The California Adolescent Health Collaborative (CAHC) and our partners work with some of the most vulnerable youth: young people who live in very rural areas without public transportation or access to quality healthcare, foster children who have no family or even consistent school environment, homeless children and very low-income youth who don’t know where their next meal is coming from or where they will sleep the night, commercially exploited children who are treated as commodities, children (disproportionately of color) who have been accused of committing crimes and are incarcerated, young people who become parents before reaching adulthood. CAHC’s Director brings these youth into focus at the tables she sits at:
- The California Partnership to End Domestic Violence’s Leadership Team Addressing Adolescent Relationship Abuse
- The California Department of Public Health’s Office of Health Equity Advisory Committee
- The California Convergence to Counter Childhood Adversities
- The Justice for Young Families Board
CAHC advances equity in three ways: across demographics, across geography, and across sectors.
- Many people think of equity mostly in terms of demographics: people’s health is determined by where they live and grow up, the color of their skin, their employment and social status, who they love, and what’s in their wallets and bank accounts. These circumstances largely determine how social structures shape our health or illness. Biology also shapes our health, and age is one place where the two intersect. Most adolescents are at the peak of health physically, yet they are the most vulnerable to developing mental illness. This is in part due to rapid brain development, but is also impacted by the systems that young people exist within: schools, juvenile justice, foster care, media, healthcare, housing, etc. CAHC strives to address all of these social determinants of health and the inequities they engender as they intersect within California’s adolescent population. We do this by building young people’s capacity to investigate and propose solutions to problems plaguing the institutions they engage with. Some examples include:
- CAHC and Faces for the Future are collaborating with Castlemont High School to collaboratively develop the first Community Health Equity Academy (CHEA) for high school students that we are aware of. CHEA students will not only be engaged as decision-makers in co-developing Academy structures, culture, and learning opportunities, but will also be trained and coached in Youth Participatory Action Research, enabling them to cooperate with industry partners in investigating and acting to improve community health issues, while preparing them for careers in health and adjacent sectors (all of which will benefit from their highly-developed understanding of social determinants of health). This project is funded by Atlantic Philanthropies and Oakland’s Measure N through the Oakland Unified School District.
- We partnered with MISSSEY, an organization whose mission is their name: Motivating, Inspiring, Serving and Supporting Sexually Exploited Youth, to develop and pilot-test a youth-centered health curriculum that enables sexually exploited youth (SEY) to understand and advocate for their own health, that young clients named YEH (Youth, Empowerment, and Health): The More You Know. Our next step is to train youth service providers in organizations that serve SEY and rigorously test outcomes of the training. This project was funded by the Lalor Foundation, and we are currently seeking funding for the next phase
- One of the most powerful social determinants of health is place. Young people who grow up in disadvantaged urban neighborhoods experience myriad threats (and some protective factors) to their health and development, while young people who grow up in rural areas experience different health threats and protections. Such differences are highlighted in California’s Central Valley and Bay Area, two places which are rich centers of agriculture and technology respectively, but yet they are paragons of inequality with accompanying disease pockets in their most marginalized neighborhoods. CAHC connects such communities so that resources, including technology, research, finances, skilled people and lessons learned from experience can be transferred and utilized to improve community health and youth empowerment. We do this by designing and implementing whole programs with organizational partners and participants in both of these geographic areas. Some examples include:
- CAHC facilitates Project PARTNER (Partnering with Adolescents to Ready The Newest Engaged Researchers) in two majority immigrant communities: Chinatown in central Oakland and Livingston, a majority Latino immigrant agricultural community. We’ve developed inter-generational advisory boards with capacity to research community health priorities, at which point they will present to each other and receive feedback. This builds personal connections across the geographic divide and allows people from very different, but physically close, cultures to share their strengths, skills and knowledge for mutual benefit. This project is funded by the Patient-Centered Outcomes Research Institute.
- CAHC coordinates multiple partner organizations, in the Central Valley and the Bay Area, to develop economic opportunities and healthy relationships skills among youth who are students in traditional and continuation schools, youth involved with the juvenile justice system, foster youth, youth who are parents and young people who are homeless. With the Healthy Relationships and Economic Pathways (H-REP) program, we are actively developing skills such as website development among young people in communities that neighbor the Silicon Valley yet remain economically depressed. By pairing this with healthy relationships education, we reduce youth’s chances of being injured or developing diseases as a result of relationship abuse in adolescence or domestic violence in adulthood, while also increasing their chances of economic wellness, which is a strong determinant of health. This program is funded by the Office of Family Assistance of the Department of Health and Human Services.
- The work of disease prevention and health promotion is currently facilitated in three main domains: research, programs, and policy. While labor conducted within each of these domains is dependent upon that done in the other two, few people or organizations conduct their business across these three domains. Research is the purview of people with terminal degrees, by design those people with privilege to access such higher education. Similarly, policy is made by people with social power. CAHC works across those boundaries by training young people in research and advocacy, and incorporating them into program development and decision-making. We do this by partnering with young community members, service providers, and practitioners in our research studies, and building capacity for advocacy among our research team. Some examples include:
- With the support and guidance of Advisory Committee members from universities, nonprofits, and public agencies, CAHC partners with a local nonprofit to design and implement a study of the social and structural facilitators of and barriers to breastfeeding among diverse adolescent mothers. Young mothers joined the research team, making decisions, collecting and analyzing data alongside academic and community researchers. This project is funded by the California Breast Cancer Research Program of the University of California Office of the President (UCOP).
- Our study called META-Oak (the Marketing of E-cigarettes Toward Adolescents in Oakland) includes youth journalists as co-researchers on the team and built the foundation for our advocacy for a cutting-edge city policy to ban flavored and menthol tobacco products. This project is funded by the Tobacco Related Disease Research Program of UCOP and the Tobacco Control Policy Leadership Institute.
To assist in achieving health equity for America’s 42 million plus adolescents, HHS could:
- Collaborate with the state level Offices of Health Equity (OHE), such as the relatively new OHE of the California Department of Public Health, to understand and coordinate the work that they are doing and the strategies that work. Ensure that adolescents are considered as an essential population of people with particular needs and extreme vulnerabilities, along with people of color, sexual minorities, people with disabilities, etc.
- Continue to fund our H-REP program. Continue funding initiatives similar to Looking Beneath the Surface, an initiative of the Administration on Children and Families, but with particular focus on CSEC (commercially sexually exploited children) given that this population requires specific and particular programming.
- Fund community-based participatory research (or YPAR) without mandating a specific health issue be addressed. This would allow for lay researchers and community members to develop partnerships with scientific researchers, developing common language and groundwork in the process of identifying a priority health risk or disease or social determinant of health they have decided together to address. CBCRP of the UCOP has done great work in this area and would be a good funder to work with to learn how to do it well.
- Connect with the American Public Health Association’s Anti-Racism Collaborative, led by Camara Jones, to explore how HHS can specifically support progress toward health equity for all races and ethnicities.
- Explore jointly developing an RFP with the National Institutes of Justice or a similar organization that specifically addresses the need for multiple stakeholders to improve the ability of the juvenile justice system to protect the health of its youth, via both public health programming and better connecting medical care to community providers. This could be done by requiring use of a collective impact or similar strategy to facilitate structured, measurable collaboration.
- Expand funding opportunities that come from the Office of Adolescent Health so that mental health is prioritized equally with physical and sexual health. Currently, the majority of its funding activities seem to be focused on sexual health.
- Develop opportunities to connect youth in rural and urban areas.
- Work with Opportunity Youth United to discuss how HHS/ OASH can support the recommendations to increase opportunity and decrease poverty for the 5.6 million young adults who are disconnected from school and work, the “opportunity youth.”
- Convene other private and public funders to learn from each other and align strategies so that resources are leveraged and targeted to where they can have the most impact. Many funders are moving toward funding core operating support as it allows organizations to be nimble and responsive in their pursuit of their mission. Funding organizations to contribute to health equity in this way could be very effective.