‘The State of the World’s Children’ report released by UNICEF examines child, adolescent and caregiver mental health. It focuses on risks and protective factors at critical moments in the life course and delves into the social determinants that shape mental health and well-being.
The COVID-19 pandemic has affected the wellbeing of children the world over. But, the problems which are brought into focus have existed long before the pandemic.
The report explores the mental health disorders which cause children a significant but often ignored burden. An estimated 13% of adolescents between 10 to 19 years reportedly live with a diagnosed mental health disorder. This includes 86 million teenaged kids between 15 to 19 years and 80 million more between 10 to 14 years.
Despite the heavy burden of mental health disorders on children, action is inadequate. There is a heavy health, social, and financial toll on the children, families, communities due to this inaction. Suicide is the fifth leading cause of death for adolescent boys and girls aged 10–19; for adolescents 15–19, it is the fourth most common cause of death.
Despite the high demand for responses that promote, protect and care for children’s mental health, investments are too low and insufficient. To make matters worse, stigma about mental health leads young people away from the support services that are available.
Alcohol’s impact on child and adolescent mental health
The report discusses the impact of alcohol as a risk factor for mental ill health among children and young people. Adverse Childhood Experiences (ACEs), such as violence, abuse, neglect, household alcohol problems, are in turn linked to sexual risk taking, mental health issues, alcohol and other drug problems and violence. Thus, perpetuating a vision cycle.
ACEs are defined as persistent, frequent and intense “sources of stress that children may suffer early in life.” Typically, the term is used to describe adverse events in early childhood, but the age range can include newborns up to 17-year-olds. The ACE concept also includes experiences that occur outside the boundaries of home and family. These experiences can include violence in the surrounding community, the experience of living in unsafe neighbourhoods, homelessness, bullying, discrimination based on race or ethnicity, and income insecurity. The World Health Organizations definition of ACEs reflects this broader approach. It refers to ACEs as “multiple types of abuse; neglect; violence between parents or caregivers; other kinds of serious household dysfunction such as alcohol and substance abuse; and peer, community and collective violence and peer, community and collective violence.”
The UNICEF report outlines alcohol as one of the 24 risk factors across the life course affecting child and adolescent mental health. Alcohol is also linked to other risk factors impacting on children’s mental health. For example, low birthweight is a life course factor affecting mental health of a child that could be caused by parental alcohol use.
According to the report, several factors including parenting, barriers to employment, bullying and peer pressure can impact alcohol use behaviors among adolescents. The most recent data indicates that 36% of boys and 17% of girls aged 15 to 19 have had at least one alcoholic beverage in the last year.
The report provides data on adolescent alcohol use, that is the percentage of adolescents ages 15−19 years who had at least one alcoholic drink at any time during the last twelve months (see table below). Early onset of alcohol consumption is an important indicator for mental health and risk factor for the development of mental and physical health conditions during the life course.
There are six sub-regions with an average of alcohol use onset that is high above the global average, meaning the products and practices of the alcohol industry are causing particular harm.
| Region | Male alcohol use 2016 | Female alcohol use 2016 |
|---|---|---|
| East Asia and Pacific | 44 | 22 |
| Europe and Central Asia | 53 | 34 |
| Western Europe | 75 | 49 |
| Eastern Europe and Central Asia | 31 | 19 |
| Latin America and Caribbean | 41 | 18 |
| North America | 72 | 45 |
| South Asia | 27 | 12 |
| Sub-Saharan Africa | 29 | 12 |
| West and Central Africa | 37 | 15 |
| Eastern and Southern Africa | 23 | 19 |
| Middle East and North Africa | 3 | 1 |
| Least Developed Countries | 19 | 7 |
| Global | 36 | 17 |
Western Europe and North America are the regions with the highest percentage of adolescents taking up alcohol consumption early. Those are the regions with the strongest footholds of the alcohol industry. Notable are the regions where early onset of alcohol use by minors is below the global average, such as Eastern Europe and Central Asia, South Asia, Eastern and Southern Africa, North Africa and the Middle East, as well as Least Developed Countries.
But that all other regions, including West and Central Africa are above the global average of the number of minors consuming alcohol is worrying in the context of the state of the world’s children.
Lost human potential due to risk factor alcohol
New analysis for the State of the World’s Children’ report indicates that the annual loss in human capital arising from mental health conditions in children aged 0–19 is US$387.2 billion (purchasing power parity dollars).
Of this, US$340.2 billion reflects disorders that include anxiety and depression, and US$47 billion reflects the loss due to suicide.
Of the US$340.2billion, anxiety disorders account for 26.9%, behavioural disorders account for 22.6%, and depression accounts for 21.9%.
Alcohol is a major risk factor for anxiety, childhood behavioral disorders, and depression, as well as suicide.
At critical moments of child development, factors based on experience and environment can represent a risk to mental health or can help to protect it. Policy approaches should aim to minimize risk and maximize protective factors.
Risk and protective factors can be organized into three spheres of influence:
- The world of the child focuses on home and care giving settings,
- The world around the child involves safety and security and healthy attachments in preschools, schools and communities; and
- The world at large includes large-scale social determinants – such as poverty, disaster, conflict and discrimination.
Alcohol adversely impacts all three spheres, as outlined in a comprehensive analysis of alcohol’s effects on the Sustainable Development Goals.
The report emphasizes that from newborn to adolescence, positive and negative experiences and environments can have a cascading effect on a child’s or young person’s development. In the early stages of development, positive experiences such as nurturing caregiving and optimum nutrition initiate a cascade of positive development. Conversely, negative experiences – neglect, abuse and persistent extreme stress – increase exposure to other risks.
Exposure in early childhood to risks such as neglect and violence can emerge later in life as difficulties in school, trouble with peers and alcohol use problems. A high dose of exposure to adverse experiences can have consequences that affect cognitive development, physical and mental health, educational achievement and professional success.
The COVID effect on alcohol use and harm
The new report provides some data showing that adolescents, especially boys and young men, consumed more alcohol as a coping mechanism to deal with the pandemic and other mental health issues.
Movendi International has consistently reported news and latest science about alcohol harm in adolescents.
- Recently, the 7th wave of the Growing Up in Australia: The Longitudinal Study of Australian Children (LSAC) found that 16 and 17 year old teens who were permitted to use alcohol in their homes also experienced more harm due to alcohol.
- Another study published in the Drug and Alcohol Review found that the more alcohol an adolescent consumed the higher the odds of causing harm to others.
Big Alcohol puts youth in harm’s way
Despite the harm caused to children and adolescents from alcohol, the alcohol industry continues to target young people through marketing. Contrary to what Big Alcohol says about their commitment to reducing underage alcohol use, the industry was exposed to have made $17.5 billion in sales revenue (in 2016) from alcohol sales to minors in the United States (U.S.).
Marketing by the alcohol industry is a major driver of under-age alcohol use. A growing body of scientific findings illustrates that alcohol marketing is related to youth alcohol consumption, earlier initiation to alcohol use and high-risk alcohol use. With social media and internet becoming increasingly popular, digital alcohol marketing has been linked to increased alcohol use.
A study published earlier this year in the journal Alcohol&Alcoholism found that alcohol adverts commonly appeal to minors. Half of 11 to 17-year-olds surveyed in the UK reacted positively to the adverts featuring Fosters and Smirnoff brands (53% and 52% respectively), and a third reacted positively to an advert featuring the Haig Club brand (34%). Among adolescents who had never consumed alcohol, associations were seen between positive reactions to the adverts and susceptibility to initiate alcohol use in the next year.
That is why the World Health Organization (WHO), together with UNICEF and The Lancet have issued a new Commission on the future for the world’s children where they call out “predatory commercial exploitation” as an existential threat. WHO and UNICEF identify the alcohol industry’s strategy to encourage harmful and addictive activities as extremely deleterious to young people’s health.
The Commission highlights the harmful influence of the alcohol industry – along with other health harmful industries – on the world’s children.
Companies make huge profits from marketing products directly to children and promoting addictive or unhealthy commodities, including fast foods, sugar-sweetened beverages, alcohol, and tobacco, all of which are major causes of non-communicable diseases.”
World Health Organization, UNICEF, and The Lancet Commission on the future for the world’s children
Recommendations from the report: Commitment, communication, action
The report calls for commitment, communication and action as part of a comprehensive approach to promote good mental health for every child, protect vulnerable children, and care for children facing the greatest challenges.
Commitment
Commit means to strengthen leadership to work with a diverse range of partners and stakeholders on clear goals and ensuring investment in solutions and people across a range of sectors. It involves strengthening global leadership and partnerships and investing in support to mental health.
Communication
Communicate means tackling stigmas around mental health, opening conversations and improving mental health literacy. It means amplifying the global conversation on mental health to raise awareness and mobilize all stakeholders to take action and facilitate learning. It also means ensuring children, young people, and people with lived experience are part of the conversation, that they have a voice and can meaningfully engage in the development of mental health responses.
Action on risk and protective factors
Act means working to minimize the risk factors and maximize the protective factors for mental health in key areas of children’s and adolescents’ lives, especially the family and school. It also means investment and workforce development across some key sectors and systems, including mental health services and social protection, and the development of strong data collection and research.
Alcohol policy solutions
There are low-cost evidence based measures governments can actively invest in to prevent and reduce alcohol harm in children, adolescents, and youth, such as the World Health Organization’s (WHO) SAFER package. In terms of alcohol harm on children and adolescents, alcohol policy solutions on pricing, advertising, sponsorship, promotion and legal age laws are specifically useful and effective.
Despite significant gaps, evidence-based programmes and policies have been implemented and tested to promote and protect mental health and care for the most vulnerable children and young people. Many of these efforts are integrated into established parenting, education, social protection, health-care and humanitarian responses. And many can reach across traditional boundaries to involve multiple sectors.
However, the report itself fails to mention alcohol policy solutions are key tools to protect and improve the health, well-being, and development of the world’s children.
We welcome the report and the insights it provides into how our children are faring, especially considering their mental health during the pandemic,” says Kristina Sperkova, International President of Movendi International.
We commend the report’s comprehensive analysis of risk and protective factors and adverse childhood experiences. And our members are committed to promote the recommendations of the report and work for change.
At the same time, the report misses an important opportunity to investigate the global extent of children growing up in households with alcohol problems. And the report misses the opportunity to underline the importance of alcohol policy solutions for the well-being of the world’s children.
We think UNICEF can and should do better, given the pervasive impact of alcohol harm and the science proving how effective the alcohol policy best buys are in promoting children’s health.”
Kristina Sperkova, International President, Movendi International
Parenting support
Parenting for Lifelong Health (PLH), for example, offers a package of evidence-based, cost-effective and home-based parenting programmes that rely on local lay workers in low- and middle-income countries. PLH was officially launched in 2013 by partners including WHO and UNICEF. It features four packages of age-appropriate interactions grounded in evidence about child development issues such as attachment, cognitive development, behaviour management, social learning and problem solving. For adolescents, the interventions have not improved mental health outcomes specifically, but have reduced family violence, depression in caregivers and use of alcohol and other drugs. They have also led to improvements in family finances.
Primary healthcare systems
One of the longer-running initiatives for young people is Headspace, a system of primary health-care centres for young people aged 12–25 in Australia. Headspace integrates mental health into interventions that also provide vocational support and address physical and sexual health and alcohol and other drug use. The intervention also offers online, phone and text messaging services. In addition, Headspace reaches out to primary and secondary schools with tools to help teachers and parents support students with mental health conditions. Some of the centres offer specialized mental health services that care for young people with complex conditions, including psychosis.