Effective chronic disease and obesity prevention programs cannot rely solely on direct education aimed at changing individual behavior. A broader look, utilizing a socio-ecological framework that acknowledges factors beyond an individual’s behavior impact health and wellness, such as environmental conditions, policies, systems, and cultural norms is needed if progress in health and wellness is going to be made. Recognizing that environmental differences among communities are major contributors to individual’s and communities’ health disparities, the U.S. Department of Health and Human Services [1] identified addressing social determinants of health - such as social and economic opportunities, high-quality education, and access to nutritious food - as a priority for improving the nation’s health. For example, environmental conditions (i.e. lack of appropriate lights, traffic congestion, lack of green spaces, lack of grocery stores) negatively impact youth well-being, including their physical, social, and emotional health [2, 3]. Through a socio-ecological framework, public health practitioners, nutrition educators, and communities are addressing environmental conditions directly, as well as through supporting adoption of health-related policies that then lead to positive, social and cultural norms. Continuing the example of environmental conditions, here are some examples of work that nutrition and health educators are conducting:

Skid Row Healthy Food Micro-Enterprise Project (Let’s Get Healthy California, 2016):

Skid Row Healthy Food Micro-Enterprise Project by the Los Angeles Community Action Network is a pilot project in the early stages of development that seeks to serve the Skid Row community of Downtown Los Angeles. Skid Row is home to approximately 15,000 homeless, formerly homeless, and other low-income residents. The project has three components: (1) a low-cost organic market, (2) a rooftop garden, and (3) a micro-enterprise training program to ensure the food access projects are operated by Skid Row residents. This innovative effort is planned, led, and implemented by homeless and low-income residents, and combines improvements to the built environment, easier access to affordable fruits and vegetables and key training for a community that has been disconnected or excluded from mainstream employment [4] (para 1).

Healthy Stores for a Healthy Community (2017):

Public health advocates specializing in tobacco control, nutrition and alcohol prevention are working together to improve the health of Californians through changes in community stores and to educate people on how in-store marketing influences consumption of unhealthy products. In 2013, more than 7,300 stores were surveyed in all 58 counties. Nearly 700 individuals participated in gathering the information including representatives from all local health departments, community volunteers and youth volunteers. The real-world data and ongoing community education is inspiring change across the state [5] (para 1).

In October 2015 in Sidney, Nebraska, more than 25 participants representing community and health care organizations, city planning and development, and businesses joined together to create a community-driven plan to increase walking and biking as a way to improve overall health in Sidney… The committee is helping ensure that the city’s pedestrian and bike planning process includes representation from walking and biking advocates. The committee created a revised trail map and new signs to help people who walk and bike better understand and use the trail network in Sidney. It looked for new ways to promote walking and biking through existing community events (para 1-3).

These innovative efforts have had positive impacts within the communities where the work is taking place. Many of the programs are built on citizen engagement, where local residents are the owners and identifiers of the changes needed in their communities to improve upon the environmental factors that impact their health and wellness. Taking these efforts a step further, engaging youth as leaders and change agents in their communities may strengthen and expand the positive impacts for youth, families, and other community members. Klisch and Soule [6] explained that “successful implementation of youth engagement strategies can increase adolescents’ positive social and emotional development; leadership, problem-solving, and decision making skills; a sense of belonging; and a sense of purpose, while decreasing adolescent engagement in high-risk behaviors. Engaging adolescents in identifying and addressing the social determinants of health in their communities can have a compounding impact on adolescent and community wellness.” The following example highlights one program’s success.

4-H Student Nutrition Advisory Councils:

The University of California Cooperative Extension’s Youth, Families, and Communities Program in San Luis Obispo and Santa Barbara Countries developed integrated programming to connect SNAP-Ed programming (known as UC CalFresh Nutrition Education) with 4-H Youth Development programming in order to support youth interests in improving wellness in their school and neighborhood communities. Within a single school district, four 4-H SNAC clubs meet weekly at four different K-6th elementary schools to provide opportunities for youth to train as community leaders and educators. Youth learn presentation, public speaking, cooking, advocacy and healthy living skills throughout the year and teach back to their peers through classroom, garden, PE, lunchroom, and afterschool educational opportunities. Also, they teach back to their parents and community members. In FY 15-16 these 4-H SNAC Club leaders put in over 600 hours of youth leadership (including their training and peer/parent education) in their schools. Youth worked with adult allies to build knowledge and skills, practice public speaking and advocacy, increase their understanding of access when it comes to health, and identify changes they wanted to make at their schools in order to promote wellness. Youth leaders worked on food security projects, installing and promoting water fountains to increase access to and appeal of water at school, teaching cooking skills, and building and sustaining school gardens.

As community health professionals and agencies continue addressing the social determinants of health with community engagement as the core of identifying and designing interventions at the social and environmental level, more are likely to begin involving youth in the programming and research efforts, as there becomes greater awareness of the benefits and positive outcomes of engaging youth leaders in nutrition education. To ensure that this programming is effective, organizations should provide specific training for nutrition and health educators in proven youth engagement strategies, positive youth development outcomes, and evaluation methods. There are a number of resources available to support these training needs, including the 4-H Youth Development Program [8] and the Search Institute [9].