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Suggested Citation:"3 Engaging Young People." Institute of Medicine. 2015. The Role and Potential of Communities in Population Health Improvement: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18946.
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3


Engaging Young People

Three examples of successful youth-organizing programs were shared during the workshop. Jose Joel Vasquez, a college student and a youth leader at Jóvenes SANOS, and his mentor, Kymberly Lacrosse, a community organizer and the director of Jóvenes SANOS at the United Way of Santa Cruz, described their youth-based advocacy and leadership organization’s work to prevent and raise awareness about childhood obesity in Watsonville, California. Karen Marshall, the executive director of Kids Rethink New Orleans, described how what started as a one-time summer program has grown into a youth-powered movement to improve the youths’ overall educational experience. Julie Willems Van Dijk, an associate scientist and the deputy director of the County Health Roadmaps project at the University of Wisconsin Population Health Institute, reported on a pre-workshop site visit by roundtable members with youth engaged in the United Students program of InnerCity Struggle in East Los Angeles, California, which, after making great progress reducing gang violence, shifted its focus to educational justice. An open discussion was moderated by George Flores, a program manager at The California Endowment, during which many participants considered issues of spread and scale, the challenges of measuring success, and the importance of workforce development and fostering leadership from within the community.

Suggested Citation:"3 Engaging Young People." Institute of Medicine. 2015. The Role and Potential of Communities in Population Health Improvement: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18946.
×

JÓVENES SANOS

Focusing on Obesity

Jose Joel Vasquez and Kymberly Lacrosse described Jóvenes SANOS, which is a Watsonville, Califonia, youth-based advocacy and leadership organization which operates under the auspices of the United Way of Santa Cruz.1 The mission of Jóvenes SANOS, Vasquez explained, is to prevent and to raise awareness about childhood obesity in Watsonville by advocating for policies that promote healthy eating and increased physical activity. Obesity is a nationwide concern. Vasquez noted that in the United States about one-third of adults and approximately 17 percent of children and adolescents aged 2 to 19 years are obese. He added that in California, 15 to 20 percent of children who are 2 to 4 years of age are obese. In Watsonville, Vasquez said, about 50 percent of children are obese, compared to 31 percent [in the city of Santa Cruz, and approximately 38 percent] in the county. Vasquez noted that Watsonville is an agricultural community, known for its fruits and vegetables, yet the local residents generally do not have access to these foods. He said that his mother works in the fields but is rarely able to bring home strawberries from where she works. When she gets out of work late and does not have time to cook, it is easier for her to stop at a fast food restaurant and bring dinner home, he said.

Jóvenes SANOS works both to meet immediate needs and to create long-term sustainable change. The work is rooted in equity, justice, and affordable access, Lacrosse said, with the goal that individuals have easy access to healthy food and to safe places for physical activity. Vasquez highlighted some of the projects that Jóvenes SANOS has been involved in (see Box 3-1). Youth are involved in all of the projects, from conducting surveys and assessing stores to see what can be improved, to presenting their concerns to the city council. In all of these projects, Vasquez said, youth are empowered by seeing that they have a voice at city council and that they can change things in their community.

For example, Vasquez said, Get Out Get Fit is a summer program run by the youth center in Watsonville. Jóvenes SANOS partners with the center to keep youth active for most of the day. Youth advocates also teach a 1-hour nutrition class at the center, mentoring their younger peers (i.e., middle-school students) on how to make healthier choices when they go out to eat or on what they can do to incorporate activity into their lives so they are not just sitting around or watching television.

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1 For more information see http://www.unitedwaysc.org/jóvenes-sanos (accessed August 15, 2014).

Suggested Citation:"3 Engaging Young People." Institute of Medicine. 2015. The Role and Potential of Communities in Population Health Improvement: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18946.
×

BOX 3-1
Jóvenes SANOS Projects

Access to healthy foods

  • Healthy Restaurant Project
  • Healthy Eating Options Ordinance
  • The Healthy Corner Market Project
  • Healthy Options Vending/Vendor Policy

Access to active living

  • Family Fitness Challenge Day
  • Get Out Get Fit summer youth program
  • Built environment advocacy: increasing parks, soccer fields, sporting facilities, bike paths, and safe routes to school

SOURCE: Lacrosse and Vasquez presentation, April 10, 2014.

Other community-based activities include a family fitness challenge day that drew about 350 people last year, Lacrosse said. At the free event, the market and restaurants that Jóvenes SANOS worked with provided free, healthy food, and there were 10 different activities presented by community-based businesses and organizations such as the YMCA, the National Tennis Association, and a local running club.

Lacrosse also discussed the Healthy Options Vending Policy, passed in 2012 by the Santa Cruz Metropolitan District Board in partnership with Jóvenes SANOS. The policy states that 50 percent of the beverage and food options in all vending machines in Santa Cruz METRO transit facilities must be healthy options (meeting nutritional standards set by the Centers for Disease Control and Prevention). In addition, vendors can participate in a healthy vendor award program.

Youth Organizing

Lacrosse described her role as a youth organizer as providing the youth with the space to be their best selves and guiding them and asking them questions to help them develop in their own way. An adult mentor must let go of the idea of fixed agendas and perfect presentations, she said, because the magic is in the youth sharing their lives and stories. The goal is to help them develop and express their voices, not to tell them what to say or to speak on their behalf.

Everyone is welcome to join, and all youth have different assets to share, Lacrosse continued. Not all want to speak publicly or to conduct

Suggested Citation:"3 Engaging Young People." Institute of Medicine. 2015. The Role and Potential of Communities in Population Health Improvement: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18946.
×

surveys, but everyone brings something to the table, and all of them have the ability to grow and stretch themselves. Lacrosse said that she strives for a holistic environment of trust and respect where members share their personal stories and support each other both within and outside the organization. Developing open, authentic relationships is key, she said, and this allows the group to focus and to be effective and powerful because everyone is there for the same reasons.

Vasquez described his first experiences speaking at city council meetings as a shy teen and how he has developed confidence by participating in the group. Members set high expectations for themselves because they know that they represent others who do not have an opportunity to speak up. Making connections and having fun are also key elements, he said. Lacrosse noted that the organization is often asked to speak on other topics and issues (e.g., pesticides), but she said that she feels that Jóvenes SANOS will have more impact if it is clear and strong in its focus on obesity.

Forging Partnerships and Changing Policy

Partnerships and relationships are the foundation of the work, Lacrosse said. People come together because of a shared passion for a healthy community. Although the work starts with Jóvenes SANOS, there is a ripple effect in the community. The relationships that Jóvenes SANOS develops with store and restaurant owners and with city staff and leaders help to solidify this shared commitment to a common goal. There is also a need for relationships with experts. For example, for projects such as the Healthy Restaurant Project and the Healthy Corner Market Project, Lacrosse said it was necessary to bring in professional consultants to work with the markets and restaurants on redesigning their menus to offer healthier options.

Before Jóvenes SANOS can establish partnerships in the community, its members have to make partnerships among themselves, Vasquez said. Members get to know each other’s backgrounds and views. Every week, group meetings start with an icebreaker where members share their “high and low” experiences from the previous week. Sharing these experiences often brings out new ideas to present to the city council. For example, for his low experience one week, Vasquez described a night when police arrived to tell him and several friends they could not continue to play soccer on a local tennis court, which was the only place with lights. This inspired them to approach the city council about getting a lighted soccer field.

In addition to learning how to develop relationships, youth learn the role of policy in creating cultural shifts Lacrosse said. The Jóvenes SANOS

Suggested Citation:"3 Engaging Young People." Institute of Medicine. 2015. The Role and Potential of Communities in Population Health Improvement: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18946.
×

strategy is to study the social problem through data, surveys, ground truthing, and discussions; to form a task force and develop a policy solution that everyone is invested in; and then to approach policy makers with a powerful presentation including both data and how those data relate to the lives of the youth. They share their real life experiences and ask for partners and collaborators to make changes, Lacrosse added.

Learning and Teaching

In youth organizing, Lacrosse said, it is important to stay focused on the vision and the big picture, taking the time to talk about the rationale for the work being done. The details are also important, but organizers must remain flexible in both process and expectations. It is not about sitting in meetings and going over the agenda items, she said. It is also important to see the potential in each other and to provide opportunities for all to participate.

Vaquez said that he has learned that there are many roads to the same end and that there is no single right way to achieve the goal. Accountability, determination, and dedication will get you to where you need to go, he said. And while the end goal is important for Jóvenes SANOS members, is it the journey, not the destination.

Because other communities have expressed interest in Jóvenes SANOS, the group is developing a curriculum with detailed descriptions about what it does, what has worked, and what has not. The vision, Lacrosse said, is to train other youth in other communities, to provide technical assistance for them to start their own groups, and to thereby continue the movement.

KIDS RETHINK NEW ORLEANS SCHOOLS

Kids Rethink New Orleans Schools2 is a youth-organizing program that supports youth becoming thoughtful and capable leaders through the analysis of their own educational experience, said Karen Marshall, the program’s executive director. The program was born out of crisis in 2006, in post–Hurricane Katrina New Orleans. As the Katrina diaspora began to return to New Orleans, Jane Wholey and Betty Burkes, two community organizers in New Orleans, put together what was meant to be a onetime arts-based summer program to make sure that the young people of New Orleans had a voice in the rebuilding of New Orleans schools and to provide an outlet for them to talk about their experiences related to the impact of Hurricane Katrina (including temporarily living and attending school elsewhere in the country). Twenty middle-school students

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2 For more information see http://therethinkers.org (accessed August 15, 2014).

Suggested Citation:"3 Engaging Young People." Institute of Medicine. 2015. The Role and Potential of Communities in Population Health Improvement: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18946.
×

gathered that summer to “rethink” the kinds of schools they wanted to have. At the end of the summer the students pushed for the program to continue, and it is now a year-round program and a 501(c)(3) nonprofit organization. As the Rethink program continued, the students who were no longer in middle school did not want to stop participating, so the organization expanded to include high school students, Marshall said.

Early Initiatives

That first group of students, who called themselves “Rethinkers,” chose school food as their first initiative. For business reasons, many of the school food providers that serviced New Orleans prior to Katrina had decided not to return. The new providers served food that was unrecognizable to most of the returning students. Food is a huge part of the culture of New Orleans, Marshall said, and the poor school food choices were a real issue for the students. A major achievement for the Rethinkers, she said, was getting the food service provider, Aramark, to agree to serve fresh local food in the cafeterias twice a week. This early victory created momentum not only for the young people who were a part of that push for better food, but for the Rethink organization in general, to continue to move forward.

Another early victory for these 20 young people was getting the school district to agree to repair 350 substandard bathrooms in schools across the area, Marshall said. As a result of dis-investment in public schools pre-Katrina, some of the schools were already in disrepair. After Katrina, the disrepair was significant and widespread. Students who temporarily relocated after Katrina had the opportunity to attend schools in different parts of the country, and they were amazed by what other schools had that they did not, Marshall said. When these students returned to New Orleans, they did not see why the New Orleans schools should not also have good facilities, and this spurred them to take action. In addition to getting the school district to repair the 350 substandard bathrooms, the students got hand-washing sinks installed in all of the school cafeterias. Their argument was that students wanted both to be able to wash their own hands and to have school staff wash their hands before serving the food, Marshall said.

Structure and Strategy

Students who want to participate in the middle-school or high-school component generally start in the 6-week Rethink summer program. The program focuses on the foundational skills of youth advocacy, organizing, and leadership. Marshall explained how students explore their indi-

Suggested Citation:"3 Engaging Young People." Institute of Medicine. 2015. The Role and Potential of Communities in Population Health Improvement: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18946.
×

vidual and collective identities and begin to understand how they can connect the struggles in their own lives to what is going on in a larger community. They then collectively identify an issue, research and analyze it, and develop a collective understanding.

During the summer, students also explore historical narratives of oppression and injustice as well as historical narratives of local resistance, particularly by youth and people of color. Currently, there is a strong narrative of marginalized communities in the South “just lying back and taking what is happening,” Marshall said. Students discuss these narratives in four steps: the stock stories that everybody is told (e.g., how to become successful, how you are identified as a “good person”); the concealed stories that are the true experiences of the people on the margins (and often the very opposite of the stock stories); the resistance stories, when people have resisted this marginalization (successful or not); and constructed stories, which are the students’ dreams for a better school and better community.

The concealed stories are not just the negative things that happen, but also the great things that come out of the community—things that others may not understand because they cannot comprehend the back story. To illustrate, Marshall said that when she would return to her native Jamaica and talk about how her life was affected by snow when she lived in Philadelphia, her listeners could not understand. Snow had impacted her life in such an important way, but no one in Jamaica had experienced snow directly, so they could not relate. Generally their only experience of snow was intangible, such as seeing it in a movie, where it might be only portrayed as fun to play in. Sometimes, she noted, you will censor yourself because it is clear your listeners cannot understand the impact these experiences have on you. But if, for instance, you find someone in Jamaica who grew up in Buffalo, New York, you now have your own snow group, and you can talk secretly about having a life that is in some way shaped by your experience with snow. This is not unlike the experiences of the young people in New Orleans who live in a world of concealed stories that others may simply not be able to comprehend. There is good and bad in all of this experiences that shaped who you are and how you talk to people, she said, but it can be challenging to share.

There are also two school-year programs, Marshall said: school-based clubs and year-round action committees. The Rethink School clubs have an average of 8 to 10 Rethinkers who identify and collectively take on issues that they would like to change in their schools. Once an issue is identified, the Rethinkers conduct youth participatory action research, talking to other youth in their own school and in other schools, in order to get a greater sense of what is going on across New Orleans. They then develop recommendations that they bring to the administrators, princi-

Suggested Citation:"3 Engaging Young People." Institute of Medicine. 2015. The Role and Potential of Communities in Population Health Improvement: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18946.
×

pals, and teachers. Marshall stressed that the intent of the approach is not to vilify people or institutions but rather to look at the larger school system and structure and at how people are affected in different ways by policies and practices. Many students try to relate the experiences of the teachers with those of the students on issues such as school food and discipline policies. Marshall said that many schools in New Orleans implement zero-tolerance discipline policies, and Rethinkers say this makes schools a “prison pipeline.” She added that many teachers are uncomfortable with current discipline policies as well, and they feel caught or unable to address larger systemic issues. The Rethink students try to see if these teachers are willing to join their movements and coalitions to address these issues.

The other program involves the citywide action committees. Any student in New Orleans who wants to participate in youth organizing as a Rethinker can join through one of the issue-focused action committees (food justice, garden committee, architecture, digital media, and restorative justice), Marshall said.

In response to a question, Marshall explained that to Rethink, restorative justice is an alternative to punitive disciplinary practices. Rethink partners with the Center for Restorative Approaches to teach schools about alternatives to traditional discipline. In particular, the Center works with teachers and administrators, and Rethink works with young people, so that the zero-tolerance school policy concerning discipline is changed. In a community context, Rethink advocates helping youth to understand how their actions not only harm them as individuals, but also have a broader impact on others. Through activities like solution circles, youth work together to discuss problems and solutions to conflict, including what actions need to be taken to repair relationships and restore members to the community.

Marshall reiterated that a historical understanding of the issues is important, especially with regard to the experiences of people of color in New Orleans in terms of access to food. Somehow, she stated, the idea that people of color do not know how to choose healthy food persists, but the real issue is lack of access to healthy food. Everything Rethink does comes back to shaping identities, understanding historical narratives, and “analyzing the roots and leaves of every issue,” Marshall said.

Overcoming Barriers

A primary barrier to youth organization, not just in New Orleans, but worldwide, is what Marshall referred to as the “cultural norms of adultism.” There are people who want to work with youth and want to respect the youth voice, but if there is a sacrifice that needs to be made it

Suggested Citation:"3 Engaging Young People." Institute of Medicine. 2015. The Role and Potential of Communities in Population Health Improvement: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18946.
×

will be made at the young person’s expense. For example, one might want to hear the youth voice but then schedule meetings at 9 a.m., when students are in school, rather than at 5 p.m., when they can attend the meeting. There also is a tendency on the part of adult allies to tokenize youth, Marshall said, even when they do not intend to. Some people may think it is cute that a sixth-grader is involved in issues, and they may treat youth as token representatives. In this regard, Rethink leaves the decision to the youth as to whether or not they want to be a part of any kind of media activity. Rethink holds press conferences twice per year. If youths decide they want to participate, they are trained in how to interact with the media. Rethink stresses the power of students telling their own stories. The most powerful action students can take is to use the media attention for their own gain.

In 2008, Rethinkers started to use a school food report card, an approach that has been very powerful in overcoming the resistance to change in some schools. The Rethinkers grade every school based on the health, appearance, and taste of the food provided, using surveys of both students and adults. The Rethinkers hold a press conference for the release of the report and invite administrators to make promises about how they are going to change the food. This is also one activity where students learn how to navigate the media and use it to their advantage, Marshall said.

INNERCITY STRUGGLE

The evening before the workshop, several members of the roundtable and the workshop planning committee met with youth engaged in the United Students program of InnerCity Struggle in the Boyle Heights neighborhood of East Los Angeles. An overview of the visit was provided by Julie Willems Van Dijk, who said how humbling it was for her to report on behalf of a whole group’s experience and, particularly, for her to tell someone else’s story. Inspired by an icebreaker activity used by a United Students coordinator during the Institute of Medicine (IOM) site visit the evening before, Willems Van Dijk asked the workshop participants to move to one side of the room or the other depending on their preferred choice of getting up early or staying up late at night; Elvis or the Beatles; Facebook or Twitter; zombies or vampires; and several other youth-oriented choices. Willems Van Dijk said that it was a fun way to get people to begin to interact with one another.

Safe and Healthy Communities

For 20 years InnerCity Struggle has worked to promote safe, healthy, and nonviolent communities in Los Angeles’s Eastside neighborhoods

Suggested Citation:"3 Engaging Young People." Institute of Medicine. 2015. The Role and Potential of Communities in Population Health Improvement: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18946.
×

(Boyle Heights, unincorporated East Los Angeles, El Sereno, and Lincoln Heights).3 Willems Van Dijk explained that the group began with mothers who organized in East Los Angeles around their concern about the gang violence that was causing them to lose many of their sons. They came together to negotiate peace pacts between the gangs and to encourage gang members to sign promises to stop the violence occurring across gang lines in the community. Willems Van Dijk noted that the early 1990s was a particularly violent time in Los Angeles, with the beating of Rodney King and the riots that followed shortly thereafter in response to the acquittal of the police officers involved in the beating.

In the early 2000s, after making great progress in reducing gang violence, InnerCity Struggle shifted its focus to educational justice and improving the school system and facilities in East Los Angeles. Initiatives included implementing culturally relevant curriculum in the schools and ensuring that students had equal access to college preparatory courses across the required subjects (“A–G requirements”). A component of the struggle for educational justice was battling the assumption that children in Eastside did not want to go to college. Willems Van Dijk said that at one point in time, the courses necessary to be admitted to the University of California system were not even offered in East Los Angeles schools.

InnerCity Struggle also focused on getting new schools built. In 2004, for the first time in 80 years, a referendum was passed to build new schools in East Los Angeles. Based on her experience as a school board member, Willems Van Dijk said that she found it astounding that a school district in a growing part of the nation would not build a new school in 80 years. The new schools that were built after the referendum led to reduction of class sizes in overcrowded schools, which had significant positive implications for learning. More recently, InnerCity Struggle has added a focus on restorative justice, working to eliminate punitive discipline practices, passing a School Climate Bill of Rights, and placing a restorative justice coordinator in the schools. There have also been engagement and organizing initiatives around voter recruitment so that these communities are fairly represented on issues of school financing, Willems Van Dijk added.

United Students

United Students organizes the youth at Eastside high schools to transform the quality of their education. Campus clubs meet at several of the schools, and Willems Van Dijk said that there is a system in place to provide students with transportation to the meeting locations when necessary, for example, by being driven by United Students staff. Meetings begin with

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3 For more information see http://innercitystruggle.org (accessed August 15, 2014).

Suggested Citation:"3 Engaging Young People." Institute of Medicine. 2015. The Role and Potential of Communities in Population Health Improvement: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18946.
×

a communication and education session, and Willems Van Dijk described the session that was led by one of the students during the IOM site visit.

A young woman, a high school senior, led an educational session on stereotypes. Willems Van Dijk remarked how impressed she was at how the student effectively engaged the group and personalized the issue for them by, for example, asking people to stand if they or a member of their family had ever experienced being judged because of their appearance. Willems Van Dijk also observed that the group was very respectful of the student presenter.

The student conducted an exercise in which she brought up representatives of different types of people (Mexican, Muslim, gay) and had the group shout out (i.e., acknowledge) the stereotypes of those different populations. She then challenged the group to think about what effects those stereotypes have when individuals belonging to the group being stereotyped embrace them, laugh about them, or perpetuate them. What is the cost to the group when society thinks of it in this way? The student ended her presentation by talking about stereotypes of East Los Angeles (e.g., gangs, drive-by shootings, chickens in people’s yards) and showed a video of a band from East Los Angeles performing on the subject of real life in their neighborhood, including diffusing the stereotypes.4 The video was a strong statement about people coming together as a community, Willems Van Dijk said.

Empowering Students to Become Leaders in Community Improvement

Willems Van Dijk shared her perspective on several lessons learned about the outcomes of InnerCity Struggle’s work as described by staff and students. Students said they were drawn to the program by its success, specifically that it provided both opportunities to address issues that affected their community and opportunities for self-improvement. In addition to academic support, InnerCity Struggle organizers took students on college visits, helped them to sign up and study for college admissions tests, and helped with college applications.

Students also benefited from leadership skill development through speaking up and public speaking. As an example, Willems Van Dijk said that one of the students who participated in the site visit emailed her that same night to thank the IOM visitors for coming and offering to answer

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4 The clip from the video shown by Willems Van Dijk can be viewed as part of the archived footage of Willems Van Dijk’s presentation, available on the roundtable website at http://iom.edu/Activities/PublicHealth/PopulationHealthImprovementRT/2014-APR-10/Videos/Site%20Visit%20Presentation/13-Van-Dijk-Video.aspx (accessed August 15, 2014).

Suggested Citation:"3 Engaging Young People." Institute of Medicine. 2015. The Role and Potential of Communities in Population Health Improvement: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18946.
×

additional questions as needed. This young woman asked for Willems Van Dijk’s business card, followed up promptly, expressed gratitude, and felt confident enough to offer additional assistance.

Students have developed an increased awareness of issues important to their community and what they can do about these issues, including mentoring their peers and sharing awareness with their peers and family. Another element of InnerCity Struggle is that it draws talent and cultivates leaders from within the community, and Willems Van Dijk noted that one of the former United Students members is now the director of academic support for InnerCity Struggle.

Finally, Willems Van Dijk said, language is important in youth organizing. She described how, during the site visit, one of the announcements that student group leaders made was that students had an opportunity to sign up to consult with a television show about life in an East Los Angeles high school and earn a stipend. Based on a question from a student, it became clear that many of the students did not know what a stipend was. Similarly, one of the student leaders talked about the “push out” rate in high schools. She was talking about what is usually referred to as the dropout rate. Willems Van Dijk noted that her choice of words was a powerful reframing of the phenomenon.

Willems Van Dijk referred participants to an article about citizen participation as a ladder, climbing from nonparticipation, through steps of tokenism, to steps of citizen power (Arnstein, 1969),5 and she suggested that the InnerCity Struggle program allows young people in Eastside to move up to the highest rungs of citizen power. In closing, Willems Van Dijk observed, based on her experience working on the County Health Ranking and Roadmaps Program at the University of Wisconsin, that a common element across communities that are truly engaged in moving a culture of health forward is strong youth leadership. She suggested that there is an imperative to develop the youth voice to truly be able to move forward in building the culture of health.

DISCUSSION

A common thread throughout the discussions on youth organizing, as moderator George Flores noted, was human and social capital building, creating very productive and worthwhile aims that direct activity at community improvement. Speakers discussed the process of engaging

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5 Tokenism refers to citizens being informed, consulted, or placated by power holders who maintain for themselves the ability to make decisions on behalf of citizens. Citizen power refers to increasing levels of citizen involvement in direct decision making: partnership, delegated power, and citizen control. Arnstein’s diagram can be seen in Arnstein (1969).

Suggested Citation:"3 Engaging Young People." Institute of Medicine. 2015. The Role and Potential of Communities in Population Health Improvement: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18946.
×

young people so that they contribute to community health and well-being in constructive ways, through growing awareness and building identity, and also providing skills so the young people can gain a voice and move into leadership among their peers and in the community.

Flores suggested that youth participation in helpful activities, habits, and behaviors also influences family members, younger siblings, and community members. Students learn to think differently and learn that they can question authority as long as they are constructive and offer solutions. These programs put the young people involved on a trajectory to be very productive in shaping society, Flores said. Targeting policy, systems, and environmental change through programs such as obesity prevention is a gateway to thinking beyond illness to the overall community conditions that foster community health. Reflecting on this panel and on the keynote address by Manuel Pastor, Flores said that workshop participants came to the conversation not as blank slates, but with all of their own traditions, lessons learned, and other influences. Some participants had experienced harder knocks than others, but all certainly came with points of view that need to be taken into account when working toward community improvement.

David Kindig added his observation that it is not only the effectiveness of these efforts in making policy changes that is important, but also the degree to which some of the youth are growing in leadership potential. He concurred with Marshall that people often think of going up against an enemy or antagonist, but it is the policy or the program, not the people or the institutions, that should be the focus of change efforts.

Scale

The presentations in this session prompted further discussion of spread and scale. Marshall noted that Rethink has been approached by others in Louisiana about starting Rethink chapters elsewhere. While Rethink can relate to what is happening in other places, she said, the group is effective because its work is contextual and deeply rooted in a particular community. As such, rather than starting Rethink chapters elsewhere, the group shares what it has done and the lessons learned in order to support others in starting similar efforts. Another consideration is capacity, and Marshall said that there are only a certain number of Rethinkers that organizers can effectively work with at one time. Rethink is building capacity by taking on high school and college students as interns. However, Rethink is careful not to grow just for the sake of growing. There are other issues and other ways of doing things, Marshall acknowledged, and Rethink also supports and guides students in starting their own movements, their own nonprofits, or other efforts.

Suggested Citation:"3 Engaging Young People." Institute of Medicine. 2015. The Role and Potential of Communities in Population Health Improvement: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18946.
×

Lacrosse agreed with Marshall on capacity as a consideration in scaling up efforts. While acknowledging that there are other health issues in the community, she reiterated that Jóvenes SANOS wants to focus on reducing obesity until the task is complete. Having received a foundation grant, the group plans to pilot the Jóvenes SANOS curriculum in several different communities in California. It is looking for partners to help it identify which communities have the most urgent need and are most similar to Watsonville, so that the efforts can be most effective. All communities are different, but Jóvenes SANOS has certain tools and skills to share, and as part of its focus on equity and justice, it can help guide the communities in defining their issues.

Vasquez said that one way of engaging youth is through mentoring—by adults and other youth—and added that this can be very influential in setting the models that youth choose to emulate. Social media are also incredibly influential in gaining the attention of many youth. Statements and videos that youth post on Facebook and YouTube about their own lives and their own communities can garner millions of hits (i.e., readers and viewers).

Measuring Success

A participant asked whether there had been any formal evaluation or if there was any anecdotal evidence of the impact of the youth-organizing activities on the health of the community. Lacrosse responded that a key measure of success for Jóvenes SANOS is seeing the youth grow into emerging leaders and the increasing influence they have on their communities. Certainly, there is evidence in the built environment where, for example, some of the markets Jóvenes SANOS has worked with now display fewer advertisements for cigarettes and soda, have more healthy advertising, and have healthy foods near the checkout for easy access. Lacrosse noted that each of the five markets the group has worked with is different, and progress cannot be measured the same way in each store. Lacrosse said that at first many restaurants complied with the healthy options ordinance in an effort to get the Golden Carrot Award from the city for the healthiest restaurant. However, after several years interest waned, restaurants no longer complied, and it was discovered that most of the new restaurants did not know about the ordinance or the award. Lacrosse added that it can be difficult to attribute change specifically to Jóvenes SANOS activities. Many restaurants are now making changes on their own (i.e., not as a result of working with Jóvenes SANOS), but these changes may be associated with all of the work Jóvenes SANOS has done to influence the culture and the norms.

Suggested Citation:"3 Engaging Young People." Institute of Medicine. 2015. The Role and Potential of Communities in Population Health Improvement: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18946.
×

Another example of impact was provided by Marshall, who said that after each annual school food report card press conference, the Rethinkers record all of the promises that various administrators have made, and they spend the next year “holding the administration’s feet to the fire” about particular changes. After one school received a grade of F for its food, it reached out to Rethink for help in providing fresh food. Marshall said that the Rethinkers on the garden committee worked with that school to design and build a garden, and they worked with the students to teach them how to take care of it.

Marshall said that the youth participatory action research project at Rethink is partnering with the Institute of Women and Ethnic Studies and several other youth-oriented nonprofit organizations in New Orleans to understand the mental health aspects of youth organizing. She said studies suggest that the process of being involved in organizing, in and of itself, has a positive effect on both physical and mental health. Being able to take action in a particular situation has proven to help many young people dealing with trauma to have a sense of agency and empowerment. On the topic of metrics and data collection, Marshall said that every Rethink project and program is subject to robust evaluation. Because most of what Rethink does is based on participatory pedagogy, the youth design the evaluation and define the metrics of success before the projects starts, and they continually reevaluate the data during and after the project.

Workforce Development

Many participants discussed further the issue raised by Willems Van Dijk of developing talent from within the community. George Isham, a senior advisor at Health Partners, said that part of investing in a community is hiring locally for projects instead of bringing in people from outside who then go home to communities elsewhere. When experts are brought in, he asked, how can their skills and expertise be shared with the community, in turn leading to the creation of meaningful jobs for community members when they leave?

Melissa Simon, an associate professor in obstetrics and gynecology, general and preventive medicine, and medical social sciences at Northwestern University Feinberg School of Medicine and moderator of the third workshop panel, shared her personal experience coming from the “bottom 1 percent in Detroit” and rising through the ranks of academia to a leadership position. She recalled being told many times the things she would never accomplish, including getting into and graduating from college and getting into and graduating from medical school. She reiterated

Suggested Citation:"3 Engaging Young People." Institute of Medicine. 2015. The Role and Potential of Communities in Population Health Improvement: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18946.
×

the importance of youth organizing, noting that what helped her most was being involved in organizing the Latino students at the University of Chicago when she was a student there. “It really was important to me to do the work because it has influenced everything I have done thereafter,” she said. “So, with my lived experience I can bridge to that world.” She said that she hoped to see more people like her return to the communities they came from to help empower others. She noted that physicians who come from underrepresented minority groups are more likely to return to those communities to work. The same thing is true for researchers and community-engaged research and participatory research. It is workforce development, specifically, developing the talent in our communities, that helps individuals come together to participate in eliminating the health disparities which impact population health, she said.

Suggested Citation:"3 Engaging Young People." Institute of Medicine. 2015. The Role and Potential of Communities in Population Health Improvement: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18946.
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Suggested Citation:"3 Engaging Young People." Institute of Medicine. 2015. The Role and Potential of Communities in Population Health Improvement: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18946.
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Suggested Citation:"3 Engaging Young People." Institute of Medicine. 2015. The Role and Potential of Communities in Population Health Improvement: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18946.
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Suggested Citation:"3 Engaging Young People." Institute of Medicine. 2015. The Role and Potential of Communities in Population Health Improvement: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18946.
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Suggested Citation:"3 Engaging Young People." Institute of Medicine. 2015. The Role and Potential of Communities in Population Health Improvement: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18946.
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Suggested Citation:"3 Engaging Young People." Institute of Medicine. 2015. The Role and Potential of Communities in Population Health Improvement: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18946.
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Suggested Citation:"3 Engaging Young People." Institute of Medicine. 2015. The Role and Potential of Communities in Population Health Improvement: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18946.
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Suggested Citation:"3 Engaging Young People." Institute of Medicine. 2015. The Role and Potential of Communities in Population Health Improvement: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18946.
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Suggested Citation:"3 Engaging Young People." Institute of Medicine. 2015. The Role and Potential of Communities in Population Health Improvement: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18946.
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Suggested Citation:"3 Engaging Young People." Institute of Medicine. 2015. The Role and Potential of Communities in Population Health Improvement: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18946.
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Suggested Citation:"3 Engaging Young People." Institute of Medicine. 2015. The Role and Potential of Communities in Population Health Improvement: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18946.
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Suggested Citation:"3 Engaging Young People." Institute of Medicine. 2015. The Role and Potential of Communities in Population Health Improvement: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18946.
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Suggested Citation:"3 Engaging Young People." Institute of Medicine. 2015. The Role and Potential of Communities in Population Health Improvement: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18946.
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Suggested Citation:"3 Engaging Young People." Institute of Medicine. 2015. The Role and Potential of Communities in Population Health Improvement: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18946.
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Suggested Citation:"3 Engaging Young People." Institute of Medicine. 2015. The Role and Potential of Communities in Population Health Improvement: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18946.
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Suggested Citation:"3 Engaging Young People." Institute of Medicine. 2015. The Role and Potential of Communities in Population Health Improvement: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18946.
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The Role and Potential of Communities in Population Health Improvement is the summary of a workshop held by the Institute of Medicine Roundtable on Population Health Improvement in April 2014 that featured invited speakers from community groups that have taken steps to improve the health of their communities. Speakers from communities across the United States discussed the potential roles of communities for improving population health. The workshop focused on youth organizing, community organizing or other types of community participation, and partnerships between community and institutional actors. This report explores the roles and potential of the community as leaders, partners, and facilitators in transforming the social and environmental conditions that shape health and well-being at the local level.

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