The voices of Urban Institute's researchers and staff
December 11, 2015

Without access to resources, neighborhood public health interventions are limited

December 11, 2015

Twenty-three percent of DC’s 179 neighborhoods are deemed economically challenged. The majority of those neighborhoods are located east of the Anacostia River. These challenged neighborhoods have some of the District’s highest rates of unemployment, low education attainment, and single household incomes. Unequal distribution of poverty isn’t new—and the patterns, people, and problems often look the same. The impacts of these geographic disparities, however, go beyond income.

Last year, the Planned Parenthood Ophelia Egypt Center in Washington, DC’s Ward 7 closed its doors permanently, leaving a neighborhood with the city’s second highest rates of teen pregnancy (33 percent in Ward 7 compared to 11 percent in other wards combined) and HIV (2.6 percent in Ward 7 compared to the 2.7 total percent in DC) without a key source of teen-centered reproductive health care or preventative programming. The health clinic’s closing is just one example of the dearth of resources available to youth living east of the river in the nation’s capital.

My colleagues recently wrote about the Promoting Adolescent Sexual Health and Safety (PASS) program that we have been co-implementing in Ward 7’s Benning Terrace. The program was created to empower young people with accurate sexual health information, a positive support system, and group discussions so they can make healthy and informed decisions about their bodies, relationships, self-expression, and identity.

As the program facilitated and trained residents as sexual health ambassadors and peer navigators, the neighborhood’s larger context remained an ongoing obstacle. The material effects of poverty counteracted the daily efforts of the PASS program. Low wages or joblessness (and its correlation to higher rates of crime), the prevalence of abandoned buildings, transportation barriers, generational trauma, and loss were central to resident’ lives, yet our charge was to establish a sustainable intervention to promote sexual health and safety.

During the two-year PASS demonstration, we learned that the benefits of a sexual health and safety program, while important, were limited. Although bringing together trained service providers with residents cultivated trust, a sense of community, and critical knowledge among the adolescents, we were still missing a major piece of the puzzle.

The PASS educators couldn’t fully empower young people to become better decision makers without talking about the realities of structural inequality. We couldn’t explore the high transmission rates of HIV and other sexually transmitted infections without acknowledging that our youth rarely, if at all, have access to resources.

Place Matters

Youth are at disproportionate risk of poor health outcomes when they lack access to stable community structures. We learned the value of building a public health intervention to shift individual- and neighborhood-level behaviors, and we can even do it collaboratively by centering the voices and preferences of the targeted populations. But service provision can only go so far without institutional attention and evidence-based policy development.

MOST CHALLENGED DC NEIGHBORHOODS LIE EAST OF THE ANACOSTIA RIVER

The Benning Terrace teens had priorities and questions that made this loud and clear. They wanted to know if they’d have safe transportation to a judgment-free health clinic. Would they have access to accurate information in their classrooms? Would they be challenged by their teachers to think critically or have school trips that exposed them to the rest of the district? Would their city government provide the funding and have the capacity to support safer recreation spaces?

PASS has helped connect youth to organizations and individuals who can respond to their sexual health needs, but the answer to these questions is often “no” for too many young people living in low-income, underresourced, socially isolated neighborhoods. And their ability to change that reality requires a) their own solution building and b) a listening and responsive audience. 

Programs like PASS simultaneously carry the weight of shifting outcomes as well as recognizing the interplay of disenfranchisement.

Voice Matters

Poor sexual and reproductive health outcomes are both preventable and systemic. Motivating young people to have difficult conversations about sexuality, to properly and consistently use family planning options, and to assertively communicate within intimate relationships takes a lot more than education. Health talks alone cannot substantially affect the rate of teen pregnancy, sexually transmitted infections, nor intimate partner violence.

Confronting public health disparities requires more than education and services. It’s about looking at the context in which people live, work, and play. When you think about how unevenly neighborhood resources are distributed, it’s then less surprising that some of the District’s highest rates of preventable illness are concentrated east of the river. But your zip code should not determine your health. 

Public health initiatives like PASS would be better off including a civic engagement component to make meaningful differences. Coupling a program’s focus (in our case, sexual health education and positive youth development) with practical opportunities to improve local policies and systems may lead to more sustainable outcomes, or at a minimum, be a more authentic way to inspire young people to make healthier choices.

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