deaths and serious injuries achieved in each of the 77 countries relative to the base case.
The interventions are assumed to be independent but with multiplicative effects. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
However, the effectiveness value for particular interventions varies between countries as different circumstances apply.
For example, the effect of alcohol enforcement is obviously reduced in Islamic countries where the consumption of alcohol is restricted.
In addition, some countries already have interventions in place, but the level of implementation or enforcement across those countries might vary significantly. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
This is evident in such data as the WHO estimates of the different levels of helmet wearing and seat belt usage across the globe.
The benefits arising from the interventions are the economic and social costs of road accidents avoided because of the reduction in accidents.
The analysis focused only on the avoided deaths and serious injuries involving severe and profound impairment, such as to preclude employment. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Two types of benefits arise from fewer deaths and serious injuries: increased employment and productivity leading to higher GDP and the social benefits of each healthy life, over and above the benefits of higher GDP through increased labour force participation.
The number of people who are in the labour force was calculated by using labour force participation rate projections from the ILO (2023). | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
For each year and age and sex cohort, the number of people in the labour force was calculated by applying the labour force participation rate estimate appropriate for each estimate of the number of people in that year by age and sex.
The economic contribution from these people in the labour force was calculated by multiplying the number by an estimate in that year of the GDP per person in the labour force and a factor estimating the productivity of their age compared to average productivity. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The results for each cohort are their contribution to GDP each year in which they are in the labour force.
Summing across all the cohorts gives a measure of the GDP resulting from the deaths and serious disability averted by the intervention programme.
The increased GDP and social benefits arising from these reductions enable the calculation of BCRs. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
7.4.5 Results The implementation of the interventions would result in approximately 49% of the projected deaths and 46% of serious injuries being averted between 2023 and 2050 (see Table 7.2).
The interventions to achieve these reductions in deaths and disabilities were estimated to have an NPV (3% discount rate) of US$ 104.8 billion with a total benefit of US$ 954 billion (see Table 7.3).
Fig.
7.5 shows the costs and benefits disaggregated by income status and gender. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The contribution of each intervention is summarized in Fig.
7.6, which highlights the importance of alcohol and speed compliance as well as improved infrastructure. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Table 7.2 Projected deaths and serious injuries due to road traffic accidents in adolescents, 77 countries, 2023–2050 Total Low-income Lower middle-income Upper middle-income Deaths 1 778 830 559 513 883 584 335 734 Deaths after interventions 905 142 273 630 451 180 180 332 Averted deaths 873 688 285 882 432 404 155 402 Serious injuries 13 172 423 3 092 431 7 442 702 2 637 290 Serious injuries after interventions 7 090 626 1 574 823 3 964 648 1 551 155 Serious injuries averted 6 081 797 1 517 608 3 478 054 1 086 135 80 Adolescents in a changing world. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The case for urgent investment Table 7.3 Estimated costs and benefits of investment in road safety interventions for adolescents, net present value, 77 countries, 2023–2050, weighted BCRs, $ million Deaths 121 778 Disability 833 053 Deaths plus disability 954 831 Cost, million dollars (NPV) 104 821 BCR deaths 1.2 BCR disability 7.9 BCR deaths plus disability 9.1 Fig. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
7.5 Estimated BCRs of investment in road safety interventions for adolescents by gender, 77 countries, 2023–2050 Male Female Deaths 0 5 10 15 20 25 Disabilities Deaths plus disabilities Fig.
7.6 Costs, benefits and intervention type, road traffic fatalities and serious injuries, adolescents, $ million. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
LHS is left hand axis, RHS is right-hand axis Alcohol compliance Infrastructure improvements Speed compliance Safety campaigns Motorcycle helmet compliance Graduated licensing scheme Safer cars 1,200,000 Serious injuries (RHS) 7,000,000 1,000,000 6,000,000 800,000 5,000,000 600,000 4,000,000 400,000 3,000,000 200,000 2,000,000 0 0 1,000,000 $ million Number Deaths (RHS) Interventions benefits (LHS) Interventions costs (LHS) 81 7. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Violence and injuries 7.5 Conclusions The strategies discussed above have sought to address some of the types of violence perpetrated against adolescents, such as bullying, child marriage and IPV.
The strategies are based on frameworks such as INSPIRE and RESPECT, targeting harmful norms and values, providing income support or providing parent and caregiver support and improving education and life skills.
These are delivered via the three platforms of health, schools and community settings. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Most need to be adapted to the needs of different countries.
The contribution to the investment case made by these interventions is relatively small.
However, beyond measuring and quantifying the costs and benefits in monetary terms, interventions are needed to make sure the basic human rights of adolescents to be free from violence are upheld. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Evaluations adopting cost-benefit analyses have been successful in demonstrating the economic impact of interventions to reduce child marriage in addition to highlighting their important social and cultural role in changing the environment for adolescent women and girls.
The most recent modelling presented in this chapter shows the huge potential economic impact of delaying marriage and enabling their continued schooling. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
As projected, this could result in another 101 million girls completing school in the period to 2050.
This equates to another US$ 7.7 trillion of GDP in present value terms, largely for the LICs and LMICs included in the analysis.
These economic impacts provide the basis for a BCR of 25.9. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Deaths and serious injuries from road traffic accidents are a major issue for young people, but especially for young people in LICs and MICs, with over 70 000 10–19-year-olds being killed and over 450 000 being seriously injured in 2022.
These deaths and serious injuries can be addressed by interventions that have been broadly accepted in the literature as effective and have been well-developed in HICs. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
This study has shown that implementing these interventions represents a very good economic and social investment with BCRs at a 3% discount rate of 9.1.
This would be achieved through the prevention of 870 000 deaths and 6 million serious injuries from 2023 to 2050 with more male than female deaths and serious injuries averted due to the much greater initial rates for males.
Evidence of successful, cost-effective interventions to address suicide is limited, especially outside UMICs.
The Stelmach et al. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The Stelmach et al.
(2022) study found that the BCR for a universal school-based programme based on the findings of Wasserman et al.
(2015) and Ahern et al.
(2018) is a relatively low 3.5.
A targeted hospital-based suicide prevention intervention for adolescents yielded a much higher BCR of 62.0.
82 Adolescents in a changing world. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
82 Adolescents in a changing world.
The case for urgent investment 8. Financing the investment in adolescent well-being The cost of the investment programme for adolescents discussed in this report for the period to 2035 is US$ 2.8 trillion in NPV terms, averaging about US$ 230 billion per annum.
The largest component is for education interventions at approximately US$ 2.3 trillion. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Health follows at about US$ 40 billion and the remainder includes interventions to address child marriage and road accidents, all in NPV terms.
The large component of the total expenditure on education emphasizes its role in addressing multiple aspects of adolescent well-being.
This investment in adolescents would form an important component of the SDGs. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
While almost all of the SDGs have some relevance to the well-being of adolescents, achieving SDG 3 (good health and well-being) and SDG 4 (quality education) for adolescents absorbs a large share of the investment required to achieve the well-being outcomes contemplated in this investment case.
This means that the task of financing this investment case for adolescents is a component of the one to finance the SDGs; they share the same challenges. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Financing social development programmes for LICs and LMICs has never been easy.
In addition to the typically modest domestic capacities, a significant proportion of investment in social development, such as health and education, has come from foreign sources in the form of aid programmes and external borrowings. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
For instance, in LICs, the share of total health spending derived from external funding is 31% (WHO, 2023d), and 13% of education expenditure is official development assistance (ODA) (World Bank, 2023c).
For many developing countries, investment from China through the Belt and Road Initiative has been largely in physical infrastructure. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
While this may have had the effect of freeing up domestic revenue sources for investment in social programmes, for most countries, there has been very little Chinese investment in social expenditure, such as schools and health facilities.
For the last decade, both ODA and World Bank loans and credits have grown at a solid rate. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Western foreign aid, as represented by Development Assistance Committee members, increased from US$ 246.1 billion in 2012 to US$ 335.4 billion in 2021, equating to a compound annual growth rate of 3.5% and increasing as a share of the global GDP from 3.3% to 3.5%.
The rate of growth was increased by a spurt of COVID-related funding between 2019 and 2021.
Prior to 2020, it had been growing at 2.8% per annum. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Reflecting the demands of the COVID-19 pandemic, ODA grew at 6% per annum from 2019 to 2021 with an increase of US$ 9.0 billion in social infrastructure expenditure between 2020 and 2021 (OECD.Stat, 2023).
World Bank lending (International Bank for Reconstruction and Development [IBRD]) loans and International Development Association [IDA] credits) to LMICs increased at 4.9% per annum, in current US dollars, over the period 2012 to 2021, with a COVID-19-induced lift of 10% between 2020 and 2021. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Prior to that, from 2012 to 2019, World Bank loans were growing at an average annual rate of 4.4% (World Bank, 2023e).
Overall, this would suggest that both Western foreign aid and World Bank lending, while not at the levels required to achieve the SDGs, were increasing in line with world economic growth.
For many LICs and LMICs, external borrowings, including those that are at concessional interest rates, are often burdensome. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
As outlined by the UN Global Crisis Response Group (2023), several factors in the post-COVID-19 world have added to the existing challenges.
The level of borrowing is at its highest level.
As shown in Figure 8.1, total public debt for developing countries as a share of GDP has risen from 35% to 60%, and the external public debt share of GDP increased from 19% to 29% over the period 2010 to 2021.
Developing countries have been adversely affected by both falling currency values and rising interest rates. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
External debt servicing as a share of export income almost doubled, increasing from 3.9% to 7.4% over the same period (UN Global Crisis Response Group, 2023).
This increasing debt-servicing load has an impact on available resources for other public expenditures.
As a share of government revenues, interest payments rose substantially for developing countries from 4.2% in 2010 to 6.9% in 2022 and have been growing more rapidly over the past decade than expenditure on health and education. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
83 8. Financing the investment in adolescent well-being The number of countries with a debt servicing load of over 20% of government revenues reached 25 in 2022; a number not seen since 2000 (UN, 2023a). | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Developing countries have sourced an increasing share of their financing requirements from private creditors, which is not only more expensive than doing so from international banks that lend on potentially concessional terms but such creditors are harder to negotiate with should debt restructuring be necessary.
The additional funding required to finance the SDGs therefore coincides with reduced domestic financing capacity in developing countries. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Moreover, the modest rates of growth of ODA and World Bank lending are less than that required to meet the SDGs.
Both suffer from constraints to substantial increases in funding.
A substantial lift in ODA is constrained by high indebtedness and fiscal constraints for HICs.
Fig.
8.1 Developing countries’ increasing external public debt, median values for developing countries, 2010–2021 Notes: Total public debt refers to general government debt. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
External public debt refers to external public and publicly guaranteed debt.
Source: UN Global Crisis Response Group (2023, p9).
Lending by the World Bank and other development banks is constrained by real declines in their capital.
As a share of world GDP, the current value of contributed capital to the World Bank and other development banks is a fraction of the amount given when they were first established. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
For the World Bank, the current amount contributed equates to approximately half of its level in 2000 (UN, 2023a).
The World Bank would require a massive increase in contributed capital to return its lending capacities in real terms to these earlier levels.
The UN has developed a set of reforms for the world development financing structure to help meet the requirements of the SDGs and other sustainability objectives associated with climate change. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
These are grouped under three action areas with 17 specific reform proposals (UN, 2023a, 2023b).
The three action areas are: 1. tackling the rising risks of debt distress and the high cost of public debt; 2. massively scaling-up affordable and long-term financing for development; and 3. expanding contingency financing to countries in need. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
External public debt as share of exports Total public debt as share of GDP External public debt service as share of exports External public debt as share of GDP 140 120 100 80 60 40 20 0 71% 35% 19% 3.9% 112% 60% 29% 7.4% 2010 2020 2018 2016 2014 2012 84 Adolescents in a changing world. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The case for urgent investment In financial terms, the most far-reaching of these is the proposal to increase the paid-in capital of the four main development banks, IBRD (World Bank), African Development Bank, Asian Development Bank and the Inter-American Development Bank, by between US$ 47 and US$ 148 billion from a total of US$ 47 billion.
This is estimated to provide between US $487 billion and US $1.86 trillion in lending capacity, based on a lending multiplier of 10–12 times capital (UN, 2023a, p.9). | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
This would be combined with improved lending terms for LICs and a better approach to blended finance with the private sector.
Other reforms include improved liquidity arrangements for countries in immediate need and longer-term reforms to the sovereign debt architecture that would improve the focus of international lending arrangements on achieving the SDGs and other climate change related funding objectives. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
In its more detailed discussion of the reforms, the UN (2023b) addressed the need to stem the flow of illicit income from developing countries and introduce measures to reduce tax avoidance to protect the domestic revenues generated by multinational corporations.
For some resource-rich developing countries, this is a major cause of lost revenue.
The agenda of reforms outlined by the UN indicates that the issue of funding the SDGs is very much a focus of its support to Member States to achieve those SDGs. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The aims of the initiatives evaluated in this report are consistent with the SDG targets and programmes recommended by the UN.
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