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Archive for the ‘Youth’ Category

In our attempts to encourage people to lead healthier lives, we often make the mistake of bombarding them with facts and stats, do’s and don’ts, assuming the problem is a lack of knowledge. But let’s be honest – most people know that French fries are not the healthiest food in the world, fruits and vegetables are good for you, and that you really ought to exercise regularly.

So, what’s the problem? One aspect of the problem is of course the systems level issues of food access, cost, time and space to be active, etc. that we have mentioned before.

Another aspect though is one of attitude and culture.

Feel Rich, which launched in December, is attempting to address just this (sidenote: the organization’s CEO and others involved were on a SXSW Panel just this past weekend).

Feel Rich’s goal is the creation of a health and fitness culture born from the urban and hip-hop community’s love and respect for music, movement, and entertainment. Their message: health is the new wealth.

As opposed to your typical public health campaign centered on facts, stats, and do’s and don’ts, Feel Rich is attempting to first foster a desire for health (in other words, crafting an attitude and creating a culture that sees health as critical and desirable as wealth), engaging urban youth in a meaningful way that speaks to their interests. In Feel Rich’s own words – “It’s health on your terms, fitness in your style, and food choices that make sense on the streets where you live.” It’s also about making health and wellness cool.

I think it’s an exciting and inspiring approach, and the way the Feel Rich movement taps into attitudes (not just information), reminds me of the baby carrots campaign I’ve written about before. After all, whether we’re talking about the junk food industry, big tobacco, or pretty much any other product we see commercials for, appealing to emotion and attitudes is the way advertising is done. It’s long past due that prevention and health promotion advocates started utilizing this powerful strategy.

Feel Rich ties this powerful appeal to attitude and culture with empowering information on food, fitness, and health, and an array of videos and stories to engage and inspire their audience.  And with over 3 million YouTube views, it looks like they are doing just that.

I’ll close with some food for thought on this topic from David Katz’s most recent Huffington Post article:

“What if health were more like wealth?

  • If health were like wealth, we would value it while gaining it — not just after we’d lost it.
  • If health were like wealth, we would make getting to it a priority.
  • If health were like wealth, we would invest in it to secure a better future.
  • If health were like wealth, we would work hard to make sure we could pass it on to our children.
  • If health were like wealth, we would accept that it may take extra time and effort today, but that’s worth it because of the return on that investment tomorrow.
  • If health were like wealth, society would respect those who are experts at it.
  • If health were like wealth, young people would aspire to it.

This post is cross-posted at http://occupyhealthcare.net 

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As this video from the Center on the Developing Child illustrates, in looking at determinants of health and well being, it is important to consider the enormous influence early childhood and later youth development have on children’s futures. Physical, social, and emotional health and well being, as well as factors related to health and well being such as education and income levels, can often be predicted from childhood exposures. Moreover, brain development research suggests young people are particularly receptive to prevention and youth development interventions and supports, as well as strategies geared towards developing resilience and social competence.

In a 2010 report entitled The Foundations of Lifelong Health Are Built in Early Childhood, the following framework is put forward.

The framework highlights much of what we are striving for here at #occupyhealthcare – public health, community development, primary healthcare – all with the goal of better health across the lifespan.

And while interventions and supports in very early childhood are critical, continuing this support through adolescence is also imperative. Young people who are surrounded by a variety of opportunities for engagement encounter less risk and ultimately show evidence of higher rates of successful transitions into adulthood.

The positive youth development movement centers around cultivating five essential characteristcs, commonly known as the five Cs:

While both early childhood development and positive youth development are extensive fields, with a vast array of research and related programs and policies, this simple introduction establishes the essence of these fields and the link between them and health and well being.

So, what can we do? This week’s action items:

*Support evidence-based positive childhood and youth development programs by volunteering, fundraising and donating, and advocating for policies that help sustain and expand them.

*Be a mentor – January is National Mentoring Month, and what better New Year’s Resolution can we make than to invest in the future by mentoring a child?

(This post is cross-posted at http://occupyhealthcare.net/)

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A couple weeks ago, President Obama proposed $3.5 billion in cuts to the federal Prevention and Public Health Fund as part of the President’s Plan for Economic Growth and Deficit Reduction.

And as the Prevention Institute alerted me to via e-mail, the Senate Appropriations Committee approved a bill on September 21st that “zeroed out funding for the CDC’s Youth Violence Prevention activities – suddenly and without input”.

The e-mail I received pointed out that elimination of this $19.7 million in funding would have a devastating impact on violence prevention efforts across the country and compromises decades of work.

I agree wholeheartedly. Even more frustrating though, is the fact that not only do these cuts to prevention and public health funding affect critical work, they go against the very purpose of these funding cuts, i.e. “economic growth and deficit reduction.”

Cutting prevention funding does NOT help the economy or the deficit. Whether it’s the Prevention and Public Health Fund, CDC’s Youth Violence Prevention efforts, or other funding streams, public health takes a systems level, upstream approach to preventing population-level health problems – this means a lot of public health efforts are targeted at things like helping people find jobs or gain a better education, and making neighborhoods safer and revitalizing communities. These things make our economic situation better, not worse.

As the Prevention Institute points out:

“Cutting prevention may seem to save a few dollars in the short run, but it will cost an enormous number of lives and money in the long run…Prevention shows a 5-to-1 return on investment. Cutting 3.5 billion in prevention would shut the door to as much as $20 billion in potential savings in health care costs in the future.”

And there are a lot of other cost savings too – keeping youth out of the criminal justice system, keeping community members gainfully employed, and more.

I understand that cuts need to be made, but let’s stay away from cutting things that are actually saving us money, shall we?

Pick up the phone, call your senators and representatives (I just did!), and try to make it to clear to politicians and the general public that prevention funding is not merely an expendable cost, but an investment – and one that is far more likely to pay off than pretty much any other.

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The United States spends $60 billion each year on incarceration and has the highest incarceration rate in the world (due more to the length of sentences than the number of individuals incarcerated each year), as this New York Times article details. The only other major industrialized nation that even comes close to the U.S.’s rate is Russia, with others having much lower rates (1/5 the U.S.’s rate or lower). The U.S. has less than 5% of the world’s population but almost 25% of its prisoners, with 2.3 million criminals behind bars, more than any other nation. China is a distant second with 1.6 million people in prison.

And as this NAACP report points out, there’s a lot more to worry about:

–  The majority of the 2.3 million people incarcerated in U.S. prisons and jails are people of color, people with mental health issues and drug addiction, people with low levels of educational attainment, and people with a history of unemployment or underemployment. (According to a 2008 study, 1 in 100 U.S. adults of any age and 1 in 9 black men ages 20-34 are in prison).

–  The nation’s reliance on incarceration to respond to social and behavioral health issues is evidenced by the large numbers of people who are incarcerated for drug offences – nearly a quarter of all those incarcerated.  (And as mentioned here, in 1980, we had 41,000 drug offenders in prison; today we have more than 500,000, an increase of 1200%.)

– During the last two decades, state spending on prisons grew at six times the rate of state spending on higher education.  (And according to a Pew report, total state spending on corrections, the bulk of which is spent on prisons, quadrupled during the past 20 years, making it the second fastest growing area of state budgets, trailing only Medicaid.)

Even worse – much of what we do in terms of incarceration does not seem to be preventing crime, much less helping people escape the various vicious cycles that can lead to things like poverty, crime, substance abuse, poor education, poor health, etc. This can be seen not only in the recidivism rates mentioned above (with about 1 out of 4 American offenders ending up right back in prison within three years of release), but also limited drug offender effects,  negative impacts on family and community, and other issues detailed in this Sentencing Project report. Moreover, as the report goes on to say, “a variety of research demonstrates that investments in drug treatment, interventions with at-risk families, and school completion programs are more cost-effective than expanded incarceration as crime control measures.”

The call is echoed in editorials such as this one, written to describe a consensus reached in a Pennsylvania conference among prosecutors and defenders, victim advocates, prison reformers, and parole officers and judges. The consensus: the need for a change in the justice paradigm, from a system focused primarily on punishment to one emphasizing restorative practices. The editorial goes on to highlight a number of public health strategies as promising alternatives including therapies that address addictive behaviors and mental and emotional disorders.

And there have also been repeated calls to take some of the billions of dollars we spend on incarceration and put it toward education, one of the more recent calls coming from Gaye Tuchman, a University of Connecticut sociology professor, in one of this week’s New York Times Room for Debate articles about Rick Perry’s “plan” for a $10,000 B.A. degree – “New money for education has to come from somewhere,” Tuchman writes. “Why not a new kind of retrenchment: Cut back on imprisonment for some victimless crimes — like marijuana possession — and use the money for higher education. As The New York Times reported in February, arrests for marijuana use have been skyrocketing in New York City alone. Better to educate people than lock them up.”

And indeed better to educate and support high risk youth than lock them up. Let’s target youth in high risk communities (a la “hot spotters”) for intensive tutoring and mentoring support, provision of safe spaces, and more, providing them with role models and people and places to turn to when in distress or in need of help accessing various resources.

John F. Kennedy once said “children are the world’s most valuable resource and its best hope for the future” – let’s invest in this resource and nurture this hope, preventing our children from entering the criminal justice system in the first place.

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At a conference on gang awareness and prevention that I attended last week, I heard folks from a local community service board speak about their work supporting youth in the community through in-school and after school programs. They showed video testimonials from some of the youth they worked with, and it was just amazing to hear these teens’ heartfelt words about the CSB personnel and the impact they had on these young people’s lives as tutors, mentors, role models, and trusted sources of support and advice. These were for the most part high-risk youth, growing up with a number of factors against them – poverty, unsafe neighborhoods, unstable family lives, constant exposure to drugs and alcohol, and more – making the impact of the CSB’s work even more valuable. One girl, breaking into tears, said that this group saved her life.

And it got me thinking…

In Atul Gawande’s New Yorker article “The Hot Spotters”, he talks about how medicine’s primary mechanisms of service, the doctor visit and the E.R. visit, are vastly inadequate for people with complex problems, comparing them to “arriving at a major construction project with nothing but a screwdriver and a crane.”

In some ways, I feel like the way we handle young people in this country is like that too. On one end, you have the regular public education system, which is fine for those of us lucky enough to have grown up in a stable family and neighborhood environment, with all our basic needs and much besides that met. On the other end, you have the highly punitive criminal justice system, which some would argue is necessary to keep dangerous youth off the streets.

I have many qualms about the latter point, but that notwithstanding, there’s still a major problem here: both systems are vastly inadequate for the vast majority of high risk youth in this country, who need one-on-one mentoring and support, consistent role models and safe spaces, etc. that organizations like the CSB I mentioned above provide. This could result in a much healthier, happier, better-educated population of youth that are far more likely to break through the cycles of poverty, substance abuse, etc. that often contribute to their behavior. Neither the traditional education system nor a punitive approach is going to the trick for these youth.

In addition to being punitive, the criminal justice system makes it incredibly hard for young people to get back to living happy, healthy lives – their criminal records make it hard to become gainfully employed and the system does very little to help address the root causes of criminal behavior, and provides little in the way of education or job skills. And as this recent Pew Report details, more than four out of 10 adult American offenders return to prison within three years of their release, suggesting that “the system designed to deter them from continued criminal behavior clearly is falling short”.

Gawande points out in “The Hot Spotters” that if we recruited staffs of primary-care doctors and nurses and social workers, based right in the neighborhoods where the costliest patients lived, staff expenses would be more than covered with the tens of millions of dollars in hospital bills that could be saved.

Similarly, if we recruited staffs of mentors, tutors, social workers, educators, and prevention specialists, based right in the neighborhoods where the highest risk youth lived, expenses would likely be more than covered by the money saved in criminal justice expenses.

Seems like an investment worth making, doesn’t it? If I haven’t convinced you yet, more on U.S. criminal justice statistics and ways to support youth coming in Part II!

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