Global, Regional, and National Mortality Among Young People Aged 10–24 Years, 1950–2019: A Systematic Analysis for the Global Burden of Disease Study 2019

Background Documentation of patterns and long-term trends in mortality in young people, which reflect huge changes in demographic and social determinants of adolescent health, enables identification of global investment priorities for this age group. We aimed to analyse data on the number of deaths, years of life lost, and mortality rates by sex and age group in people aged 10–24 years in 204 countries and territories from 1950 to 2019 by use of estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Methods We report trends in estimated total numbers of deaths and mortality rate per 100 000 population in young people aged 10–24 years by age group (10–14 years, 15–19 years, and 20–24 years) and sex in 204 countries and territories between 1950 and 2019 for all causes, and between 1980 and 2019 by cause of death. We analyse variation in outcomes by region, age group, and sex, and compare annual rate of change in mortality in young people aged 10–24 years with that in children aged 0–9 years from 1990 to 2019. We then analyse the association between mortality in people aged 10–24 years and socioeconomic development using the GBD Socio-demographic Index (SDI), a composite measure based on average national educational attainment in people older than 15 years, total fertility rate in people younger than 25 years, and income per capita. We assess the association between SDI and all-cause mortality in 2019, and analyse the ratio of observed to expected mortality by SDI using the most recent available data release (2017). Findings In 2019 there were 1·49 million deaths (95% uncertainty interval 1·39–1·59) worldwide in people aged 10–24 years, of which 61% occurred in males. 32·7% of all adolescent deaths were due to transport injuries, unintentional injuries, or interpersonal violence and conflict; 32·1% were due to communicable, nutritional, or maternal causes; 27·0% were due to non-communicable diseases; and 8·2% were due to self-harm. Since 1950, deaths in this age group decreased by 30·0% in females and 15·3% in males, and sex-based differences in mortality rate have widened in most regions of the world. Geographical variation has also increased, particularly in people aged 10–14 years. Since 1980, communicable and maternal causes of death have decreased sharply as a proportion of total deaths in most GBD super-regions, but remain some of the most common causes in sub-Saharan Africa and south Asia, where more than half of all adolescent deaths occur. Annual percentage decrease in all-cause mortality rate since 1990 in adolescents aged 15–19 years was 1·3% in males and 1·6% in females, almost half that of males aged 1–4 years (2·4%), and around a third less than in females aged 1–4 years (2·5%). The proportion of global deaths in people aged 0–24 years that occurred in people aged 10–24 years more than doubled between 1950 and 2019, from 9·5% to 21·6%. Interpretation Variation in adolescent mortality between countries and by sex is widening, driven by poor progress in reducing deaths in males and older adolescents. Improving global adolescent mortality will require action to address the specific vulnerabilities of this age group, which are being overlooked. Furthermore, indirect effects of the COVID-19 pandemic are likely to jeopardise efforts to improve health outcomes including mortality in young people aged 10–24 years. There is an urgent need to respond to the changing global burden of adolescent mortality, address inequities where they occur, and improve the availability and quality of primary mortality data in this age group

Newcomers, Migrants, Surgeons: Making Career in the Amsterdam Surgeons’ Guild of the Eighteenth Century

Like many current-day organisations, the Amsterdam Surgeons’ Guild recruited its members from the ranks of locally born citizens as well as migrants. But how a surgeon’s migration status impacted his chances of being admitted by, and making a career within, the Surgeon’s Guild, remained before this day unknown. The current article therefore investigated enrolment lists of apprentices, journeymen, and master surgeons in order to find out how a surgeon’s birth-place origin influenced his chances of a career within the Amsterdam Surgeons’ Guild. While the Guild itself was open to new members born within and outside of Amsterdam, migrants who lacked Amsterdam-based work experience were disadvantaged. These results reveal mechanisms of integration that can be generalised to cases outside the Amsterdam Surgeons’ Guild

Science as collaborative knowledge generation

The COVID-19 pandemic points to the need for scientists to pool their efforts in order to understand this disease and respond to the ensuing crisis. Other global challenges also require such scientific cooperation. Yet in academic institutions, reward structures and incentives are based on systems that primarily fuel the competition between (groups of) scientific researchers. Competition between individual researchers, research groups, research approaches, and scientific disciplines is seen as an important selection mechanism and driver of academic excellence. These expected benefits of competition have come to define the organizational culture in academia. There are clear indications that the overreliance on competitive models undermines cooperative exchanges that might lead to higher quality insights. This damages the well-being and productivity of individual researchers and impedes efforts towards collaborative knowledge generation. Insights from social and organizational psychology on the side effects of relying on performance targets, prioritizing the achievement of success over the avoidance of failure, and emphasizing self-interest and efficiency, clarify implicit mechanisms that may spoil valid attempts at transformation. The analysis presented here elucidates that a broader change in the academic culture is needed to truly benefit from current attempts to create more open and collaborative practices for cumulative knowledge generation

Morality and Social Identity

Moral norms and values are key features of human essence, that provide the standards against which behavior is evaluated. Some moral norms and values are universally endorsed (e.g., “do no harm”), others can be more specific (e.g., “eat no meat”). Professional, cultural or religious groups and communities often define their own unique system of moral norms that true group members are expected to adhere to. These are used to identify ‘proper’ group members, regulate the behavior of individuals, and sanction those who transgress them. This is functional to the extent that such guidelines help provide groups and their members with a unique and distinct social identity. Yet they can also constitute a source of social tension and intergroup conflict. This hallmark feature of human morality represents an important challenge to contemporary societies

Status stress: Explaining defensiveness in members of dominant groups.

This chapter examines an important barrier to achieving more equality in society: The resilience of dominant group members to social change initiatives. We build on relevant theory and research to examine structural and psychological factors that contribute to the emergence of ‘status stress’, i.e., the threat among those high in status due to shifting inter-group status relations. We describe psychophysiological research revealing that as long as status differences are stable, members of lower status (disadvantaged or subordinate) groups show cardiovascular responses indicative of threat (high vascular resistance, low cardiac performance, high blood pressure). However, when status differences become unstable this cardiovascular threat response emerges among members of higher status (privileged, dominant) groups. Importantly, these responses occur autonomously, implying both that they are relatively uncontrollable, and that they may not show up in self-reports. Nevertheless, research that shows the emergence of status stress has a clear and predictable impact on behavior. We discuss the implications of these insights for interventions that seek to overcome defensiveness against social change among members of dominant groups