Challenges to youth health equity during COVID-19

Today’s guest bloggers are Kristin Mmari, DrPH, pictured at left, and Tamar Mendelson, PhD, pictured at right. They co-lead the Bloomberg American Health Initiative’s risks to adolescent health area. Mmari is an associate professor and Mendelson a professor in the Department of Population, Family and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health, where Mendelson also directs the Center for Adolescent Health. 

The world has not seen a global health crisis as devastating as COVID-19 since the 1918 flu pandemic. Although older adults are more likely to become seriously ill, COVID-19 also has profound impacts on adolescents and young adults. 

The ongoing pandemic is highlighting and worsening longstanding health inequities resulting from income inequality and structural racism. For young people of color in low-income communities, the effects of COVID-19 are especially dire, as many have already been disconnected from key systems of support.   

Adolescence and young adulthood are critical developmental stages, when rapid physical, cognitive and emotional changes occur. Young people learn to navigate peer and romantic relationships, evolve their personal values and identity and become increasingly independent. During the pandemic, however, many of these important milestones have been disrupted. 

Social distancing measures and school closures have not only led to cancellations of big events, such as prom and in-person graduation ceremonies, but also have limited important day-to-day opportunities for peer social connection, identity development and independence. With structured in-person education not possible, many students will fall behind academically.

The challenges are even more profound for young people in communities of concentrated disadvantage. Families in these communities often face barriers to accessing quality medical care and may lack adequate housing space to separate the sick from the well.

Young people in these communities are more likely than their financially advantaged peers to experience illness and death of loved ones, but also are less likely to have mental health care access. 

Parents working low-wage jobs may suffer layoffs and heightened financial strain, increasing children’s stress. School closures also remove a key source of weekday meals, increasing food insecurity among children and adolescents. As many schools pivoted to virtual academic instruction, children from low-income families who lack technology or internet access have been unable to participate.  

One population particularly at risk for COVID-related challenges is youth who are disconnected from both education and the workforce, otherwise known as “opportunity youth.” In 2019, approximately 1 in 9 U.S. youth ages 16-24 fit that definition. 

That rate — while unacceptably high — is dramatically lower than it was in 2010, when nearly 6 million young people, or approximately 1 in 5, were disconnected as a result of the Great Recession. With rates of unemployment comparable to those during the Great Depression in the 1930s, the pandemic may erase gains of the prior decade, with the rate of disconnection surpassing even what was observed 10 years ago. 

Young people tenuously linked to school or employment can also easily transition into disconnection as their support systems become increasingly inaccessible. For instance, youth without computers or with increased family responsibilities due to the outbreak may fall far behind their peers, leading to school dropout later. 

We can’t afford to let this happen. The coronoavirus relief package passed by Congress in March named young people a “priority population,” and we need to treat them as such. 

Baltimore working to stay connected with youth
Baltimore City offers several promising examples of positive action. For instance, the city council passed a bill to provide emergency funds to supply students with access to the internet and digital devices. Resources are being made available to the public, including meal and food distribution. And a range of youth-serving organizations are stepping up to meet the current challenges. 

HeartSmiles, a grassroots nonprofit, has created virtual “success sessions” for city youth, offered for five hours each school day. These sessions feature diverse guest speakers, who have ranged from Maryland Lt. Gov. Boyd Rutherford and the Johns Hopkins Bloomberg School of Public Health’s Josh Sharfstein, MD, to domestic violence and sexual assault advocate William Kellibrew and Hip-Hop pioneer Doug E. Fresh. 

A number of multi-sector, youth-focused efforts are also in process. For instance, Johns Hopkins University and Health Systems are collaborating with Baltimore City Public Schools, the mayor’s office and other city agencies to address youth needs. Activities include online informational town halls for students and parents, as well as virtual social events such as movie nights and poetry slams. 

These kinds of strategies cannot fully address the pandemic’s economic, social and psychological impacts on youth, but they are an important step toward healing.