From Investment to Participation: Involving Youth in Sustainable Development for Improving Children's Health

There are 1.8 billion people between the ages of 10 and 24 today, making this the largest generation of young people in human history. (1, 2, 3) Characterized as the healthiest and most educated generation, there is a lot of hope for a more socially equitable and fair world.2 However, the current dialogue on health and sustainability is incongruent with the hope associated with youth—not nearly enough is being done to address the burden of disease that plagues youth around the world, especially in low and middle income countries (LMICs). The Sustainable Development Goals (SDGs), which began in 2015, set out to accomplish the UN’s most ambitious goals, including sections that address the health and well-being of youth. However, I question the dedication to the health of young people because of the lack of a more involved role for youth in the decision-making and implementation processes. These are issues that directly affect young people, and thus, should include young people past simply “investment” and towards participation. In order to improve young people’s health in LMICs and the future health of the world, I propose a more concerted effort for youth engagement in the UN’s SDGs, through community-based participation.

The sense of urgency in addressing the health and well-being of young people—especially in LMICs—is dangerously lacking. Of these 1.8 billion young people in the world today, about 90% live in LMICs.1 Reasons for death among those who are 10 years to 24 years old are dominated by HIV/AIDS, road injuries, self-harm, and interpersonal violence—statistics that are rising rather than falling.(4, 3) It is what Ameratunga and Denty (2016) call a “remarkable confluence of threats to young people’s health.”4 After collecting annual assessments for 188 countries from 1990-2013 (covering 206 diseases and injuries, 1,233 sequalae, and 79 risk factors), the Global Burden Disease Study 2013 found that injuries, mental health disorders, and sexual reproductive health problems are leading causes of morbidity and mortality in young people.(3) This age range is a particularly interesting and important time because of the types of challenges faced at this point in the life cycle, especially in the realm of cognitive and physical development.(3, 2) The ages of 10 to 24 are a time of increased exposure to the world (through human interactions, world issues, situations, etc.) in the face of great change (cognitive, physical, emotional, etc.). This age also signifies the transition to adulthood, and the rights and privileges associated with adulthood. Upon entering adulthood, there is increased power in areas such as health choices and voting.1 It is a time to be a citizen. It is imperative that young people are exposed to issues encapsulated in the SDGs because it is very much a part of their lives today and into the future. Having the language and finesse to navigate these issues requires time (which could be afforded through participation from youth). Despite the clear need for more resources in the direction of young people, there is not enough dialogue that directly addresses these issues in terms of the SDGs.

Although the Sustainable Development Goals (SDGs) have good intent and are most certainly worthwhile goals, the conversation needs to include more young people for the sake of its own success. Those who are 10 years old to 24 years old today will be 22 years old to 36 years old in 2030—the year it’s hoped the SDGs are accomplished. Thus, involving and engaging youth today will have a wide-reaching effect on the world in 2030. Compared to the Millennium Development Goals (MDGs) that ended in 2015, the SDGs have better integrated the “triple bottom line approach to human well-being”: economic development, environmental sustainability, and social inclusion.(5, 6) One of the greatest improvements that the SDGs have applied is the dedication to sustainability—the idea that this will last and that the role of human activity on environment is acknowledged.(5) The 22 to 36 year olds of 2030 will be in a prime position to continue that task. In many ways, there is another “triple” effect occurring: by including young people, the health of young people will improve, their future health will improve, and the health of their children (the next generation) will improve. By centering young people, there is a more overt commitment to the future and to sustainability.

In many instances, the process of “passing on the torch”—or transitioning from older to younger folks in leadership—is rough and difficult. However, it is often a necessary aspect of any organization or initiative. After first being ideated in 2011, the SDGs were agreed upon in 2012 at the Rio+20 United Nations conference, where they were being proposed as “actionoriented, concise and easy to communicate, limited in number, aspirational, global in nature and universally applicable to all countries while taking into account different national realities, capacities and levels of development and respecting national policies and priorities.”(6) The definition inherently transcends age and with a 15-year timeline, implies an understanding that tomorrow might belong to a different set of people. This relates to my own experience participating in a student activist group at my undergraduate institution. I saw a distinct gap in age when meeting with our partner organization. While our club was comprised of 18 to 22 year olds, the primary market for our partner organization was retired people—at least 65 and older. It made for interesting discussions on the future of peace activism—a future that would likely not include many of our partner organization’s members in 15 years’ time. It was a difficult conversation that we had been avoiding in our monthly meetings. Yet, it seemed important to address as we talked about our long-term plans. For youth—those ages 10 to 24 years—to be involved in the beginning would help carve a future that is streamlined and focused on sustainability from the get-go. There would be a less rough and difficult transition into adulthood and the powerful roles that many will overtake. I question the dedication of many professionals who claim to involve young people in the pursuit of these SDGs. My proposal is more than a passing of the torch, but full-fledged participation and integration into the discussion and decision-making processes. Improving young people’s health means viewing youth as people with agency and power. They may need some guidance on the way, but I believe that full participation, integration, and engagement is imperative for a future for all.

Some may argue that because of age and the plethora of changes young people face that they are ill-equipped to handle world issues. The pushback against giving youth agency and involving youth in decision-making processes is currently playing out in the national spotlight. In February 2018, 17 people died in a mass shooting at Marjory Stoneman Douglas High School in Parkland, Florida.(7) In the aftermath of the devastating events, Stoneman Douglas High School students began speaking out for stricter gun control policies through speeches, organizing, and rallying. Although the general public has divided the blame into equal and unequal parts of mental health, school security, gun control, partisanship, and more, there are a few things that have been made abundantly clear: some things need to change, the youth are our future, and the youth are creating the future. Yet, the students have been widely criticized—especially in extreme right-wing circles—as being opportunistic, driven by emotion, and far too young to be having these thoughts.(7) It is a reality that these high school students and many young people must grapple with when trying to take a seat the table. However, the students have already made an impact through fundraising, organizing a march, and national attention. What the students of Stoneman Douglas High School (and young people all over the country) prove is the power of youth in imagining and working towards a future that is better and safer, a future that transcends the present moment.

Alternatively, similar tactics—like youth-led campaigns—can be employed in engaging youth in the SDGs, where engagement is localized and highly participatory. I believe in building an infrastructure that raises the voices of young people (especially ages 10 to 24 in low and middle income countries). As previously mentioned, young people in LMICs face a hefty list of factors that drastically threaten their lives. Yet, the discussions on addressing demographic health issues usually do not focus on young people ages 10 to 24. As Ameratunga posits, the neglect of this age group “represents a myopic standpoint with far reaching consequences.”(4) It is myopic in that it fails to address how the health of young people not only affects their health today, but also their future health and their children’s health. Several articles that address the changes from MDGs to SDGs do not even point out the role of youth.(5, 6) Although important articles in their own right, there is a palpable disconnect where there could (and should) be a bridge. Both Sachs and Glaser focus on the highly contextual approach of the SDGs. Whereas the MDGs focused on a certain subset of countries, the SDGs are tackling the whole world. However, the SDGs also prioritize the local cultures. I argue that youth participation means meeting the youth where they are. By holding events and campaigns in areas where youth can gather and organize and discuss, there could be greater impact in addressing local concerns, improving young people’s health, and achieving the SDGs for the long term.

My proposal includes bringing the dialogue from “investment” to include participation. Although “investment” or “social mobilization” are common words to apply to young people’s roles in activism and sustainability, it is not quite “participation” and “engagement.” Investment often refers to imposed programs that do not involve the target audience.(1) Although time, money, and energy may be given to address the needs of that target audience, the creation of materials, or the organization of the material may not be led by the target audience. This takes away agency and makes the target audience a more passive and a short-term spectator. On the other hand, “social mobilization” also falls prey to similar issues. Hart (2013) defines social mobilization as the “activation of people to carry out predetermined agenda.”(8) Again, this is sometimes effective, but it is often short-term. Rather, a strengths-based approach that highlights participation and engagement might be more conducive for a long-term plan. Rather than imposing, it would be integrating the target audience into creators and organizers. They would no longer just be an audience, but leaders. I believe that having youth participate will allow more sustainable involvement in these issues.

Building an infrastructure to support the participation and engagement of youth can help improve young people’s health in LMICs. By being involved in all aspects of the process, young people would have a say in the ways in which policies and programs are put out into the world—more importantly, their world. With the SDGs, in particular, there is a focus on 17 goals that have to be contextualized to local regions all over the planet. Although there is pushback to youth involvement due to perceived immaturity, there is great value in localizing data by meeting young people in the regions where they are. Young people ages 10 to 24 deserve to be heard and given a voice. Currently, their voices and their bodies are marginalized. Youth ages 10 to 24 face a heavy burden of disease, with youth in LMICs bearing the brunt of this burden. As the population increases (with an expected human population of 9 billion people by 2050), there is even more reason to think about the future and the sustainability of the planet. Young people’s health should be prioritized through youth participation.