key: cord-1008418-7lldbcau
authors: Ross, David A.; Hinton, Rachael; Melles-Brewer, Meheret; Engel, Danielle; Zeck, Willibald; Fagan, Lucy; Herat, Joanna; Phaladi, Gogontlejang; Imbago-Jácome, David; Anyona, Pauline; Sanchez, Alicia; Damji, Nazneen; Terki, Fatiha; Baltag, Valentina; Patton, George; Silverman, Avi; Fogstad, Helga; Banerjee, Anshu; Mohan, Anshu
title: Adolescent Well-Being: A Definition and Conceptual Framework
date: 2020-08-13
journal: J Adolesc Health
DOI: 10.1016/j.jadohealth.2020.06.042
sha: 837fce32679cb4f95b236697930c07532b1e9f79
doc_id: 1008418
cord_uid: 7lldbcau

nan

In 2015, all the member states of the United Nations signed up to the 2030 Agenda for Sustainable Development and its 17 Sustainable Development Goals (SDGs) [1] . SDG 3 aims to "ensure healthy lives and promote well-being for all at all ages." Central to this goal are the concepts of health and well-being. This is at least as true for adolescents (10e19 years) as for any other age group. The United Nations Secretary General's Global Strategy for Women's, Children's and Adolescents' Health (2016e 2030), which aims to "ensure health and well-being for every woman, child and adolescent" within the context of the SDGs, recognizes that adolescents will be central to the overall success of the strategy [2] . Similarly, the World Health Organization (WHO)eUnited Nations International Children's FundeLancet Commission calls for children (defined as <18 years of age) to be at the center of the SDGs [3] . A recent call was also made for Universal Health Coverage to take a comprehensive approach to addressing the health and well-being needs of adolescents [4] .

Adolescent well-being is a personal and societal good in its own right, and at the same time, adolescence is a critical period of the life course when many of the factors that contribute to lifelong well-being are, or are not, acquired or solidified. The direct and indirect effects on adolescents' well-being of the coronavirus disease 2019 pandemic and the responses to it have reinforced the importance of systems being in place to support the well-being of adolescents. But what is adolescent wellbeing? And how do adolescent well-being and adolescent health relate to each other?

As a contribution to answering these questions, the Partnership for Maternal, Newborn & Child Health and the WHO are leading an initiative of the United Nations H6þ Technical Working Group on Adolescent Health and Well-Being to develop a consensus framework for defining, programming, and measuring adolescent well-being [5] . This framework adds to recent work to develop a Nurturing Care Framework for early child development [6] . It is also part of a broader program of work that includes a multistakeholder Call to Action to prioritize adolescent well-being [7] , building momentum for a 2022 "Global Summit on Adolescents," which will review progress and aim to increase political and financial investments for this population group [8] .

Many descriptions of well-being have been developed [9] . Two conceptual approaches dominate discussions: subjective and objective well-being. Subjective constructs emphasize personal experiences and individual fulfillment, which include eudaemonic well-being (e.g., finding meaning in life and experiencing a sense of personal growth), hedonic well-being (e.g., feeling happy and being satisfied with one's own life), as well as others (e.g., optimism) [10, 11] . In contrast, objective approaches define well-being in terms of quality of life indicators such as material resources (e.g., income, food, and housing) and social attributes (education, health, political voice, social networks, and connections) [12] . Such objective indicators commonly reflect capabilities, which include both an individual's functioning and the opportunities provided in a given environment, as argued by Sen [13] . "Relational well-being" emphasizes that an individual's well-being is heavily influenced by their relationships, with wellbeing seen as emerging "...through the dynamic interplay of personal, societal, and environmental structures and processes." [14] .

Indicators to measure adolescent well-being reflect these two concepts to differing degrees. Measures of subjective well-being apply indicators such as the subjective well-being measure used in the Gallup World Poll [15] and psychological need satisfaction and frustration scales [16] , whereas measures of objective wellbeing use indicators such as the Global Youth Development Index [17] , positive youth development indicators [18] , or developmental assets scores [19] .

Based on a scoping of the literature and consultations across the UN H6þ Technical Working Group, youth networks, and adolescent-serving organizations, we propose a short and an expanded definition of adolescent well-being (Box 1). We also propose five interconnected domains for adolescent well-being and the requirements for adolescents to achieve well-being within each of these domains ( Table 1 ). The five domains encompass both subjective and objective constructs and include health as one of the five domains. The domains are also underpinned by gender, equity, and rights considerations. An individual's degree of independence to access opportunities that foster their own well-being will vary across the decade of adolescence. Although important at all ages, adolescent wellbeing may, therefore, require greater adult support at younger ages.

The examples that are given in the subdomains and the requirements to achieve these are illustrative and not exhaustive.

The definition of adolescent well-being and its five domains applies everywhere and is relevant for all adolescents, including males and females, wealthy and poor, and the able-bodied and those with chronic disability, for example. They also emphasize the multidimensional nature of well-being. Therefore, programming to improve adolescent well-being will require a multisectoral approach, and the measurement of adolescent well-being will require multidimensional indicators that encompass all five domains and include both subjective and objective measures. It is for this reason that in addition to working toward a consensus set of health indicators, the multiagency Global Action for Measurement of Adolescent Health initiative led by WHO involves assessing indicators of adolescent well-being, with a view to agreeing on a core set of well-being indicators [20] .

Maintaining and improving the well-being of its citizens is the fundamental duty of all governments, supported by the United Nations, civil society organizations, private sector, families and communities, adolescents, among many others. This requires a clear definition and measurable indicators. Given the multidimensional nature of well-being, spanning five domains, it will be essential that multiple sectors unite behind the common objective of improving well-being, using a common set of definitions, concepts, and indicators. Here, focusing on adolescents, we have proposed the first two of these requirementsda clear definition and description of five domains that underpin a conceptual framework for adolescent well-being, whereas work continues on the development of the common set of indicators and the policy and programming implications of this framework.

Proposed definition of adolescent well-being.

Adolescents thrive and are able to achieve their full potential.

Adolescents have the support, confidence, and resources to thrive in contexts of secure and healthy relationships, realizing their full potential and rights. Safety: Protection from all forms of violence and from exploitative commercial interests in families, communities, among peers and in schools, and the social and virtual environment. Material conditions: The adolescent's rights to food and nutrition, water, housing, heating, clothing, and physical security are met. Equity: There is a supportive legal framework and policies and equitable access to valid and relevant information, products, and high-quality services. Equality: Positive social norms, including gender norms, to ensure equal rights and opportunities for all adolescents. Nondiscrimination: Free to practice personal, cultural, and spiritual beliefs and to express their identity in a nondiscriminatory environment and have the liberty to access objective, factual information, and services without being exposed to judgmental attitudes. Privacy: Their personal information, views, interpretations, fears, and decisions, including those stored online, are not shared or disclosed without the adolescent's permission. Responsive: Has access to a wide range of safe and stimulating opportunities for leisure or personal development.

Emotional Sociocultural Resilience: Equipped to handle adversities both now and in the future, in a way that is appropriate to their evolving capacities and stage of development. Fulfilment: Feels that they are fulfilling their potential now and that they will be able to do so in the future.

Agency: Has opportunities to develop self-esteem, a sense of agency, the ability to make meaningful choices and to influence their social, political and material environment, for self-expression and self-direction. Identity: Has the safe space to develop clarity and comfort in their own self and their identity(s), including their physical, cultural, social, sexual, and gender identity. Purpose: Has opportunities to develop a sense of purpose, desire to succeed, and optimism about the future. Resilience: Has opportunities to develop the ability to handle adversities both now and in the future, in a way that is appropriate to their evolving capacities and stage of development. Fulfilment: Has opportunities to fulfill their potential now and to be able to do so in the future. 

Sustainable development goals

The global strategy for women's, children's and adolescents' health

A future for the world's children? A WHOeUNICEFeLancet Commission

International Association for Adolescent Health, Partnership for Maternal, Newborn & Child Health, Child Health Initiative, UN Major Group for Children and Youth, UNFPA. Adolescent health e the missing population in universal health coverage

Promoting health through the life-course. H6: Harnessing the collective strengths of the UN system to reach every woman, child and adolescent. Geneva: World Health Organization

Nurturing care for early childhood development: A framework for helping children survive and thrive to transform health and human potential. Geneva: World Health Organization

Partnership for Maternal, Newborn & Child Health, WHO, UNFPA, UNICEF, Plan International UK and the Child Health Initiative

PMNCH calls for action on adolescent wellbeing at the ICPD25 Summit

The challenge of defining wellbeing

The impact of subjective wellbeing on mortality: A meta-analysis of longitudinal studies in the general population

Subjective wellbeing, health, and ageing

Subjective wellbeing, objective wellbeing and inequality in Australia

Human rights and capabilities

Relational wellbeing: Re-centring the politics of happiness, policy and the self

Subjective well-being and human welfare around the world as reflected in the Gallup World Poll

Basic psychological need satisfaction, need frustration, and need strength across four cultures

Measuring positive youth development toolkit: A Guide for implementers of youth programs. Washington DC: YouthPower Learning, Making Cents International

User guide for the developmental assets profile

The Global Action for Measurement of Adolescent Health (GAMA) initiativedRethinking adolescent metrics

The authors thank members of the Partnership