Building the foundations for sustainable development: a case for global investment in the capabilities of adolescents, Peter Sheehan et al., The Lancet (2017)

This study presents findings from models estimating the benefit to cost ratio (BCR)—the average value of an intervention relative to its cost—of various interventions affecting adolescents in a number of low, lower-middle, and upper-middle income countries. Interventions targeting physical, mental, and sexual health included family planning, safe abortion, HIV/STI prevention and care, interventions focused on men who have sex with men, interventions focused on sex workers, interventions focused on injection drug use, and out-of-school youth-focused interventions.

The average BCR showed a $22.4 value for each dollar spent on HPV vaccination programs in a low income country, $12.8 in a lower-middle income country, and $14.0 in an upper-middle income country. For all other health interventions, the average values were $12.6, $9.9, and $6.4, respectively. Notably, the BCR may be higher than actually reported because it only accounted for deaths and serious disabilities averted, healthy life-years gained from mental health and substance-use, and prevention of unwanted pregnancy.

Application to the United States is obviously limited because it is a high-income country, but the results are still promising because even upper-middle income countries show high BCRs for sexual and mental health interventions focused on adolescents. The study supports further research to understand a more robust application of the findings, and it suggests large-scale economic investments in adolescents should be considered an essential element for health and well-being.