Beyond tokenism: meaningful youth engagement in planetary health

16-year-old Greta Thunberg's insurgence on the world stage has startled us all. Her School Strike For Climate movement is mobilising a generation of young people to challenge their governments' failure to deliver meaningful climate action. It is no longer possible to view the victims of climate change as abstract future generations: their disillusioned faces line our streets every Friday. This month the UN will be holding its first Youth Climate Summit in New York (NY, USA). The day before, a global youth climate strike is set to be the largest mass climate protest the world has ever seen. These historic occasions demand reflection by those working in planetary health about how they can be agents for meaningful youth engagement. As a field with a strong focus on the health and wellbeing of future generations, we call on the planetary health community to champion youth leadership. Thunberg has begun to mobilise millions of youth whose talents, creativity, and passions are ready to be harnessed for action. Young people have unique skills and attributes that might help overcome the impasses and incrementalism that have plagued sustainability efforts in recent years. As David Attenborough has stated “we cannot be radical enough” in tackling the climate crisis. 1Vaughan A David Attenborough on climate change: “We cannot be radical enough”. https: //www. newscientist. com/article/2209126-david-attenborough-on-climate-change-we-cannot-be-radical-enough/Date: July 9, 2019Date accessed: September 11, 2019Google Scholar To achieve such transformative action, society needs young people's open mindedness, their willingness to take risks, and their ability to innovate. Given their minimal vested interest in existing power structures, youth can question the status quo and speak truth to authority figures if given a place at the decision-making table. Those in positions of power might question the capacity of youth to effectively make decisions of such importance. However, the Lancet Commission on adolescent health and wellbeing identified that most youth are developmentally ready to make choices about their health and vote at age 16 years. 2Patton GC Sawyer SM Santelli JS et al. Our future: a Lancet commission on adolescent health and wellbeing. Lancet. 2016; 387: 2423-2478Summary Full Text Full Text PDF PubMed Scopus (1043) Google Scholar To realise planetary health's goal of ensuring that the decisions made by today's society protect the health and wellbeing of those who will inherit the world tomorrow, young people must not only be heard but listened to. Youth engagement is an investment in young people's abilities and ingrains longevity into the planetary health vision, by ensuring it is the vision held by those who will lead tomorrow. Fortunately, planetary health, as a nascent discipline, is perfectly situated to take the lead on meaningful youth engagement. Where other fields have struggled to retrofit youth into existing governance structures, planetary health can include youth into all tiers of its agenda from the outset. 3Lal A Bulc B Bewa MJ et al. Changing the narrative: responsibility for youth engagement is a two-way street. Lancet Child Adolesc Health. 2019; (published online Aug 9. ) http: //dx. doi. org/10. 1016/S2352-4642 (19) 30247-0Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar How, then, can the planetary health community realise this vision? And how can it avoid falling into the twin traps of tokenism and exploitation that have undermined well intentioned efforts at youth engagement in global health, more broadly? Herein, we propose a set of practice points (consultation, facilitation, accountability, and evidence) for championing youth leadership in planetary health and present four case studies that exemplify them in action (panel). These practice points are based on the growing body of literature describing effective youth engagement that has emerged over the past two decades, and thus present those working in planetary health with the opportunity to learn from these experiences. 4WHOEngaging young people for health and sustainable development: strategic opportunities for the World Health Organization and partners. World Health Organization, Geneva2018Google Scholar, 5UN Department of Economic and Social AffairsYouth and the 2030 Agenda for Sustainable Development. United Nations, Geneva2018Google Scholar, 6French M Bhattacharya S Olenik C Youth engagement in development: effective approaches and action-oriented recommendations for the field. United States Agency for International Development, Washington, DC2014Google Scholar As the planetary health community continues to grow, we urge our colleagues to note and implement these recommendations. PanelCase studies of the practice points in actionConsultationCanada's Prime Minister's Youth Council is an initiative that provides a platform for a diverse group of youth to offer advice, both in person and online, to the highest levels of government; issues advised on were not limited to those explicitly concerning youth, but included areas such as the economy and climate policy. FacilitationWomen Deliver is a global program offering female youth advocates opportunities to develop advocacy skills through access to media experiences at institutions such as the BBC and Guardian, mentorship, and training; further personal development is achieved through provision of small grants or scholarships to attend the Women Deliver Global Conference and access to an alumni network. AccountabilityIn 2009, the UN Population Fund in Nepal did a youth audit to assess the degree of meaningful youth engagement within their organisation; the audit tool was developed and implemented with youth input at all stages. EvidenceYouth Lead the Change: Participatory Budgeting Boston was a project lead by the city of Boston, which allocated US1 million to implement community initiatives proposed and voted for by youth; materials were translated, underserved areas were targeted, and text messaging was used to contact those unable to participate in person. Researchers created publicly available evidence about the program's impact through attending meetings and conducting post–ante interviews. Consultation Canada's Prime Minister's Youth Council is an initiative that provides a platform for a diverse group of youth to offer advice, both in person and online, to the highest levels of government; issues advised on were not limited to those explicitly concerning youth, but included areas such as the economy and climate policy. Facilitation Women Deliver is a global program offering female youth advocates opportunities to develop advocacy skills through access to media experiences at institutions such as the BBC and Guardian, mentorship, and training; further personal development is achieved through provision of small grants or scholarships to attend the Women Deliver Global Conference and access to an alumni network. Accountability In 2009, the UN Population Fund in Nepal did a youth audit to assess the degree of meaningful youth engagement within their organisation; the audit tool was developed and implemented with youth input at all stages. Evidence Youth Lead the Change: Participatory Budgeting Boston was a project lead by the city of Boston, which allocated US1 million to implement community initiatives proposed and voted for by youth; materials were translated, underserved areas were targeted, and text messaging was used to contact those unable to participate in person. Researchers created publicly available evidence about the program's impact through attending meetings and conducting post–ante interviews. First, structured, systematic consultation with young people must guide work in planetary health. Leaders in planetary health need to establish clear, consistent, and safe opportunities for young people in agenda setting and decision making and provide support and resources for translating youth input into tangible outcomes. Dedicated youth ambassadors and advisory bodies are a potentially useful starting point. However, consulting select groups of young people is not an adequate substitute for engagement with a broad spectrum of youth perspectives. Planetary health leaders must therefore develop comprehensive youth consultation and engagement strategies to maximise the diversity of available youth expertise. These strategies should include deliberate effort to seek out marginalised groups, whose voices are often not heard. Second, as well as providing opportunities for young people to participate in planetary health, leaders must facilitate youth participation by identifying and removing barriers. Many of these barriers are inherent to the adult-centric nature of institutions and decision-making processes, and without necessary orientation and support young people can be left disempowered. The accessibility of opportunities across diverse groups of young people should be a key priority. Funding is another notable barrier to equitable youth participation. Planetary health organisations must, therefore, allocate funding for youth engagement, including adequately remunerating young people for the time and expertise they contribute. Third, the planetary health sector must hold itself accountable for the adequacy and efficacy of its youth engagement and strive for consistent improvement. To this end, young people should be involved in the design and implementation of appropriate monitoring and evaluation frameworks. The sector would benefit from developing a common set of indicators of youth engagement. Monitoring and evaluation should occur systematically and consistently and provide a basis for young people to both provide and receive regular feedback on their participation in planetary health initiatives. Finally, the planetary health sector should work to enhance the evidence base supporting youth participation in public health programs, governance, and resource management. Doing so would help to provide a mandate for youth leadership in a variety of sectors and help counter misguided assumptions about the efficacy of youth input in shaping health priorities and action in local, national, and international arenas. Planetary health journals should seek out and publish evidence on the efficacy of youth-driven initiatives. Youth have spoken over recent years and their voices only grow louder. It is no longer enough to pursue sustainable development for them, it must be done with them. Their unique perspectives, attributes, and experiences must be sincerely valued. Planetary health has the opportunity to exemplify what it means to meaningfully engage youth. In this Comment, we detail principles essential for shifting from tokenistic to meaningful youth engagement. By focusing on broad consultation, facilitation, accountability, and building an evidence base, we can achieve this essential goal. We call on the planetary health community to reflect on its values and framework and realise that empowerment, mobilisation, and partnership with youth lies at the core of the discipline, and should be placed at the forefront of all of its work. This online publication has been corrected. The corrected version first appeared at thelancet. com/planetary-health on October 1, 2019 This online publication has been corrected. The corrected version first appeared at thelancet. com/planetary-health on October 1, 2019 We declare no competing interests. Correction to Lancet Planet Health 2019: 3: e373–75Spajic L, Behrens G, Gralak S, Moseley G, Lindholm D. Beyond tokenism: meaningful youth engagement in planetary health. Lancet Planet Health 2019; 3: 373–75—In this Comment, co-author Daniel Linholm's surname has been corrected from Lindolm. This correction has been made to the online version as of October 1, 2019. Full-Text PDF Open Access