ByJohn J. Green , Molly Phillips , Katie Kerstetter
Education, health, housing, food security, a safe environment—these are the means by which we seek to build and maintain sustainable livelihoods. However, unequal access to these resources means that many individuals, households and communities struggle to attain a basic level of health and well-being. As implied in both the sustainable livelihoods1 and community capitals2 frameworks, it is essential to create and sustain social infrastructures for asset development and to ensure that these infrastructures are more equitably distributed across socioeconomic and geographic lines.
Key to building strong and functional social infrastructures are opportunity pathways: networks and resources connecting individuals in meaningful and accessible ways with the social institutions that promote asset development. For instance, it is not enough to convince someone that it is possible to achieve a higher level of education when there are significant challenges and barriers to accessing postsecondary education that go beyond personal levels of control. In these situations, one means of intervention is the creation of pathways for development that are supportive and nurturing rather than limiting and challenging, especially in those places where people are vulnerable due to long-term socioeconomic stressors.
One example of a place facing such stressors is the Delta region of Mississippi. The 11 counties in this northwest region of the state are commonly known for rural isolation, limited educational attainment, low median household incomes and high rates of poverty.3 The Delta has particularly high rates of obesity, heart disease, hypertension and diabetes,4 and racial disparities in health and educational outcomes persist.5 Additionally, much of the region is designated as a Health Professional Shortage Area by the Health Resources and Services Administration.
Despite these challenges, there are numerous development efforts in progress throughout the region, including the New Pathways to Health Initiative, a collaborative venture between a diverse set of organizations that provides program participants with a specialized set of opportunity pathways in the Delta, with special focus on Bolivar, Coahoma, Quitman, Sunflower and Tallahatchie counties. (For more information about the collaborative, please see Figure 1 or visit http://institutecbr.wordpress.com/resources/newpathways.)
New Pathways to Health is intended to open opportunities for young people interested in advancing their education and pursuing health care careers. Working in a poor region with under-resourced schools, the program offers a series of weekend and summer educational enrichment activities for middle and high school students, mentorship, school health councils, certified nursing assistant and phlebotomy training programs, dedicated education units (DEUs) for college students studying nursing and a community health worker training program. Through these initiatives, New Pathways to Health creates avenues by which students can pursue careers in the health professions.
One particularly unique component of New Pathways to Health is the inclusion of a participatory problem-solving process that involves youth, young adults and professional practitioners in collaborative work. Modeled on the Dreyfus Health Foundation’s Problem Solving for Better Health® (PSBH®) methodology grounded in community work across more than 30 countries,6 participants are taken though a series of group activities in a workshop environment. They focus on identifying a problem, proposing a solution in the form of a “good question,” and articulating an action plan. Through intensive dialogue with their peers and outside support facilitators, the participants refine their ideas and build synergy by connecting with other “problem solvers.” Then they take these plans to their schools, organizations and broader community for implementation. Participants gain hands-on experience in working toward intentional social change and, through this process, build their own human capital and contribute to the development of their communities and the Delta region.
The University of Mississippi Center for Population Studies assists the initiative with evaluation and collaborative organizational capacity development. Researchers are investigating the outcomes from various program components and their impacts on student self-efficacy, academic performance and health behaviors. A recent synthesis of this research found that by providing support for individuals’ aspirations while also exposing and addressing the procedural and structural barriers that prevent the realization of these goals, the program has contributed to individual, household and community well-being.7 Two illustrative examples follow.
In October 2012, 21 middle school students participated in a PSBH® workshop to discuss health challenges impacting youth in Clarksdale, Miss. Many of the conversations focused on addressing childhood obesity; by the end of the workshop, students had proposed creating a nutrition and fitness summer camp. Following the workshop, students connected with leadership at the Aaron E. Henry Community Health Services Center (AEH) and the Tri-County Workforce Alliance (TCWA), who together had developed Healthy, Set, Go, a youth summer program that met in June 2013. Under the leadership of AEH and TCWA, students helped guide the curriculum and participated in marketing, outreach and recruitment. Camp attendance grew each week; by the end of the month, 160 young people from 5 to 18 years of age had participated. The camp, which was free and open to all youth in the community, was so successful that it has been institutionalized as an annual program through AEH. During summer 2014, the camp was held in four Delta counties.
The second example involves Mississippi’s state-level policy requiring that all schools have health councils to address challenges impacting students. Despite the law, many schools do not have active councils, and those that do have limited youth representation. To address this inconsistency, New Pathways to Health helped create a youth-run school health council at J.W. Stampley 9th Grade Academy in Clarksdale. In November 2013, 31 students interested in joining the council participated in a PSBH® workshop to develop project ideas. Students were particularly concerned about stress and proposed hosting a series of schoolwide assemblies related to different stressors, including teen pregnancy, dropping out, gang violence, and alcohol and drug abuse. After the workshop, council members met with the school principal and counselor, as well as leadership at AEH and TCWA, and held monthly assemblies featuring guest speakers who shared personal experiences related to these stressors. Through participation in the school health council, youth gained skills related to research and program planning as well as leadership experience. One student was even asked to represent the group on a statewide advisory council run by the governor.
An important element of promoting sustainable livelihood development in vulnerable places is the creation of opportunity pathways for individuals to access a wide range of social, economic and environmental assets. As shown through the New Pathways to Health Initiative and its use of the PSBH® process, people—including youth and young adults—can access the resources they need to promote health and well-being in their communities when provided with structured and accessible ways to engage with each other and resource organizations to solve problems.