Offline: Young people—from listening to leadership

Abstract

The hypocrisy of global health can be suffocating. Writing in their 2016 Lancet Commission on Adolescent Health and Wellbeing, George Patton and colleagues argued for the “establishment of forums for meaningful youth participation”. Such forums should strengthen “mechanisms for the meaningful participation of adolescents in the design, communication, and implementation and monitoring of policies and practices that affect their health and wellbeing. This is particularly important for socially and economically marginalised adolescents”. Such enhanced engagement could be a powerful force for social change and would require “financial investment, strong partnerships with adults, training and mentorship, and the creation of structures and processes that allow adolescent and young adult involvement in decision making”. Although the Commission's recommendation was widely endorsed, and although young people are increasingly given platforms to express their views (witness the inspirational voice of Greta Thunberg in leading action to address the growing climate crisis), the difficult truth is that young people are rarely invited to contribute to shaping the future of their societies. They are rarely invited to shape the future of global health, despite the platitudes of global health leaders. But there is one example of serious engagement with young people that should stimulate greater attention to the ideas and opinions of new generations. The annual Arab Youth Survey is a spectacular exercise in youth participation. The results of the 11th survey were published last month and revealed a dramatically different vision for the Arab world than is typically displayed in western news media. Young people in the Arab world are the overwhelmingly dominant demographic—two-thirds of the Arab population is under 30 years of age. 3300 Arab men and women (the sample was split 50:50) aged 18–24 years were interviewed across 15 countries and territories, including Saudi Arabia, Egypt, Jordan, Lebanon, Iraq, Algeria, Yemen, and the occupied Palestinian territory. The findings represent the views of 200 million Arab youth. Contrary to western stereotypes, young Arabs report that religion plays far too large a part in Middle East affairs. They want religious institutions to be reformed. Three-quarters of Arab youth describe the quality of education in their country as unacceptable. More than half want to leave to pursue higher education in the west. Young people in Arab countries want an end to regional conflicts. A majority describe drugs as easily accessible, with drug use on the rise. Mental health is a top health priority for Arab youth, and they argue that access to high-quality mental health care is poor. The health priorities in the Arab world are not surprising, given political tensions across the region. 31% of Arab young people know someone suffering from a mental health condition. And 50% say that mental health problems are stigmatised. Around 90% of young Arabs believe governments have a responsibility to provide health care to all citizens. And for young Arabs social media is seen as more trustworthy than traditional media. The biggest obstacles facing Arab countries are the rising costs of living, unemployment, lack of Arab unity, slow economic growth, the Palestinian–Israeli conflict, civil war in Syria, the threat of terrorism, lack of democracy, loss of traditional values, and lack of political leadership. In an overview of these findings, Afshin Molavi concludes that the survey reveals “the pragmatic desires of Arab youth for jobs, security, better education, and more government accountability, while rejecting terrorism, extremism, and corruption”. But who is listening? Not Arab political leaders. Young people must be given not only voice but also power to shape their futures. This power is their fundamental right. Despite advocacy for greater youth engagement, much of what passes for participation is still little more than tokenism and lip service. Power is rarely given to young people. Yet, as George Patton and colleagues showed, “adolescents are emotionally primed to engage”. The denial of engagement will increase the risk of later life mental ill health or, worse, violent extremism, even terrorism. Young people in every nation are entitled to express their views and visions for their futures. It is then up to political leaders to create the means to channel those ideas into a political process for action. The fact that they do not is a monumental betrayal of their people.