Noncommunicable diseases, or NCDs, are the leading causes of death worldwide. Of the 41 million deaths they claim each year, 15 million occur prematurely to adults between the ages of 30 and 69, often when they are at the height of their economic productivity. And these premature deaths occur disproportionally in low- and middle-income countries. NCDs pose a major threat to the health of populations, place an increasing burden on health systems, and threaten economic growth and development. NCD prevention is a critical priority for addressing the growing epidemic and is also essential for meeting the Sustainable Development Goals’ target to reduce by 2030 the premature mortality from NCDs by one-third. And focusing on youth is a key to reducing premature NCD mortality.
Over 80 percent of all premature deaths from NCDs are due to cardiovascular diseases, cancers, diabetes, and chronic respiratory diseases. These NCDs share four key risk factors: tobacco use, harmful use of alcohol, physical inactivity, and unhealthy diet. These risk factors are all modifiable behaviors that typically start or are established in adolescence and young adulthood. A unique window of opportunity exists now to curb the growing NCD epidemic before young people develop unhealthy behaviors and while many low- and middle-income countries still have relatively young populations. By encouraging positive behaviors and discouraging negative ones among young people as they gain autonomy and more control over their lives, we can reduce premature deaths from NCDs and also set young people on healthier paths for their lives.
The World Health Organization (WHO) estimates that globally more than one of every 10 youth ages 13 to 15 uses tobacco. The maps show current tobacco use or use of any tobacco products in the past 30 days, among youth ages 13 to 15, using the latest data available from 191 countries between 2006 and 2016. Current tobacco use among boys is generally highest in WHO’s Western Pacific Region, followed by the Eastern Mediterranean, Africa, the Americas, and Europe. Among girls, the Western Pacific Region also has the highest rates, followed by Europe, the Americas, Africa, and the Eastern Mediterranean. Tobacco use is the lowest in South-East Asia for both boys and girls. Use varies widely, however, within each region: Tobacco use is typically higher among youth in low- and middle-income countries.
Note: A small number of countries reported data for ages 12 to 17. In such cases, the age category will appear when hovering over a country.
Sources: Jeffrey Drope et al., The Tobacco Atlas, Sixth Edition (Atlanta: American Cancer Society and Vital Strategies, 2018); WHO & Centers for Disease Control and Prevention (CDC), Global School-Based Student Health Survey; WHO & CDC, Global Youth Tobacco Survey.
The tobacco industry targets youth more actively in regions where regulations are weaker and income growth has made tobacco products more affordable, such as parts of Asia and Africa. Without changes in policies, Africa is projected to see the largest increase among world regions in smoking prevalence by 2030. Shifts in social norms are also making tobacco use more acceptable among youth, even among girls. In some countries, including Ethiopia, Nigeria, and Senegal, tobacco use among youth surpasses use among adults. Cigarettes are the most popular tobacco products among youth globally, though other smoked and smokeless products are popular in some regions. Globally, around 25 million youth ages 13 to 15 smoke cigarettes and almost 13 million use smokeless tobacco products. Chewing tobacco and other smokeless tobacco products are popular in South-East Asia. Water pipes, while traditionally popular in the Eastern Mediterranean, are now gaining popularity among young people in other regions. The rising popularity of e-cigarettes and increasing availability of heated tobacco products (that produce aerosols containing nicotine and other chemicals) in some countries are another concern, as they attract youth and are typically addictive. To be effective, policies and programs addressing tobacco use among youth must target all products, not just cigarettes.
The graphs show the share of 13-to-15-year-old students who are current alcohol users or who have had any alcoholic beverages in the past 30 days. The graphs present the three countries with the highest rates in each WHO region with available data between 2012 and 2017 from the Global School-Based Student Health Survey (data on alcohol use among youth is limited, especially for countries and regions where alcohol use is socially taboo or prohibited). Unlike other regions, data for Europe refer to the top three countries with alcohol use at least once a week available in 2013/2014 from the Health Behaviour in School-Aged Children Survey.
Note: *For Europe, data refer to the percent of 15-year-olds drinking any alcohol in the past seven days.
Source: Jo Inchley et al., ed. Growing Up Unequal: Gender and Socioeconomic Differences in Young People’s Health and Well-Being, Health Behaviour in School-Aged Children (HBSC) Study: International Report From the 2013/2014 Survey (Copenhagen: WHO Regional Office for Europe, 2016); WHO & Centers for Disease Control and Prevention (CDC), Global School-Based Student Health Survey.
Alcohol use varies widely across and within regions. Countries with the highest rates of current alcohol use among adolescents are in the Americas, with rates for some countries at or above 50 percent among boys. Eastern Europe also has countries with high use, where around 25 percent of boys report drinking at least once a week. Alcohol use is much lower in South-East Asia, but some countries have alcohol use rates surpassing 20 percent. Girls generally are less likely to drink, but the gap is narrowing in many countries. While alcohol use has declined among youth in some high-income countries, it is projected to increase in low- and middle-income countries as social trends shift and companies target countries with rising economies and sizable populations of young people with disposable income.
Rates of obesity and overweight among children and adolescents ages 5 to 19 have grown alarmingly, according to WHO. In 1975, 1 percent of children and adolescents were obese and 3 percent were overweight. By 2016 those numbers had grown to 7 percent obese and 11 percent overweight. Childhood obesity is linked to the food industry’s marketing of unhealthy foods and drinks that target children. It is also associated with the extensive availability of low cost, unhealthy foods around the world.
Note: A small number of countries reported data for ages 12 to 17. In such cases, the age category will appear when hovering over a country.
Source: Jo Inchley et al., ed. Growing Up Unequal: Gender and Socioeconomic Differences in Young People’s Health and Well-Being, Health Behaviour in School-Aged Children (HBSC) Study: International Report From the 2013/2014 Survey (Copenhagen: WHO Regional Office for Europe, 2016); WHO & Centers for Disease Control and Prevention (CDC), Global School-Based Student Health Survey.
The maps show the share of 13-to-15-year-olds who are overweight or obese, using the latest data available from 132 countries around the world between 2007 and 2017. The share of boys who are overweight or obese boys is generally highest in the Americas and Western Pacific, followed by the Eastern Mediterranean and Europe. The region with the largest share of overweight or obese girls is the Americas, followed by the Eastern Mediterranean, Western Pacific, and Europe. South-East Asia has the lowest rates of overweight or obesity among both boys and girls. Comparable data, especially on Africa, is sorely needed to monitor this serious health threat. While the overweight and obesity rates in high-income countries have stabilized, they are still on the rise among disadvantaged groups, contributing to widening health inequalities, and continue to increase in low- and middle-income countries. Many of these countries now face the double burden of undernutrition with increasing overweight and obesity.
Aside from physical benefits such as maintaining a healthy body weight and developing healthy bones, muscles, and organs, exercise can ward off mental health disorders such as anxiety and depression that many youth experience. Physical activity among youth is also typically associated with lower levels of other NCD risk behaviors, such as tobacco and alcohol use. As low- and middle-income countries rapidly urbanize, work and transportation depend less on physical activity. Heavy traffic, poor air quality, and crime also deter people from engaging in outdoor physical activity. Other factors that reduce people’s exercise levels include the lack of safe, well-lit sidewalks or parks and other recreational spaces. Young people are not only getting less exercise, they are also spending more time on sedentary activities (watching television, playing video games, etc).
One explanation for the increase in sedentary behaviors among youth is an increase in screen-based activities. The line graphs show trends in the share of 15-year-olds who reported using a computer for two or more hours on weekdays between 2002 and 2014 in select countries in Europe. The graphs show countries with the highest and lowest rate of use from each of the four subregions in 2002. All countries, even those with initially low rates of computer use in 2002, show sharp increases over time. Boys overall have higher rates than girls, but girls have much larger increases in the rates over time. The data (not presented here) also showed that while television watching has declined among youth across Europe during the same period, the decline was more than offset by the increase in computer use. Adolescents in low- and middle-income countries are following a similar trend, as computers and other electronic devices become more widely available.
Note: The four European subregions in the boys’ map correspond to Northern (Finland, Norway), Western (France, Germany), Eastern (Hungary, Poland), and Southern (Croatia, Portugal) Europe; those in the girls’ map correspond to Northern (Finland, Sweden), Western (Netherlands, Switzerland), Eastern (Czechia, Russia), and Southern (Greece, Portugal) Europe.
Source: Jo Inchley et al., ed. Adolescent Obesity and Related Behaviours: Trends and Inequalities in the WHO European Region, 2002-2014. Observations From the Health Behavior in School-Aged Children (HBSC) WHO Collaborative Cross-National Study (Copenhagen: WHO Regional Office for Europe, 2017).
Policy changes and new regulations can discourage risk behaviors and facilitate healthy ones. WHO recommends a number of policy options and “Best Buy” interventions for preventing and controlling NCDs.
Tobacco Use
Alcohol Use
Unhealthy Diet
Physical Inactivity
Offer safe and convenient public spaces to encourage physical activity and active transport, such as walking and bicycling.
Increasing young people’s knowledge about NCD risks can encourage them to adopt healthy behaviors. Screening for risk factors and counseling young people can also help them change behaviors and sustain healthy ones. School is a logical place to intervene because young people spend so much of their time there and school-based interventions tend to be cost-effective, with some programs reporting success. WHO recommends “whole-of-school” programs that involve:
Given the many influences in young people’s lives, interventions should also try to reach young people within their broader social and cultural environments. Mass media and social media are also good ways to reach youth with health promotion messages. Mass media campaigns that aim to educate the public are among the “Best Buy” interventions WHO recommends for being cost-effective and feasible. Some of them:
Other WHO recommendations include:
Up-to-date data on young people’s risk behaviors and trends, including those relating to mental health, are essential for identifying needs and setting priority areas, tracking progress, and developing appropriate responses. Data availability, however, varies substantially across countries and world regions. Even when data exist, they may vary in frequency, scope, and methodology, making comparisons across countries difficult. Regular population-level surveillance of the risk factors among youth using cross-culturally comparable measures, along with prompt and wide dissemination of the results in accessible formats, is essential for monitoring progress and ensuring that the best policies and programs to address the current needs of youth are implemented. More up-to-date intervention studies and rigorous evaluations of existing policies and programs, especially in low- and middle-income countries, are also needed to understand what works in what contexts, and which approaches are most cost-effective and sustainable. As the evidence base improves, we can better identify areas requiring immediate attention, prioritize actions, and develop best practices for addressing NCD risk behaviors among young people in different parts of the world.
Read more about youth and NCDs in the latest report supported by the AstraZeneca Young Health Programme and the regional reports in Africa, Asia, Latin American and the Caribbean, and the Middle East and North Africa.
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Jawad Mohammed et al., “The Prevalence and Trends of Waterpipe Tobacco Smoking: A Systematic Review,” (February, 2018) accessed at www.ncbi.nlm.nih.gov/pmc/articles/PMC5806869.
O. Tomori et al., “Preventing a Tobacco Epidemic in Africa: A Call for Effective Action to Support Health, Social, and Economic Development,” (August, 2015) accessed at http://repository.hsrc.ac.za/handle/20.500.11910/2186.
WHO, “Noncommunicable Diseases Fact Sheet” (June 2018) accessed at www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases.
This web feature was produced by Toshiko Kaneda, Ph.D., senior research associate and Michael Orcutt, the Fletcher Summer Intern in International Programs at the Population Reference Bureau (PRB). The authors thank Liam Sollis at Plan International UK for his helpful comments. The Youth and NCDs Data Center and related analytical work were funded by the AstraZeneca Young Health Programme (YHP). YHP is a disease prevention programme with a unique focus on adolescents. It was founded in partnership with Johns Hopkins Bloomberg School of Public Health and Plan International, with local NGO partners implementing YHP programs on the ground. The YHP mission is to positively impact the health of adolescents in marginalized communities worldwide through research, advocacy, and on-the-ground programs focused on NCD prevention.
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