Advancing Equity through Effective Youth Engagement in Public Health to Operationalize Racism as a Public Health Crisis: The Flint Public Health Youth Academy Model
1. Introduction
The Case:
2. Background
While we understand that there are many approaches to youth engagement, and no one model or framework is absolute, we posit that this model can serve as one of the many tools for engaging youth into the public health profession and the effort to operationalize racism as a public health crisis from a youth perspective. We are not reporting research; we are assessing a conceptual model/framework based on science and real-life application for youth programming focused on a public health/social justice issue (racism as a public health crisis).
3. Methods
In the development of our model, we examined 45 articles from the literature on youth engagement including research studies, reviews, theories, models, and frameworks. We identified 15 articles that focused specifically on at least one or more of the following criteria: (1) BIPOC youth mentorship, (2) pipeline/pathway to careers programs and (3) public health workforce, (4) youth empowerment. This review helped us to identify the domains needed in a comprehensive model to effectively engage youth into the field of public health. Furthermore, we wanted a model to address racism and the inequities and negative disparities it produces in the lives of BIPOC communities nationally and globally. Finally, we centered our efforts on Youth Empowerment Theory and the Continuum of Community Engagement.
4. Review of the Literature
5. FPHYA Model
Visibility and branding. Since 2018, the FPHYA has created visibility and branding that is distinct from that of other youth programs in the Flint/Genesee County community. FPHYA has partnered with over 50 local youth programs to provide distinct and unique competencies specific to public health. FPHYA has worked with local community school districts, church youth groups, fraternity/sorority youth mentor groups, and other non-profit entities to provide programming to over 3000 youth. Furthermore, FPHYA youth have presented their programs and findings at national scientific meetings such as the American Public Health Association and the Community-Based Public Health Caucus. This visibility has garnered on-going interest from academic institutions, philanthropic institutions, and state and local agencies wanting to partner with FPHYA interns as consultants for a host of projects including topics such as (1) COVID-19 messaging, (2) environmental health, and (3) mental health, to name a few. The successful visibility and branding of FPHYA provide community support for FPHYA to create a safe space for youth in Flint/Genesee County, Michigan, to have conversations about racism and to begin discussing solutions to address it.
Caped warrior/celebrity model. The FPHYA has engaged with various types of celebrities, whether pop-culture celebrities or celebrities in their respective fields. Jenifer Lewis, movie star and, most recently, TV star in the hit series Blackish, came to the city of Flint shortly after the onset of the Flint Water Crisis and met with the FPHYA and other youth groups in the city. Over time, a relationship was created, and Ms. Lewis, who is a national public spokeswoman advocating for mental health, specifically bipolar disorder, has made appearances on the FPHYA’s “Youth Perspectives” talk show, focusing on mental health. Ms. Lewis is vocal on her social media platforms, which reach millions of viewers, as she continues to highlight racism and its impact on the Flint Water Crisis. FPHYA continues to partner with various celebrities to bring awareness regarding public health and social justice.
Framing public health as social justice. The FPHYA, since its inception, has linked current and relevant social justice issues to public health. The Social Determinants of Health are a staple in the FPHYA curriculum, and lessons on the linkage between the SDOH and health inequities and health disparities connect public health with many of the social injustices that youth see nationally. Racism and discrimination are SDOH. The FPHYA Model provides guidance to empower youth to address those issues. The declaration of racism as a public health crisis provided another opportunity for FPHYA to address and link a social justice issue (racism) to public health frameworks, approaches, and models. Furthermore, it provided an opportunity to use effective community engagement strategies like community dialogues to capture themes, ideas, and recommendations from local youth regarding racism through a public health lens.
Packaging public health with health behaviors. Health behaviors and self-accountability are key features in the FPHYA program. Public health issues like smoking, obesity, diabetes, and community violence often have health behavioral factors associated with them. FPHYA has been actively engaging youth in conversations related to these topics, and, more importantly, providing a platform for youth to share their perspective on these issues. During annual summer camp programming, FPHYA youth have launched several Photovoice projects highlighting these health behavior/health outcome concerns and have recommended policy solutions to support behavior change. More recently, FPHYA has launched a youth perspective health campaign on gun violence, examining behaviors, assessing laws and gun regulations, and looking at the role of self-accountability for both parents and youth.
Public health summer employment opportunities. Summer employment initiatives have been vital for engaging youth in public health and providing academic and professional experience for that trajectory. Initially, FPHYA programming provided summer employment during our summer camps. After the onset of COVID-19, FPHYA youth internships became year-round and not just for the summer. Youth interns supported by FPHYA staff pivoted from in-person programming to virtual programming, which resulted in the launch of the “Youth Perspectives” talk show. To date, we continue to provide monthly stipends to FPHYA youth for developing, facilitating, and evaluating programming initiatives/projects. Furthermore, youth interns from FPHYA are connected to a mentorship team who leverages their networks to provide additional opportunities for employment, internships, and scholarships for FPHYA youth.
6. Discussion
In our case study, we highlighted racism and its negative impact on an entire city caused by a political decision that created the worst modern-day public health crisis of our time. This case is a classic example of the impact racism has on the public health of BIPOC communities and the various and varied health inequities and disparities experienced by those populations. The message, declared all over the country, is clear: racism is a public health crisis. This crisis, framed in the context of public health, calls for a public health response to racism. The need for racial justice in health is evident. In addition, the need to diversify the public health workforce is on-going and important to national efforts to reduce racial and ethnic health disparities. Effective youth mentoring programs can play effective roles in early career exploration and attainment, centering on social justice (as suggested in the FPHYA Model). Combining mentorship with career exploration programs may be essential to BIPOC youth and their communities. These types of experiential learning opportunities can assist youth in creating networks to become effective contributors to public health and social justice issues relevant to our national and global communities. Furthermore, it introduces youth to career pathways to public health and other adjacent careers such as those in medicine, social work, policy, and other disciplines needed to address the social injustices and health disparities that result from inequities caused by systemic and structural racism. The FPHYA Model has worked for Flint and could possibly be a template to be tailored and scaled out nationally.
7. Future Direction and Implications
The FPHYA Model helps address the need for effective youth programming within a social justice context that can contribute to strategies to address racism. In addition, this model can be used to address other social justice issues rooted in health inequities and disparities. Finally, this model was created by academics, community partners, and youth and was revised with input from the broader community. More importantly, this model has been implemented by the FPHYA and has yielded effective engagement and programming for youth in Flint/Genesee County, Michigan.
Linking public health, disparities, and inequities to social justice serves as an effective catalyst for youth engagement. Historically, youth have been involved in most major movements that have made a critical impact in the United States, such as the civil rights and the women’s liberation movements. Youth have significant roles in advancing causes, demonstrating, and mobilizing marches and other protests. Linking this type of youth synergy for the cause of social justice to critical public health inequities is an ideal method and approach for (1) introducing youth to careers in public health; (2) engaging youth in the civic process; (3) creating a platform for youth to form their own agendas; and (4) creating a template from which adults can learn and understand effective intergenerational engagement with youth, especially BIPOC youth, who often feel unseen and unheard.
Public Health:
The FPHYA Model has implications for engaging youth perspective to operationalize racism as a public health crisis. There is no one cookie-cutter template for addressing racism. It is a systemic and complex issue which will call for a systemic and complex response. With more than 240 declarations across the United States, this model can contribute to toolkits, strategies, and approaches that utilize public health approaches to address community and social issues such as racism. More importantly, the FPHYA Model is a public health model designed specifically for youth grounded in science and the theory of youth empowerment and guided by the Continuum of Community Engagement. These two foundational elements have been proven to be effective in the field of public health and beyond. Public health planners, programmers, and recruiters may learn effective youth recruitment and engagement strategies from the FPHYA Model. Given the need for more public health professionals in the workforce, and, more importantly, the need for BIPOC public health professionals, the FPHYA Model can contribute to a national strategy to advance public health by recruiting youth from the communities most impacted by health disparities. This early introduction to the field could be the catalyst for a youth career pathway to public health.
Policy:
The FPHYA Model is an effective strategy for engaging youth in a solution-focused environment. Engaging youth through a public health lens and utilizing community assessments/community dialogues and Photovoice methodologies creates a platform for youth to share their perspectives with local leaders, policy makers, and other relevant stakeholders. The FPHYA Model also underscores the importance of advocacy and community mobilization, which contribute to good civic engagement. Thus, it is critical that policy makers (1) engage consistently with youth; (2) create clear lines of bi-directional communication; and (3) ensure youth-friendly spaces and platforms. If we are to ensure that youth understand and participate in the civic process, which is central to how the country is governed, elected officials and other stakeholders should support youth programming that introduces youth to the policy-making process at all levels of government (city, county, state, and federal).
Equity, Diversity, and Inclusion (EDI):
As the United States continues to diversify and grow, attracting ethnicities from across the globe, the need for representation becomes critical. Advancing EDI should be a pathway to advance youth voice and perspective. The FPHYA Model ensures the EDI of youth in public health concerns, community issues, and social justice efforts. Youth who are often overlooked and usually not engaged have a lot to contribute. They see things differently, they experience things differently, and they hear things differently. As leaders of the present and future, their input, suggestions, feedback, and recommendations are central to advancing our local, regional, national, and global communities. We cannot advocate for EDI with only adults in the room. When we speak of EDI, we must also have our youth in mind, and, more importantly, include them in the processes, strategies, and decisions we make.
8. Conclusions
It is our hope that this model will serve as a guide for youth-empowering programs, especially those serving BIPOC youth. We further hope that the value of mentorship is underscored as a critical component for effective youth engagement. In addition, this model may serve as a blueprint for recruiting and diversifying the public health work force with people representing BIPOC communities. This model can serve as a guide for researchers, public health professionals, youth programmers, civic leaders, and policy makers who desire to include a youth voice and youth perspective.
To the extent possible, this information can be shared with youth programmers and the public, policy makers, school officials, and leaders of various health initiatives to enhance their understanding of effective youth engagement. We also anticipate that the FPHYA Model will be adopted by universities, institutions, organizations, and agencies to effectively provide guidance and direction centering on youth to create transformative change communities across this country.