Engaging Youth in Policy Making to Promote Health

Practice Matters, September 2014

A publication of the Act for Youth Center of Excellence

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by Christine T. Bozlak, PhD, MPH

About the Author

Christine T. Bozlak is an assistant professor in the Department of Health Policy, Management, and Behavior at the University at Albany School of Public Health.

Introduction

Adolescents are frequently the target of public health policies and programs. The goal of these interventions is to change behavior in the hope of preventing related health problems, such as sexually transmitted diseases, obesity, and tobacco-related illness. Although societal-level interventions, such as policies, have proven to be effective in some areas of public health related to adolescents (van Sluijs, McMinn, & Griffin, 2007; Catalano et al., 2012), there is concern that their effectiveness can be limited (Santelli et al., 2006; Lovato, Sabiston, Hadd, Nykiforuk, & Campbell, 2007). The positive youth development (PYD) philosophy suggests that when youth are involved as advocates for their own health and well-being, policies and programs are likely to be more effective. In this article, I discuss the benefits of youth participation in public health efforts, provide examples of youth participation in the policy-making process, and offer recommendations for engaging youth in policy-related activities.

Youth Participation and Civic Engagement 101

Youth participate in society in many ways, including, but not limited to, participation in sports, the arts, their schools, and volunteering in their communities (Moore & Lippman, 2005). For the purpose of this article, youth participation is "a process of involving young people in the institutions and decisions that affect their lives" (Checkoway, 2011b).

Civic engagement -- taking action to create social change -- is one form of youth participation (Checkoway, 2011a). While younger adolescents are not allowed to vote, their civic participation can take the form of grassroots campaign involvement, advocacy on issues that impact them, and utilizing social media to voice their opinion and concerns (Thackeray & Hunter, 2010). It is clear that youth are capable of participating in a civic and political manner, but their participation may be limited due to structural and societal barriers outside their control (Checkoway, 2011b; Flanagan & Levine, 2010; Hyman & Levine, 2008).

Benefits and Considerations of Youth Civic Engagement

Those of us who have worked in youth development and/or adolescent health are quite familiar with the term "risk behavior." Historically, programs for adolescents have been designed to decrease behaviors in youth that lead to the principal causes of morbidity and mortality in this population (DiClemente, Santelli, & Crosby, 2009). However, the PYD approach emphasizes protective factors, which strengthen young people's resiliency and foster positive outcomes rather than solely decreasing risk behaviors.

Civic engagement is considered a protective factor for youth. It has been shown to help youth transition into adulthood by helping them critically reflect upon their values, develop their identities, and contribute to their communities (Flanagan & Levine, 2010; Youniss & Yates, 1997). Opportunities for civic engagement can also contribute to an adolescent's understanding of the societal forces that impact an individual, as well as skills necessary to confront these forces (Watts & Guessous, 2006).

Although there is evidence of the benefits of civic engagement to youth, one must keep in mind that there are varying types and degrees of youth civic engagement -- many of which have not been studied for their impacts. Thus, the potential for negative impacts of civic engagement on youth cannot be dismissed (Levine, n.d.). For these reasons, we need to be mindful of emerging best practices in purposeful, deliberate, and authentic youth civic engagement (National League of Cities, 2010).

Examples of Youth Civic Engagement

The following are examples of youth participation in advocacy and the policy process:

Recommendations

Drawn from research and practitioner experience, these recommendations are worth consideration when engaging youth in policy making:

  1. Critically reflect upon your view of youth participation and civic engagement. The National League of Cities (2010) advocates for "Authentic Youth Civic Engagement" that allows youth to take on meaningful roles in the policy process, avoiding the pitfall of tokenism. As adults, we may lack awareness of the barriers we create for youth engagement. In order to more authentically engage youth in a civic manner (National League of Cities, 2010; Watts & Flanagan, 2007), we must reflect on our own perceptions of adolescents, how these perceptions impact our willingness or unwillingness to work with youth, and how we need to modify these perceptions to fully empower youth in any civic activity that impacts their lives and their communities. Youth-adult partnerships (Zeldin, Camino, & Mosk, 2005) are critical to effective decision making and policy making.
  2. Start early. Children are never too young to engage in a civic manner. Although many of the examples I cite in this article profile organizations that engage individuals in their later adolescence, in my research, I found that youth as young as nine were able to articulate policy changes that they would like to see implemented in their community to improve their well-being (Bozlak, 2010). Be inclusive of all age groups, and modify activities according to participants' cognitive level.
  3. Engage ALL youth -- especially those who are the most vulnerable and in need of having their voice heard. Morbidity and mortality data demonstrate that the youth most at risk of using substances, engaging in risky sexual activity, and practicing other risk behaviors are typically those who are the most vulnerable in our society (DiClemente et al., 2009). These include, for example, youth with special health care needs, in the foster care system, and/or from low income families, as well as those who are refugees and immigrants. One excellent example of a group of New York youth who "have been labeled in a state system" and who are empowering themselves for organizing and advocacy purposes is YOUTH POWER! (YOUTH POWER!, 2013).
  4. Meet where youth are. This key principle in community organizing and public health literature (Minkler & Wallerstein, 2002) should be applied to youth. It is not uncommon for adults to hold meetings during times when youth are unavailable (i.e. during the school day). In order to fully engage youth, meetings and other activities should be held on a day, time, and location that accommodates both youth and adults. Also, opportunities to engage youth in policy and advocacy-related activities via social media should be explored (Thackeray & Hunter, 2010).
  5. Allow youth to generate the problem AND the solution. Youth are increasingly engaged in community assessment activities, such as Photovoice, to identify problems (Wang et al., 1998; Strack, Magill, & McDonagh, 2004). It is also important to sustain youth involvement when identifying and implementing solutions, when opportunities to advocate for local policy changes might occur.
  6. Offer advocacy training for all. The United Nations Convention on the Rights of the Child (United Nations, 1989) emphasizes the need for freedom of expression through any form of media. Although people often naturally engage in advocacy for their own well-being, this skill needs to be fostered and developed. This is true for youth (Sherrod, 2006) as well as adults. Advocacy training may include topics such as understanding the policy-making process, grassroots mobilizing techniques, and effective communication with decision makers.
  7. Remember that youth can contribute evidence for a policy. Allow youth to tell their own stories. In policy-related campaigns, there may be the perception that the adult perspective is the only expert perspective. However, youth are seen as credible advocates by decision makers. They also have their own expert opinion and perspective to share on the subject matter (Bozlak & Kelley, 2010).
  8. Evaluate youth participation in the policy-making process. Civic engagement opportunities, such as youth participation on advisory councils and committees, need to be carefully planned to reap benefits (Matthews, 2001). Thus, it is important to evaluate youth participation in any policy-making process (coalition, advocacy campaign, etc.) or other civic activity to ensure that the activity is empowering for young participants (Bozlak & Kelley, 2010; Checkoway & Richards-Schuster, 2003). Evaluation can tell us if goals for youth participation are being met, including whether youth are benefiting from the experience and are empowered in the process. It is advised that both adults and youth be interviewed as part of the evaluation (Bozlak & Kelley, 2010).
  9. Institutionalize youth engagement in decision making. Set a policy for authentic youth engagement in decision making at the institutional level, especially if your organization serves youth or impacts young people. Youth can be included effectively in advisory boards and councils as well (Municipal Research and Services Center, 2012), but again, evaluation of their participation is necessary. The National Association of County and City Health Officials (2014) has created a "Policy Statement on Positive Youth Development Approaches in Adolescent Health," and is implementing a federally-funded "Strengthening Youth Engagement" project that is designed to help local health departments engage youth in decision making on adolescent health initiatives.
  10. Remember that youth are the experts on their own well-being. Despite the fact that they are still developing cognitively, youth are clearly able to articulate their needs and how their well-being can be improved. Be mindful of developmental considerations when working with youth, but do not allow these considerations to restrict youth engagement in decision making (Bozlak, 2010).

Sample Evaluation Questions

Conclusion

Increasingly, we see examples of youth civic engagement, including youth participation in policy making. However, there is substantial room for improvement. Some may assume that youth do not want to be engaged in this manner. However, any lack of youth participation and engagement is more likely due to barriers put in place by our adult-centric society where adults are most often the decision makers (Watts & Flanagan, 2007). There are clear power and structural dynamics at work, with the adult voice being the voice that is most often heard and valued. In order to develop engaged citizens and improve adolescent health, we must intentionally, and in collaboration with youth, create opportunities for youth to be authentically engaged in decision making that impacts their well-being.

Resources

References

Acknowledgement

The author wishes to acknowledge Michele A. Kelley, ScD, MSW, MA, ACSW for serving as her doctoral advisor during the completion of her PhD and the personal research studies referenced in this article.