The health and well-being of young people in BiH are increasingly threatened by modern lifestyles, the influence of social media, the long-term consequences of the COVID-19 pandemic even five years later, as well as the lack of a systemic response and social awareness. Although BiH inherited a modern system of education, health, and social protection from the period of the former Socialist Federal Republic of Yugoslavia (SFRY), decades of transition, post-war recovery, external shocks, and growing inequalities have significantly weakened the capacities to provide quality services.

The healthcare system in BiH is decentralized and complex. Health competence is divided between two entities and BD BiH, with no Ministry of Health at the state level. There are 13 different health funds and responsible institutions, leading to overlapping jurisdictions, fragmentation, and limited coordination. Although healthcare expenditures amount to about 9.2% of GDP, which is among the highest in the region, health outcomes, staffing, and infrastructure still lag behind the regional average.

In 2024, the outbreak of a measles epidemic highlighted the problem of low vaccination rates and weak institutional trust. By July 2024, more than 7,000 cases had been registered in the Federation of Bosnia and Herzegovina (FBiH) and the Brcko District BiH (BD BiH) alone, including the deaths of two adolescents. The World Health Organization (WHO) and UNICEF called on the authorities to urgently improve vaccination coverage and information-sharing among parents and young people.

Of additional concern is the fact that a significant number of young people in BiH lack health insurance, especially the unemployed and those from rural areas. The health system is based on contributions from formal employment, and the right to services varies depending on status and place of residence. While emergency services are available to everyone, planned and specialist services require valid insurance. The Brčko District BiH has its own health insurance system, while citizens can choose a pension fund between the entities.

Youth mental health is becoming an increasingly serious challenge. According to UNICEF’s report Voices of Youth 2024: Insights from Bosnia and Herzegovina, adolescents are more frequently expressing emotional stress, anxiety, and feelings of discrimination. This is particularly evident among LGBTIQ+ youth, youth with disabilities, and those living in poverty. Although BiH has a developed network of 74 mental health centers, the distribution of services is uneven and often dependent on donor support. The lack of a state strategy further hampers a systemic approach.

Young people in BiH face numerous risks such as poor mental health (with increased suicide rates), peer violence, the rise of psychoactive substance and tobacco use, poor nutrition, physical inactivity, lack of knowledge about sexual and reproductive health and HIV. Society still lacks an organized, reliable, and accessible system of information and counseling for youth. Health professionals are often not sensitive to youth needs, as this population is considered “healthy,” so attention in primary healthcare institutions is mainly focused on the working-age population and the elderly.

Addressing the issues of youth health and well-being requires a multisectoral and multidisciplinary approach that extends from the local to the state level. Key factors include cooperation between the public and non-governmental sectors, decentralization of responsibilities, involving young people in policymaking, and investing in education and preventive measures. Numerous initiatives launched in 2024 and 2025, including those supported by UNICEF, the European Union (EU), and local communities, highlight the importance of digital tools, strengthening mental health, and peer counseling. However, for sustainable change, stronger coordination at the state level, systemic financing, and the inclusion of young people’s voices in all decision-making processes are required.

Main trends in the health condition of young people

When discussing the lifestyle of young people in BiH, it is important to note that the Ministry of Education, Science and Youth of Sarajevo Canton, in cooperation with the Association XY, introduced in 2014 a curriculum template entitled “Healthy Lifestyles” for primary schools. The program was created to familiarize children with the basic aspects of quality life: the importance of proper nutrition, physical activity, and emotional well-being. According to research by Association XY, 33.9% of young people stated that they go shopping at least once a week, while half reported never shopping online. For 39% of respondents, wearing branded clothing was important or very important. Nutrition mattered for 84.5%, while only 1.2% considered it insignificant. However, only 16.7% of young people could financially afford healthy food and branded clothing. Interestingly, 81% believed their physical appearance was important, 48.5% were satisfied with their appearance, while 27.2% expressed high satisfaction.

In terms of consumption, 51% of young people reported never drinking alcohol, while 96% said they had never used soft drugs. Smoking was less prevalent (66.6% never smoked), but it was concerning that 20.3% smoked daily. First sexual intercourse most commonly occurred between the ages of 17 and 18, with 42% regularly using contraception, though 15.5% felt uncomfortable discussing the topic. Overall, 71.6% rated their health as very good or excellent, indicating high awareness of the importance of a healthy lifestyle.

Additionally, 66.3% of youth considered sports important or very important, but 49% rarely or never engaged in sports activities. The main reason cited was the high cost of equipment or membership fees, pointing to economic barriers to accessing sports and recreational activities. Poverty was reported as a concern by 40.8% of youth, further limiting opportunities for regular physical activity beyond the demands of modern sports environments.

Recent data from 2024–2025 highlight additional alarming trends. According to the Voices of Youth 2024 survey conducted by the Center for Development Evaluation and Social Science Research (CREDI) for UNICEF, carried out between August 15 and September 15, 2024 through online and focus groups, 65% of children and youth aged 10 to 30 reported experiencing symptoms of depression or anxiety in the past 12 months, representing an increase compared to earlier years and clearly pointing to mental health challenges.

In addition, the report emphasizes that young people expressed the need for greater availability of inclusive recreational and social activities, as well as better-quality psychological support at the local level.

In the field of mental health, the World Health Organization (WHO) launched in March 2025 the Qualitative Standards for Child and Youth Mental Health, which provide a framework for improving community-based and outpatient services. This was a concrete response to the growing need for a structured and calibrated support system.

Physical activity and sports show positive effects on emotional well-being. An international review in August 2024 on the mental health of young athletes showed that regular physical activity reduces stress symptoms and improves mood.

In conclusion, while statistics from 2014 showed a solid foundation of awareness among youth, the latest data from 2024/2025 underline the emergence of mental health burdens. Depression and anxiety have become significant public health priorities, alongside economic barriers to participating in sports. Urgent action is needed, such as supportive spaces within schools and sports centers, as well as accessible psychological services tailored to young people across BiH, with special emphasis on high-risk populations.

Main Concepts

BiH inherited a social security system that includes health insurance, pension insurance, unemployment and disability insurance, as well as child protection in Republika Srpska (RS). The right to insurance is directly linked to formal employment and paid contributions. Employers deduct contributions from employees’ salaries, not lower than the minimum wage, and transfer the funds to the fund responsible for the worker’s place of residence, in accordance with entity and cantonal rules. Due to the complex administrative structure, health and pension funds operate at the entity level (FBiH and RS), while BD BiH has its own health fund, but no pension fund, since workers choose an entity pension fund for their contributions.

Patients in FBiH and RS are entitled to planned healthcare within the entity of residence, while emergency care is provided at the nearest institution regardless of insurance. Cross-entity access to specialist services is regulated by inter-institutional protocols and agreements. Each insured person receives a health booklet or smart card, regularly updated to confirm contribution payments.

Although the BiH Constitution, harmonized with the European Convention on Human Rights, guarantees healthcare even to the uninsured, in practice coverage is 78% of residents in RS and 86% in FBiH. However, many uninsured, especially youth, postpone preventive check-ups and seek services only when health problems become serious, thereby further burdening the system with high treatment costs without prior assistance.

A WHO analysis from April 2025 showed a decrease in poverty rates due to healthcare expenses in the Federation of BiH from 7% (2015) to 6% (2021), and in RS from 8.5% to 4.3%. These figures point to improved financial protection but show that vulnerable groups, particularly youth, remain at risk of unexpected costs.

Since 2024, BiH has been included in the EU4Health program (with a budget of EUR 4.4 billion for the 2021–2027 period). In July 2024, an Association Agreement was signed, enabling domestic institutions, including public institutes, health funds, and BD BiH, to apply for grants for healthcare system digitalization, non-communicable disease (NCD) prevention, and strengthening the capacities of health workers.

In the work programs for 2024 and 2025, the first calls were launched for developing digital tools and disease prevention, marking a significant opportunity for improving public health in BiH.

These concepts, employment-based insurance, administrative fragmentation, financial risk for youth, and new EU programs aimed at e-health, are key to understanding the context of youth healthcare and social protection in BiH. The next steps in reform include stabilizing the insurance system, strengthening preventive healthcare among youth, and integrating digital solutions with a focus on accessibility and sustainability.