Flavia Bustreo, Anshu Banerjee, David A. Ross, Thahira Shireen Mustafa, Oommen C. Kurian and Anshu Mohan, “Maternal, Newborn, Child and Adolescent Health and Well-Being: A Critical Agenda for the G20,” T20 Policy Brief, May 2023.
The health and well-being of women, children, and adolescents is central to the development of a country’s human capital and therefore deserves focused attention. Globally, millions of women, children and adolescents are unable to realise their right to health, development and well-being because of poverty, food insecurity, lack of access to quality health services, and the absence of education and social protection policies. In the current era of rapid technological innovations, entire population groups are being left behind, thereby increasing inequities that lead to conflicts and migration, and environmental degradation that sustain the vicious circles of intergenerational poverty. The Covid-19 pandemic and ever-growing threats associated with climate change are further exacerbating the situation.
There are six key reasons for investing in MNCAH&W:
As a platform for international economic cooperation, the G20 has a critical role to play in addressing the challenges to MNCAH&W. Accounting for around 80 percent of global GDP and nearly 60 percent of the global population,[33] the G20 countries’ policies and actions can impact health and well-being outcomes worldwide both through direct improvements in their own country, through national leadership and trailblazing; and through development assistance.[34] The G20, therefore, is critical to achieving the 2030 Agenda. Since its establishment in 1999, the G20 has increasingly prioritised health in its agenda, but, to date, has not directly addressed the issue of MNCAH&W in a comprehensive manner.
The establishment of the G20 Health Working Group (HWG) in 2017 presented an opportunity to develop a shared international agenda on key health and nutrition-related policy issues. Since then, the HWG has been actively involved in addressing various health issues, including those related to maternal and child health.[35] In 2018, the G20 Health Ministers adopted a joint statement that recognised the need to address the social determinants of health and improve health literacy, particularly among women, children, and adolescents.[36] In the same year, the Development Working Group of the G20 launched the Initiative for Early Childhood Development. The initiative promotes a life-course approach and advocates for a multisectoral strategy to improving outcomes for children.[37], [38]
In 2019, the G20 Leaders' Declaration at the Osaka Summit reiterated the G20's commitment to improving global health and called for strengthening health systems, including the promotion of universal health coverage. The declaration also recognised the need to address the health and well-being of women, children, and adolescents, particularly through improving access to quality health services and promoting gender equality.[39]
In 2021, the Health Ministers' Meeting focused on the Covid-19 pandemic and its impact on global health. The G20 Health Declaration adopted at the meeting emphasised the need for global cooperation, solidarity and innovation to address the pandemic and build more resilient health systems. The G20 also further committed to promote the equitable distribution of vaccines and strengthening health systems to address future health emergencies.[40], [41]
The Government of India has identified Universal Health Coverage and improving healthcare service delivery as an important issue among the health priorities[a] for their G20 Presidency in 2023 and has proposed several initiatives for digital health innovation and solutions including the development of a global health data platform, the promotion of digital health technologies, and the establishment of a G20 health task force.[42] India's presidency provides an opportunity to take a major step forward in the G20's commitments to women's, children's, and adolescents' health and well-being.
Despite the G20's recognition of the importance of investing in women's, children's, and adolescents' health and well-being, there are many challenges to effectively addressing their contextual needs including the lack of adequate funding for targeted health programmes. Many G20 countries have limited budgets for health and well-being programmes, and funding for women's, children's, and adolescents' health and well-being is often low on the priority list. Another challenge is the lack of access to healthcare services, particularly in low-income (LICs) and middle-income countries (MICs). Many women, children, and adolescents do not have access to basic healthcare services, including maternal and child health services, adolescent health and/or school health services, age-appropriate sexual and reproductive health services, and mental health services.
The authors thank Bernadette Daelmans (WHO), Kathleen Strong (WHO), Chiara Servili (WHO), Lisa Rogers (WHO), Theresa Diaz (WHO) and Lori McDougall (PMNCH) for their contributions.
The burden of disease and injury during the first two and a half decades of life in the G20
As mentioned in the policy brief, one of the major global achievements of recent times is that mortality rates among young children (under-five years) have been halved since 1990 (Table A1). Although global mortality rates have declined among older children, adolescents and youth, these declines have not been as great in the second or third decade.[A[46], A[47], A[48]]
The G20 countries span those with very low to those with moderately high mortality burdens in these age groups (Figure A1).[A[49]] Among the under-fives, as mortality rates decrease, congenital anomalies make up a greater proportion of under 5 deaths; infectious diseases, and especially acute respiratory infections, diarrhoea and tuberculosis along with preterm birth, birth asphyxia/trauma and sepsis are the leading causes for high mortality countries within the G20 (Figure A2).[A1,A2] The causes of death among older adolescents in 19 of the G20 countries are shown in Figure A3.[A1,A2] It can be seen from this that as older adolescent mortality rates decline, injuries and self-harm become the leading killers, whereas for G20 countries with higher adolescent mortality the causes vary more, but communicable diseases (especially tuberculosis and HIV/AIDS in some countries) and interpersonal violence and unintentional injuries (especially road traffic injuries) are prominent.
While mortality has been declining at different rates across the first two and a half decades of life, burdens from morbidity and the disability it causes have been largely stagnant, so the overall proportion of the burden of disease and injury due to morbidity and disability has increased. Figure A4 [A1, A2] which displays the causes of disability among children under five years of age within 19 of the countries of the G20, shows that, as the mortality burden decreases in this age group from left to right in the figure, the proportion of the burden due to disability caused by protein-energy malnutrition decreases, whereas that due to congenital anomalies increases. Disability due to newborn conditions (preterm birth, birth trauma and sepsis), diarrhoea and asthma is important in all or almost all the countries. Turning to disability In older adolescents (15-19 years), Figure A5 shows that, across 19 countries in the G20, higher mortality countries have greater proportions of their burden of disability from infectious diseases and iron deficiency anaemia, whereas the proportion of the disability burden due to injuries increases in lower mortality countries.[A1,A2] Mental health and substance use disorders are leading causes of disability in this age group across all 19 countries.
The demographic transition related to mortality is demonstrated across the G20 countries (Figure A1). The probability of dying within the first 28 days of life is higher than the probability of dying either during post-neonatal infancy or between first and fifth birthdays in all 19 G20 countries included in Figure A1, except South Africa and Japan. However, there is a particularly strong gradient in neonatal and post-neonatal mortality between countries with the highest under-five mortality and those country with the lowest. In all 19 countries the probability of dying between the fifteenth and 20th birthdays are higher than in the 5-9 years and 10-14 years age groups which have fairly similar, relatively low death rates (Figure A1). Similar patterns are seen for the overall burden of disease and injury measured by disability-adjusted life years (DALYs) lost (Figure A6).
The epidemiological transition across the G20 countries emphasises the increasing importance of mental health and substance use disorders, injuries and noncommunicable diseases, such as congenital anomalies and asthma, while communicable diseases (especially acute respiratory infections, diarrhoea and tuberculosis in young children and tuberculosis and HIV/AIDS in some countries in adolescents) decrease, though still remain important. Congenital anomalies,[A[50]] preterm births,[A5] mental health and substance use disorders,[A[51]] anaemia[A[52]] and interpersonal violence[A[53]], unintentional injuries[A[54]] and self-harm/suicide[A[55]] are priorities across all G20 countries (Figures A7 and A8).
The largest reductions in mortality have been from communicable diseases, though they remain an unfinished agenda (Table A2)[A[56], A[57]], especially since mortality from most communicable diseases is preventable. The reductions in the burden from communicable diseases have increased the relative importance of non-communicable diseases, including premature births, congenital anomalies, anaemia, mental health disorders and of violence, unintentional injuries and self-harm, including suicide. It has also increased the proportion of the burden of disease and injury due to illness and disability.
Table A1. Global mortality rates (0-24 years) and their declines and proportions of deaths, by age [A3]
| Age | Mortality Rate, 2021 | Decline in mortality rate (%) 1990-2021i | Proportion of all deaths before age 25 years (%), 2021ii |
| Newborns (0-27 days) (deaths/1000 livebirths) | 18 | 52 | 33 |
| 1-59 months (deaths/1000 population entering the age range) | 21 | 64 | 38 |
| 5-9 years (deaths/1000 population) | 3 | 70 | 7 |
| 10-14 years (deaths/1000 population) | 3 | 40 | 5 |
| 15-19 years (deaths/1000 population) | 5 | 38 | 8 |
| 20-24 years (deaths/1000 population) | 6 | 33 | 10 |
Key: i Approximate because of rounding in the data
ii Percentages do not add up to 100% because of rounding
Table A2. Global mortality during the first 25 years of life, by major groups of causes of death, 2019[A11, A12]
| Cause of death | Under 5 years (%) | 5-24 years (%) |
| Communicable, maternal, perinatal, and nutritional conditions | 72.3 | 38.5 |
| Injuries | 5.0 | 32.9 |
| Noncommunicable diseases (including congenital anomalies and mental health) | 22.5 | 28.6 |
Figure A1: Probability of dying by age in 19 Member States of the G20

Figure A2: Proportional mortality for children under-5 years by cause in 19 Member States of the G20

Figure A3: Proportional mortality for adolescents 15 to 19 years by cause in 19 Member States of the G20

Figure A4: Proportional disability (years of healthy life lost due to disability (YLDs)) in children under-5 years in 19 Member States of the G20

Figure A5: Proportional disability (years of healthy life lost due to disability (YLDs)) in 15–19 year-olds in 19 Member States of the G20

Figure A6: Burden of disease and injury (disability-adjusted life years (DALYs) lost) in 19 Member States of the G20, by age

Figure A7: Proportional burden of disease and injury (disability-adjusted life years (DALYs) lost) by cause in under-5 year-olds in 19 Member States of the G20

Figure A8: Proportional burden of disease and injury (disability-adjusted life years (DALYs) lost) by cause in 15–19 year-olds in 19 Member States of the G20

[a] Government of India’s health priorities for the G20 Presidency in 2023 include: 1) Health Emergencies Prevention, Preparedness and Response (with focus on One Health & AntiMicrobial Resistance); 2) Strengthening Cooperation in Pharmaceutical Sector with focus on Access and Availability to safe, effective, quality and Affordable Medical Countermeasures (Vaccines, Therapeutics and Diagnostics); and 3) Digital Health Innovations and Solutions to Aid Universal Health Coverage and Improve Healthcare Service Delivery.
[1] Markus Kaltenborn, et al., Sustainable development goals and human rights (Switzerland: Springer Open, 2020).
[2] United Nations, World Population Prospects 2022 (New York, USA; UNDESA Population Division, 2022).
[3] Mark Tomlinson, et al., "What will it take for children and adolescents to thrive? The global strategy for women's, children's, and adolescents' health." The Lancet Child & Adolescent Health 3, no. 4 (2019): 208-209.
[4] Venkatesan P. “Worrying global decline in measles immunisation.” The Lancet Microbe (2022): 3:E9.
[5] Cohen, ZP, et al., “The impact of COVID-19 on adolescent mental health: preliminary findings from a longitudinal sample of healthy and at-risk adolescents.” Front Pediatr. (2021): 9:622608.
[6] WHO and UNICEF. End preventable deaths: Global Action Plan for Prevention and Control of Pneumonia and Diarrhoea. (Geneva, Switzerland: WHO, 2013).
[7] Thomson MC, et al., “Climate Change and Vectorborne Diseases.” N Engl J Med (2022): 387:1969-78.
[8] WHO, UNAIDS, UNESCO et al., Global AA-HA! (Accelerated Action for the Health of Adolescents). Guidance to Support Country Implementation (Geneva, Switzerland: 2017).
[9] World Bank, The human capital project (Washington DC, USA: 2018).
[10] World Bank, The human capital project: frequently asked questions (Washington DC, USA: 2018).
[11] Donald Bundy, et al., "A commentary on the interagency symposium: ‘Building a healthier future: a human capital perspective on health and education’, presented at the European Congress of Tropical Medicine and International Health, Liverpool, UK, October 2019." International health 12, no. 4 (2020): 235-237.
[12] G20, G20 Initiative for Early Childhood Development: Building human capital to break the cycle of poverty and inequality. (Buenos Aires, Argentina: 2018).
[13] G20, G20 Leaders’ declaration: Building consensus for fair and sustainable development (Buenos Aires, Argentina: 2018).
[14] WHO et al., Nurturing care for early childhood development: a framework for helping children survive and thrive to transform health and human potential (Geneva, Switzerland: WHO, 2018).
[15] WHO and UNICEF, Nurturing Care Progress Report (Geneva, Switzerland: WHO, in press)
[16] Peter Sheehan, et al., "Building the foundations for sustainable development: a case for global investment in the capabilities of adolescents." The Lancet 390, no. 10104 (2017): 1792-1806.
[17] Peter Sheehan et al., The economic case for investment in adolescent well-being (Geneva, Switzerland: PMNCH, 2021)
[18] WHO, UHC compendium (Geneva, Switzerland: WHO, 2023)
[19] WHO, Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030). Report to the World Health Assembly by the Director-General. Executive summary (Geneva, Switzerland: WHO, 2023)
[20] UNESCO, Education: from school closure to recovery (Paris: UNESCO, 2023)
[21] World Bank, UNESCO and UNICEF, The state of the global education crisis: A path to recovery. (Washington DC, Paris, New York: 2021)
[22] WHO, Global initiative to support parents (Geneva, Switzerland: WHO, 2023)
[23] WHO and UNICEF, Investing in our future: a comprehensive agenda for the health and well-being of children and adolescents (Geneva, Switzerland: WHO, 2021)
[24] Alice McGushin, et al., "Adolescent well-being and climate crisis: adolescents are responding, what about health professionals?." BMJ; 379 (2022).
[25] Neha Singh et al., "Adolescent well-being in humanitarian and fragile settings: moving beyond rhetoric." BMJ;380 (2023)
[26] Ilona Kickbusch, et al., “The Lancet and Financial Times Commission on governing health futures 2030: growing up in a digital world.” Lancet;398 (2021)
[27] David A Ross et al., “Adolescent well-being: a definition and conceptual framework.” J Adolesc Health;67:472-476 (2020)
[28] Anshu Mohan et al., “Improving adolescent well-being is an urgent global priority.” BMJ;379 (2022) .
[29] PMNCH et al, Global consensus statement: Meaningful adolescent & youth engagement (Geneva, Switzerland: PMNCH, 2020)
[30] WHO, Global Action for Measurement of Adolescent Health (GAMA) (Geneva, Switzerland: 2023).
[31] Every Woman Every Child, The global strategy for women's, children's and adolescents' health (2016-2030) (Geneva, Switzerland: WHO, 2015)
[32] WHO and UNICEF, Protect the promise: 2022 progress report on the Every Woman Every Child Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030) (Geneva, Switzerland: WHO, 2022)
[33] United Nations, Department of Economic and Social Affairs, Population Division, World Population Ageing 2019 (New York, USA: UNDESA, 2020)
[34] UNDP, Beyond Recovery: Towards 2030 (2020)
[35] G20, Health Working Group (2017)
[36] G20, Declaration G20 Meeting of Health Ministers (Mar del Plata, Argentina: 2018)
[37] G20, Initiative.
[38] G20, Building consensus.
[39] G20, G20 Osaka Leaders' Declaration (Osaka, Japan: 2019)
[40] G20, Italian G20 Presidency. Joint G20 Finance and Health Ministers meeting Communiqué (Rome, Italy: 2021)
[41] G20, G20 Rome Leaders’ Declaration (Rome, Italy: 2021)
[42] G20, G20 India Health Track. Ministry of Health and Family Welfare (New Delhi, India: Press Information Bureau, 2023)
[43] United Nations, The 2023 SDG Summit – the High-level Political Forum on Sustainable Development under the auspices of the General Assembly (2023).
[44] PMNCH, 1.8 Billion Young People for Change Campaign and the Global Forum for Adolescents (2023).
[45] United Nations, The Summit of the Future in 2024 (2023).
[46] WHO, Global health estimates (Geneva: WHO, 2019).
[47] United Nations, Levels and trends in child mortality report (New York, USA: UN IGME, UNICEF, WHO, World Bank, United Nations, 2021)
[48] United Nations, Levels and trends in child mortality report 2022 (New York, USA: UN IGME, UNICEF, WHO, World Bank, United Nations, 2023)
[49] WHO, Maternal, newborn, child and adolescent health and ageing data portal (Geneva: WHO, 2023).
[50] WHO, Every Newborn Action Plan (Geneva: WHO, 2023).
[51] WHO, Comprehensive Mental Health Action Plan (Geneva: WHO, 2021)
[52] WHO, Comprehensive implementation plan on maternal, infant and young child nutrition (Geneva: WHO, 2014)
[53] WHO, UNODC, UNDP 2014. Global status report on violence prevention (Geneva: WHO, 2014).
[54] WHO, Injuries and violence (Geneva: WHO, 2023).
[55] WHO, LIVE LIFE: an implementation guide for suicide prevention in countries (Geneva: WHO, 2021).
[56] Jamie Perin et al., “Global, regional and national causes of under-5 mortality in 2000-19: an updated systematic analysis with implications for the sustainable development goals.” Lancet Child Adolesc Health; 6:106-15 (2022)
[57] Li Liu et al., “National, regional and global causes of mortality in 5-19-year-olds from 2000-2019: a systematic analysis.” Lancet Glob Health; 10:e337-47 (2022)
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Flavia Bustreo Vice-Chair Fondation Botnar: and Co-Chair of The Lancet Commission on Gender-Based Violence and Maltreatment of Young People
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Anshu Banerjee Director for the Department of Maternal Newborn Child and Adolescent Health and Ageing World Health Organization (WHO)
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David A Ross Extra-ordinary Professor in Epidemiology and Public Health Institute for Life Course Health Research Department of Global Health Stellenbosch University
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Thahira Shireen Mustafa Technical Lead for Political Engagement and Policy Advocacy Partnership for Maternal Newborn and Child Health (PMNCH)
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Oommen C. Kurian is Senior Fellow and Head of the Health Initiative at the Inclusive Growth and SDGs Programme, Observer Research Foundation. Trained in economics and ...
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Anshu Mohan Senior Strategic Advisor and Lead for Adolescent Well-being Partnership for Maternal Newborn and Child Health (PMNCH)
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