Closing Thoughts : On the Power of Youth and System Change

Change is happening in the Cooperative Extension System as the organization focuses its efforts on the overall goal of creating a culture of health in the United States. Well Connected Communities is a Cooperative Extension and National 4-H Council initiative supported by the Robert Wood Johnson Foundation that involves modeling a systems-level approach to community efforts versus an individual prevention model. The initiative also engages the power of youth to catalyze progress for communities to achieve their best health and well-being.

network of positive youth-adult relationships, Cooperative Extension's 4-H program has inspired youth to act and learn by doing in the areas of agriculture, science, civic engagement, and healthy living for more than a century.When youth get more opportunities to learn by doing, they develop skills to navigate life's challenges, pursue their passions, and contribute to the world around them.4-H is proof that "doing" works and that our society needs more of it.
The Well Connected Communities initiative expands the traditional 4-H program to focus on youth within community settings outside of their youth clubs or their clubs' service projects.By doing so, the youth are not only serving as leaders of other youth in their clubs, but as recognized leaders and fully engaged active members of community health coalitions.In this role, youth help to examine the health needs assessments for their communities, identify the priorities for action, and engage in the work of the coalition through youth-adult partnerships.
Youth thus become more than a representative sample or a select sub-committee, but rather authentic council members with equal voices.The leadership, communication, and teamwork skills that are a part of individual 4-H projects and club work are foundational skills as youth engage with a community health council.The "learn by doing" motto of 4-H is being built upon and further tested and validated as youth participate in community councils.In some cases, youth involved in the health councils have no prior 4-H experience, so the councils serve as an opportunity to develop their life skills outside of the traditional club setting.
At the national level, there has been an intentional effort to model authentic engagement of youth.Youth representatives were involved during the initial planning phases for the initiative, with their ideas and passion being documented in their own action plans, and they now serve in prominent positions on the Well Connected Communities national steering committee.Including youth in the processes to create and implement the Well Connected Communities initiative is just one aspect of the work; listening to what young people have to say and understanding all the best ways we can support them is an ideal learning opportunity for the adults involved in this work.It is an expectation that each of the communities involved in Well Connected Communities will incorporate youth as members of their existing community health councils or incorporate youth as new councils are formed-with all the rights and responsibilities of the adult coalition members.This approach will take learning as well as acceptance and trust by all involved.

Organizations Challenged to Adopt the Social Ecological Model
An important strength that youth bring to their health councils is their understanding that good health is influenced by many factors beyond medical care, including housing, education, jobs, access to healthy foods, and more.Youths' understanding of health influencers has been demonstrated by the multiple action plans that they have brought over the last 4 years to the National Youth Summit on Healthy Living at the National 4-H Conference Center in Washington, DC.Youth voices recognize that the choices people have are dependent upon the choices that are available to them, such as the dynamic interrelations between personal, environmental, and policy factors.This concept, referred to as the social ecological model, can be traced back to Bronfenbrenner's (1979) ecological framework for human development, which was introduced as a theoretical model in the 1980s.The model posits that multiple systems of the environment at the individual, community, and societal levels, as well as policies and systems, influence human health and well-being.Good health is more than just the result of individual choices.
While the youth do not reference the model specifically, they understand and bring the model's concepts to the table, along with energy and enthusiasm about leading change.
A 2009 report from the World Health Organization, Systems Thinking for Health Systems Strengthening, further builds on the multiple systems concept: Systems thinking is an approach to problem solving that views "problems" as part of a wider, more complex dynamic system.Systems thinking involves much more than a reaction to present outcomes or events.It demands a deeper understanding of the linkages, relationships, interactions and behaviours among the elements that characterize the entire system (de Savigny & Adam, 2009, p. 33).
The challenge is not in a lack of knowledge about the socio-ecological model or systems thinking, but rather in the organizational change needed to incorporate systems thinking and doing into health and wellness efforts.For example, Cooperative Extension, along with many other health-focused organizations, has a long history of prevention education, specifically on individual behavior change.Programs have targeted individual change on topics such as "healthy" foods, physical activity, drug and alcohol prevention, osteoporosis prevention, diabetes prevention, and many more.In many cases, there is empirically proven impact data documenting the changes in individual behavior as a result of these efforts.However, this individual approach fails to acknowledge that there are significant social conditions, environmental factors, and policies that inhibit an overall change in health and well-being beyond individual choices.Substantial and sustainable changes in health require a focus on not only individual, but also interpersonal, organizational, community, policy, system, and environmental factors.A visual representation that brings great clarity to this was provided by former director of the Center for Disease Control and Prevention, Dr. Tom Frieden (2010), in the model pictured in Figure 1, which shows that the smallest impact on health is attributed to education and counseling focused on the individual; even clinical interventions demonstrate some of the smallest impacts.
Only when the policy, system, and environmental factors are also addressed will the largest health impact be achieved.Youth at the National Youth Summit on Healthy Living have created action plans that focus on making changes in their communities that incorporate policy, system, and environmental factors.In 2014, the Extension Committee on Organization and Policy (ECOP) adopted the National Framework for Health and Wellness (Braun et al., 2014), which is based on the social ecological model.The framework aligns with the Health Impact Pyramid and illustrates that traditional Extension educational efforts focused on individual behavior change alone will not achieve the goal of all Americans having equal, just, and fair opportunities to live the healthiest life possible, regardless of where they live, work, play, or worship.Furthermore, the framework acknowledges that a combination of focuses on individual behavior and related policy, system, and environmental factors is a necessary change in approach.
Well Connected Communities is a system-wide effort to put the Extension National Framework for Health and Wellness into practice.Cooperative Extension is joining or facilitating the creation of multi-sector collaborations in this work.The unique nature of each community and its partners, the work involved in engaging community members of youth and adults alike around common health goals and priorities, and developing strategies beyond the usual individual education/prevention strategies, has proven to be time-and people-resource-intensive at the start.While not as quick and straightforward as a direct educational effort, the CDC Health Impact Pyramid reinforces that an effort to change the approach is necessary to establish longterm transformative change in health and well-being, and like most community development efforts, will occur over time and with commitment.
Well Connected Communities challenges the Extension organization to engage community members, youth and adult alike, to focus on individual behaviors as well as the policy, system, and environmental factors that contribute to health and wellness.Prior to this initiative, one of the most obvious examples of the Cooperative Extension System transitioning to a systems approach was the Supplemental Nutrition Assistance Program-Education (SNAP-Ed), which has a joint focus on policy, system, and environmental factors, as well as individual education related to human nutrition and health.Most often, however, SNAP-Ed is done with separate youth and adult efforts.We are observing that both the university faculty and community organizations involved in SNAP-Ed provide a great starting point for further development of Well Connected Communities and are a natural place for youth and adults to come together.
RWJF is dedicated to ensuring that everyone in America has the opportunity for health and well-being, regardless of who they are, where they live, or how much money they make.Well Connected Communities provides RWJF with an opportunity to connect with a network that has more than a century of experience in making lives better for millions of people across the nation-especially in rural America.Cooperative Extension serves every county and parish in the nation, and has experience in bringing communities together to empower them to achieve positive change with respect for their local values and beliefs.The initiative is putting youth at the center of the work by authentically engaging young people, allowing them to prioritize the